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<1>
Accession Number
2035088788
Title
Systematic review of the training process of minimally invasive surgery in
neonates and infants.
Source
Pediatric Surgery International. 41(1) (no pagination), 2025. Article
Number: 195. Date of Publication: 01 Dec 2025.
Author
Zahradnikova P.; Babala J.; Lindak M.; Pechanova R.; Hnilicova S.; Molnar
M.; Nedomova B.; Pos L.; Dotlacil V.; Kucerova B.
Institution
(Zahradnikova, Babala, Lindak, Pechanova) Department of Pediatric Surgery,
Faculty of Medicine, Comenius University and National Institute of
Children's Diseases, Bratislava, Slovakia
(Hnilicova) Institute of Medical Education and Simulations, Faculty of
Medicine, Comenius University, Bratislava, Slovakia
(Molnar) Department of Pediatric Surgery, Jessenius Faculty of Medicine,
Comenius University, Martin, Slovakia
(Nedomova) Department of Pediatric Anesthesiology and Intensive Medicine,
Faculty of Medicine, Comenius University and National Institute of
Children's Diseases, Bratislava, Slovakia
(Pos, Dotlacil, Kucerova) Department of Pediatric Surgery, Charles
University and Motol University Hospital Prague, Prague, Czechia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Minimally invasive surgery (MIS) in neonates and infants presents
technical challenges and is still unfamiliar to many paediatrics surgeons.
This study aims to identify currently available simulators for
neonatal/infant MIS training, to assess their validity, level of evidence,
and related recommendations. <br/>Method(s): The review followed PRISMA
guidelines and was registered in PROSPERO (CRD420250581050). Electronic
search limited to English articles was performed through PubMed/MEDLINE,
SCOPUS, Web of Science and Cochrane Database from January 2010 to June
2024. <br/>Result(s): Out of 1084 identified records, 72 studies met the
inclusion criteria and were analysed across general, gastrointestinal,
thoracic, and urological MIS specialties. Recent efforts have led to the
development of 3D-printed, animal-based, and hybrid models several of
which showed high fidelity, skill differentiation, and educational value.
Despite promising results, no universal MIS training model exists for
neonate/infant patients, highlighting the need for structured,
proficiency-based curricula. Overall, studies demonstrated moderate levels
of evidence and recommendation, supporting integration of cost-effective
simulation into paediatrics MIS training <br/>Conclusion(s): This
systematic review highlights the need for validated, standardized
simulation models and proficiency-based curricula to optimize neonate and
infant MIS training and guide future research toward improving model
fidelity, accessibility, and long-term educational outcomes.<br/>Copyright
&#xa9; The Author(s) 2025.

<2>
Accession Number
2039287860
Title
Once-weekly insulin efsitora alfa versus once-daily insulin glargine U100
in adults with type 2 diabetes treated with basal and prandial insulin
(QWINT-4): a phase 3, randomised, non-inferiority trial.
Source
The Lancet. 405(10497) (pp 2290-2301), 2025. Date of Publication: 28 Jun
2025.
Author
Blevins T.; Dahl D.; Perez Manghi F.C.; Murthy S.; Ortiz Carrasquillo R.;
Li X.; Chang A.M.; Carr M.C.; Katz M.
Institution
(Blevins) Texas Diabetes & Endocrinology, Austin, TX, United States
(Dahl) Gemeinschaftspraxis fur Innere Medizin und Diabetologie, Hamburg,
Germany
(Perez Manghi) Centro de Investigaciones Metabolicas, Buenos Aires,
Argentina
(Murthy) Lifecare Hospital and Research Centre, Bangalore, India
(Ortiz Carrasquillo) Manati Center for Clinical Research, Manati, Puerto
Rico
(Li, Chang, Carr, Katz) Eli Lilly and Company, Indianapolis, IN, United
States
Publisher
Elsevier B.V.
Abstract
Background: Insulin efsitora alfa (efsitora), a once-weekly basal insulin,
has the potential to reduce the treatment burden of people with type 2
diabetes who require insulin. We aimed to assess the efficacy and safety
of once-weekly efsitora compared with insulin glargine U100 in adults with
type 2 diabetes treated with basal and prandial insulin. <br/>Method(s):
This phase 3, randomised, 26-week, parallel-design, open-label,
treat-to-target, non-inferiority study was done at 78 outpatient clinics
and hospitals in Argentina, Germany, India, Italy, Mexico, Spain, and the
USA (including Puerto Rico). Participants with type 2 diabetes (glycated
haemoglobin [HbA<inf>1c</inf>] 7.0-10.0%) treated with basal and prandial
insulin and up to three non-insulin glucose-lowering agents were randomly
assigned (1:1) to efsitora or glargine U100, both with prandial insulin
lispro. Randomisation was stratified by country, baseline HbA<inf>1c</inf>
(<8% vs >=8%; <63.9 mmol/mol vs >=63.9 mmol/mol), and routine use of
personal continuous glucose monitoring or flash glucose monitoring at
randomisation (yes vs no). The primary endpoint was HbA<inf>1c</inf>
change from baseline to week 26 (non-inferiority margin 0.4%). The
completed trial is registered at ClinicalTrials.gov (NCT05462756).
<br/>Finding(s): Between Aug 11, 2022, and Feb 27, 2024, 1037 study
participants were screened and 730 were randomly assigned to efsitora
(n=365) or glargine U100 (n=365). 369 (51%) of 730 participants were
female and 361 (49%) were male, the mean participant age was 58.9 years
(SD 10.5), and the mean participant BMI was 31.85 kg/m² (SD
5.47). Using the treatment regimen estimand, the least-squares mean
baseline HbA<inf>1c</inf> was 8.18% (SE 0.04; 65.9 mmol/mol [SE 0.47]) in
the efsitora group and 8.18% (0.04; 65.9 mmol/mol [0.47]) in the glargine
U100 group. At week 26, the least-squares mean HbA<inf>1c</inf> was 7.17%
(SD 0.05; 54.8 mmol/mol [0.51]) in the efsitora group and 7.18 (0.05; 55.0
mmol/mol [0.51]) in the glargine U100 group. The change from baseline to
week 26 using the treatment regimen estimand was -1.01 percentage points
for the efsitora group and -1.00 percentage points for the glargine U100
group, indicating non-inferiority of efsitora versus glargine U100. Rates
of overall and nocturnal level 2 (<54 mg/dL; 3.0 mmol/L) or level 3
(severe) hypoglycaemia during the treatment period were similar for
efsitora versus glargine U100 (6.6 vs 5.9 events per patient-year of
exposure, estimated rate ratio [ERR] 1.11, 95% CI 0.85-1.44; p=0.44; 0.67
vs 1.00 events per patient-year of exposure, ERR 0.67, 95% CI 0.44-1.01;
p=0.058), respectively. Adverse event occurrence was similar between
efsitora and glargine U100. Serious adverse events were reported by 25
(7%) of 365 participants in the efsitora group and 23 (6%) of 365
participants in the glargine U100 group. <br/>Interpretation(s): Efsitora
showed non-inferior HbA<inf>1c</inf> reductions and similar rates of
combined clinically significant or severe hypoglycaemia versus glargine
U100 in participants with type 2 diabetes treated with basal and prandial
insulin. These findings show that efsitora is a well tolerated and
efficacious once-weekly alternative to daily basal insulin, with a reduced
injection frequency, for the treatment of adults with type 2 diabetes.
<br/>Funding(s): Eli Lilly and Company.<br/>Copyright &#xa9; 2025 Elsevier
Ltd

<3>
Accession Number
2034990066
Title
Anti-inflammatory and anti-rejection effects of herbal medicine
ingredients in organ transplantation: a systematic review and
meta-analysis.
Source
Frontiers in Immunology. 16 (no pagination), 2025. Article Number:
1568988. Date of Publication: 2025.
Author
Lin J.; Wu Z.; Liu H.; Qiu F.; Dai Z.
Institution
(Lin, Liu, Qiu, Dai) Immunology Program, the Second Affiliated Hospital of
Guangzhou University of Chinese Medicine, Guangzhou, China
(Wu) South China Research Center for Acupuncture, Medical College of
Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine,
Guangzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Although postoperative rejection in transplant patients can be
managed with immunosuppressants, their use is associated with some
complications due to excessive immunosuppression. Recent animal studies in
allotransplantation have suggested that certain ingredients of Chinese
herbal medicine can extend transplant survival. However, their effects on
transplantation have not been systematically reviewed and analyzed. The
aim of this study was to evaluate the effects of herbal medicine
ingredients on complications and survival of transplanted organs after
heart, liver and kidney transplantation, and to explore the possible
mechanism of action. <br/>Material(s) and Method(s): Databases, including
PubMed, EMBASE, Cochrane Library, Web of Science, Wang Fang, China
National Knowledge Infrastructure (CNKI), China Science and Technological
Journal Database (VIP) and Chinese Biomedical Literature Database (CBM),
were searched up to January 1 2025. Animal studies reporting the effects
of Chinese herbal medicine ingredients (HMIs) on postoperative
complications and organ transplant survival/outcome were included.
Methodological quality was assessed using the SYRCLE risk of bias tool.
Meta-analysis was performed using R 4.3 software to assess levels of
inflammatory factors, oxidative stress markers, apoptosis markers,
indicators of liver/kidney function, median graft survival time and immune
cell subsets. <br/>Result(s) and Conclusion(s): A total of 18 studies,
involving 357 rodents were included. The overall quality of the included
reports was moderate. We found that HMIs enhanced organ graft survival by
reducing the Banff score, extending the median survival time (MST), and
exerting anti-inflammatory, antioxidant and anti-apoptotic effects. HMIs
can also inhibit T cell proliferation, dendritic cell (DC) maturation and
increase the proportion of CD4⁺ regulatory T (Treg) cells.
Furthermore, the improvement in liver and kidney function indicators, such
as alanine aminotransferase (ALT), aspartate transaminase (AST), Serum
creatinine (Scr) and blood urea nitrogen (BUN) also suggested protective
effects of HMIs on liver and kidney function. However, the high
heterogeneity observed in several analyses highlights the need for
standardized experimental designs and further studies to confirm these
findings and to explore their underlying mechanisms. Thus, our
meta-analysis indicates that HMIs improve transplantation outcomes in
animal models. These results lay a solid foundation for translating HMIs
into clinical strategies for improving transplantation outcomes.
Systematic review registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002755, identifier
crd420251002755.<br/>Copyright &#xa9; 2025 Lin, Wu, Liu, Qiu and Dai.

<4>
Accession Number
2039334289
Title
Analgesic efficacy of pregabalin in dogs undergoing mastectomy with
ovariohysterectomy.
Source
Topics in Companion Animal Medicine. 67 (no pagination), 2025. Article
Number: 100993. Date of Publication: 01 Jul 2025.
Author
Cerazo L.M.L.; Peruchi L.G.; Bruno T.S.; Segatto C.Z.; Nicacio G.M.; Cassu
R.N.
Institution
(Cerazo, Peruchi, Bruno, Segatto, Nicacio) Department of Veterinary
Surgery and Anesthesiology, Faculty of Veterinary Medicine, University of
Western Sao Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil
(Cassu) Department of Veterinary Surgery and Animal Reproduction, School
of Veterinary Medicine and Animals Science, Sao Paulo State University
(UNESP), SP, Botucatu, Brazil
Publisher
W.B. Saunders
Abstract
The aim of this study was to evaluate the analgesic efficacy of pregabalin
in dogs diagnosed with mammary carcinoma undergoing mastectomy with
ovariohysterectomy. In a randomized, blinded, clinical, placebo-controlled
study, 24 dogs were assigned to receive either an oral pregabalin
suspension (4 mg/kg/0.1 mL/kg, Pregabalin group, n = 12) or a placebo
solution (0.1 mL/kg, Placebo group, n = 12), administered 60 minutes
before and every 8 hours after surgery. The dogs were premedicated with
intramuscular (IM) morphine (0.3 mg/kg). Anesthesia was induced with
intravenous (IV) propofol at a sufficient dose to allow intubation and was
maintained with isoflurane. Intraoperatively, a constant rate infusion of
morphine (0.1 mg/kg/h) was maintained until the end of surgery. Meloxicam
(0.2 mg/kg, IV) was administered immediately after intubation.
Intraoperatively, fentanyl (2.5 microg/kg, IV) was administered to control
cardiovascular responses to surgical stimulation. Pain was assessed using
the short-form Glasgow Composite Pain Scale 24 hours prior to surgery
(baseline) and at 0.5, 1, 2, 4, 6, 8, 12, and 24 hours after extubation.
Sedation scores were evaluated at the same time points using a descriptive
numerical scale. Morphine (0.5 mg/kg, IM) was administered as rescue
analgesia. Data were analyzed using t-tests, Fisher's exact test,
Kaplan-Meier curve, Mann-Whitney test, and Friedman test. Differences were
considered significant when P < 0.05. Pain scores, sedation scores, and
analgesic requirements did not differ significantly between groups.
Intraoperative fentanyl and postoperative rescue analgesia were required
in 100% and 75% of the dogs, respectively, in both treatment groups. In
conclusion, as part of a multimodal analgesic protocol, oral pregabalin at
4 mg/kg every 8 hours did not provide additional postoperative analgesic
benefits over placebo in dogs undergoing mastectomy with
ovariohysterectomy.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<5>
Accession Number
2035130666
Title
Effect of dynamic lung compliance-guided positive end-expiratory pressure
on postoperative pulmonary complications following thoracoscopic
lobectomy: a randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 306. Date
of Publication: 01 Dec 2025.
Author
Zhou Y.; Song Z.; Cai J.; Huang S.; Zhu M.; Jiang Y.; Bao Q.; Zhang L.;
Jin R.; Gu L.; Tan J.
Institution
(Zhou, Song, Cai, Huang, Bao, Jin, Gu, Tan) The Affiliated Cancer Hospital
of Nanjing Medical University, Jiangsu, Yangzhou, China
(Cai, Zhu, Zhang, Gu, Tan) Jiangsu Province Key Laboratory of
Anesthesiology, Xuzhou Medical University, Jiangsu, Yangzhou, China
(Jiang) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Jiangsu, Yangzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: The risk of postoperative pulmonary complications is
significantly increased in patients undergoing video-assisted thoracic
surgical lobectomy. Individualized positive end-expiratory pressure (PEEP)
is extensively employed to optimize respiratory mechanics and enhance
oxygenation during one-lung ventilation (OLV). However, there is no
consensus regarding the optimal level of positive end-expiratory pressure
and its effects during OLV. Therefore, we designed a randomized controlled
trial to assess whether titrating PEEP to the maximum dynamic lung
compliance in patients undergoing lung resection surgery impacts the
occurrence of postoperative pulmonary complications (PPCs).
<br/>Method(s): In this randomized controlled trial, patients undergoing
thoracoscopic lobectomy were randomly assigned to either a dynamic lung
compliance group that received individualized PEEP guided by the maximum
dynamic pulmonary compliance or a conventional ventilation group with a
fixed PEEP of 5 cm H<inf>2</inf>O. The primary outcome was a composite of
PPCs occurring within seven days, as defined by the European Perioperative
Clinical Outcome criteria. Secondary outcomes included PEEP, Cdyn,
PaO<inf>2</inf>, serum concentrations of IL-6 and TNF-alpha, and the
duration of postoperative hospital stays. <br/>Result(s): One hundred
patients were enrolled. The optimal PEEP obtained in the dynamic lung
compliance group was 9.04 +/- 1.83 cm H<inf>2</inf>O. Patients in the
conventional ventilation group experienced 38% postoperative pulmonary
complications versus 20% in the dynamic lung compliance group compared
with the control group (P < 0.01). The serum Interleukin-10 concentrations
at T<inf>5</inf> in the dynamic lung compliance group were higher than
those in the ventilation group (P = 0.046), and the serum Interleukin-1
concentrations at T<inf>5</inf> and T<inf>6</inf> in the dynamic lung
compliance group were lower than those in the ventilation group (P <
0.01). <br/>Conclusion(s): In patients undergoing video-assisted
thoracoscopic lobectomy for lung resection with maximum dynamic
compliance-guided positive end-expiratory pressure (PEEP), the incidence
of postoperative pulmonary complications (PPCs) within 7 days was
significantly lower compared to those receiving a PEEP of 5 cm
H<inf>2</inf>O. Trial registration: This study was registered at the
Chinese Clinical Trials Registry on 04/07/2021 with registration number
ChiCTR2100048201.<br/>Copyright &#xa9; The Author(s) 2025.

<6>
Accession Number
2039205330
Title
Comparative analysis of perioperative outcomes between hybrid system and
MiECC: A prospective pilot study.
Source
Journal of Extra-Corporeal Technology. 57(2) (pp 74-81), 2025. Date of
Publication: 01 Jun 2025.
Author
Kirali K.; Aksut M.; Altas A.; Gurcu M.E.; Aydin S.
Institution
(Kirali, Aksut, Altas, Gurcu, Aydin) Department of Cardiovascular Surgery,
Kosuyolu High Specialization Education and Research Hospital, Cevizli
Kavsagi, Kartal, Istanbul, Turkey
(Gurcu, Aydin) Department of Perfusion, Kosuyolu High Specialization
Education and Research Hospital, Cevizli Kavsagi, Kartal, Istanbul, Turkey
(Aydin) Department of Anesthesiology, Kosuyolu High Specialization
Education and Research Hospital, Cevizli Kavsagi, Kartal, Istanbul, Turkey
Publisher
EDP Sciences
Abstract
Background: Minimally invasive extracorporeal circulation (MiECC) has been
introduced to mitigate the inflammatory response and reduce blood
transfusion needs compared to conventional cardiopulmonary bypass (CPB)
perioperatively. A hybrid system (HS) that merges aspects of both
traditional CPB and MiECC aims to optimize patient perioperative outcomes.
This study focuses on comparing the postoperative transfusion rates,
intensive care unit (ICU) course, and biochemical parameters between the
HS and MiECC. <br/>Material(s) and Method(s): This prospective,
randomized, controlled, single-center study was conducted at Kos uyolu
High Specialization Education and Research Hospital, Istanbul from
February 2024 to June 2024. Forty patients undergoing isolated coronary
artery bypass grafting (CABG) were included, with 20 patients in the
HS-group and 20 in the MiECC-group. Data on oxygen delivery management,
hemoglobin and platelet values trends, biochemical parameters, the number
of red blood cells and platelet units transfused postoperatively, and ICU
stay duration were collected. <br/>Result(s): The CPB time was not
significantly shorter in the HS group compared to the MiECC group (93.35
+/- 33.06 min vs. 108.65 +/- 30.02 min, p = 0.134). Hemoglobin levels did
not differ significantly between the groups preoperatively,
perioperatively, or postoperatively at 6, 12, and 24 h no difference in
red blood cells unit transfusion. Indexed oxygen delivery did not differ
significantly between the HS and MiECC groups (311.60 +/- 28.29
mL/min/m² vs. 332.25 +/- 57.04 mL/min/m², p =
0.275). Partial pressure of oxygen was higher in the MiECC group (210.90
+/- 49.64 mmHg vs. 177.70 +/- 70.41 mmHg, p = 0.093), but this difference
was also not statistically significant. Biochemical parameters showed
notable differences. Postoperative lactate levels were significantly lower
in the HS group (2.85 +/- 1.20 mmol/L vs. 4.04 +/- 1.40 mmol/L, p =
0.009). Conversely, Lactate Dehydrogenase levels during and after CPB
were, lower in the MiECC group. Postoperative 6th-hour troponin levels
were significantly lower in the HS group (3.188 +/- 2.684 ng/mL vs. 4.645
+/- 3.422 ng/mL, p = 0.038). Mechanical ventilation duration, ICU stay,
and hospital stay were comparable between the two groups, with no
significant differences observed. <br/>Conclusion(s): The hybrid system
demonstrated comparable results to the MiECC in patients undergoing
isolated CABG. No significant differences were observed in CPB time or
postoperative blood transfusion requirements. However, the HS group showed
favorable biochemical parameters, including significantly lower
postoperative lactate levels and troponin levels at 6 h. Indexed oxygen
delivery and partial pressure of oxygen were similar between groups, and
ICU and hospital stay durations were comparable. These findings suggest
that the hybrid system offers outcomes on par with the MiECC approach,
with potential benefits in terms of biochemical markers. Further studies
with larger sample sizes are needed to validate these results and explore
possible advantages in broader clinical settings.<br/>Copyright &#xa9;The
Author(s), published by EDP Sciences, 2025.

<7>
Accession Number
2039328246
Title
Comparing non-ischaemic heart preservation (NIHP) with ischaemic static
cold storage of donor hearts in adult cardiac transplantation: study
protocol for a randomised controlled trial.
Source
BMJ Open. 15(6) (no pagination), 2025. Article Number: e100553. Date of
Publication: 25 Jun 2025.
Author
Pigot H.; Steen S.; Nilsson J.
Institution
(Pigot, Nilsson) Department of Translational Medicine, Artificial
Intelligence and Bioinformatics in Cardiothoracic Sciences, Lund
University, Lund, Sweden
(Steen, Nilsson) Department of Clinical Sciences in Lund Thoracic Surgery,
Lund University, Lund, Sweden
(Nilsson) Department of Thoracic and Vascular Surgery, Skane University
Hospital Lund, Lund, Sweden
Publisher
BMJ Publishing Group
Abstract
Introduction Ischaemia-reperfusion (I/R) injury remains a major challenge
in heart transplantation, with mortality risk increasing significantly
when allograft ischaemic time exceeds 4 hours. Non-ischaemic heart
preservation (NIHP), using continuous hypothermic perfusion, has shown
promise in preliminary studies for reducing I/R injury and improving
outcomes. This randomised controlled trial aims to compare NIHP with
standard static cold storage (SCS) in adult heart transplantation. Methods
and analysis The trial is a prospective, open-label, multicentre,
single-blinded, randomised controlled trial including 66 adult heart
transplant recipients across four Swedish hospitals. Participants will be
randomised into 1:1 ratio to NIHP or SCS preservation groups and undergo a
12-month follow-up period. The primary outcome is 1-year survival free
from acute cellular rejection or retransplantation. Secondary outcomes
include quality of life, I/R injury markers, graft function and adverse
events. Substudies will evaluate renal function using MRI and continuously
monitor physical activity and heart rhythm via wearable devices. Analysis
will follow intention-to-treat principles, with time-to-event analysis
using Cox proportional hazard models and Kaplan-Meier estimates. Ethics
and dissemination The study has been approved by the Swedish Ethical
Review Authority. It will be conducted according to the Declaration of
Helsinki and relevant local and international regulations. Results will be
published in peer-reviewed journals following Consolidated Standards of
Reporting Trials guidelines.<br/>Copyright &#xa9; 2025 Author(s).

<8>
Accession Number
2039420196
Title
Survival Trends of Patients After Coronary Artery Bypass Grafting and
Sex-Specific Differences-A Meta-Analysis of Reconstructed Time-to-Event
Data.
Source
American Journal of Cardiology. 253 (pp 53-58), 2025. Date of Publication:
15 Oct 2025.
Author
Kirov H.; Caldonazo T.; Toshmatov S.; Tasoudis P.; Fischer J.; Runkel A.;
K A.D.; Mukharyamov M.; Doenst T.
Institution
(Kirov, Caldonazo, Toshmatov, Fischer, Runkel, K, Mukharyamov, Doenst)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena,
Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, NC, United States
Publisher
Elsevier Inc.
Abstract
Randomized evidence suggest that coronary artery bypass grafting (CABG)
has the potential to improve life expectancy. Women are considered to have
worse outcomes after CABG, but they are generally underrepresented in
randomized trials meanwhile registry data and trial sub-analyses provide
controversial results. We systematically assessed the survival after CABG
in both sexes by analyzing studies that assessed CABG outcomes compared to
the age-matched general population. Three databases were assessed
(MEDLINE, ScienceDirect and Cochrane Library). Primary and single outcome
was long-term all-cause mortality. Reconstruction of time-to-event data
was performed. Hazard ratios (HR) and 95% confidence intervals (CI) were
calculated. A total of 1,352 studies were retrieved. Eight studies and
142,165 patients were included in the analysis. For the entire 19-year
observation period, patients who underwent CABG had worse survival than
the general population in both male (HR = 1.14, 95% CI, 1.05 to 1.23, p =
0.002) and female patients (HR = 1.21, 95% CI, 1.01 to 1.47, p = 0.045).
Performing landmark analyses suggests that there is no difference in life
expectancy compared with the general population in the first 10 years. The
direct comparison of men versus women suggests that very long-term
survival was slightly better in women (HR: 1.04, 95% CI, 1.01 to 1.08).
Both men and women after CABG treatment for CAD experience similar life
expectancy in the first decade compared to the general population. Beyond
10 years, life expectancy becomes worse than the general population and is
the worst in men. It may be speculated that this difference is due to
graft occlusions.<br/>Copyright &#xa9; 2025 The Author(s)

<9>
Accession Number
2035022521
Title
Commando procedure in cardiac surgery: a narrative review.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025. Date
of Publication: 2025.
Author
Yi H.; Li Y.; Zhao Q.; Wu X.
Institution
(Yi, Li, Zhao, Wu) Lanzhou University Second Hospital, No. 82, Cuiyingmen,
Linxia Road, Chengguan District, Gansu, Lanzhou, China
Publisher
Springer
Abstract
Objective: The Commando procedure is a technically demanding, high-risk
cardiac operation. This review synthesizes advancements in the Commando
procedure, with emphasis on technical modifications, broadening clinical
applications, and associated clinical outcomes. <br/>Method(s): The study
employed a systematic literature search in PubMed, utilizing the term
"Commando Procedure," covering all publication dates, yielding 178
identified articles. The inclusion criteria favored peer-reviewed studies
that offered detailed surgical accounts, case series with a minimum of
five patients, outcome evaluations, or technical innovations-e.g., novel
patching or suture techniques. The editorials and studies devoid of
procedural details or quantitative results were excluded. Editorials and
studies devoid of procedural details or quantitative results were
excluded. <br/>Result(s): The review details the expanded clinical
applications, technical improvements, and outcome trends of the Commando
procedure. Initially crafted to manage aortic annular dilation, the
technique now covers a broader spectrum of complex multivalvular diseases.
The correlation between recent procedural standardization and broader
clinical adoption is evident in improved survival rates. However,
unresolved challenges remain. However, unresolved challenges remain.
<br/>Conclusion(s): In recent years, we have witnessed a proliferation of
procedural modifications and adaptations of the Commando technique,
tailored to address anatomically distinct pathologies across heterogeneous
clinical scenarios.<br/>Copyright &#xa9; The Author(s), under exclusive
licence to The Japanese Association for Thoracic Surgery 2025.

<10>
Accession Number
2038027363
Title
Management of angina pectoris.
Source
Trends in Cardiovascular Medicine. 35(6) (pp 341-350), 2025. Date of
Publication: 01 Aug 2025.
Author
Rinaldi R.; Kunadian V.; Crea F.; Montone R.A.
Institution
(Rinaldi, Crea, Montone) Department of Cardiovascular and Pulmonary
Sciences, Catholic University of the Sacred Heart, Rome, Italy
(Rinaldi) Cardiology Unit, Infermi Hospital, Rimini, Italy
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University, 4th Floor William Leech Building,
Newcastle-upon-Tyne, United Kingdom
(Kunadian) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
(Crea) Center of Excellence of Cardiovascular Sciences, Ospedale Isola
Tiberina - Gemelli Isola, Rome, Italy
(Montone) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Rome, Italy
Publisher
Elsevier Inc.
Abstract
Angina pectoris, a primary manifestation of ischemic heart disease,
imposes a significant clinical and economic burden globally. This review
highlights recent advancements in the management of angina, emphasizing a
patient-centred approach that integrates pharmacological, interventional,
and lifestyle strategies to reduce cardiovascular risk and improve patient
outcomes. For obstructive coronary artery disease, optimal medical therapy
represents the cornerstone of treatment. Individualized regimens should be
tailored to clinical factors such as blood pressure, heart rate, left
ventricular function, comorbidities like heart failure and diabetes,
concomitant medications, patient preferences, and drug availability.
Myocardial revascularization is reserved for select cases to alleviate
symptoms or improve prognosis. For angina or ischemia with non-obstructive
coronary arteries (ANOCA/INOCA), precise endotype classification,
differentiating microvascular angina, vasospastic angina, mixed type and
non-coronary chest pain, enables personalized treatment strategies.
Lifestyle interventions, including smoking cessation, weight management,
adherence to Mediterranean diet, and exercise therapy, are essential
components of care, promoting improved cardiovascular outcomes and quality
of life. Structured exercise programs, particularly within cardiac
rehabilitation settings, have demonstrated efficacy in enhancing
functional capacity and reducing adverse events. Emerging therapies,
including pharmacological agents and novel interventional approaches such
as the coronary sinus reducer, hold promise for addressing unmet needs in
refractory angina and challenging ANOCA/INOCA cases. Future directions
should prioritize the integration of precision medicine, digital health
technologies, and multidisciplinary care to optimize outcomes and advance
personalized angina management.<br/>Copyright &#xa9; 2025 The Authors

<11>
Accession Number
2039302189
Title
Modified Measurement of Tricuspid Annular Plane Systolic Excursion for
Assessing Right Ventricular Function During Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Ye K.; Zhao Y.; Hu X.; Zhou X.
Institution
(Ye, Zhao, Hu, Zhou) Department of Anesthesiology, Second Affiliated
Hospital, Zhejiang University School of Medicine, Hangzhou, China
Publisher
W.B. Saunders
Abstract
Precise and prompt identification of right ventricular (RV) dysfunction is
critical in cardiac surgery. Tricuspid annular plane systolic excursion
(TAPSE) has been widely used as a simple, rapid, and repeatable index for
assessing RV function. However, the current measurement of TAPSE is based
mainly on M-mode ultrasound and is used predominantly in transthoracic
echocardiography (TTE). Owing to differences in imaging views and the
angle dependence of M-mode ultrasound, directly applying TAPSE measurement
from TTE to transesophageal echocardiography (TEE) is not advisable.
Therefore, exploring a modified TAPSE measurement method suitable for TEE
is of great value for obtaining more accurate TAPSE values and informing
subsequent clinical decision making. This review summarizes and discusses
in detail the research progress on modified TAPSE in TEE as reported in
the literature. By systematically reviewing relevant studies, it aims to
provide new methods and insights for cardiac subspecialist
anesthesiologists. Modified measurement methods will enable them to more
accurately use TAPSE to assess RV function during perioperative TEE. This
not only will help optimize clinical decision making, but also will
provide an important basis for predicting patients' clinical
outcomes.<br/>Copyright &#xa9; 2025 The Authors

<12>
[Use Link to view the full text]
Accession Number
647046893
Title
Routine Cerebral Embolic Protection during Transcatheter Aortic-Valve
Implantation.
Source
The New England journal of medicine. 392(24) (pp 2403-2412), 2025. Date of
Publication: 26 Jun 2025.
Author
Kharbanda R.K.; Kennedy J.; Jamal Z.; Dodd M.; Evans R.; Bal K.K.; Perkins
A.D.; Blackman D.J.; Hildick-Smith D.; Banning A.P.; Baumbach A.; Ludman
P.; Palmer S.; Stables R.H.; Henderson R.; Appleby C.; Cotton J.; Curzen
N.; Ozkor M.; Byrne J.; Aggarwal R.; Das R.; Doshi S.; Watkins S.; Muir
D.F.; Anderson R.; Chowdhary S.; Varcoe R.; Dorman S.; Firoozi S.;
Chelliah R.; Owens C.; Redwood S.; Prendergast B.; Iqbal J.; Ratib K.;
Dospinescu C.; Suresh V.; Cruden N.; Rajathurai T.; Malik I.S.; Wiper A.;
Costopoulos C.; Khurana A.; Banning A.; Clayton T.
Institution
(Kharbanda) Department of Cardiovascular Medicine, John Radcliffe
Hospital, Oxford, United Kingdom
(Kharbanda, Kennedy) Acute Multidisciplinary Imaging and Interventional
Centre, Radcliffe Department of Medicine, University of Oxford, Oxford,
United Kingdom
(Kharbanda) Oxford Biomedical Research Centre, Oxford, United Kingdom
(Jamal, Dodd, Evans, Bal, Perkins, Clayton) Clinical Trials Unit, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Blackman) Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds,
United Kingdom
(Hildick-Smith) Sussex Cardiac Centre, University Hospitals Sussex,
Brighton, United Kingdom
(Banning) Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Baumbach) Centre for Cardiovascular Medicine and Devices, William Harvey
Research Institute, Queen Mary University of London, London, United
Kingdom
(Baumbach, Ozkor) Barts Heart Centre, Barts Health NHS Trust, London,
United Kingdom
(Baumbach, Prendergast) LondonUnited Kingdom
(Ludman, Doshi) Institute of Cardiovascular Sciences, University of
Birmingham, Birmingham, United Kingdom
(Palmer) Centre for Health Economics, University of York, York, United
Kingdom
(Stables, Appleby) Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Stables) University of Liverpool, Liverpool, United Kingdom
(Henderson, Varcoe) Nottingham University Hospitals NHS Trust, Nottingham,
United Kingdom
(Cotton) Heart and Lung Centre, New Cross Hospital, Wolverhampton, United
Kingdom
(Cotton) University of Wolverhampton, Wolverhampton, United Kingdom
(Curzen) Faculty of Medicine, University of Southampton and University
Hospital Southampton, Southampton, United Kingdom
(Byrne) King's College Hospital Foundation Trust, London, United Kingdom
(Aggarwal) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Das) Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne, United
Kingdom
(Doshi) University College Birmingham, Birmingham, United Kingdom
(Watkins) Golden Jubilee University National Hospital, United Kingdom
(Watkins) University of Glasgow, Glasgow, United Kingdom
(Muir) James Cook University Hospital, Middlesbrough, United Kingdom
(Anderson) University Hospital of Wales, Cardiff, United Kingdom
(Chowdhary) Manchester Academic Health Sciences Unit, Wythenshawe
Hospital, Manchester, United Kingdom
(Dorman) Bristol Heart Institute, Bristol, United Kingdom
(Firoozi) St. George's Hospital University Foundation Trust, London,
United Kingdom
(Chelliah) Castle Hill Hospital, Cottingham, United Kingdom
(Owens) Royal Victoria Hospital, Belfast, United Kingdom
(Redwood) St. Thomas' Hospital, London, United Kingdom
(Iqbal) Sheffield Teaching Hospitals NHS Foundation Trust and University
of Sheffield, Sheffield, United Kingdom
(Ratib) Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
(Dospinescu) Aberdeen Royal Infirmary, Aberdeen, United Kingdom
(Suresh) University Hospitals Plymouth, Plymouth, United Kingdom
(Cruden) Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
(Rajathurai) University Hospital Coventry and Warwickshire NHS Trust,
Coventry, United Kingdom
(Rajathurai) University of Warwick, Warwick, United Kingdom
(Malik) Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Wiper) Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool,
United Kingdom
(Costopoulos) Royal Papworth Hospital, Cambridge, United Kingdom
(Khurana) Swansea Bay University Health Board, Swansea, United Kingdom
(Banning) Leicester Cardiovascular Biomedical Research Centre, University
Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United
Kingdom
Abstract
BACKGROUND: Transcatheter aortic-valve implantation (TAVI) is associated
with procedure-related stroke. Cerebral embolic protection (CEP) devices
may reduce embolization to the cerebral circulation and hence the
incidence of stroke. <br/>METHOD(S): We conducted a randomized, controlled
trial across 33 centers in the United Kingdom. We randomly assigned 7635
participants with aortic stenosis in a 1:1 ratio to undergo TAVI with a
CEP device (CEP group) or TAVI without a CEP device (control group). The
primary outcome was stroke within 72 hours after TAVI or before discharge
from the hospital (if discharge occurred sooner). <br/>RESULT(S): A total
of 3815 participants were assigned to the CEP group and 3820 to the
control group. A primary-outcome event occurred in 81 of 3795 participants
(2.1%) in the CEP group and in 82 of 3799 participants (2.2%) in the
control group (difference, -0.02 percentage points; 95% confidence
interval, -0.68 to 0.63; P = 0.94). Disabling stroke occurred in 47
participants (1.2%) in the CEP group and in 53 (1.4%) in the control
group. Death occurred in 29 participants (0.8%) in the CEP group and in 26
(0.7%) in the control group. Overall access-site complications appeared to
be similar in the two groups (8.1% in the CEP group and 7.7% in the
control group). A total of 24 serious adverse events occurred in 22 of
3798 participants (0.6%) in the CEP group, and 13 serious adverse events
occurred in 13 of 3803 participants (0.3%) in the control group.
<br/>CONCLUSION(S): Among participants undergoing TAVI, routine use of CEP
did not decrease the incidence of stroke within 72 hours. (Funded by the
British Heart Foundation and Boston Scientific; BHF PROTECT-TAVI ISRCTN
Registry number, ISRCTN16665769.).<br/>Copyright &#xa9; 2025 Massachusetts
Medical Society.

<13>
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. 41(7) (pp 1258-1269), 2025. Date of
Publication: 01 Jul 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

<14>
Accession Number
2034368361
Title
Fasting Versus Non-Fasting Before Cardiac Catheterization: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials.
Source
Catheterization and Cardiovascular Interventions. 106(1) (pp 408-417),
2025. Date of Publication: 01 Jul 2025.
Author
Muniz J.; Goncalves Neto A.O.; Morais B.A.A.H.; Suciu-Bogdan C.; Ferreira
D.; Braghiroli J.; Camara S.F.; Ribeiro H.B.
Institution
(Muniz, Suciu-Bogdan) Internal Medicine Department, Schmieder Klinik
Heidelberg, Heidelberg, Germany
(Goncalves Neto) Federal University of Parana, Curitiba, Brazil
(Morais) Centro Universitario CESMAC, Maceio, Brazil
(Ferreira) Cardiovascular Department, John Hunter Hospital, Newcastle,
Australia
(Braghiroli) Department of Cardiology, Jackson Memorial Hospital, FL,
United States
(Camara, Ribeiro) Heart Institute of Sao Paulo (InCor), University of Sao
Paulo, Sao Paulo, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Background: Current guidelines recommend routine fasting before cardiac
catheterization under conscious sedation. However, data supporting this
practice have been limited. <br/>Aim(s): We aimed to compare the safety
and patient well-being of a non-fasting strategy to standard fasting in
patients who undergo heart catheterization procedures. <br/>Method(s): We
conducted a meta-analysis of randomized studies comparing fasting versus
non-fasting before cardiac catheterization. We systematically reviewed
PubMed, Embase, and Cochrane databases until October 2024. We incorporated
unpublished subgroup data from the previously published SCOFF Trial,
exclusively on patients who underwent catheterization procedures.
<br/>Result(s): We included 7 RCTs comprising 3289 patients who underwent
cardiac catheterization procedures. The pooled analysis demonstrated the
non-inferiority of the non-fasting strategy, with no significant
differences in the incidences of nausea/vomiting (RR 0.90; 95% CI
0.50-1.61; p = 0.72), hypoglycemia (RR 0.78; 95% CI 0.45-1.35, p = 0.38),
acute kidney injury (RR 1.45; 95% CI 0.77-2.75, p = 0.251), and length of
hospital stay (SMD 0.005, 95% CI -0.109 to 0.099, p = 0.92) compared to
the fasting strategy. The non-fasting strategy was significantly
associated with reduced rates of intraprocedural hypotension and showed a
statistically significant improvement in overall patient satisfaction (SMD
-0.749; 95% CI -1.26; -0.234, p = 0.004) when compared to the fasting
strategy. <br/>Conclusion(s): A non-fasting strategy before cardiac
catheterization procedures is as safe as the standard fasting protocol and
demonstrates a significant improvement of overall patient satisfaction.
These findings support the consideration of non-fasting protocols as a
patient-centered approach that maintains safety while enhancing the
patient experience.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<15>
Accession Number
2032444100
Title
Definition of Palliative Surgery in Cancer Care: A Systematic Review.
Source
Journal of Surgical Oncology. 131(7) (pp 1439-1454), 2025. Date of
Publication: 01 Jun 2025.
Author
Wong J.S.M.; Low X.C.; Farber O.N.; Mack J.W.; Cooper Z.; Lilley E.J.
Institution
(Wong, Farber, Cooper, Lilley) Center for Surgery and Public Health,
Department of Surgery, Brigham and Woman's Hospital, Boston, MA, United
States
(Wong, Low) Department of Sarcoma, Peritoneal & Rare Tumors, Division of
Surgery and Surgical Oncology, National Cancer Center Singapore &
Singapore General Hospital, Singapore City, Singapore
(Low) Programme in Health Services and Systems Research, Duke-NUS Medical
School, Singapore City, Singapore
(Farber, Cooper, Lilley) Department of Surgery, Brigham and Woman's
Hospital, Boston, MA, United States
(Farber, Cooper, Lilley) Department of Surgery, Harvard Medical School,
Boston, MA, United States
(Mack) Department of Pediatric Oncology, Dana-Farber Cancer Institute,
Boston, MA, United States
(Lilley) Department of Psychosocial Oncology and Palliative Care,
Dana-Farber Cancer Institute, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Palliative surgery is commonly performed in cancer centers worldwide. Yet,
there is little agreement on the definition of palliative surgery or its
relevant outcomes. This systematic review sought to characterize the
definitions of palliative surgery and outcomes for patients with cancer
undergoing thoraco-abdominal procedures. Following PRISMA guidelines, we
conducted a search using PubMed, EMBASE and CINAHL databases to identify
English-language publications between August 1, 2005, and December 31,
2023 reporting palliative thoraco-abdominal procedures for patients with
cancer. Definitions of palliative surgery were coded and analyzed using an
inductive approach. Outcomes were classified according to an outcome
measures hierarchy. Among 92 articles met inclusion criteria and four
themes emerged in how palliative surgery was defined throughout the
literature: prognosis (incurable cancer diagnosis), purpose (intent to
treat symptoms or improve quality of life), procedure type (specific
operative interventions), or persistent disease following surgery
(incomplete cytoreduction). Survival (90%) and perioperative
complications/morbidity (72%) were the most commonly reported outcomes,
whereas symptom relief, quality of life, and sustainability of success
were infrequently reported. Definitions of palliative surgery vary across
studies of patients with cancer undergoing thoracic or abdominal
procedures and measured outcomes often do not align with the intent of
surgery.<br/>Copyright &#xa9; 2024 Wiley Periodicals LLC.

<16>
Accession Number
2034317072
Title
The Impact of Concomitant Mitral Regurgitation on Echocardiography
Parameters After TransCatheter Aortic Valve Replacement: A Systematic
Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 106(1) (pp 367-376),
2025. Date of Publication: 01 Jul 2025.
Author
Darouei B.; Amani-Beni R.; Rabiee Rad M.; Ghasempour Dabaghi G.; Eshraghi
R.; Bahrami A.; Amini-Salehi E.; Hashemi S.M.; Mazaheri-Tehrani S.;
Movahed M.R.
Institution
(Darouei, Amani-Beni, Rabiee Rad, Ghasempour Dabaghi) Isfahan
Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Eshraghi) Social Determinants of Health Research Center, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Bahrami) Student Research Committee, Kashan University of Medical
Sciences, Kashan, Iran, Islamic Republic of
(Amini-Salehi) Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Hashemi) Cardiovascular Research Center, Hormozgan University of Medical
Sciences, Bandar Abbas, Iran, Islamic Republic of
(Mazaheri-Tehrani) Child Growth and Development Research Center, Research
Institute for Primordial Prevention of Non-Communicable Disease, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Movahed) Department of Medicine, University of Arizona College of
Medicine, Phoenix, United States
(Movahed) Department of Medicine, University of Arizona Sarver Heart
Center, Tucson, AZ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Mitral regurgitation (MR) commonly coexists with aortic
stenosis (AS) and is a potential risk factor influencing outcomes
following transcatheter aortic valve replacement (TAVR). This
meta-analysis aimed to evaluate the mean changes in key echocardiographic
parameters before and after TAVR and to compare these changes between
patients with moderate-to-severe MR (MR >= 2) and those with none-to-mild
MR (MR < 2). <br/>Method(s): A comprehensive literature search was
conducted using six electronic databases. We included studies that
evaluated patients undergoing TAVR, classified them based on baseline MR
grade >= 2 (moderate/severe MR) or MR grade < 2 (none/mild MR), and
reported the mean difference (MD) in echocardiographic parameters before
and after TAVR in both groups. The primary outcomes included changes in
ejection fraction (EF), LV end-diastolic volume (LVEDV) index, LV
end-systolic volume (LVESV) index, LV end-diastolic diameter (LVEDD), LV
end-systolic diameter (LVESD), aortic valve area (AVA), and the mean
aortic gradient. Pooled MDs were analyzed using a random-effects model.
<br/>Result(s): Thirteen studies with 7163 patients were included, of
which 2376 had an MR >= 2. The MR < 2 and MR >= 2 groups experienced
significant improvements in AVA and reductions in mean aortic gradient,
LVEDV index, LVESV index, LVEDD, and LVESD. Compared to MR < 2 patients,
those with MR >= 2 exhibited significantly greater improvements in EF (MD
= 2.03; 95% CI: 0.81, 3.24), LVEDV index (MD = -5.55; 95% CI: -7.85,
-3.26), LVESV index (MD = -5.43; 95% CI: -7.28, -3.58), LVESD (MD = -2.23;
95% CI: -3.71, -0.26), and mean aortic gradient (MD = 1.43; 95% CI: 0.79,
2.07). However, the changes in LVEDD and AVA were not significantly
different between the groups. <br/>Conclusion(s): These findings suggest
that patients with moderate-to-severe baseline MR before TAVR showed
greater pronounced improvements in specific echocardiographic parameters
related to LV function and geometry, particularly in LVEF, LVEDV index,
LVESV index, and LVESD, compared to those with none-to-mild MR. Future
studies should focus on stratifying outcomes according to MR etiology and
using advanced imaging techniques to delineate better the mechanisms
underlying these improvements.<br/>Copyright &#xa9; 2025 Wiley Periodicals
LLC.

<17>
Accession Number
2034605509
Title
Continuation Versus Interruption of Oral Anticoagulation During TAVI: A
Systematic Review and Meta-Analysis Oral Anticoagulation Management in
TAVI.
Source
Catheterization and Cardiovascular Interventions. 106(1) (pp 644-653),
2025. Date of Publication: 01 Jul 2025.
Author
Borges Martins J.M.; dos Santos Borges R.; Gosch Berton G.; Ferreira
Vieira P.L.; Machado Gomes de Sousa P.A.; Chaves Vieira A.L.; Ken Fukunaga
C.; Karlinski Vizentin V.; Rodrigues Macedo E.M.; Guida C.M.
Institution
(Borges Martins, Ferreira Vieira, Chaves Vieira, Rodrigues Macedo)
Department of Medicine, Federal University of Para, Belem, Brazil
(dos Santos Borges) Department of Medicine, Federal University of Minas
Gerais, Belo Horizonte, Brazil
(Gosch Berton) School of Medicine, University of Passo Fundo, Passo Fundo,
Brazil
(Gosch Berton) Department of Neurology, Mater Misericordiae University
Hospital - University College Dublin, Dublin, Ireland
(Machado Gomes de Sousa) Department of Medicine, Federal University of
Uberlandia, Uberlandia, Brazil
(Ken Fukunaga, Guida) Department of Medicine, FMABC University Centre,
Santo Andre, Brazil
(Karlinski Vizentin) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Guida) Department of Cardiology, Dante Pazzanese Institute of Cardiology,
Sao Paulo, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Patients undergoing transcatheter aortic valve implantation (TAVI) often
require long-term oral anticoagulation (OAC), but it is unclear whether to
continue or interrupt OAC during the procedure. This meta-analysis
compares clinical outcomes of continuing versus interrupting OAC during
TAVI. PubMed, Embase, and Cochrane Central databases were searched from
inception to September 2024 for studies comparing continuation versus
interruption of OAC in patients undergoing TAVI with an indication for
OAC, including vitamin K antagonists and direct oral anticoagulants. Risk
ratios (RR) with 95% confidence intervals (CI) were pooled using a
random-effects model. Sensitivity analysis was performed using the
Hartung-Knapp-Sidik-Jonkman method. Three studies were included, one
randomized controlled trial and two cohort studies, with 2773 patients, of
whom 1314 (47.4%) continued OAC during TAVI. At a 30-day follow-up after
TAVI, there were no significant differences between groups in all-cause
mortality (RR 0.74; 95% CI 0.45-1.20; p = 0.22), any bleeding (RR 1.08;
95% CI 0.81-1.43; p = 0.60), and major bleeding (RR 0.90; 95% CI
0.67-1.21; p = 0.48). However, the continued OAC group was associated with
a lower stroke rate (RR 0.65; 95% CI 0.42-1.01; p = 0.053), also attested
after a sensitivity analysis (RR 0.65; 95% CI 0.47-0.90; p < 0.03). In
patients with an indication for OAC undergoing TAVI, uninterrupted
anticoagulation is associated with similar thrombotic and hemorrhagic
outcomes compared to interrupted OAC. Stroke risk was lower in the
continued OAC group, with a significant reduction, as demonstrated in
sensitivity analysis.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<18>
Accession Number
2034636587
Title
Impact of Periprocedural Statin Therapy on Mortality and Cardiovascular
Outcomes in Transcatheter Aortic Valve Replacement: A Meta-Analysis and
Meta-Regression.
Source
Catheterization and Cardiovascular Interventions. 106(1) (pp 720-729),
2025. Date of Publication: 01 Jul 2025.
Author
Goyal A.; Maheshwari S.; Mashkoor Y.; Singh A.; Rafique F.; Sheikh A.B.;
Bansal K.
Institution
(Goyal) Department of Internal Medicine, Cleveland Clinic Foundation,
Cleveland, OH, United States
(Maheshwari) Department of Internal Medicine, University of Alabama at
Montgomery, Montgomery, AL, United States
(Mashkoor, Singh, Rafique) Department of Internal Medicine, Dow University
of Health Sciences, Karachi, Pakistan
(Sheikh) Department of Internal Medicine, University of New Mexico,
Albuquerque, NM, United States
(Bansal) Department of Family and Community Medicine, Baylor College of
Medicine, Houston, TX, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) stands as a
notable alternative to surgical valve replacement for severe aortic
stenosis (AS). Despite the established benefits of statins in
cardiovascular pathologies, their specific impact in patients with severe
AS undergoing TAVR remains uncertain. <br/>Aim(s): Our meta-analysis aims
to assess whether periprocedural statin therapy improves survival and
outcomes post-TAVR, thus addressing this gap in literature.
<br/>Method(s): A comprehensive literature search using various databases
with relevant keywords terms was conducted to identify studies on the
impact of periprocedural statin therapy on TAVR outcomes. We assessed the
primary outcome of all-cause mortality alongside various secondary
outcomes including stroke/transient ischemic attack (TIA), myocardial
infarction, acute kidney injury (AKI), 30-day mortality, in-hospital
mortality, rehospitalization, cardiovascular complications, and pacemaker
requirement. A random-effects model using Comprehensive Meta Analysis
Software was employed to analyze the data for each outcome. Statistical
significance was set at a p < 0.05. <br/>Result(s): Our analysis of 19
observational studies revealed that periprocedural statin therapy
significantly reduces all-cause mortality following TAVR surgery (OR =
0.71, 95% CI: 0.61-0.83, p < 0.001). However, the influence of statins on
other outcomes remains inconclusive. These outcomes include stroke/TIA (OR
= 0.90, 95% CI: 0.68-1.19, p = 0.455), risk of MI (OR = 1.72, 95% CI:
0.73-4.04, p = 0.214), AKI (OR = 0.99, 95% CI: 0.75-1.31, p = 0.968),
30-day mortality (OR = 0.71, 95% CI: 0.46-1.10, p = 0.126), in-hospital
mortality (OR = 0.42, 95% CI: 0.13-1.38, p = 0.151), rehospitalization (OR
= 0.92, 95% CI: 0.66-1.29, p = 0.645), cardiovascular complications (OR =
1.12, 95% CI: 0.91-1.37, p = 0.297), and pacemaker requirement (OR = 0.83,
95% CI: 0.65-1.06, p = 0.133). <br/>Conclusion(s): Our meta-analysis
indicates a potentially promising role for periprocedural statin therapy
in enhancing patient outcomes post-TAVR surgery. We found a notable
association between statin therapy and a reduction in all-cause mortality.
However, the effects on secondary outcomes did not reach statistical
significance, which warrants further investigation through larger,
well-designed, randomized controlled trials.<br/>Copyright &#xa9; 2025
Wiley Periodicals LLC.

<19>
Accession Number
2034975667
Title
Cardiovascular Outcomes of Perioperative Sodium-Glucose Transporter 2
Inhibition in Cardiac Surgery Patients: An Open-Label Randomized Pilot
Study.
Source
Acta Anaesthesiologica Scandinavica. 69(6) (no pagination), 2025. Article
Number: e70075. Date of Publication: 01 Jul 2025.
Author
Snel L.I.P.; Oosterom-Eijmael M.J.P.; Lankadeva Y.R.; Plummer M.P.;
Preckel B.; Zuurbier C.J.; 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, van Raalte, Hulst) Amsterdam Cardiovascular
Sciences Research Institute, Amsterdam, Netherlands
(Oosterom-Eijmael, 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) Department of Critical Care, Melbourne Medical School, The
University of Melbourne, Melbourne, VIC, Australia
(Lankadeva) Department of Anesthesia, Austin Health, Melbourne, VIC,
Australia
(Plummer) Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA,
Australia
(Plummer) School of Medicine, University of Adelaide, Adelaide, SA,
Australia
(Preckel, Hermanides) Amsterdam Public Health Research Institute, Quality
of Care, Amsterdam, Netherlands
(Zuurbier) Laboratory of Experimental Intensive Care and Anesthesiology,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Background: Previous studies have shown cardiovascular benefits of SGLT2
inhibitors. The aim of this study was to evaluate the cardiovascular
effects of perioperative SGLT2 inhibition in patients undergoing cardiac
surgery. <br/>Method(s): In this open-label pilot study, adult patients
undergoing cardiac surgery were randomized to receive a daily dose of
empagliflozin (10 mg; oral) 3 days before surgery until 2 days after
surgery, or standard of care. Blood pressure, heart rate, postoperative
diuresis, intravenous fluid administration, fluid balance, and vasoactive
support were compared between groups during the first 24 postoperative
hours. <br/>Result(s): About 55 patients (sex: 73% male, age: 66 +/- 10
years, BMI: 28 +/- 4 kg/m², empagliflozin n = 25, control n =
30) were included in this study and analyzed according to the
intention-to-treat principle. Empagliflozin was associated with increased
diuresis, mean difference 549 mL (95% CI 258-839, p < 0.001), and less
positive fluid balance postoperatively, mean difference -1217 mL (95% CI
-2373- -61, p = 0.039). Empagliflozin did not increase the amount of
intravenous fluid administered. In the empagliflozin group, norepinephrine
was infused for 11.8 +/- 11.5 h compared to 19.3 +/- 19.3 h in the control
group (p = 0.080). No significant between-group differences were observed
in postoperative blood pressure and heart rate. <br/>Conclusion(s):
Perioperative SGLT2 inhibition was associated with increased diuresis and
lesser fluid accumulation without an increase in vasopressor requirement.
These data warrant validation and further evaluation in a larger-scale,
double-blind, placebo-controlled trial. Editorial Comment: In this
sub-study of the randomized MERCURI-2 trial of perioperative empagliflozin
for nondiabetics in cardiac surgery, the authors describe the hemodynamic
outcomes and fluid status of the patients. The authors noted a higher
urine output and a more negative fluid balance in the intervention group
compared to the placebo group. An interesting observation is the trend
towards lower noradrenaline usage, although this cannot be concluded with
confidence based on this data. The findings support considering and
further studying the use of these medications for patients with
cardiovascular disease undergoing surgery. Trial Registration:
https://onderzoekmetmensen.nl/en/trial/26563 Identifier:
NL9561.<br/>Copyright &#xa9; 2025 The Author(s). Acta Anaesthesiologica
Scandinavica published by John Wiley & Sons Ltd on behalf of Acta
Anaesthesiologica Scandinavica Foundation.

<20>
Accession Number
2039324982
Title
Rhomboid Intercostal Block for Postoperative Analgesia in Mastectomy: A
Prospective, Randomized Controlled Trial.
Source
Bali Journal of Anesthesiology. 9(2) (pp 113-118), 2025. Date of
Publication: 01 Apr 2025.
Author
Gunawan P.; Gusti Ngurah Mahaalit Aribawa I.; Adi M.S.P.
Institution
(Gunawan) Department of Anesthesiology and Intensive Care, Harapan
Hospital, Magelang, Indonesia
(Gusti Ngurah Mahaalit Aribawa, Adi) Udayana University, Jimbaran,
Indonesia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Postoperative pain following mastectomy remains a significant
concern, often requiring high-dose opioids that may lead to adverse
effects. The rhomboid intercostal block (RIB) is a novel ultrasound-guided
fascial plane block shown to reduce pain in thoracic and breast surgeries.
This study aimed to evaluate the effectiveness of RIB in reducing
postoperative opioid consumption and pain scores in patients undergoing
mastectomy. <br/>Material(s) and Method(s): In a randomized, double-blind
trial, 28 patients (American Society of Anesthesiologists [ASA] I-II, aged
19-60 years) were randomized 1:1 to receive either general anesthesia with
RIB (Group A) or general anesthesia alone (Group B). The sample size was
based on prior data demonstrating opioid reduction with RIB undergoing
mastectomy. The primary outcome was total morphine consumption within 24 h
postoperatively. Secondary outcomes included pain scores at multiple time
points and intraoperative fentanyl use. Data were analyzed using
appropriate statistical tests based on data distribution, with a
significance level of P < 0.05. <br/>Result(s): Group A demonstrated
significantly lower morphine consumption in the first 24 h postoperatively
(1.71 +/- 0.99 mg vs. 10 +/- 1.30 mg; P < 0.001). Pain scores were
significantly reduced in Group A across all time points (1st, 3rd, 6th,
12th, and 24th h; P < 0.001). Intraoperative fentanyl requirements were
also significantly lower in Group A (125 microg vs. 225 microg; P <
0.001). No significant differences in side effects were observed between
groups. <br/>Conclusion(s): RIB significantly reduces postoperative opioid
requirements and pain intensity in mastectomy patients and may serve as a
valuable adjunct in enhanced recovery pathways for breast
surgery.<br/>Copyright &#xa9; 2025 Bali Journal of Anesthesiology <br/>
Published by Wolters Kluwer - Medknow.

<21>
Accession Number
2039457879
Title
Dexmedetomidine for delirium prevention after cardiac surgery: An updated
systematic review and meta-analysis with trial sequential analysis.
Source
Anaesthesia Critical Care and Pain Medicine. 44(5) (no pagination), 2025.
Article Number: 101578. Date of Publication: 01 Sep 2025.
Author
Caetano da Silva L.; Tapioca V.; Viana P.; Pereira E.M.; Gibicoski T.;
Amaral S.
Institution
(Caetano da Silva) Department of Medicine, Federal University of Paraiba,
Brazil
(Tapioca) Department of Medicine, Bahiana School of Medicine and Public
Health, Brazil
(Viana) Department of Medicine, University of the Extreme South of Santa
Catarina, Brazil
(Pereira) Department of Medicine, Federal University of Minas Gerais,
Brazil
(Gibicoski) Department of Medicine, Federal University of Health Sciences
of Porto Alegre, Brazil
(Amaral) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Postoperative delirium remains a common complication after
cardiac surgery. The impact of dexmedetomidine (DEX) on preventing
postoperative delirium is still controversial as recent randomized
controlled trials (RCTs) have presented conflicting results.
<br/>Method(s): We conducted an updated systematic review and
meta-analysis of RCTs evaluating DEX efficacy in preventing delirium after
cardiac surgery. A systematic search of MEDLINE, Embase, and Cochrane
databases identified RCTs comparing DEX with placebo or other treatments
in patients aged >=18 years. Sensitivity, subgroup analyses, and trial
sequential analysis (TSA) assessed the robustness of the findings.
<br/>Result(s): A total of 31 RCTs including 5628 patients were analyzed,
50.1% of them receiving DEX. Delirium incidence was significantly lower in
the DEX group (RR 0.61; 95% CI, 0.49-0.75; P < 0.001). This protective
effect remained across subgroup analyses based on age, control type,
delirium assessment method, and after excluding trials at high risk of
bias. DEX use was associated with a shorter intensive care unit length of
stay (MD -0.14 days; 95% CI, -1.28 to -0.04; P < 0.01). TSA confirmed the
result's robustness. However, DEX increased bradycardia risk (RR 1.53; 95%
CI, 1.05-2.21; P = 0.02). No significant differences were found in
mortality, intubation duration, hospital length of stay, atrial
fibrillation, or hypotension. <br/>Conclusion(s): Dexmedetomidine
significantly reduces postoperative delirium following cardiac surgery,
with moderate evidence confirmed by TSA. While it demonstrates clinical
benefits, careful bradycardia monitoring is warranted. Systematic review
protocol: PROSPERO (CRD42024593472).<br/>Copyright &#xa9; 2025 Societe
Francaise d'Anesthesie et de Reanimation (SFAR)

<22>
Accession Number
2034984279
Title
Outcomes of heart surgery in neonates with trisomy 13 and 18: a systematic
review with metanalysis.
Source
European Journal of Pediatrics. 184(7) (no pagination), 2025. Article
Number: 430. Date of Publication: 01 Jul 2025.
Author
de Sa Bittencourt Camara Bastos C.; Vale da Cruz L.; Hirano Arruda Moraes
L.; Jornada Krebs V.L.; de Carvalho W.B.
Institution
(de Sa Bittencourt Camara Bastos, Vale da Cruz, Jornada Krebs, de
Carvalho) Department of Pediatrics, Faculty of Medicine of the University
of Sao Paulo, Instituto da Crianca e do Adolescente do Hospital das
Clinicas, Av. Dr. Eneas de Carvalho Aguiar, 647, Sao Paulo, Sao Paulo,
Brazil
(Hirano Arruda Moraes) Neonatal Section, Pediatric Division, University
Hospital of the University of Sao Paulo, Sao Paulo, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
This systematic review and meta-analysis aimed to evaluate the clinical
outcomes of cardiac surgery in neonates with trisomy 13 (T13) or trisomy
18 (T18) compared to those managed with palliative care. A literature
search was conducted in PubMed and EMBASE, following PRISMA guidelines,
and included five retrospective cohort studies (1627 patients). Outcomes
analyzed included in-hospital mortality, survival at 12 months, length of
stay (LOS), hospital discharge rates, and the need for mechanical
ventilation. The meta-analysis showed that cardiac surgery significantly
reduced the odds of in-hospital mortality (OR 0.12, CI 95% 0.03-0.42, p <
0.01), increased survival at 12 months (OR 19.77, CI 95% 5.12-76.36, p <
0.01), and improved discharge rates (OR 12.53, CI 95% 3.63-43.22, p <
0.01). However, limited data were available on quality of life and
mechanical ventilation duration. <br/>Conclusion(s): Despite the positive
impact of cardiac surgery on survival and discharge rates, the evidence
remains low quality, as the included studies were primarily retrospective
cohorts with moderate risk of bias. The findings highlight the importance
of involving families in the decision-making process, given their
differing perspectives on quality of life. Further high-quality studies,
such as randomized controlled trials, are needed to provide stronger
evidence on this topic.<br/>Copyright &#xa9; The Author(s), under
exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature
2025.

<23>
Accession Number
2034574020
Title
Dual ProGlide Versus ProGlide and Angio-Seal for Femoral Access
Hemostasias in Transcatheter Aortic Valve Replacement: A Meta-Analysis of
Up-to-Date Evidence.
Source
Catheterization and Cardiovascular Interventions. 106(1) (pp 621-624),
2025. Date of Publication: 01 Jul 2025.
Author
Naeem F.; Tabassum S.; Burhan M.; Qamar U.; Alraies M.C.; Abramov D.
Institution
(Naeem) Department of Cardiology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Tabassum) Department of Internal Medicine, King Edward Medical
University, Lahore, Pakistan
(Burhan) Department of Internal Medicine, Rawalpindi Medical University,
Lahore, Pakistan
(Qamar) Department of Internal Medicine, Mayo Clinic, Rochester, NY,
United States
(Alraies) Department of Cardiology, Department of Medicine, Detroit
Medical Center, Detroit, MI, United States
(Abramov) Department of Medicine, Division of Cardiology, Loma Linda
University Health, Loma Linda, CA, United States
Publisher
John Wiley and Sons Inc

<24>
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. 73(6) (pp 1836-1846), 2025.
Date of Publication: 01 Jun 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.

<25>
[Use Link to view the full text]
Accession Number
2039305873
Title
Protective effect of sevoflurane on myocardial ischemia-reperfusion
injury: a systematic review and meta-analysis.
Source
International Journal of Surgery. 110(11) (pp 7311-7330), 2024. Date of
Publication: 01 Nov 2024.
Author
Nasiri-Valikboni A.; Rashid M.; Azimi A.; Zarei H.; Yousefifard M.
Institution
(Nasiri-Valikboni, Azimi, Zarei, Yousefifard) Physiology Research Center,
Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Rashid) Student Research Committee, Babol University of Medical Sciences,
Babol, Iran, Islamic Republic of
Publisher
Wolters Kluwer Health Inc
Abstract
Background: Myocardial ischemia-reperfusion (I/R) injury significantly
impacts recovery in both cardiac and noncardiac surgeries, potentially
leading to severe cardiac dysfunction. Sevoflurane, a volatile anesthetic,
is reputed for its protective effects against myocardial I/R injury,
although evidence remains inconclusive. This systematic review and
meta-analysis aim to clarify the cardioprotective efficacy of sevoflurane.
<br/>Method(s): The systematic search of databases including Medline,
Embase, Scopus, and Web of Science, was supplemented with a manual search
to retrieve studies using rat or mouse models of myocardial I/R injury,
comparing sevoflurane pretreatment (>= 24 h before I/R), preconditioning
(within 24 h before I/R), or postconditioning (after I/R) against
nontreated controls. The outcomes were cardiac function, myocardial
infarct size, apoptosis, inflammation, oxidative stress, and cardiac
biomarkers. Using the random effects model, standardized mean differences
(SMD) were pooled to perform meta-analyses. <br/>Result(s): Fifty-one
studies, encompassing 8189 subjects, were included in the meta-analysis.
Pretreatment with Sevoflurane significantly reduced infarct size.
Sevoflurane preconditioning exhibited positive effects on left ventricular
parameters and ejection fraction, and reduced infarct size, apoptosis, and
oxidative stress. Postconditioning with Sevoflurane demonstrated
improvements in cardiac function, including enhanced left ventricular
parameters and reduced infarct size, apoptosis, inflammation, oxidative
stress, and cardiac biomarkers. <br/>Conclusion(s): Sevoflurane
demonstrates a significant protective effect against myocardial I/R injury
in animal models. These findings support the potential clinical utility of
sevoflurane as an anesthetic choice in preventing and managing myocardial
I/R injury during surgeries.<br/>Copyright &#xa9; 2024 The Author(s).
Published by Wolters Kluwer Health, Inc.

<26>
Accession Number
2035001545
Title
Adjustment of positive end-expiratory pressure based on body mass index
during general anaesthesia: a randomised controlled trial*.
Source
Anaesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Selpien H.; Penon J.; Thunecke D.; Schadler D.; Lautenschlager I.;
Ohnesorge H.; Eimer C.; Wolf C.; Sablewski A.; Becher T.
Institution
(Selpien, Penon, Thunecke, Schadler, Lautenschlager, Ohnesorge, Eimer,
Wolf, Sablewski, Becher) Department for Anaesthesiology and Intensive Care
Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Lung-protective ventilation is essential for preventing
postoperative pulmonary complications. While maintaining a low driving
pressure and optimising PEEP is of importance, the ideal strategy remains
contentious. This study evaluated whether adjusting PEEP based on BMI,
compared with standard PEEP, could reduce driving pressure and
peri-operative loss of lung aeration. <br/>Method(s): We conducted a
randomised controlled, patient-blinded, single-centre superiority trial
with two parallel groups. Adult patients undergoing surgery with general
anaesthesia who required tracheal intubation were assigned randomly to
either standardised PEEP (PEEP = 5 cmH<inf>2</inf>O; group PEEP-5) or PEEP
set according to BMI (PEEP = BMI/3 cmH<inf>2</inf>O; group PEEP-BMI/3).
Patients' lungs were ventilated using a volume-controlled mode with tidal
volumes of 7 ml.kg^-1 predicted body weight. Lung aeration
scores were assessed using ultrasound pre- and postoperatively.
<br/>Result(s): Sixty patients were enrolled and allocated randomly.
Adjustment of PEEP according to BMI/3 was associated with a significantly
lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4
[5.2-14.9]) cmH<inf>2</inf>O in group PEEP-5 and 7.9 (7.2-8.5 [5.9-14.1])
cmH<inf>2</inf>O in group PEEP-BMI/3 (p = 0.027) and higher mean (SD)
respiratory system compliance (group PEEP-5, 0.83 (0.20) ml
cmH<inf>2</inf>O^-1 kg^-1 predicted body weight vs.
group PEEP-BMI/3, 0.95 (0.17) ml cmH<inf>2</inf>O^-1
kg^-1 predicted body weight; p = 0.020). Lung ultrasound
revealed a reduced postoperative loss of lung aeration in patients
allocated to the BMI/3 group. Patients allocated to the BMI-adjusted group
required less supplemental oxygen, had less newly developed atelectasis
and had higher oxygen saturations upon arrival in the post-anaesthesia
care unit. <br/>Discussion(s): In patients without major pulmonary disease
who were undergoing non-cardiothoracic surgeries with tracheal intubation,
adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and
reduced postoperative loss of lung aeration. This approach provides a
straightforward and pragmatic method for individualising PEEP in patients
undergoing general anaesthesia.<br/>Copyright &#xa9; 2025 The Author(s).
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<27>
Accession Number
2039272458
Title
Comparison of Myocardial Protective Effect of Sevoflurane Versus Propofol
in Patients Undergoing Mitral Valve Replacement Surgery.
Source
International Journal of Current Pharmaceutical Review and Research. 17(4)
(pp 954-959), 2025. Date of Publication: 2025.
Author
Meena R.; Sachin; Meena S.; Vijay M.; Garg A.; Rasha M.
Institution
(Meena) Department of Anaesthesia, SMS Medical College, Jaipur, India
(Sachin, Vijay, Rasha) Department of Anaesthesia, SMS Medical College,
Jaipur, India
(Meena) Department of Emergency Medicine, SMS Medical College, Jaipur,
India
(Garg) Department of Anaesthesia, SMS Medical College, Jaipur, India
Publisher
Dr. Yashwant Research Labs Pvt. Ltd.
Abstract
Background and Aims: Cardiac surgical procedures unavoidably produce
myocardial cell injury. This study was plannedto compare myocardial
protective effect of sevoflurane versus propofol in terms of comparing the
plasma cardiac troponin-I (cTnI) and creatine kinase isozyme (CK-MB) level
as the primary markers of myocardial cell injury in patients undergoing
heart valve replacement surgery. <br/>Material(s) and Method(s): This
hospital based Prospective, Randomized, Interventional study included 70
eligible cases of age 30-65 years divided equally into two groups. In
group A Sevoflurane and in group B, Propofol was used for maintaining
anaesthesia. Cardiac Troponin I, CK MB were determined before induction,
3hours,6 hours after aortic unclamping, 24hrs and 48hours after surgery.
As secondary objective hemodynamic parameters were also recorded at
different intervals. <br/>Result(s): Cardiac Troponin I and CK MB levels
were lower in sevoflurane group at all time intervals after aortic
unclamping with statistically significant lower values at 3hr and 6hr of
aortic unclamping compared to propofol group. Hemodynamic parameters,
Automatic heartbeat recovery, Mechanical ventilation duration and ICU stay
duration in both groups were comparable. <br/>Conclusion(s):
Administration of sevoflurane during cardiac surgery can produce better
myocardial protection in comparison of intravenous infusion of
propofol.<br/>Copyright &#xa9; 2025 Dr. Yashwant Research Labs Pvt. Ltd..
All rights reserved.

<28>
Accession Number
2039344974
Title
A comparative study of the effects of spontaneous ventilation versus
one-lung mechanical ventilation on ipsilateral lung injury during thoracic
surgery: an empirical analysis based on a rat model.
Source
Journal of Thoracic Disease. 17(6) (pp 3948-3961), 2025. Date of
Publication: 30 Jun 2025.
Author
Liao S.; Zhang X.; Long L.; Zeng J.; Sun Z.; Wang B.; Jiang B.; Tan B.;
Hong L.; Huang A.; Ouyang Y.; Chen X.; Yang F.; Zhang C.; Lan L.
Institution
(Liao, Zhang, Lan) Department of Anesthesiology, The First Affiliated
Hospital of Guangzhou Medical University, Guangzhou, China
(Zhang, Long, Zeng, Sun, Wang, Jiang, Tan, Hong, Huang, Ouyang, Chen,
Yang) The Second Clinical College, Guangzhou Medical University,
Guangzhou, China
Publisher
AME Publishing Company
Abstract
Background: One-lung ventilation (OLV) is prone to adverse reactions,
particularly ventilator-induced lung injury (VILI). Spontaneous
ventilation (SV) is supposed to reduce this risk. To investigate the
effects of the ventilated lung during surgery, we established a rat model
for research. <br/>Method(s): Forty-two rats were randomly divided into 7
groups: control, OLV, and SV [OLV/SV group was subdivided into 3 time
points (10, 20, 30 min)]. Blood gas analysis, bronchoalveolar lavage fluid
(BALF) test, and lung tissue wet-to-dry ratio were performed. Hematoxylin
and eosin (HE), Masson and immunohistochemical for tumor necrosis
factor-alpha (TNF-alpha) examinations were conducted. <br/>Result(s): At
30 minutes of ventilation, compared to the OLV group, the SV group had
higher arterial oxygen partial pressure and lower carbon dioxide partial
pressure (P<0.05). Moreover, the wet-to-dry ratio in the OLV group
significantly exceeded that in the SV group (P<0.01). Results from BALF,
HE and Masson staining all indicated that the inflammatory response
induced by OLV was stronger than that of SV. Based on HE staining,
quantitative analysis of bronchial inflammation in the ventilated lung of
each group showed that the degree of terminal bronchiole injury
(P<0.0001), alveolar capillary congestion, and inflammatory cell
infiltration (P<0.01) were more severe in the OLV group compared to the SV
group. Additionally, in the immunohistochemical staining measurement of
TNF-alpha, the expression level of TNF-alpha in the OLV group was higher
than that in the SV group. <br/>Conclusion(s): Based on the rat model in
this study, we can infer that during unilateral open pneumothorax surgery,
with 30 minutes of ventilation, lung injury caused by OLV is more severe
than that caused by SV in the ventilated lung.<br/>Copyright &#xa9; AME
Publishing Company.

<29>
Accession Number
2035002093
Title
Increase in calcidiol level is associated with improved sternal bone
healing after cardiac surgery with sternotomy-REINFORCE-D trial results.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 224. Date of
Publication: 01 Dec 2025.
Author
Cerny D.; Cecrle M.; Sedlackova E.; Mikova B.; Drncova E.; Skalsky I.;
Mieresova M.; Halacova M.
Institution
(Cerny, Cecrle, Mieresova, Halacova) Department of Clinical Pharmacy, Na
Homolce Hospital, Prague, Czechia
(Cerny, Cecrle) Institute of Pharmacology, First Faculty of Medicine,
Charles University in Prague, Albertov 4, Prague, Czechia
(Sedlackova, Skalsky) Department of Cardiac Surgery, Na Homolce Hospital,
Prague, Czechia
(Mikova) Department of Radiology, Na Homolce Hospital, Prague, Czechia
(Drncova) Department of Clinical Biochemistry, Hematology and Immunology,
Na Homolce Hospital, Prague, Czechia
(Mieresova, Halacova) Department of Pharmacology, Second Faculty of
Medicine, Charles University in Prague, Prague, Czechia
(Cerny) Department of Clinical Pharmacy, Regional Hospital Liberec,
Liberec, Czechia
(Cerny) Institute of Biomedicine and Radiology, Faculty of Health Studies,
Technical University of Liberec, Liberec, Czechia
(Cecrle) Department of Occupational Medicine, General University Hospital
in Prague, Prague, Czechia
(Halacova) Department of Anaesthesia and Intensive Care Medicine, Third
Faculty of Medicine, Charles University in Prague and FNKV University
Hospital, Prague, Czechia
(Sedlackova) Department of Infectious Diseases, Masaryk Hospital, Usti and
Labem, Labem, Czechia
Publisher
BioMed Central Ltd
Abstract
Introduction : Heart surgery is associated with a sternotomy in most
patients. Low serum calcidiol level below 80 nmol/l carries the risk of
bone loss as a risk factor in sternotomy healing. <br/>Objective(s): The
primary objective was to compare postoperative complications of sternotomy
healing in two groups of patients treated with cholecalciferol or placebo.
Secondary objectives were focused on the degree of sternal healing, length
of hospitalization, number of days spent in ICU and mechanical
ventilation, and number of repeated hospitalizations for sternotomy
complications. Methodology: Monocentric, randomized, double-blind,
placebo-controlled, prospective study was conducted from September 2016 to
December 2020 at Na Homolce Hospital. Of the 216 originally recruited and
randomized subjects, 141 completed the study. Seventy-two subjects were
enrolled in the cholecalciferol arm, and sixty-nine subjects in the
placebo arm. The detailed methodology has been published previously. The
results are presented as a comparison between two groups: calcidiol above
80 nmol/l (saturated subjects) and the calcidiol lower or equal to 80
nmol/l (unsaturated subjects). <br/>Result(s): Statistics include 141
subjects. After a 6-month follow-up, CT imaging and calcidiol levels were
performed. Primary objective: postoperative complications in sternotomy
were not among the population under or above 80 nmol/l statistical
difference (p = 0.907). <br/>Secondary Objectives: monitored parameters
did not differ between individual arms. But the key was the state of
saturation with calcidiol (> 80 nmol/l), which was associated with a
significantly lower risk of complete non-healed sternotomy (p = 0.008).
<br/>Conclusion(s): Optimal calcidiol level (> 80 nmol/l) indicates a
positive trend towards greater sternal healing. Cholecalciferol oral
administration can be considered as a safe method how to achieve the
required calcidiol concentration. Trial registration: EU Clinical Trials
Register, EUDRA CT No: 2016-002606-39.<br/>Copyright &#xa9; The Author(s)
2025.

<30>
[Use Link to view the full text]
Accession Number
647733793
Title
Feasibility and acceptability of a relational coordination training
intervention among healthcare professionals in an ICU.
Source
Nursing. 55(7) (pp 44-52), 2025. Date of Publication: 01 Jul 2025.
Author
House S.; Palazzolo J.; Stucky C.; Newhouse R.
Institution
(House) IN), Sherita House is an Assistant Professor at the University of
North Carolina Greensboro (Greensboro ,NC). John Palazzolo is an Assistant
Professor at Truman State University (Kirksville ,MO). Christopher Stucky
is the Chief of Research and a Nurse Scientist in the Center for Nursing
Science and Clinical Inquiry at the Landstuhl Regional Medical Center in
Germany (Landstuhl ,Germany). Robin Newhouse is a Professor and Dean at
Indiana State University (Indianapolis
Abstract
PURPOSE: To explore the feasibility and acceptability of a relational
coordination (RC) training intervention among healthcare professionals in
the ICU. <br/>METHOD(S): A two-group, randomized control trial pilot study
was conducted in four ICUs in a 975-bed Magnet hospital. Two units were
randomly selected as the control unit (an 8-bed cardiothoracic surgical
ICU and a 20-bed neurologic ICU) and two ICUs for the intervention unit (a
24-bed cardiac ICU and a 30-bed medical ICU). <br/>RESULT(S): Survey
completion rates ranged from 18% to 36% across data collection time points
in the intervention and control units and only 8% (n = 22) of eligible
participants in the intervention group completed the RC training
intervention. Thus, two of our feasibility benchmark outcomes were unmet.
<br/>CONCLUSION(S): The results from this study and participant feedback
will inform the development of our RC training intervention and refinement
of procedures to improve communication among healthcare professionals in a
larger-powered study.<br/>Copyright &#xa9; 2025 Wolters Kluwer Health,
Inc. All rights reserved.

<31>
Accession Number
2033391590
Title
Impact of Continuation Versus Interruption of Oral Anticoagulation During
TAVI on Health-Related Quality of Life.
Source
Catheterization and Cardiovascular Interventions. 105(6) (pp 1329-1337),
2025. Date of Publication: 01 May 2025.
Author
van Ginkel D.J.; Bor W.L.; Aarts H.M.; Dubois C.; Backer O.D.; Rooijakkers
M.J.P.; Rosseel L.; Veenstra L.; Delewi R.; ten Berg J.M.
Institution
(van Ginkel, Bor, ten Berg) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(Aarts, Delewi) Department of Cardiology, Amsterdam UMC, Amsterdam,
Netherlands
(Aarts) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Dubois) Department of Cardiovascular Medicine, University Hospital
Leuven, Leuven, Belgium
(Backer) The Heart Center, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Rooijakkers) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Rosseel) Department of Cardiology, Hartcentrum Aalst, Aalst, Belgium
(Veenstra, ten Berg) Department of Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(Veenstra, ten Berg) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Background: One-third of patients undergoing TAVR have a concomitant
indication for oral anticoagulation. The impact of continuation as
compared to interruption of oral anticoagulation during TAVR on
health-related quality of life is unknown. <br/>Aim(s): To investigate the
impact of continuation as compared to interruption of oral anticoagulation
on health-related quality of life. <br/>Method(s): The POPular PAUSE TAVI
(Periprocedural Continuation vs. Interruption of Oral Anticoagulant Drugs
during Transcatheter Aortic Valve Implantation) trial was an
international, open-label, randomized, clinical trial performed at 22
European sites. Health-related quality of life was assessed using the
Kansas City Cardiomyopathy Questionnaire (KCCQ) and Short Form-12 (SF-12)
before, and at 1 and 3 months after TAVR. <br/>Result(s): A total of 8
patients were included: 431 were assigned to continuation and 427 to
interruption of oral anticoagulation. Before TAVR, the mean overall KCCQ
summary score was 53.6 (+/-26.0). At 1 month, the mean change in KCCQ
summary score as compared to baseline was +11.4 points (95% confidence
interval [CI] 8.0-14.8) in the continuation group and +12.2 points (95% CI
8.8-15.6) in the interruption group (difference -0.7 points; 95% CI -4.6
to 3.1). At 3 months, the mean change was +11.0 points (95% CI 7.3-14.6)
versus +13.8 points (95% CI 10.2-17.4), respectively (difference -2.8
points; 95% CI -7.1 to 1.5). Mean changes in SF-12 physical and mental
component summary scores showed no differences between both groups at 1
and 3 months after TAVR. <br/>Conclusion(s): In patients undergoing TAVR
with a concomitant indication for oral anticoagulation, continuation as
compared to interruption of oral anticoagulation during TAVR did not
significantly impact health-related quality of life up to 3 months after
TAVR.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<32>
Accession Number
2039374769
Title
Serratus posterior superior intercostal plane block versus thoracic
paravertebral block for pain management after video-assisted thoracoscopic
surgery: a randomized prospective study.
Source
Brazilian Journal of Anesthesiology (English Edition). 75(5) (no
pagination), 2025. Article Number: 844647. Date of Publication: 01 Sep
2025.
Author
Dogan G.; Kucuk O.; Kayir S.; Dal G.C.; Ciftci B.; Zengin M.; Alagoz A.
Institution
(Dogan, Kayir) Hitit University Faculty of Medicine, Department of
Anesthesiology and Reanimation, Corum, Turkey
(Kucuk, Alagoz) University of Health Sciences, Ankara Ataturk Chest
Diseases and Thoracic Surgery Training and Research Hospital, Department
of Anesthesiology and Reanimation, Ankara, Turkey
(Dal) Siirt Training and Research Hospital, Department of Anesthesiology
and Reanimation, Siirt, Turkey
(Ciftci) Istanbul Medipol University, Department of Anesthesiology and
Reanimation, Istanbul, Turkey
(Zengin) Ankara Etlik City Hospital, Department of Anesthesiology and
Reanimation, Ankara, Turkey
Publisher
Elsevier Editora Ltda
Abstract
Background: Video-Assisted Thoracoscopic Surgery (VATS) is a minimally
invasive procedure associated with faster recovery and fewer complications
compared to open thoracotomy. Effective postoperative pain management is
important for optimizing recovery. This study compares the analgesic
efficacy of the Serratus Posterior Superior Intercostal Plane Block
(SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain
following VATS. <br/>Method(s): In this randomized, prospective,
double-blind study, 70 patients aged 18-65 years (ASA I-III) undergoing
VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n =
35). The primary outcome was the 24-hour postoperative Visual Analog Scale
(VAS) pain score at rest. Secondary outcomes included VAS pain scores
during coughing, time to first opioid request, total opioid consumption
within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15)
scores. Opioid consumption was assessed using intravenous tramadol through
Patient-Controlled Analgesia (PCA), with additional morphine, if required.
<br/>Result(s): The mean age of the patients was 52 +/- 11 years, and
64.2% were male. VAS pain scores were evaluated at 24 hours and at seven
time points. There was no significant difference between groups (p > 0.05)
except at 1 hour postoperatively, where the TPVB group had a significantly
lower resting VAS score (19 [8-28] vs. 26 [18.5-33], p = 0.031). The total
24 hour tramadol consumption was 220 mg (135-260) in the TPVB group versus
150 mg (110-230) in the SPSIPB group (p = 0.129). The proportion of
patients requiring additional analgesia was 25.7% in the TPVB group versus
28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative
QoR-15 scores were similar between the groups (preoperative: 137 vs. 136,
p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction
scores were also comparable (8 [7-10] vs. 9 [7-10], p = 0.789).
<br/>Conclusion(s): SPSIPB provides analgesic efficacy similar to TPVB for
VATS, with comparable pain scores, opioid consumption, and recovery
outcomes. Given its ease of use and safety profile, SPSIPB represents a
promising alternative to TPVB in multimodal analgesia for minimally
invasive thoracic surgery.<br/>Copyright &#xa9; 2025

<33>
Accession Number
2039344963
Title
Electrical impedance tomography-based evaluation of regional lung
ventilation according to ventilation strategy during cardiopulmonary
bypass in minimally invasive cardiac surgery: a prospective randomized
controlled trial.
Source
Journal of Thoracic Disease. 17(6) (pp 3912-3923), 2025. Date of
Publication: 30 Jun 2025.
Author
Yeo H.J.; Kim H.Y.; Je H.G.; Kim H.-J.; Park S.; Yoon J.-P.; Ju M.H.; Lim
M.H.; Lee C.-H.
Institution
(Yeo) Department of Internal Medicine, Pusan National University School of
Medicine, Yangsan, South Korea
(Yeo) Research Institute for Convergence of Biomedical Science and
Technology, Pusan National University Yangsan Hospital, Yangsan, South
Korea
(Kim, Kim, Park, Yoon) Department of Anesthesia and Pain Medicine, Pusan
National University Yangsan Hospital, Yangsan, South Korea
(Kim, Kim, Park, Yoon) Department of Anesthesia and Pain Medicine, School
of Medicine, Pusan National University, Yangsan, South Korea
(Je) Department of Cardiovascular and Thoracic Surgery, Seoul National
University College of Medicine, Seoul National University Bundang
Hospital, Seongnam-si, South Korea
(Ju, Lim, Lee) Department of Cardiovascular and Thoracic Surgery, Research
Institute for Convergence of Biomedical Science and Technology, Pusan
National University Yangsan Hospital, Pusan National University College of
Medicine, Pusan, South Korea
Publisher
AME Publishing Company
Abstract
Background: Despite the potential benefits of minimally invasive cardiac
surgery (MICS), cardiopulmonary bypass (CPB) during MICS can cause
pulmonary complications. However, the optimal ventilation strategy for the
left lung under CPB during MICS remains unclear. Thus, this study aimed to
evaluate differences in postoperative pulmonary ventilation and
complications according to ventilation strategy during MICS.
<br/>Method(s): This prospective, randomized controlled trial included 60
patients who underwent MICS with one-lung ventilation. They were randomly
assigned to either the non-ventilation (NV) group, in which ventilation
was halted during CPB, or the ventilation (V) group, in which ventilation
at a tidal volume of 5 mL/kg was maintained during CPB. Electrical
impedance tomography (EIT) monitoring was performed immediately after
surgery to evaluate differences in regional ventilation and ventilation
heterogeneity. <br/>Result(s): The V group exhibited better ventilation
homogeneity across the entire lung (0.5+/-0.1 vs. 0.6+/-0.2, P=0.02) and
increased ventilation in the left posterior region (1.3+/-0.4 vs.
1.0+/-0.3, P=0.003). However, no differences were found in the clinical
outcomes, including arterial blood gas analysis and postoperative
respiratory complications. <br/>Conclusion(s): Ventilation of the left
lung during CPB in MICS showed better ventilation homogeneity and
ventilation of the left posterior lung area, but did not result in
differences in early complications, including respiratory issues.
Therefore, the necessity of left lung ventilation during CPB in short
surgeries with a CPB time of <90 min is unclear.<br/>Copyright &#xa9; AME
Publishing Company.

<34>
[Use Link to view the full text]
Accession Number
2038353617
Title
Anesthesia for pediatric organ transplantation, current concepts.
Source
Current Opinion in Anaesthesiology. 38(3) (pp 230-235), 2025. Date of
Publication: 01 Jun 2025.
Author
Licata S.; Blasiole B.; Visoiu M.; Damian D.
Institution
(Licata, Blasiole, Visoiu) Department of Anesthesiology and Perioperative
Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United
States
(Damian) Department of Anesthesiology and Perioperative Medicine, UPMC
Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Although less common than in adults, pediatric organ
transplantation has seen significant recent innovations in surgical
techniques, perioperative management, and postoperative outcomes. These
advances, which we will delve into in this review, are at the forefront of
improving the survival and quality of life of pediatric transplant
recipients. Recent findings Advances in donor utilization (e.g. donation
after circulatory death and split-liver grafts) and surgical approaches
(partial heart transplants and novel multiorgan procedures) have expanded
the donor pool and enhanced graft viability. Improved perioperative care,
including refined anesthetic monitoring, fluid management, and immediate
extubation, reduces the incidence of complications. Research into
model-informed precision dosing for antibiotics addresses under- or
overdosing in critically ill children, whereas emerging immunosuppressants
offer potential benefits over conventional regimens. Nonetheless,
coagulopathy, hemodynamic instability, and developmental variations remain
major challenges. Summary Optimization of pediatric transplantation is a
complex task that requires multidisciplinary collaboration. This review
underscores the importance of standardizing perioperative protocols,
advancing precision medicine, and refining surgical and anesthetic
techniques. It also highlights the need for dedicated pediatric transplant
registries and multicenter trials to generate robust data, minimize
practice variability, and improve outcomes.<br/>Copyright &#xa9; 2025
Lippincott Williams and Wilkins. All rights reserved.

<35>
[Use Link to view the full text]
Accession Number
2038640118
Title
Impact of Point-of-care Allogeneic Red Blood Cell Washing on Markers of
Transfusion-related Respiratory Complications: A Phase II Randomized
Clinical Trial.
Source
Anesthesiology. 143(1) (pp 98-113), 2025. Date of Publication: 01 Jul
2025.
Author
Kor D.J.; Warner M.A.; Norris P.J.; Armour S.; Wittwer E.D.; Santrach
P.J.; Meade L.A.; Conn C.M.; Schulte P.J.; Pendegraft R.S.; Di Germanio
C.; Podgoreanu M.; Welsby I.J.
Institution
(Kor, Armour, Wittwer, Meade) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
(Warner) Division of Critical Care, Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
(Norris) Vitalant Research Institute, San Francisco, CA, United States
(Norris) Departments of Pathology and Laboratory Medicine, University of
California-San Francisco, San Francisco, CA, United States
(Santrach, Conn) Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, United States
(Schulte, Pendegraft) Department of Quantitative Health Sciences, Mayo
Clinic, Rochester, MN, United States
(Di Germanio) Immunology Core, Vitalant Research Institute, San Francisco,
CA, United States
(Di Germanio) Laboratory Medicine, University of California-San Francisco,
San Francisco, CA, United States
(Podgoreanu) Department of Anesthesiology, Duke University Medical Center,
Raleigh, NC, United States
(Welsby) Duke University Medical Center, Durham, NC, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transfusion-related acute lung injury (TRALI) and
transfusion-associated circulatory overload (TACO) are leading causes of
transfusion-related morbidity and mortality. Soluble factors in
erythrocyte supernatant may increase risk for these complications. The
authors hypothesized that point-of-care allogeneic erythrocyte washing may
be an effective intervention to mitigate elevations in soluble factors as
well as physiologic responses associated with transfusion-associated
respiratory complications in the setting of cardiac surgery.
<br/>Method(s): This is a two-center, nonblinded, randomized clinical
trial evaluating point-of-care washed versus standard issue allogeneic
erythrocyte transfusions administered during or on the day of cardiac
surgery. The primary analysis was performed via modified intention to
treat. The primary outcomes assessed were changes in intermediate markers
of lung injury as well as cardiopulmonary physiologic responses to
erythrocyte transfusion. Secondary outcomes included the duration of
intensive care unit and hospital stay, durations of mechanical ventilation
and oxygen supplementation, presence of TRALI or TACO, and mortality.
<br/>Result(s): Among 154 analyzed patients (81 washed, 73 standard
issue), the median age was 66 yr, and 77 (50.0%) were women. The median
(interquartile range) number of allogeneic erythrocyte units transfused on
the day of surgery was 3.0 (2.0 to 5.0) in the washed erythrocyte group
and 3.0 (2.0 to 4.0) in the standard issue group (P = 0.13). No
between-group differences were identified in any of the assessed recipient
lung injury biomarkers (all P values > adjusted alpha). Durations of
intensive care unit stay (median [interquartile range], 3.0 [2.0 to 5.0]
vs. 3.0 [2.0 to 4.0] days; P = 0.117) and hospital length of stay (12.0
[9.0 to 17.0] vs. 12.0 [9.0 to 17.0] days; P = 0.801) were similar, as
were the number of ventilator-free days at day 28 (27.0 [27.0 to 27.0] vs.
27.0 [26.0 to 27.0]; P = 0.699) and oxygen-free days at day 28 (24.0 [19.0
to 26.0] vs. 24.0 [22.0 to 26.0]; P = 0.400). No significant differences
were noted in mortality rate or in incidence rates for TRALI, TACO, and
acute kidney injury. <br/>Conclusion(s): Among patients undergoing
cardiovascular surgery with high risk of erythrocyte transfusion,
point-of-care washing of allogeneic erythrocyte transfusions did not
mitigate changes in intermediate markers of lung injury or cardiopulmonary
physiologic responses to erythrocyte transfusion and was not associated
with improved clinical outcomes.<br/>Copyright &#xa9; 2025 American
Society of Anesthesiologists. All Rights Reserved.

<36>
Accession Number
2039269878
Title
Early Invasive or Conservative Strategies for Older Patients With Acute
Coronary Syndromes: A Meta-Analysis.
Source
JAMA Internal Medicine. (no pagination), 2025. Date of Publication: 2025.
Author
Reddy R.K.; Koeckerling D.; Eichhorn C.; Jamil Y.; Ardissino M.; Braun V.;
Abu Sharar H.; Frey N.; Howard J.P.; Ahmad Y.
Institution
(Reddy, Ardissino, Howard) National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Koeckerling, Abu Sharar, Frey) Department of Cardiology Angiology and
Respiratory Medicine, Heidelberg University Hospital, Heidelberg, Germany
(Eichhorn) Division of Acute Medicine, University Hospital Basel, Basel,
Switzerland
(Jamil) Inova Heart and Vascular Institute, Inova Fairfax Medical Campus,
Falls Church, VA, United States
(Ardissino) British Heart Foundation Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge,
Cambridge, United Kingdom
(Ardissino) Medical Research Council Laboratory of Medical Sciences,
Imperial College London, London, United Kingdom
(Braun) Medical Faculty Mannheim, University of Heidelberg, Heidelberg,
Germany
(Ahmad) Division of Cardiology, University of California, San Francisco,
United States
Publisher
American Medical Association
Abstract
Importance: The optimal management strategy for older patients who present
with acute coronary syndrome (ACS) remains unclear due to a paucity of
randomized evidence. New large and longer-term randomized data are
available. <br/>Objective(s): To test the association of an early invasive
strategy vs a conservative strategy with clinical outcomes for patients 70
years or older who present with ACS. <br/>Data Sources: A literature
search strategy was designed in collaboration with a medical librarian.
MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials
were systematically searched,with no language restrictions from inception
through October 2024. Bibliographies of previous reviews and conference
abstracts from major cardiovascular scientific meetings were handsearched.
Study Selection: Studies were deemed eligible following review by 2
independent, masked investigators if they randomly allocated patients 70
years or older who presented with ACS to early invasive or conservative
management and reported clinical end points. Observational analyses were
excluded. No trials were excluded based on sample size or follow-up
duration. Data Extraction and Synthesis: Data were extracted independently
and in triplicate. Clinical end points were pooled in meta-analyses that
applied fixed-effects and random-effects modeling to calculate summary
estimates for relative risks (RRs) and hazard ratios, along with their
corresponding 95% CIs. <br/>Main Outcomes and Measures: The prespecified
primary end point was all-cause death. Secondary end points included
recurrent myocardial infarction (MI), repeated coronary revascularization,
major bleeding, cardiovascular death, death or MI, stroke, heart failure
hospitalization, major adverse cardiac events, major adverse
cardiovascular or cerebrovascular events, and length of hospital stay.
<br/>Result(s): The sample size-weighted mean age of participants across
included trials was 82.6 years, and 46% were female. In the pooled
analysis, there was no significant difference in all-cause death between
the invasive and conservative strategies (RR, 1.05; 95% CI, 0.98-1.11; P
=.15; I² = 0%). An early invasive strategy was associated with
a reduced risk of recurrent MI of 22% (RR, 0.78; 95% CI, 0.67-0.91; P
=.001; I² = 0%) and repeated coronary revascularization during
follow-up of 57% (RR, 0.43; 95% CI, 0.30-0.60; P <.001; I² =
33.3%). However, an invasive strategy was associated with an increased
risk of major bleeding (RR, 1.60; 95% CI, 1.01-2.53; P =.05; I²
= 16.7). No differences were observed in secondary end points. Results in
the non-ST-elevation ACS population were consistent with the overall
findings. <br/>Conclusions and Relevance: The results of this systematic
review and meta-analysis suggest that, in older patients with ACS, an
early invasive strategy was not associated with reduced all-cause death
compared with conservative management. An early invasive strategy was
associated with reduced recurrent MI and repeated coronary
revascularization during follow-up but increased risk of major bleeding.
Competing risks associated with an early invasive strategy should be
weighed in shared therapeutic decision-making for older patients with
ACS.<br/>Copyright &#xa9; 2025 American Medical Association. All rights
reserved.

<37>
Accession Number
2034975774
Title
Chronic cOronary Syndrome in Swedish PRImary care (COSPRI)-a study
protocol for a 5-year cluster randomized controlled trial on a novel
package versus standard investigation in patients with suspected chronic
coronary syndrome referred from primary health care.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 215. Date of
Publication: 01 Dec 2025.
Author
Nilsson S.; Gabro F.; Stertman E.; Bernfort L.; Fredrikson M.; Henriksson
P.; Johansson P.; Kastbom L.; Karner Kohler A.; Loof J.; Mourad G.; Olsson
E.; Valladares C.; Ostgren C.J.; Sederholm Lawesson S.; Engvall J.;
Iredahl F.
Institution
(Nilsson, Stertman, Kastbom, Ostgren, Iredahl) Department of Health,
Medicine and Caring Sciences, Primary Health Care Center, Linkoping
University, Linkoping, Sweden
(Gabro, Bernfort, Henriksson, Johansson, Karner Kohler, Mourad, Olsson,
Valladares) Department of Health, Medicine and Caring Sciences, Linkoping
University, Linkoping, Sweden
(Fredrikson) Department of Biomedical and Clinical Sciences and Forum
Ostergotland, Linkoping, Sweden
(Loof, Engvall) Department of Biomedical and Clinical Sciences, Linkoping
University, Linkoping, Sweden
(Ostgren) Center for Medical Image Science and Visualization, Linkoping,
Sweden
(Sederholm Lawesson) Department of Cardiology in Linkoping, and,
Department of Health, Medicine and Caring Sciences, Linkoping University,
Linkoping, Sweden
(Engvall) Department of Clinical Physiology, and, Department of Health,
Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
(Iredahl) Wallenberg Center for Molecular Medicine, Linkoping University,
Linkoping, Sweden
Publisher
BioMed Central Ltd
Abstract
Background: This trial aims to assess the effectiveness of a novel
diagnostic package in the investigation of symptomatic chronic coronary
artery disease (CAD), with a focus on reducing the time to diagnosis and
improving risk assessment, compared to the current standard investigation
approach. The package investigation is comprised of combined single photon
emission computed tomography (SPECT), echocardiography, coronary artery
calcification (CAC) scoring, not previously evaluated in Sweden for
individual cardiovascular prevention, and CadScore, an acoustic risk
score. The standard investigation is comprised of exercise bicycle stress
testing and echocardiography. <br/>Method(s): The trial involves patients
with a pre-test probability > 15% for significant CAD referred from
primary healthcare centers (PHCs) in Region Ostergotland (population
471,241 in March 2023) in south-east Sweden. All the 47 PHCs of the region
will be invited to participate and will, after approval, be cluster
randomized into two groups: package investigation versus standard
investigation. The primary outcome is a composite measure comprised of
waiting time to invasive coronary angiography or communication of
non-invasive myocardial ischemia investigation results. Secondary outcomes
include major adverse cardiovascular events (MACE), cost per patient,
signs of reversible ischemia on any test, radiation exposure, and
adherence to prescribed cardioprotective drugs. <br/>Discussion(s): This
trial addresses the urgent problem of chest pain and dyspnea assessment in
primary care and aims to speed up diagnosis, reduce the need for
specialist consultations, and potentially improve patient outcomes, with
referral to SPECT directly from PHC in comparison with the widely used
exercise test. The novel approach includes CAC scoring. Additionally, the
utility of acoustic CadScore in reclassifying the risk of CAD is explored.
Trial registration. The trial was registered on March 11, 2023, at
ClinicalTrials.gov with the identifier: NCT05782582.<br/>Copyright &#xa9;
The Author(s) 2025.

<38>
Accession Number
2036693173
Title
Transcutaneous Electrical Acupoint Stimulation (TEAS) Facilitates
Postoperative Recovery in Day Lung Cancer Surgery: A Randomized Controlled
Trial.
Source
Journal of Pain Research. 18 (pp 3017-3026), 2025. Date of Publication:
2025.
Author
Wu S.; Lou J.; Zou H.; Wang W.; Zhang Y.; Xu Y.; Hou X.; Wu J.
Institution
(Wu, Wang, Zhang, Wu) Department of Anesthesiology, Shanghai Chest
Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai,
China
(Lou, Hou) President's Office, Shanghai Chest Hospital, Shanghai Jiao Tong
University, School of Medicine, Shanghai, China
(Zou) Department of Science and Education, Shanghai Chest Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Xu) Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital,
Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Publisher
Dove Medical Press Ltd
Abstract
Background: Day thoracic surgery requires effective analgesia and a rapid
recovery. This study evaluated whether Transcutaneous Electrical Acupoint
Stimulation (TEAS) reduces postoperative pain and analgesic use in lung
cancer surgery. <br/>Method(s): In this randomized, sham-controlled trial
at a tertiary hospital in Shanghai, 100 patients (18-70 years old, ASA
I-II) who underwent day lung cancer surgery (video-assisted thoracoscopic
pulmonary wedge resection) were enrolled. Participants were randomized to
receive either TEAS or sham TEAS in the Post-Anesthesia Care Unit. The
TEAS group received 30 minutes of stimulation at Hegu (LI4) and Neiguan
(PC6), whereas the sham group received electrode placement without
stimulation. Primary outcome was pain intensity 24 h after surgery,
measured using the visual analog scale (VAS). Secondary outcomes were VAS
scores at 1 h and 12 h post-surgery, analgesic consumption, incidence of
moderate-to-severe pain (VAS score >4), incidence of postoperative nausea
and vomiting (PONV), Quality of Recovery (QoR-15) scores, and safety
events. <br/>Result(s): The TEAS group had significantly lower VAS scores
at 1 hour (0.94 vs 1.84, p = 0.006), 12 hours (2.00 vs 5.40, p < 0.001),
and 24 hours (1.72 vs 4.02, p < 0.001). The incidence of
moderate-to-severe pain within 12 hours was reduced (12.0% vs 74.0%, p <
0.001). Analgesic consumption was lower in the TEAS group. The QoR-15
scores at 24 h were higher in the TEAS group (130.8 vs 115.9, p < 0.001).
No significant differences were observed in PONV, length of hospital stay,
or adverse events. <br/>Conclusion(s): TEAS reduces postoperative pain and
analgesic use, improves the recovery quality in lung cancer surgery, and
supports its integration into ERAS protocols. Trial Registration:
ChiCTR2200066600.
https://www.chictr.org.cn/showproj.html?proj=187035.<br/>Copyright &#xa9;
2025 Wu et al.

<39>
Accession Number
2035000001
Title
Comparison of left atrial appendage occlusion with medical treatment for
non-valvular atrial fibrillation: systematic review, network and
reconstructed individual patient data meta-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Lerman T.T.; Hershenson R.; Greenberg N.; Kheifets M.; Talmor-Barkan Y.;
Codner P.; Perl L.; Witberg G.; Rotholz A.; Vons S.; Orvin K.; Eisen A.;
Belkin D.; Fishman B.; Golovchiner G.; Kornowski R.; Levi A.
Institution
(Lerman, Hershenson, Kheifets, Talmor-Barkan, Codner, Perl, Witberg,
Rotholz, Vons, Orvin, Eisen, Golovchiner, Kornowski, Levi) Department of
Cardiology, Rabin Medical Center, 39 Jabotinski St., Petah Tikva, Israel
(Lerman, Hershenson, Greenberg, Kheifets, Talmor-Barkan, Codner, Perl,
Witberg, Rotholz, Vons, Orvin, Eisen, Belkin, Fishman, Golovchiner,
Kornowski, Levi) The Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
(Greenberg) Department of Internal Medicine F-Recanati, Beilinson
Hospital, Rabin Medical Center, Petah Tikva, Israel
(Fishman) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Percutaneous left atrial appendage occlusion (LAAO) is a
non-pharmacological strategy to prevent stroke and systemic emboli in
patients with non-valvular atrial fibrillation (AF). However, data
regarding its safety and efficacy profile compared to different oral
anti-coagulant regimens remain limited. <br/>Method(s): A network
meta-analysis compared LAAO, warfarin, and NOACs (standard dose [SD] and
low-dose [LD]). Outcomes included all-cause mortality, stroke or systemic
embolism, and bleeding risk. Bayesian models with surface under the
cumulative ranking curve (SUCRA) and reconstructed individual patient data
(IPD) were utilized. <br/>Result(s): Twelve studies, including eight
randomized controlled trials, were analyzed (13,049 patients with LD NOAC,
29,513 with SD NOAC, 29,611 with warfarin, and 2811 with LAAO). Warfarin
was inferior for all-cause mortality compared to LAAO (OR 1.44 [95% CrI;
1.07-1.89]), LD NOAC (OR 1.13 [95% CrI; 1.01-1.26]), and SD NOAC (OR 1.11
[95% CrI; 1.02-1.20]). SUCRA analysis ranked SD NOAC as the most effective
for stroke or systemic emboli prevention, LD NOAC as the most effective in
preventing major bleeding and LAAO in preventing hemorrhagic stroke.
<br/>Conclusion(s): SD NOACs were the most effective for preventing stroke
or systemic embolism, while LD NOACs were the safest in terms of major
bleeding. LAAO was comparable to NOACs and superior to warfarin in both
safety and efficacy. Further studies are needed to clarify LAAO's role in
the management of atrial fibrillation.<br/>Copyright &#xa9;
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<40>
Accession Number
2039318632
Title
Surgical revascularization of chronic coronary total occlusions - A
systematic review and meta-analysis.
Source
Revista Portuguesa de Cardiologia. 44(7) (pp 427-439), 2025. Date of
Publication: 01 Jul 2025.
Author
Silva A.L.; Costa G.F.; Martins J.L.; Leite L.; Goncalves L.
Institution
(Silva, Costa, Martins, Leite, Goncalves) Cardiology Department, Unidade
Local de Saude de Coimbra, Coimbra, Portugal
(Costa, Leite, Goncalves) Faculty of Medicine of the University of
Coimbra, Coimbra, Portugal
(Costa, Leite, Goncalves) ICBR, Coimbra Institute for Clinical and
Biomedical Research, Coimbra, Portugal
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Introduction and objectives: Chronic coronary total occlusion (CTO)
optimal therapeutic management remains a topic of debate despite its
association with adverse clinical outcomes. This study aimed to compare
clinical outcomes of patients with CTOs treated with coronary artery
bypass graft (CABG) versus medical therapy (MT), assessing the effect of
CTO revascularization in patients with multivessel disease undergoing
CABG. <br/>Method(s): In July 2023, PubMed, Embase, Cochrane, and Web of
Science databases were systematically searched for studies comparing CTOs
treated with CABG versus MT. A sub-analysis of CABG patients, comparing
complete surgical revascularization, including CTO bypass, to CABG without
CTO bypass, was performed. A pooled odds ratio meta-analysis assessed four
main outcomes: mortality, myocardial infarction (MI), stroke, and major
adverse cardiovascular events (MACE). The primary outcome was all-cause
mortality. <br/>Result(s): Ten observational studies (6458 patients)
comparing CABG-CTO with MT-CTO showed lower all-cause mortality in the
CABG group (OR 0.31, 95% CI 0.24-0.40, p<0.001, I²=36%).
Despite heterogeneity, CABG exhibited reduced CV mortality and MACE (OR
0.37, 95% CI 0.24-0.57, p<0.001, I²=59%; OR 0.37, 95% CI
0.15-0.92, p=0.03, I²=80%, respectively). The MI rate was lower
in the CABG group (OR 0.41, 95% CI 0.30-0.56, p<0.001, I²=0%).
Comparing bypassed to non-bypassed CTO groups (5 studies, 1949 patients),
the bypassed-CTO group had considerably lower MACE (OR 0.49, 95% CI
0.30-0.81, p=0.005, I²=44%). <br/>Conclusion(s): This study
suggests a clinical benefit of bypassing a CTO in multivessel disease
patients during CABG, with significantly lower MACE. The improved outcomes
of CABG over MT further underscore these findings, warranting careful
consideration by the Heart Team during their decision-making
process.<br/>Copyright &#xa9; 2025 Sociedade Portuguesa de Cardiologia

<41>
[Use Link to view the full text]
Accession Number
2038353648
Title
Minimally invasive surgery in the operating rooms near you.
Source
Current Opinion in Anaesthesiology. 38(3) (pp 261-266), 2025. Date of
Publication: 01 Jun 2025.
Author
Strope M.; Amin A.
Institution
(Strope) University of Cincinnati, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review This review delineates the benefits of minimally
invasive surgery (MIS) and its utilization at surgical centers and our
institution. It further explores the literature for comparative outcomes
of performing MIS to traditional open surgery for a variety of surgical
subspecialties. Recent findings In addition to its proven safety when
compared to the open surgical technique, MIS has broad applications in
many surgical subspecialties to enhance perioperative outcomes in both
pediatric and adult patients. Summary Although there are certain
disadvantages with regard to cost of implementation in nascent communities
and total operating time when the surgical complexity increases (such as
utilizing a robotic approach), the added benefit of improved patient
outcomes due to smaller incision sites is repeatedly proven in the
literature making this technique globally essential.<br/>Copyright &#xa9;
2025 Wolters Kluwer Health, Inc. All rights reserved.

<42>
Accession Number
646585397
Title
Comparative analysis of fully automated vs. conventional ventilation in
postoperative cardiac surgery patients: Impact on alarms, interventions,
and nurse acceptance.
Source
Intensive & critical care nursing. 89 (pp 103963), 2025. Date of
Publication: 01 Aug 2025.
Author
van Haren L.M.A.A.; Nabben D.L.J.; Kloeze C.; Dekker M.A.C.; De Vries
T.J.C.; Buiteman-Kruizinga L.A.; Neto A.S.; van Leijsen T.; Paulus F.; van
Meenen D.M.P.; Montenij L.; Korsten E.H.M.; Bindels A.J.G.H.; Bouwman
A.R.; Schultz M.J.; De Bie Dekker A.J.R.
Institution
(van Haren) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands
(Nabben, Montenij, Korsten) Intensive Care Department, Catharina Hospital,
Eindhoven, Netherlands; Anaesthesiology Department, Catharina Hospital,
Eindhoven, Netherlands; Electrical Engineering, Signal Processing,
Eindhoven University of Technology, Eindhoven, Netherlands
(Kloeze) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands
(Dekker, Bindels) Intensive Care Department, Catharina Hospital,
Eindhoven, Netherlands
(De Vries) Department of Medical Physics, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
(Buiteman-Kruizinga) Department of Intensive Care, Reinier de Graaf
Hospital, Delft, Netherlands; Department of Intensive Care and Laboratory
of Experimental Intensive Care and Anesthesiology, Amsterdam University
Medical Centers, Amsterdam, Netherlands
(Neto) Australian and New Zealand Intensive Care Research Centre
(ANZIC-RC), School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia; Department of Intensive Care, Austin
Hospital, Melbourne, Australia; Department of Critical Care, Melbourne
Medical School, University of Melbourne, Austin Hospital, Melbourne,
Australia; Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(van Leijsen, Paulus, van Meenen) Department of Intensive Care and
Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam
University Medical Centers, Amsterdam, Netherlands
(Bouwman) Anaesthesiology Department, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
(Schultz) Department of Intensive Care and Laboratory of Experimental
Intensive Care and Anesthesiology, Amsterdam University Medical Centers,
Amsterdam, Netherlands; Mahidol-Oxford Tropical Medicine Research Unit
(MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of
Medicine, University of Oxford, Oxford, United Kingdom; Division of
Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Medicine,
Department of Anaesthesiology, General Intensive Care and Pain Medicine,
Medical University Vienna, Vienna, Austria
(De Bie Dekker) Intensive Care Department, Catharina Hospital, Eindhoven,
Netherlands; Electrical Engineering, Signal Processing, Eindhoven
University of Technology, Eindhoven, Netherlands
Abstract
OBJECTIVES: To compare the number of alarms, interventions and nurses'
acceptance of automated ventilation with INTELLiVENT-ASV versus
conventional ventilation strategy in patients receiving postoperative
ventilation after cardiac surgery. <br/>METHOD(S): This preplanned
secondary analysis of the 'POSITiVE' randomized clinical trial compared
INTELLiVENT-ASV (automated ventilation) with conventional ventilation in
postoperative cardiac surgery patients. The number of critical alarms and
manual ventilator interventions were compared during the first three hours
of ventilation or until extubation. Nurses' acceptance was assessed using
a Technology Acceptance Model 2-based questionnaire and a user acceptance
score from 1 to 10. <br/>RESULT(S): POSITiVE randomized 220 patients (109
to automated and 111 to conventional ventilation). The average number of
critical alarms per monitoring hour was similar between the automated and
conventional group (5.6 vs 5.7; p = 0.823). The automated group required
fewer manual interventions per monitoring hour for both ventilation
control (0.7 vs 1.9; p < 0.001) and alarm management (2.0 vs 2.8; p <
0.001). The automated ventilation mode scored higher for perceived
usefulness (2.6 vs 2.1; p < 0.001) and user acceptance (8.0 vs 7.0; p <
0.001), but similar for perceived ease of use. <br/>CONCLUSION(S):
Automated ventilation for postoperative cardiac surgery patients had
similar alarm frequencies as conventional ventilation, but reduced the
number of interventions and showed higher nurses' acceptance, indicating
its potential to optimize patient care and reduce nurses' workload.
IMPLICATIONS FOR CLINICAL PRACTICE: Our findings suggest that automated
ventilation modes like INTELLiVENT-ASV can reduce the frequency of manual
interventions and improve nurses' acceptance, which may help alleviate
nurses' workload for postoperative cardiac surgery patients.<br/>Copyright
&#xa9; 2025 Elsevier Ltd. All rights reserved.

<43>
Accession Number
2039167611
Title
Erector spinae plane block complementary analgesic to enhance recovery
after cardiac surgery: A prospective double-blinded randomized controlled
trial.
Source
Saudi Journal of Anaesthesia. 19(3) (pp 327-333), 2025. Date of
Publication: 01 Jul 2025.
Author
Zabani I.A.; Alamoudi D.; Alhroub K.; Alhassoun A.; Tawfik G.; Alzanbagi
A.; Alzahrani F.; Zia F.; Almuqati R.; Tayeb A.; Alsayouri Z.; Saad H.
Institution
(Zabani, Alamoudi, Alhroub, Alhassoun, Tawfik, Alzanbagi, Alzahrani, Zia,
Almuqati, Tayeb, Alsayouri, Saad) Departments of Anesthesiology, King
Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Post-sternotomy pain is a significant challenge in cardiac
surgeries. Effective pain management can reduce opioid reliance and lower
pain scores, contributing to shorter hospital stays. The erector spinae
plane block (ESPB) has shown promise as an analgesic for various surgical
procedures. Given the frequency of sternotomies in our center and the
associated prolonged pain that delays intensive care unit (ICU) discharge,
we aimed to assess the impact of ESPB on postoperative opioid (fentanyl)
use and pain levels up to 48 h after extubation. <br/>Method(s): This
study was a prospective, double-blind, randomized controlled trial
involving 80 adult patients (ASA III) scheduled for cardiac surgery.
Participants were randomized into two groups: the ESPB group (n = 40;
bilateral 0.25% bupivacaine, 20 mL) and a control group (n = 40; no ESPB).
The main outcomes measured were fentanyl use post-surgery and pain scores
using the visual analog scale (VAS). Secondary outcomes included
intraoperative fentanyl use, time to first analgesic dose, extubation
timing, and ICU stay duration. SPSS v.26 was used for statistical
analysis. <br/>Result(s): The ESPB group had significantly reduced
fentanyl consumption during intubation (150 [0-800] vs. 950 [30-5260], P <
0.0001), at 3 h post-extubation (25 [0-50] vs. 0 [0-200], P = 0.034), 12 h
post-extubation (0 [0-80] vs. 0 [0-200], P = 0.002), over 12 h total (0
[0-100] vs. 30 [0-600], P = 0.01), at 24 h (0 [0-100] vs. 30 [0-900], P =
0.003), and at 48 h (0 [0-100] vs. 50 [0-1200], P = 0.001). VAS scores
were consistently lower for the ESPB group at rest at multiple points up
to 48 h (P < 0.0001). Additionally, the ESPB group required less
intraoperative fentanyl (P = 0.001), had shorter ICU stays (P = 0.009),
and faster extubation times (P = 0.013). The time to first analgesic and
paracetamol use did not differ significantly (P = 0.97 and 0.255,
respectively). <br/>Conclusion(s): The findings suggest that ESPB is an
effective addition to multimodal anesthesia for cardiac surgery,
significantly reducing pain and opioid use, and improving postoperative
outcomes.<br/>Copyright &#xa9; 2025 Saudi Journal of Anesthesia.

<44>
Accession Number
2039014873
Title
Safety of beta-blocker discontinuation after acute coronary syndromes with
preserved or mildly reduced left ventricular ejection fraction: A target
trial emulation from a real-world cohort.
Source
European Journal of Preventive Cardiology. 32(8) (pp 622-632), 2025. Date
of Publication: 01 Jun 2025.
Author
Johner N.; Branca M.; Carballo D.; Baggio S.; Nanchen D.; Tessitore E.;
Raber L.; Luscher T.F.; Matter C.M.; Windecker S.; Rodondi N.; Mach F.;
Gencer B.
Institution
(Johner, Carballo, Tessitore, Mach, Gencer) Cardiology Division, Geneva
University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
(Branca) CTU Bern, Department of Clinical Research, University of Bern,
Bern, Switzerland
(Baggio, Rodondi, Gencer) Institute of Primary Healthcare (BIHAM),
University of Bern, Mittelstrasse 43, Bern, Switzerland
(Baggio) Laboratory of Population Health (#PopHealthLab), University of
Fribourg, Fribourg, Switzerland
(Nanchen) Center for Primary Care and Public Health (Unisante), University
of Lausanne, Lausanne, Switzerland
(Raber, Windecker) Department of Cardiology, Bern University Hospital,
University of Bern, Bern, Switzerland
(Luscher) Center for Molecular Cardiology, University of Zurich, Zurich,
Switzerland
(Matter) Department of Cardiology, University Hospital Zurich, Zurich,
Switzerland
(Rodondi) Department of General Internal Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Gencer) Department of Cardiology, Lausanne University Hospital, Rue du
Bugnon 46, Lausanne, Switzerland
Publisher
Oxford University Press
Abstract
Aims The benefit of long-term beta-blocker therapy after acute coronary
syndromes (ACS) without heart failure in the reperfusion era is uncertain.
Two recent randomized trials found conflicting results. The present study
assessed the safety of beta-blocker discontinuation within 12 months
following ACS with left ventricular ejection fraction (LVEF) >=40%.
Methods and results In a multicentre prospective real-world cohort (n =
3762) of patients hospitalized for ACS, patients with LVEF >=40% and
beta-blockers at discharge were included. Patients who continued
beta-blockers at 1 year were compared with those who discontinued
beta-blockers within 12 months post-ACS using target trial emulation and
inverse probability weighting over an additional 4-year follow-up. The
primary endpoint was major adverse cardiovascular events (MACE), a
composite of 4-year cardiovascular death, myocardial infarction, stroke,
transient ischaemic attack, unplanned coronary revascularization, or
unstable angina hospitalization. Of 2077 patients, 1758 (85%) continued
beta-blockers and 319 (15%) had discontinued beta-blockers at 1 year. The
risk of the primary endpoint was similar in both groups [14.1 vs. 14.3%
with beta-blocker discontinuation vs. continuation; adjusted hazard ratio
(aHR) = 0.98; 95% confidence interval, 0.72-1.34, P = 0.91]. Subgroup
analysis suggested a higher risk of primary endpoint with beta-blocker
discontinuation after STEMI [aHR = 1.46 (0.99-2.16)] compared with NSTEMI
[aHR = 0.70 (0.40-1.22), P<inf>interaction</inf> = 0.033], whereas there
was no interaction with LVEF (P<inf>interaction</inf> = 0.68). Conclusion
Beta-blocker discontinuation within 12 months following ACS with LVEF
>=40% was not associated with an increased risk of MACE compared with
long-term beta-blocker therapy. Subgroup analysis suggested potential risk
in STEMI patients. Discontinuing beta-blockers 12 months after ACS appears
safe in patients with LVEF >=40%, particularly after NSTEMI.<br/>Copyright
&#xa9; 2024 The Author(s). Published by Oxford University Press on behalf
of the European Society of Cardiology. All rights reserved.

<45>
[Use Link to view the full text]
Accession Number
2039190254
Title
Intraoperative Hypotension in Patients Having Major Noncardiac Surgery
Under General Anesthesia: A Systematic Review of Blood Pressure
Optimization Strategies.
Source
Anesthesia and Analgesia. 141(1) (pp 38-60), 2025. Date of Publication: 01
Jul 2025.
Author
Lee S.; Islam N.; Ladha K.S.; Van Klei W.; Wijeysundera D.N.
Institution
(Lee, Ladha, Wijeysundera) Temerty Faculty of Medicine, University of
Toronto, Toronto, ON, Canada
(Islam) Faculty of Medicine, McGill University, Montreal, QC, Canada
(Ladha, Van Klei, Wijeysundera) Department of Anesthesiology and Pain
Medicine, University of Toronto, Toronto, ON, Canada
(Ladha, Wijeysundera) Department of Anesthesia, St. Michael's Hospital,
Unity Health Toronto, Toronto, ON, Canada
(Van Klei) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Van Klei) Division of Anaesthesiology Intensive Care and Emergency
Medicine, University Medical Center Utrecht, Utrecht, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
INTRODUCTION: Intraoperative hypotension is associated with increased
risks of postoperative complications. Consequently, a variety of blood
pressure optimization strategies have been tested to prevent or promptly
treat intraoperative hypotension. We performed a systematic review to
summarize randomized controlled trials that evaluated the efficacy of
blood pressure optimization interventions in either mitigating exposure to
intraoperative hypotension or reducing risks of postoperative
complications. <br/>METHOD(S): Medline, Embase, PubMed, and Cochrane
Controlled Register of Trials were searched from database inception to
August 2, 2023, for randomized controlled trials (without language
restriction) that evaluated the impact of any blood pressure optimization
intervention on intraoperative hypotension and/or postoperative outcomes.
<br/>RESULT(S): The review included 48 studies (N = 46,377), which
evaluated 10 classes of blood pressure optimization interventions.
Commonly assessed interventions included hemodynamic protocols using
arterial waveform analysis, preoperative withholding of antihypertensive
medications, continuous blood pressure monitoring, and adjuvant agents
(vasopressors, anticholinergics, anticonvulsants). These same
interventions reduced intraoperative exposure to hypotension. Conversely,
low blood pressure alarms had an inconsistent impact on exposure to
hypotension. Aside from limited evidence that higher prespecified
intraoperative blood pressure targets led to a reduced risk of
complications, there were few data suggesting that these interventions
prevented postoperative complications. Heterogeneity in interventions and
outcomes precluded meta-analysis. <br/>CONCLUSION(S): Several different
blood pressure optimization interventions show promise in reducing
exposure to intraoperative hypotension. Nonetheless, the impact of these
interventions on clinical outcomes remains unclear. Future trials should
assess promising interventions in samples sufficiently large to identify
clinically plausible treatment effects on important
outcomes.<br/>Copyright &#xa9; 2025 International Anesthesia Research
Society.

<46>
Accession Number
2038352707
Title
Perioperative management of direct oral anticoagulants in patients having
a high-bleed-risk surgery or neuraxial procedure: the Perioperative
Anticoagulant Use for Surgery Evaluation (PAUSE)-2 pilot randomized trial.
Source
Journal of Thrombosis and Haemostasis. 23(7) (pp 2226-2234), 2025. Date of
Publication: 01 Jul 2025.
Author
Douketis J.D.; Li N.; St. John M.; Nixon J.; Moffat K.; Shaw J.; Syed S.;
Schulman S.; Gross P.L.; Spyropoulos A.C.
Institution
(Douketis) Department of Medicine, St. Joseph's Healthcare Hamilton,
Thrombosis and Atherosclerosis Research Institute, McMaster University,
Hamilton, ON, Canada
(Li) Department of Community Health Sciences, University of Calgary,
Calgary, AB, Canada
(Li) Department of Computing and Software, McMaster University, Hamilton,
ON, Canada
(St. John, Nixon) Department of Medicine, Michael G. DeGroote Centre for
Transfusion Research, McMaster University, Hamilton, ON, Canada
(Moffat) Hamilton Regional Laboratory Medicine Program, McMaster
University, Hamilton, ON, Canada
(Shaw) Department of Medicine, Ottawa Hospital Research Institute,
University of Ottawa, Ottawa, ON, Canada
(Syed) Department of Anesthesia, Halton Healthcare, Oakville Trafalgar
Hospital, Oakville, ON, Canada
(Syed) Department of Anesthesia, McMaster University, Hamilton, ON, Canada
(Schulman, Gross) Department of Medicine, Hamilton Health Sciences General
Hospital, Thrombosis and Atherosclerosis Research Institute, McMaster
University, Hamilton, ON, Canada
(Gross) Department of Medicine, University Health Network, Toronto, ON,
Canada
(Spyropoulos) Department of Medicine, Anticoagulation and Clinical
Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, NY,
United States
(Spyropoulos) Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Hempstead, New York, NY, United States
(Spyropoulos) Institute of Health Systems Science at The Feinstein
Institutes for Medical Research, Manhasset, NY, United States
Publisher
Elsevier B.V.
Abstract
Background: There is uncertainty about the perioperative management of
patients who are receiving a direct oral anticoagulant (DOAC) and require
elective high-bleed-risk surgery, including those who are undergoing a
neuraxial or deep peripheral nerve block procedure. <br/>Objective(s): The
objectives of this pilot trial were to provide preliminary data as to
pre-operative residual DOAC levels with different management strategies
andro assess the feasibility of a larger trial. <br/>Method(s): The
Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE)-2 pilot
trial was a proof-of-concept, open-label, randomized controlled trial that
assessed the feasibility of comparing perioperative DOAC management using
an American Society of Regional Anesthesia (ASRA)-based or PAUSE-based
approach in patients with atrial fibrillation who needed an elective
high-bleed-risk surgery/procedure and/or any neuraxial
anesthesia/procedure. <br/>Result(s): There were 159 patients enrolled (86
on apixaban, 12 on dabigatran, and 61 on rivaroxaban), of whom 141 had
preoperative DOAC-level testing done. The median (IQR) residual DOAC level
was 19 (19-24) ng/mL in the ASRA group and 20 (19-24) ng/mL in the PAUSE
group (standardized difference = -0.02). The percentage of patients in the
ASRA and PAUSE groups with preoperative residual DOAC levels < 30 ng/mL
was 95.6% and 94.4%, respectively; the percentage with residual DOAC
levels of 30 to 50 ng/mL was 1.4% and 2.8%, respectively, and the
percentage with levels > 50 ng/mL was 2.9% and 2.8%, respectively.
<br/>Conclusion(s): In this pilot trial, we found that recruitment of
DOAC-treated patients who needed an elective high-bleed-risk surgery or
neuraxial procedure was feasible and that preoperative residual DOAC
levels appeared similar according to ASRA-based and PAUSE-based management
approaches, providing the foundation for a larger trial comparing ASRA-
and PAUSE-based perioperative DOAC management.<br/>Copyright &#xa9; 2025
International Society on Thrombosis and Haemostasis

<47>
Accession Number
2039190729
Title
Comparative Efficacy of Dexmedetomidine versus Midazolam Infusion for
Peri-Extubation Sedation in Adult Cardiac-Surgical Patients: A Prospective
Randomised Study.
Source
International Journal of Current Pharmaceutical Review and Research. 17(4)
(pp 1517-1521), 2025. Date of Publication: 2025.
Author
Sharma A.; Rohilla L.; Yadav S.; Shrivastava A.
Institution
(Sharma) SPS Hospitals, Punjab, Ludhiana, India
(Rohilla) Park Hospital, Rajasthan, Behror, India
(Yadav) RBIPMT, New Delhi, India
(Shrivastava) Anesthesia and Critical care, Punjab, Ludhiana, India
Publisher
Dr. Yashwant Research Labs Pvt. Ltd.
Abstract
Background: Smooth emergence and early extubation after cardiac surgery
demand a sedative that preserves haemodynamic stability without prolonging
ventilation. Midazolam is still widely used, yet dexmedetomidine-an
alpha-2 adrenoceptor agonist with sympatholytic and analgesic-sparing
properties-may confer advantages. <br/>Method(s): Sixty adult patients
scheduled for elective cardiac surgery under general anaesthesia were
randomised to receive either dexmedetomidine (0.2-0.7 microg
kg^-1 h^-1; Group D, n = 30) or midazolam (0.04-0.2 mg
kg^-1 h^-1; Group M, n = 30) from 15 min before skin
closure until extubation. Both infusions targeted a Richmond
Agitation-Sedation Scale (RASS) 0 to -2 and were combined with fentanyl
0.25 microg kg^-1 h^-1. Haemodynamic indices (SBP,
DBP, MAP, HR), sedation depth, pain (VAS), ventilation duration, rescue
analgesia, and adverse events were recorded. <br/>Result(s): Baseline
demographics were comparable. From 45 min after infusion initiation until
60 min post-extubation, SBP, DBP, MAP and HR were consistently lower in
Group D (p < 0.05). Median pain scores from extubation to 120 min were
lower with dexmedetomidine (VAS 2 [IQR 2-3] vs 3 [2-4]; p < 0.01),
translating into 17% less fentanyl rescue (60.7 +/- 19.2 vs 72.7 +/- 22.0
microg; p = 0.032). Ventilation time shortened by 20 min (116 +/- 22 vs
137 +/- 28 min; p = 0.002). Bradycardia (n = 2) and hypotension (n = 1)
occurred only in Group D but required no intervention. <br/>Conclusion(s):
Dexmedetomidine provided superior haemodynamic attenuation, analgesia, and
earlier readiness for extubation compared with midazolam, without
clinically relevant adverse effects. It represents a valuable alternative
for peri-extubation sedation in adult cardiac-surgical
patients.<br/>Copyright &#xa9; 2025 Dr. Yashwant Research Labs Pvt. Ltd..
All rights reserved.

<48>
[Use Link to view the full text]
Accession Number
2038441412
Title
Clonal Hematopoiesis of Indeterminate Potential in Chronic Coronary
Disease: A Report From the ISCHEMIA Trials Biorepository.
Source
Circulation: Genomic and Precision Medicine. 18(3) (no pagination), 2025.
Article Number: e004921. Date of Publication: 01 Jun 2025.
Author
Muller M.A.; Liu R.; Shah F.; Hu J.; Held C.; Kullo I.J.; Mcmanus B.M.;
Wallentin L.; Newby L.K.; Sidhu M.S.; Bangalore S.; Reynolds H.R.; Hochman
J.S.; Maron D.J.; Ruggles K.V.; Berger J.S.; Newman J.D.
Institution
(Muller) Department of Biomedical Engineering, New York University, Tandon
School of Engineering, Uppsala, Sweden
(Liu) Department of Population Health, Division of Biostatistics, Uppsala,
Sweden
(Shah, Bangalore, Reynolds, Hochman, Ruggles, Berger, Newman) Department
of Medicine, Uppsala, Sweden
(Muller, Hu) NYU Grossman School of Medicine, Uppsala, Sweden
(Held, Wallentin) Department of Medical Sciences, Cardiology, Uppsala
University, Uppsala, Sweden
(Kullo) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN,
United States
(Mcmanus) Department of Pathology and Laboratory Medicine, University of
British Columbia, Vancouver, Canada
(Newby) Department of Medicine, Division of Cardiology, Duke Clinical
Research Institute, Durham, NC, United States
(Sidhu) Albany Medical College, Albany, NY, United States
(Maron) Department of Medicine, Stanford University, School of Medicine,
Stanford, CA, United States
Publisher
Lippincott Williams and Wilkins

<49>
Accession Number
2034253482
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
for left main disease according to age: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(1) (pp 232-243.e21),
2025. Date of Publication: 01 Jul 2025.
Author
De Filippo O.; Di Franco A.; Improta R.; Di Pietro G.; Leone A.; Pecoraro
M.; Meynet P.; Carbone M.L.; Di Lorenzo E.; Bruno F.; Demetres M.; Carmeci
A.; Conrotto F.; Mancone M.; De Ferrari G.M.; Gaudino M.; D'Ascenzo F.
Institution
(De Filippo, Pecoraro, Meynet, Carbone, Bruno, Carmeci, Conrotto, De
Ferrari, D'Ascenzo) Division of Cardiology, Cardiovascular and Thoracic
Department, AOU Citta della Salute e della Scienza di Torino and
Department of Medical Sciences, University of Turin, Turin, Italy
(Di Franco, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Improta, Di Pietro, Mancone) Department of Clinical, Internal,
Anesthesiological and Cardiovascular Sciences, Umberto I Hospital, La
Sapienza University of Rome, Rome, Italy
(Leone, Di Lorenzo) Division of Cardiology, SG Moscati Hospital, Avellino,
Italy
(Leone) Department of Advanced Biomedical Sciences, University of Naples
Federico II, Naples, Italy
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
Publisher
Elsevier Inc.

<50>
Accession Number
2034983394
Title
Cardiovascular and Non-Cardiovascular Complications of Transcatheter
Aortic Valve Implantation.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Padilla-Serrano A.; Pozo J.I.G.; Lorente E.C.; Cruz A.C.
Institution
(Padilla-Serrano, Pozo, Lorente, Cruz) Unidad de Cuidados Intensivos
Cardiovasculares, Servicio de Medicina Intensiva, Hospital Universitario
Virgen de las Nieves, Granada, Spain
(Padilla-Serrano, Pozo, Cruz) Grupo de investigacion PAIDI, criticallab
cts 609, Granada, Spain
(Padilla-Serrano, Lorente, Cruz) Grupo de investigacion biosanitaria
ibs.Granada, TEC23-Laboratorio para la Investigacion en Medicina Intensiva
y Educacion Medica (INTENSIVEEDUCATIONLAB, Granada, Spain
(Cruz) Profesor de Medicina, Universidad de Granada, Granada, Spain
Publisher
John Wiley and Sons Inc
Abstract
Degenerative aortic valve stenosis is becoming a more prevalent disease,
and transcatheter aortic valve implantation (TAVI) offers a treatment
option for patients who are at high surgical risk. This manuscript reviews
cardiovascular and non-cardiovascular complications associated with TAVI.
A search was conducted in PubMed, Scopus, and Web of Science using the
terms "transcatheter aortic valve implantation" and each keyword referring
to potential complications, with the Boolean operator "AND" used to allow
us to obtain documents containing two or more keywords simultaneously. The
most frequent cardiovascular complications were hemorrhage and vascular
access-related complications (2.93%-24%), new-onset left bundle branch
block (13.3%-37%), and myocardial injury (95%-100%). Among
non-cardiovascular complications, stroke and subclinical brain injury
occurred in 1.6%-5% of cases; acute kidney injury, in 11.7%; and delirium,
in 17.8%-23.7%. Described mortality ranges from 1.1% to 4.2%. This
narrative review provides a multidimensional perspective of TAVI
complications by addressing both cardiovascular and non-cardiovascular
complications. Non-cardiovascular complications, such as delirium,
negatively influence mortality.<br/>Copyright &#xa9; 2025 Wiley
Periodicals LLC.

<51>
Accession Number
2033988929
Title
Three-Dimensional-Printed Models Reduce Adverse Events of Left Atrial
Appendage Occlusion: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. 105(7) (pp 1688-1694),
2025. Date of Publication: 01 Jun 2025.
Author
Santos J.D.; Beloy F.J.; Sulague R.M.; Okudzeto H.; Medina J.R.; Cartojano
T.D.; Cruz N.; Mortalla E.D.; Kpodonu J.
Institution
(Santos, Cruz) Our Lady of Fatima University College of Medicine,
Valenzuela City, Philippines
(Beloy) Ateneo School of Medicine and Public Health, Pasig City,
Philippines
(Sulague) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Okudzeto) Dodowa Health Research Center, Greater Accra Region, Dodowa,
Ghana
(Medina) Manila Central University College of Medicine, Caloocan City,
Philippines
(Cartojano, Mortalla) Cebu Institute of Medicine, Cebu City, Philippines
(Kpodonu) Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background and Aims: Left atrial appendage occlusion (LAAO) has an
excellent safety profile but there is growing evidence of adverse
long-term sequelae of peri-device leak and device-related thrombus. This
study seeks to determine if guidance from 3D-printed models of left atrial
appendages reduces the incidence of side effects. <br/>Method(s): A
systematic literature search was conducted in the following databases:
Pubmed, Google Scholar, and Europe PMC. Cohort studies that directly
compared outcomes using 3D-printed model simulations before undergoing
LAAO versus using conventional imaging only among patients with
nonvalvular atrial fibrillation, CHA<inf>2</inf>DS<inf>2</inf>-VASc scores
>= 1, and relative or absolute contraindications to long-term
anticoagulation were included. Clinical outcomes included incidence of
peri-device leak, mismatch, and device-related thrombus. Meta-analysis was
done using the random-effects model. <br/>Result(s): Only three cohort
studies were eligible for meta-analysis with a mean follow-up period of 25
months. This included a total of 204 patients (mean age, 75 years). Using
3D printed models of left atrial appendage based on transesophageal
echocardiogram and cardiac computed tomography had statistically
significantly less incidence of peri-device leak (log OR -2.47; 95% CI:
-3.70 to 1.24; p = 0.00), incidence of mismatch (log OR -1.61; 95% CI:
-2.50 to 0.73; p = 0.00) and shorter procedural time (mean difference
-24.86; 95% CI: -31.75 and -27.11; p = 0.00). Although the incidence of
device-related thromboembolism was 49% less in the 3D printing-guided
group, the difference was not statistically significant (p = 0.58).
<br/>Conclusion(s): Less incidence of peri-device leak and mismatch were
observed with 3D printing-guided left atrial appendage occlusion. A highly
powered randomized controlled trial may have to be done to confirm the
findings.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<52>
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. 73(7) (pp 453-460), 2025.
Date of Publication: 01 Jul 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.

<53>
Accession Number
2034445481
Title
Comparative Analysis of Survival in Pulmonary Arterial Hypertension for
Patients Treated with Selexipag in Clinical Practice (EXPOSURE Study).
Source
Drugs - Real World Outcomes. 12(2) (pp 189-199), 2025. Date of
Publication: 01 Jun 2025.
Author
Soderberg S.; Escribano-Subias P.; Archey C.; Muller A.; Fontana M.; Lange
T.J.; Gaine S.
Institution
(Soderberg) Department of Public Health and Clinical Medicine, Medicine,
Umea University, Umea, Sweden
(Escribano-Subias) Pulmonary Hypertension Unit, Cardiology Department,
CIBERCV, Hospital 12 de Octubre, Madrid, Spain
(Archey, Muller) Johnson & Johnson, Allschwil, Switzerland
(Fontana) Johnson & Johnson, Milan, Italy
(Lange) Department of Pulmonology, Kreisklinik Bad Reichenhall, Bad
Reichenhall, Germany
(Lange) Faculty of Medicine, Department Internal Medicine II, Regensburg
University, Regensburg, Germany
(Gaine) National Pulmonary Hypertension Unit, Mater Misericordiae
University Hospital, Dublin, Ireland
Publisher
Adis
Abstract
Background: In pulmonary arterial hypertension (PAH), comparative
assessment of treatment effect on survival in randomized controlled
settings of contemporary patients has not been feasible.
<br/>Objective(s): The aim of this study was to use EXPOSURE, the ongoing,
real-world, post-authorization safety study, and commitment to the
European Medicines Agency to perform pre-specified comparative survival
analyses between patients that newly initiated selexipag versus other
PAH-specific therapies by applying statistical methods to account for
population differences. <br/>Method(s): EXPOSURE (EUPAS19085) is an
observational study comprising patients with PAH who initiated selexipag
or other PAH-specific therapy. To balance characteristics of patients in
the other PAH therapy cohort with the selexipag cohort at PAH therapy
initiation (baseline), propensity score weighting was applied. Mortality
rate ratios (MRRs) were calculated. <br/>Result(s): 2014 patients were
available for analysis. Prior to applying propensity score weighting,
patients in the selexipag cohort were more likely to have longer time from
diagnosis, less functional impairment, and treatment with combination
background therapy versus the other PAH therapy cohort. Following
weighting, baseline variables for both cohorts were well balanced.
Weighted treatment exposure was 827.9 and 840.5 person-years for the
selexipag and modelled other PAH therapy cohort, respectively. Weighted
proportion of deaths was lower in the selexipag versus modelled other PAH
therapy cohort; MRR showed a higher survival rate for selexipag-treated
patients (MRR [95% confidence interval]: 0.55 [0.31-0.99]).
<br/>Conclusion(s): Survival analyses in EXPOSURE suggest a reduced risk
of mortality among the cohort of patients newly initiated on selexipag
compared with the modelled cohort newly initiated with other PAH-specific
therapies. Further research is needed to confirm this observation. Trial
Registry: Trial registration: EUPAS19085.<br/>Copyright &#xa9; The
Author(s) 2025.

<54>
Accession Number
2034981588
Title
Tirzepatide for reduction of morbidity and mortality in adults with
obesity: rationale and design of the SURMOUNT-MMO trial.
Source
Obesity. (no pagination), 2025. Date of Publication: 2025.
Author
Lam C.S.P.; Rodriguez A.; Aminian A.; Ferrannini E.; Heerspink H.J.L.;
Jastreboff A.M.; Laffin L.J.; Pandey A.; Ray K.K.; Ridker P.M.; Sanyal
A.J.; Yki-Jarvinen H.; Mason D.; Strzelecki M.; Bartee A.K.; Cui C.; Hurt
K.; Linetzky B.; Bunck M.C.; Nissen S.E.
Institution
(Lam) Cardiovascular and Metabolic Disorders Programme, Duke-National
University of Singapore Medical School, Singapore, Singapore
(Lam) National Heart Centre Singapore, Singapore, Singapore
(Rodriguez, Bartee, Cui, Hurt, Linetzky, Bunck) Eli Lilly and Company,
Indianapolis, IN, United States
(Aminian) Bariatric and Metabolic Institute, Department of General
Surgery, Cleveland Clinic, Cleveland, OH, United States
(Ferrannini) Endocrinology and Metabolic Diseases, CNR Institute of
Clinical Physiology, Pisa, Italy
(Heerspink) Department of Clinical Pharmacy and Pharmacology, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
(Heerspink) The George Institute for Global Health, Sydney, NSW, Australia
(Jastreboff) Department of Medicine (Endocrinology and Metabolism) and
Pediatrics (Pediatric Endocrinology), Yale University School of Medicine,
New Haven, CT, United States
(Laffin) Section of Preventive Cardiology and Rehabilitation, Department
of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Pandey) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Ray) Department of Primary Care and Public Health, Imperial College
London, London, United Kingdom
(Ridker) Divisions of Cardiovascular Medicine and Preventive Medicine,
Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United
States
(Sanyal) Stravitz-Sanyal Institute for Liver Disease and Metabolic Health
and Division of Gastroenterology, Hepatology and Nutrition, Virginia
Commonwealth University School of Medicine, Richmond, VA, United States
(Yki-Jarvinen) Department of Medicine, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Yki-Jarvinen) Minerva Foundation Institute for Medical Research,
Helsinki, Finland
(Mason, Strzelecki) Cleveland Clinic Coordinating Center for Clinical
Research, Cleveland, OH, United States
(Nissen) Cleveland Clinic Coordinating Center for Clinical Research,
Cardiology/Clinical Trials, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: Obesity is a major cause of morbidity and mortality worldwide.
Tirzepatide is a glucose-dependent insulinotropic polypeptide receptor and
glucagon-like peptide-1 receptor agonist providing substantial weight
reduction and metabolic benefits both in type 2 diabetes and obesity. We
hypothesized that tirzepatide can improve morbidity and mortality in
adults with obesity or overweight but without diabetes. <br/>Method(s):
SURMOUNT-MMO is a randomized, double-blind, event-driven trial to
investigate the impact on morbidity and mortality with once-weekly
tirzepatide compared with placebo in adults living with obesity, without
diabetes, and with, or at risk of, cardiovascular disease. The primary
endpoint is time to first occurrence of a five-component composite outcome
of nonfatal myocardial infarction, nonfatal stroke, coronary
revascularization, heart failure events, or death from any cause.
<br/>Result(s): The trial will enroll ~15,000 participants aged >=40 from
664 sites across 27 countries with BMI >=27.0 kg/m² and either
established cardiovascular disease or multiple cardiovascular risk
factors. <br/>Conclusion(s): SURMOUNT-MMO will provide evidence of the
clinical benefits of tirzepatide on multiple outcomes among individuals
with overweight or obesity but without diabetes. This is the first outcome
trial of an incretin medication that assesses both primary and secondary
cardiovascular disease prevention.<br/>Copyright &#xa9; 2025 The Obesity
Society.

<55>
Accession Number
2034949430
Title
Transcatheter aortic valve replacement in quadricuspid aortic valve: a
systematic review and meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1572251. Date of Publication: 2025.
Author
Khalifa M.A.; Hashim H.T.; Shimal A.A.; Riyas Mohamed F.R.; Ragunathan S.;
Al Sakini A.S.; Elbadawi M.H.; Irfan M.R.; Moqbel I.; Almualed M.M.;
Al-Ghuraibawi M.; Al-Aboudi B.S.
Institution
(Khalifa, Moqbel) Faculty of Medicine, Cairo University, Cairo, Egypt
(Hashim, Al-Ghuraibawi) College of Medicine, University of Warith
Al-Anbiyaa, Karbala, Iraq
(Shimal, Al Sakini) College of Medicine, University of Baghdad, Baghdad,
Iraq
(Riyas Mohamed, Irfan) College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
(Ragunathan) Panimalar Medical College and Research Institute, Chennai,
India
(Elbadawi) Faculty of Medicine, University of Khartoum, Khartoum, Sudan
(Almualed) College of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Al-Aboudi) Faculty of Medicine, University of Kufa, Najaf, Iraq
Publisher
Frontiers Media SA
Abstract
Background: While Transcatheter Aortic Valve Replacement (TAVR) is now a
standard treatment for severe aortic stenosis, its use in patients with
quadricuspid aortic valves (QAV) presents unique challenges. This review
analyzes current evidence to guide clinicians in managing aortic stenosis
in this complex valve morphology. <br/>Method(s): Following PRISMA
guidelines, a comprehensive literature search was conducted across
multiple databases up to August 15, 2024. A random-effects model was used
for meta-analysis, focusing on 30-day mortality and procedural success,
with secondary outcomes including paravalvular leak incidence, pacemaker
insertion, hemodynamic changes, and NYHA functional class improvement.
<br/>Result(s): A total of 11 case reports/series were analyzed, involving
17 adult patients with QAV. Participants had a mean age of 73.80 +/- 5.07
years. The mean left ventricular ejection fraction was 41.6%, and the mean
annulus area was 595.5 mm². Most patients (64.7%) underwent
transfemoral procedures, with nearly 70% receiving a J-valve or Edwards
SAPIEN 3 device. All procedures were largely successful, though 29.4%
experienced leakage or regurgitation. Aortic pre-dilation was done in
41.2% of cases. The mean procedural duration was 102 min, with a
fluoroscopic duration of 15 min. No patients experienced aortic
post-dilation, and one (5.8%) had an atrioventricular block within 30 days
post-procedure. <br/>Conclusion(s): TAVR is an effective and growing
treatment for high-risk patients with aortic valve disease, including
those with QAV. While it has high success rates and challenges (i.e.,
post-operatively). Future studies should focus on long-term valve
durability.<br/>Copyright 2025 Khalifa, Hashim, Shimal, Riyas Mohamed,
Ragunathan, Al Sakini, Elbadawi, Irfan, Moqbel, Almualed, Al-Ghuraibawi
and Al-Aboudi.

<56>
Accession Number
2034983492
Title
The effects of extracorporeal blood purification (oXiris) in patients with
cardiogenic shock who require VA-ECMO (CLEAN ECMO): a prospective,
open-label, randomized controlled pilot study.
Source
Critical Care. 29(1) (no pagination), 2025. Article Number: 255. Date of
Publication: 01 Dec 2025.
Author
Ko R.-E.; Choi K.H.; Lee K.; Jeon J.; Jang H.R.; Chung C.R.; Cho Y.H.;
Park T.K.; Lee J.M.; Song Y.B.; Hahn J.-Y.; Choi S.-H.; Gwon H.-C.; Yang
J.H.
Institution
(Ko, Chung, Yang) Department of Critical Care Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Choi, Park, Lee, Song, Hahn, Choi, Gwon, Yang) Division of Cardiology,
Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Lee, Jeon, Jang) Division of Nephrology, Department of Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Cho) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: A systemic inflammatory response can contribute to poor
outcomes in an advanced stage of cardiogenic shock (CS). We investigated
the efficacy of extracorporeal endotoxin and cytokine adsorption using
oXiris in patients with CS undergoing venoarterial extracorporeal membrane
oxygenation (VA-ECMO). <br/>Method(s): In this prospective, single-center,
randomized, open-label pilot trial, 40 patients with CS who were
undergoing VA-ECMO were randomly assigned to receive either oXiris for 24
h (n = 20) or usual care (n = 20). The primary endpoint was endotoxin
levels at 48 h. Secondary endpoints included changes in inflammatory
cytokines, vasoactive-inotropic score (VIS), ECMO weaning success, and
in-hospital and 30-day mortality. <br/>Result(s): The median endotoxin
levels at 48 h were 0.5 (IQR 0.4-1.0) in the oXiris group and 0.4 (IQR
0.2-0.5) in the control group, with no significant difference between them
(P = 0.097). The oXiris group showed significant temporal reductions in
GDF-15 and IL-6 levels, with IL-6 revealing significant reductions from
baseline to 24 h (P = 0.020) and from baseline to 7 days (P = 0.003). VIS
decreased significantly from baseline to 48 h (-13.63, 95% CI: -20.90 -
-6.34, P < 0.001) and 7 days (-12.19, 95% CI: -21.0 - -3.31, P = 0.007) in
the oXiris group, but intergroup differences were insignificant. ECMO
weaning success, duration of ECMO support, and mortality rates were
similar between the groups. <br/>Conclusion(s): In this pilot study
conducted on CS patients requiring VA-ECMO, oXiris treatment did not
significantly reduce endotoxin levels or improve patient centered clinical
outcomes. Trial registration: NCT05642273, registered 8 December
2022.<br/>Copyright &#xa9; The Author(s) 2025.

<57>
[Use Link to view the full text]
Accession Number
2039288191
Title
Erector spinae plane block versus intercostal nerve blocks in uniportal
videoscopic assisted thoracic surgery: a multicenter, double-blind,
prospective randomized placebo controlled trial.
Source
Anesthesiology. (no pagination), 2025. Article Number:
10.1097/ALN.0000000000005625. Date of Publication: 2025.
Author
Coppens S.; Hoogma D.F.; Dewinter G.; Neyrinck A.; Van Loon P.; Stessel
B.; Hassanin J.; Vandenbrande J.; Du Pont B.; Jansen Y.; Fieuws S.; Rex S.
Institution
(Coppens, Hoogma, Dewinter, Neyrinck, Van Loon, Rex) Department of
Anesthesiology, University Hospitals of Leuven, Herestraat 49, Leuven,
Belgium
(Coppens, Hoogma, Dewinter, Neyrinck, Rex) Biomedical Sciences Group,
Department of Cardiovascular Sciences, University of Leuven, KU Leuven,
Leuven, Belgium
(Stessel, Hassanin, Vandenbrande) Department of Anesthesiology and Pain
Medicine, Jessa Hospital, Campus Virga Jesse, Hasselt, Belgium
(Stessel, Vandenbrande) Faculty of Medicine and Life Sciences, UHasselt,
Hasselt, Belgium
(Du Pont) Department of Cardiothoracic Surgery, Jessa Hospital, Campus
Virga Jesse, Hasselt, Belgium
(Jansen) Department of Cardiothoracic Surgery, University Hospitals of
Leuven, Herestraat 49, Leuven, Belgium
(Fieuws) Biomedical Sciences Group, Leuven Biostatistics and Statistical
Bioinformatics Centre (L-BioStat), University of Leuven, Leuven, Belgium
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Although, intercostal nerve blocks are sometimes approached
with caution due to concerns about potentially high local anesthetic
uptake, they remain a valuable tool in specific clinical situations. On
the other hand, the erector spinae plane block is nowadays often favored
for its broader coverage and versatility. We hypothesized that the
intercostal nerve block, applied directly by surgeons under direct vision
in patients undergoing uniportal video-assisted thoracoscopic surgery,
might offer superior analgesia and fewer complications compared to the
erector spinae plane block. <br/>Method(s): In this multi-center,
double-blind placebo controlled, randomized trial, 100 patients undergoing
uniportal thoracoscopic surgery (wedge excision or lobectomy) within an
enhanced recovery program received either a surgical intercostal nerve
block under thoracoscopic guidance or an ultrasound-guided erector spinae
plane block, followed by 30 ml of ropivacaine 0.5% (n=50) or saline
(n=50). Primary outcome measured was 12-hour morphine consumption
post-extubation. Secondary outcomes included 24-hour morphine use, pain
severity, rescue analgesia need, postoperative complications, and length
of stay. Plasma levels of local anesthetics were also assessed.
<br/>Result(s): The intercostal nerve block group had significantly lower
mean 12-hour morphine consumption compared to the erector spinae plane
block group (10.9 mg vs. 17.6 mg, p=0.0015), as well as lower mean 24-hour
consumption (18.7 mg vs. 26.7 mg, p=0.018). Intercostal blocks also led to
lower pain scores in the first two hours postoperatively and a reduced
need for rescue analgesia (16% vs. 40%, p=0.0033). No differences were
found in patient satisfaction, complications, or length of stay. Notably,
the erector spinae plane block group showed higher systemic absorption of
local anesthetics. <br/>Conclusion(s): For uniportal thoracoscopic
surgery, intercostal nerve block significantly reduces morphine
consumption and systemic anesthetic absorption compared to erector spinae
plane block.<br/>Copyright &#xa9; 2025 American Society of
Anesthesiologists. All Rights Reserved.

<58>
Accession Number
2039014867
Title
Beta-blockers for secondary prevention following myocardial infarction in
patients without reduced ejection fraction or heart failure: An updated
meta-analysis.
Source
European Journal of Preventive Cardiology. 32(8) (pp 633-646), 2025. Date
of Publication: 01 Jun 2025.
Author
Chi K.-Y.; Lee P.-L.; Chowdhury I.; Akman Z.; Mangalesh S.; Song J.;
Satish V.; Babapour G.; Kang Y.-N.; Schwartz R.; Chang Y.; Borkowski P.;
Nanna M.; Damluji A.A.; Nanna M.G.
Institution
(Chi, Lee, Chowdhury, Mangalesh, Song, Satish, Borkowski) Department of
Medicine, Jacobi Medical Center, Albert Einstein College of Medicine,
Bronx, NY, United States
(Akman) Department of Medicine, Yale School of Medicine, New Haven, CT,
United States
(Babapour, Nanna) Section of Cardiovascular Medicine, Yale School of
Medicine, 333 Cedar St, New Haven, CT, United States
(Kang) Research Center of Big Data and Meta-Analysis, Wan Fang Hospital,
Taipei, Taiwan (Republic of China)
(Schwartz) D. Samuel Gottesman Library, Albert Einstein College of
Medicine, Bronx, NY, United States
(Chang) Section of Neurosurgery, Department of Surgery, National Cheng
Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan, Taiwan (Republic of China)
(Nanna) Department of Medicine, Albert Einstein College of Medicine,
Bronx, NY, United States
(Damluji) Inova Center of Outcomes Research, Inova Health, Fairfax, VA,
United States
Publisher
Oxford University Press
Abstract
Aims The 2023 ESC guidelines for acute coronary syndrome note that
contemporary data are heterogenous regarding beta-blocker (BB) use
post-myocardial infarction (MI) in patients without reduced ejection
fraction (EF) or heart failure (HF). We aimed to address the heterogeneity
in contemporary data around BB post-MI in this population. Methods and
results We searched six databases from 1 January 2000 to 1 September 2024
to identify contemporary studies enrolling MI patients without reduced EF
(<=40%) or history of HF receiving BB at index MI and comparing outcomes
between BB users and non-users. The primary outcome was all-cause
mortality. Secondary outcomes included major adverse cardiac and
cerebrovascular events (MACCE) and cardiovascular (CV) mortality.
Random-effects meta-analysis was conducted using the restricted maximum
likelihood method. There were 24 studies including 290 349 patients
enrolled in the contemporary era. Overall, BB use was associated with a
significant 11% reduction in all-cause mortality [hazard ratio (HR), 0.89;
95% confidence interval (CI), 0.81-0.97; I² = 40], however with
moderate-to-high statistical heterogeneity. Pre-specified subgroup
analyses demonstrate comparable all-cause mortality (HR, 0.99; 95% CI,
0.94-1.06; I² = 0%), CV mortality (HR, 0.99; 95% CI, 0.85-1.15;
I² = 0%), and MACCE (HR, 1.24; 95% CI, 1.01-1.52; I²
= 0%) in patients with a 1-year event-free period, defined as no death,
recurrent MI, or HF while on BB following index MI. In patients with no
event-free period, meta-regression revealed that BB mortality benefits
were modified by the study inclusion period (P = 0.01), reflecting a
temporal trend of decreasing BB mortality benefits over time. Based on the
temporal trend, in patients with preserved EF post-2010, BB exhibited no
reduction in all-cause mortality (HR, 0.97; 95% CI, 0.90-1.04;
I² = 0%), but a non-significant trend towards increased CV
mortality (HR, 1.29; 95% CI, 0.96-1.72; I² = 0%) and a
significant increase in MACCE (HR, 1.24; 95% CI, 1.01-1.52; I²
= 0%). Conclusion In the contemporary reperfusion era, BB may not confer
additional mortality benefits beyond a 1-year event-free period post-MI in
patients without reduced EF. Moreover, post-MI BB use was associated with
detrimental effects in patients with preserved EF.<br/>Copyright &#xa9;
2024 The Author(s). Published by Oxford University Press on behalf of the
European Society of Cardiology. All rights reserved.

<59>
Accession Number
2035120994
Title
Late follow-up for a randomized trial of surgical treatment of tricuspid
valve regurgitation in patients undergoing left ventricular assist device
implantation.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(1) (pp 244-253.e3),
2025. Date of Publication: 01 Jul 2025.
Author
Mendiola Pla M.; Russell S.D.; Milano C.A.; Chiang Y.; Kang L.; Poehlein
E.; Green C.L.; Benedetti F.; Billard H.; Bryner B.S.; Schroder J.N.;
Daneshmand M.A.; Nicoara A.; DeVore A.D.; Patel C.B.; Bishawi M.
Institution
(Mendiola Pla, Milano, Kang, Benedetti, Billard, Schroder) Division of
Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, United
States
(Russell, DeVore, Patel) Division of Cardiology, Duke University Medical
Center, Durham, NC, United States
(Chiang) Division of Cardiovascular and Thoracic Surgery, Aurora St Luke's
Medical Center, Milwaukee, Wis, United States
(Poehlein, Green) Department of Biostatistics and Bioinformatics, Duke
University School of Medicine, Durham, NC, United States
(Bryner) Division of Cardiothoracic Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Ill, United States
(Daneshmand, Bishawi) Division of Cardiothoracic Surgery, Emory
University, Atlanta, GA, United States
(Nicoara) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Background: We previously reported that concurrent tricuspid valve surgery
(TVS) was not associated with a lower incidence of early right heart
failure (RHF) in patients undergoing durable left ventricular assist
device (LVAD) implantation. This follow-up analysis aimed to further
define the clinical impact of concurrent TVS after 2 months of follow-up.
<br/>Method(s): Patients with moderate or severe tricuspid regurgitation
(TR) on preoperative echocardiography (n = 71) were randomized to LVAD
implantation either alone (no TVS group; n = 34) or with concurrent TVS
(TVS group; n = 37). Randomization was stratified by preoperative right
ventricular dysfunction. The patients were followed for at least 12 months
after surgery. The incidence of RHF was determined by an adjudication
committee using Interagency Registry for Mechanically Assisted Circulatory
Support criteria. Functional studies and repeat echocardiography were
performed at 12 months. <br/>Result(s): Demographics were similar in the 2
study arms. At 12 months, the rate of moderate or severe RHF was 50.0% in
the no TVS arm versus 51.4% in the TVS arm. No patients developed RHF
between 6 and 12 months following the procedure. Death from RHF was 5.4%
in the TVS arm versus 8.8% in the no TVS arm. At 12 months, there was no
significant difference in TR severity between the 2 arms, owing to
improvement in TR severity in the no TVS arm. Cardiopulmonary exercise
testing at 12+ months revealed no significant between-group difference in
peak oxygen consumption. <br/>Conclusion(s): In patients with significant
preimplantation TR, the severity of TR improved over time in the no TVS
arm with LVAD implantation alone. By 12 months, there was no significant
difference in TR severity between the 2 arms. This may account for the
lack of difference in late clinical or functional
parameters.<br/>Copyright &#xa9; 2024 The American Association for
Thoracic Surgery

<60>
Accession Number
2035002002
Title
Dexmedetomidine-enhanced chest wall fascial plane blocks in
ultra-fast-track minimally invasive heart valve surgery: a randomized
controlled trial.
Source
Perioperative Medicine. 14(1) (no pagination), 2025. Article Number: 62.
Date of Publication: 01 Dec 2025.
Author
Jiang S.-J.; Jiang T.; Wei H.-W.; Lou X.-K.; Wang Y.; Yan M.-J.
Institution
(Jiang) Department of Anesthesiology, Sir Run Run Shaw Hospital, School of
Medicine, Zhejiang University, Zhejiang, Hangzhou, China
(Jiang, Wei, Lou, Wang, Yan) Center for Rehabilitation Medicine,
Department of Anesthesiology, Zhejiang Provincial People's Hospital
(Affiliated People's Hospital, Hangzhou Medical College), Research
Institute of Anesthesiology and Perioperative Medicine, Hangzhou Medical
College, Zhejiang, Hangzhou, China
Publisher
BioMed Central Ltd
Abstract
Background: Injury to the sternocostal joint during minimally invasive
cardiac surgery frequently results in severe pain, yet there is no
established standard for perioperative analgesia. This randomized
controlled trial evaluated whether adding 1 mug/kg dexmedetomidine to
0.375% ropivacaine for chest wall fascial plane blocks enhances opioid
sparing in ultra-fast-track (UFT) minimally invasive heart valve surgery.
<br/>Method(s): Seventy-six elective patients were randomized (1:1) in a
double-blind manner. The control group received 60 mL of 0.375%
ropivacaine, while the DEX group was administered 60 mL of 1 mug/kg
dexmedetomidine plus 0.375% ropivacaine. The primary outcomes were
intraoperative remifentanil use and 24-h postoperative sufentanil
consumption, which served as co-primary endpoints to evaluate
opioid-sparing effects. Secondary outcomes included 24-h postoperative
sufentanil consumption, 24-h oxycodone use, patient-controlled analgesia
(PCA) activations, episodes of Visual Analog Scale (VAS) scores >= 3
within 48 h, time to recovery of consciousness, time to extubation,
duration of intensive care unit (ICU), and hospital stays, and
complications. <br/>Result(s): The DEX group exhibited significantly
reduced intraoperative remifentanil consumption (2.45 +/- 0.47 vs. 2.98
+/- 0.53 mg, p < 0.001) and 24-h sufentanil use (median with interquartile
range (IQR) 57 [54-60] vs. 63 [63-66] mug, p < 0.001). It also
demonstrated lower 24-h oxycodone consumption (median [IQR] 5 [0-10] vs.
10 [10-20] mg, p < 0.001), fewer 24-h PCA activations (median [IQR] 3
[2-4] vs. 5 [5-6], p < 0.001), and less frequent VAS >= 3 episodes (median
[IQR] 3 [2.5-4] vs. 6 [5-6], p < 0.001), alongside shorter lengths of ICU
(21.34 +/- 3.59 vs. 24.29 +/- 4.07 h, p = 0.002) and hospital stays (6.51
+/- 1.04 vs. 8.65 +/- 1.80 days, p < 0.001). Postoperative complications
did not differ significantly between groups, though
dexmedetomidine-related hemodynamic effects were not systematically
monitored. <br/>Conclusion(s): The administration of 1 mug/kg
dexmedetomidine in combination with ropivacaine for chest wall fascial
plane blocks reduces opioid requirements and shortens ICU/hospital stays
in UFT cardiac surgery, supporting its safety and efficacy, but
limitations include the single-center design, fixed dexmedetomidine
dosage, and incomplete complication assessment, warranting multicenter
validation with standardized safety monitoring. Trial registration:
ChiCTR2100051182.<br/>Copyright &#xa9; The Author(s) 2025.

<61>
Accession Number
2034929496
Title
Effect of Modified Remote Ischemic Preconditioning on Perioperative
Outcomes of CABG Patients With CPB.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
8854092. Date of Publication: 2025.
Author
Sun Q.; Wang X.; Huan C.; Guo M.; Liu J.; Wu W.; Luo Y.; Zhu H.; Hou Y.;
Wang G.; Pan D.
Institution
(Sun, Huan, Guo, Liu, Wu, Luo, Zhu, Hou, Wang, Pan) Department of
Cardiology and Cardiothoracic Surgery, The Affiliated Hospital of Xuzhou
Medical University, Jiangsu, Xuzhou, China
(Wang) Department of Cardiology, Liaocheng People's Hospital, Shandong,
Liaocheng, China
(Wang) Cardiovascular Medicine Department, Beijing Bo'ai Hospital, China
Rehabilitation Research Center, Capital Medical University, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Objective: To investigate the effect of modified remote ischemic
preconditioning (MRIC) on perioperative outcomes in patients undergoing
coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB).
<br/>Method(s): This study included 118 patients who planned to undergo
CABG surgery at the Affiliated Hospital of Xuzhou Medical University.
These patients were randomly divided into the MRIC group (n = 40), remote
ischemic preconditioning (RIPC) group (n = 39), or control group (n = 39).
The MRIC group received 3 cycles of 5 min ischemia/5 min reperfusion on
the left upper limb at 2 days, 1 day, and 2 h preoperatively. The RIPC
group received RIPC 2 h preoperatively, while the control group did not
receive ischemic preconditioning. The STS score of patients was calculated
according to the coronary angiography results and clinical data for risk
stratification. The serum concentrations of N-terminal pro-B-type
natriuretic peptide (NT-proBNP), creatine kinase MB (CK-MB),
high-sensitivity cardiac troponin-T (hs-cTnT), and creatinine (Cr) of
patients were recorded at postoperative 0, 12th, 24th, 48th, 72th h, and
seventh days for each patient. Major adverse cardiac events (MACEs) in the
hospital were recorded. <br/>Result(s): A total of 118 participants were
included. The overall MACE incidence was 83.4%. A total of 36 MACE cases
(92.3%) occurred in the control group, 28 cases (70.0%) in the MRIC group
(RR: 0.75; 95% CI: 0.61-0.95), and 35 cases (89.7%) in the RIPC group (RR:
0.97; 95% CI: 0.84-1.12). Compared to the control group, MRIC and RIPC
groups had lower concentrations of CK-MB at postoperative 0 and 12th h (p
< 0.05); MRIC group had lower concentrations of hs-cTnT at postoperative
12th h (p < 0.05). The MRIC group had a higher concentration of NT-proBNP
at postoperative 24th, 48th, and 72th h (p < 0.05). The differences in the
concentration of Cr among the three groups were not statistically
significant (p > 0.05); There was no statistically significant difference
in the effects of MRIC on the indexes of the low-risk patients and the
medium-high-risk patients (p > 0.05). <br/>Conclusion(s): (1) MRIC has
cardioprotective effects and reduces the occurrence of postoperative MACE.
(2) MRIC could not reduce the concentrations of NT-proBNP and Cr
postoperatively. (3) MRIC showed no significant difference in myocardial
protection in patients with different STS score risk
stratifications.<br/>Copyright &#xa9; 2025 Qi Sun et al. Journal of
Cardiac Surgery published by John Wiley & Sons Ltd.

<62>
Accession Number
2039276840
Title
Efficacy of Superficial versus Deep Parasternal Intercostal Plane Blocks
in Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Dost B.; De Cassai A.; Karapinar Y.E.; Turunc E.; Beldagli M.; Yalin
M.S.O.; Navalesi P.
Institution
(Dost, Turunc) Department of Anesthesiology and Reanimation, Ondokuz Mayis
University Faculty of Medicine, Samsun, Turkey
(De Cassai, Navalesi) Department of Medicine, University of Padua, Padua,
Italy
(De Cassai, Navalesi) Institute of Anesthesia and Intensive Care Unit,
University Hospital of Padua, Padua, Italy
(Karapinar, Yalin) Department of Anesthesiology and Reanimation, Ataturk
University School of Medicine, Erzurum, Turkey
(Beldagli) Department of Anesthesiology and Reanimation, Samsun Training
and Research Hospital, Samsun, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: To compare the analgesic efficacy of superficial parasternal
intercostal plane (S-PIP) block and deep parasternal intercostal plane
(D-PIP) to determine which technique provides superior pain relief in
cardiac surgery. <br/>Design(s): A systematic search of MEDLINE (via
PubMed), Scopus, Embase, Cochrane Library, Web of Science, Google Scholar,
and ClinicalTrials.gov from inception until January 18, 2025. Eligible
studies included randomized controlled trials (RCTs) and observational
studies that compared the S-PIP and D-PIP blocks in patients undergoing
cardiac surgery. The primary outcome of the study was postoperative opioid
consumption of morphine milligram equivalent (MME) at 24 hours. Secondary
outcomes included resting and movement pain scores at 0, 6, 12 and 24
hours, time to first analgesics, incidence of postoperative nausea and
vomiting (PONV), extubation time, length of stay (LOS) in the intensive
care unit (ICU), and the number of patients requiring rescue analgesics.
<br/>Main Result(s): Seven RCTs and 1 observational study, including a
total of 510 patients, were identified. The findings demonstrated no
statistically significant difference in MME at 24 hours between the S-PIP
and D-PIP block groups (mean difference, -1.23; 95% confidence interval,
-2.51 to 0.05; p = 0.061). Additionally, there were no significant
differences in pain scores, PONV incidence, time to rescue analgesics,
extubation time, or ICU LOS of stay between the 2 techniques.
<br/>Conclusion(s): S-PIP and D-PIP blocks provide comparable
postoperative analgesic efficacy in patients undergoing cardiac
surgery.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<63>
Accession Number
2039206194
Title
Temporal Trends and Severity of Postoperative Delirium in Cardiac Surgery:
Insights from a Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Shamsi T.; Janga S.R.; Baskaran N.U.; Rangasamy V.; Ramachandran R.V.;
Chen M.; Ganesh S.; Novack V.; Subramaniam B.
Institution
(Shamsi, Janga, Baskaran, Rangasamy, Chen) Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Ramachandran) University of Washington Medicine, Seatle, WA, United
States
(Ganesh) New York Institute of Technology College of Osteopathic Medicine,
New York, NY, United States
(Novack) Soroka University Medical Center, Beer-Sheva, Israel
(Subramaniam) Harvard Medical School, Sadhguru Center for a Conscious
Planet, Beth Israel Deaconess Medical Center, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Postoperative delirium (POD) is one of the most common neurocognitive
complications following cardiac surgery, typically occurring within 72
hours and leading to serious consequences, including falls, prolonged
hospitalization, and increased healthcare costs. Annually, over two
million cardiac surgeries, including coronary artery bypass grafting, are
performed worldwide. This study systematically reviews and meta-analyzes
the incidence, duration, time to onset, and severity of delirium following
cardiac surgery. No previous comprehensive analysis has addressed all
these outcomes, particularly regarding temporal patterns and severity of
POD. A systematic review was performed following PRISMA guidelines. The
studies included adult patients who underwent cardiac surgery and were
assessed for delirium using validated tools. Statistical analyses included
random-effects meta-analysis for incidence rates and subgroup analyses.
Twenty-seven studies involving 5,126 participants from 2009 to March 2024
were included. The overall incidence of POD was 25.1% (95% confidence
interval [CI]: 21.8%-28.3%), with a mean duration of 2.378 days (95% CI:
2.086-2.671), and onset occurring at 1.706 days (95% CI: 1.198-2.214).
Only three studies assessed the severity of delirium, reporting a maximum
Confusion Assessment Method score of 9.308 (95% CI: 7.309-11.307) on a
scale of 0 to 19. Subgroup analyses were conducted to examine
heterogeneity but revealed no significant differences in outcomes.
Therefore, a meta-regression analysis focusing on age, surgery duration,
assessment length, study design, and assessment tools was performed. The
incidence and burden of POD highlight the need for regular screening and
effective management strategies.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<64>
Accession Number
2034972741
Title
Comparative outcomes of Myval versus contemporary transcatheter heart
valves: a systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2025. Date
of Publication: 2025.
Author
Ozbay M.B.; Degirmen S.; Gullu A.; Nriagu B.N.; Ozen Y.; Celebi O.O.;
Yayla C.
Institution
(Ozbay) Department of Medicine, Penn Medicine Princeton Medical Center,
Plainsboro, NJ, United States
(Degirmen, Nriagu) Department of Medicine, Metropolitan Hospital Center,
New York, NY, United States
(Gullu) Department of Medicine, North Alabama Medical Center, Florence,
AL, United States
(Ozen) Department of Cardiology, Faculty of Medicine, Selcuk University,
Konya, Turkey
(Celebi, Yayla) Department of Cardiology, Ankara City Hospital, University
of Health Sciences, Ankara, Turkey
Publisher
Springer
Abstract
Transcatheter aortic valve replacement is a key intervention for high-risk
patients with severe aortic stenosis. Myval, a newer transcatheter heart
valve (THV), shows promise, but a comprehensive comparison with other THVs
is lacking. This study evaluates the safety and efficacy of Myval compared
with contemporary THVs. A systematic review and meta-analysis of six
studies involving 2335 patients was performed. Primary outcomes included
all-cause mortality, cardiovascular mortality, new permanent pacemaker
implantation (PPI), device success, early safety, acute kidney injury,
stroke, vascular complications, and valve regurgitation. Myval was
associated with significantly lower rates of new PPI (RR, 0.62; 95% CI
0.45-0.86; P =.004), higher rates of device success (RR, 1.08; 95% CI
1.01-1.16; P =.02), and early safety (RR, 1.15; 95% CI 1.05-1.27; P =.003)
compared with contemporary THVs. No significant differences were observed
in all-cause mortality, cardiovascular mortality, acute kidney injury,
stroke, vascular complications, and valve regurgitation. Myval may offer
better short-term outcomes in terms of new PPI, device success, and early
safety compared with contemporary THVs. Larger, prospective studies with
longer follow-ups are needed to confirm these findings.<br/>Copyright
&#xa9; The Author(s) under exclusive licence to Japanese Association of
Cardiovascular Intervention and Therapeutics 2025.

<65>
Accession Number
2039490983
Title
Evaluate psychological effects of prolonged fasting in patients undergoing
cardiac surgery.
Source
Cirugia Cardiovascular. (no pagination), 2025. Date of Publication: 2025.
Author
Moreno Rodriguez J.; Lorenzo Diaz M.; Aranda Domene R.; Canovas Lopez
S.J.; March Salas M.; Alcaraz Garcia M.J.; Perez Morote J.; Sanchez Motos
R.; Amor Vigueras A.; Ponce de Leon Torralba M.; Aviles Alvizu J.M.;
Galindo Rueda M.D.M.; Clemente Murcia M.
Institution
(Moreno Rodriguez, Lorenzo Diaz, Aranda Domene, Canovas Lopez, March
Salas, Alcaraz Garcia, Perez Morote, Sanchez Motos, Amor Vigueras, Ponce
de Leon Torralba, Aviles Alvizu, Galindo Rueda, Clemente Murcia)
Cardiovascular Surgery, Murcian Institute of Biosanitary Research (IMIB),
Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
Publisher
Sociedad Espanola de Cirugia Cardiovascular y Endovascular (SECCE)
Abstract
Introduction: Comprehensive care of the cardiosurgical patient is
essential to optimize clinical results. In this context, preoperative
strategies play a key role, with accelerated recovery programs (ERAS)
being a promising alternative. <br/>Objective(s): To evaluate the
psychological and metabolic effects of prolonged fasting (>8 h) in
patients undergoing elective cardiac surgery, comparing them with a group
receiving carbohydrate supplementation. Methodology: Quasi-experimental,
prospective and randomized study. Patients were assigned to two groups:
(1) Carbohydrate supplementation and (2) Prolonged fasting. Clinical
variables, capillary blood glucose, anxiety (Hamilton Scale), feeling of
hunger and thirst, perceived satisfaction and postoperative complications
were measured. <br/>Result(s): 58 patients were included. The intervention
group presented a lower sensation of hunger and thirst (p < 0.001), as
well as a significant reduction in pre-surgical anxiety (p = 0.003)
compared to the control group. Perceived satisfaction was also higher in
the intervention group (p = 0.047). No significant differences were
detected in capillary blood glucose levels between the groups. Neither was
a greater need for insulin administration observed in either group.
Regarding postoperative complications, no significant differences were
observed, nor were there any cases of mortality attributable to the
procedure. <br/>Conclusion(s): Preoperative supplementation with
carbohydrate-rich fluids improves the patient experience in terms of
anxiety and comfort, without compromising metabolic stability or
increasing the incidence of postoperative complications. The findings
found throughout the research support the incorporation of this strategy
into cardiac surgery protocols, with the potential to optimize patient
experience and outcomes.<br/>Copyright &#xa9; 2025 Sociedad Espanola de
Cirugia Cardiovascular y Endovascular

<66>
Accession Number
2039460159
Title
Are systemic and topical tranexamic acid superior to each other in
bleeding control in coronary bypass surgery?.
Source
European Research Journal. 11(4) (pp 714-721), 2025. Date of Publication:
04 Jul 2025.
Author
Gozen F.; Maltepe F.
Institution
(Gozen) Department of Anesthesiology and Reanimation, University of Health
Sciences, BursaYuksek Ihtisas Research and Training Hospital, Bursa,
Turkey
(Maltepe) Department of Anesthesiology and Reanimation, Dokuz Eylul
University, Faculty of Medicine, Izmir, Turkey
Publisher
Association of Health Research and Strategy
Abstract
Objectives: Tranexamic acid significantly reduces postoperative bleeding
and transfusion requirements in cardiac surgery. Intravenous
administration has been associated with thromboembolism and seizures. The
complex protocols and serious side effects associated with this
administration increase interest in intrapericardial administration, and
its preferability is being reviewed. The purpose of this prospective,
randomized, double-blind study was to compare the effects of
intrapericardial tranexamic acid administered following cardiac surgery
with those of intravenous administration on postoperative bleeding and
possible complications. <br/>Method(s): The study included 60 patients
over the age of 18 who were undergoing elective coronary artery bypass
grafting for the first time. The patients were randomized into intravenous
and intrapericardial groups. Primary postoperative bleeding and
transfusion requirements, and secondarily complications, reoperation and
discharge times were evaluated. <br/>Result(s): The 60 coronary artery
bypass grafting patients included in the study, consisting of 30 patients
in intravenous and intrapericardial groups, were not different from each
other in terms of demographic data and Euroscore parameters. Postoperative
24-hour chest tube drainage was measured as 890+/-551 mL in the
intrapericardial group and 708+/-504 mL in the intravenous group. The
similar drainage amounts detected in the two groups did not create a
statistically significant difference (P=0.190). Transfusion requirements
were similar in both groups. No complications developed in any patient and
no reoperation was required due to bleeding. <br/>Conclusion(s): In
conclusion; intrapericardial tranexamic acid application in coronary
artery bypass grafting surgery reduces postoperative bleeding and
transfusion requirement at an equivalent rate to intravenous.
Intrapericardial application, which can provide the same effect without
creating extra risk, may be a simpler and more practical method than
systemic application, which includes complex protocols regarding dose and
timing.<br/>Copyright &#xa9; The Author(s)

<67>
Accession Number
2039450705
Title
Mitral Valve Transcatheter Edge-to-Edge Repair or Medical Therapy in
Systolic Heart Failure: A Meta-Analysis of Randomized Trials.
Source
Journal of the American Heart Association. 14(13) (no pagination), 2025.
Article Number: e039285. Date of Publication: 2025.
Author
Reddy R.K.; Koeckerling D.; Stone G.W.; Howard J.P.; Ahmad Y.
Institution
(Reddy, Howard) National Heart and Lung Institute, Imperial College
London, London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Koeckerling) Department of Cardiology, Angiology and Respiratory
Medicine, Heidelberg University Hospital, Heidelberg, Germany
(Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Ahmad) Division of Cardiology, University of California, San Francisco,
CA, United States
Publisher
American Heart Association Inc.

<68>
Accession Number
2039189407
Title
Efficacy of subanaesthetic esketamine on the prevention of postoperative
delirium in older adult patients after cardiovascular surgery: protocol
for a single-centre, randomised, double-blind, placebo-controlled trial
(SEPDOC trial) in China.
Source
BMJ Open. 15(6) (no pagination), 2025. Article Number: e089719. Date of
Publication: 16 Jun 2025.
Author
Yan J.-M.; Liu Q.-R.; Zhao L.; Yang J.-J.; Lin H.-Q.; Wen Z.-Y.; Zhang
H.-R.; Mei Y.-X.; Zhang W.; Wang R.-D.
Institution
(Yan, Yang) Department of Anesthesiology, Pain and Perioperative Medicine,
The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou,
China
(Yan, Zhao, Lin, Wen, Zhang, Mei, Zhang, Wang) Department of
Anesthesiology and Perioperative Medicine, Central China Branch of
National Center for Cardiovascular Diseases, Henan Cardiovascular Disease
Center, Fuwai Central-China Hospital, Central China Fuwai Hospital of
Zhengzhou University, Henan Province Clinical Research Center for
Cardiovascular Disease, Henan, Zhengzhou, China
(Liu) Department of Anesthesiology, Wuxi Xishan People's Hospital,
Jiangsu, Wuxi, China
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium (POD) is a common and serious
complication in older adult patients undergoing cardiovascular surgery.
Esketamine is known for its anti-inflammatory and neuroprotective
properties. While it has shown preventive effects on POD in those not
undergoing cardiovascular surgery, its efficacy in older adult patients
undergoing cardiovascular surgery remains uncertain. Therefore, we herein
aimed to evaluate the preventive effect of intraoperative subanaesthetic
esketamine on POD in this specific population. Methods and analysis This
single-centre, randomised, double-blind, placebo-controlled trial will
enrol 778 patients aged 60-80 years undergoing open-heart cardiovascular
surgery in China, from September 2023 to December 2025. The participants
will be randomly assigned in a 1:1 ratio to the following groups: the
esketamine group and the control group. In the esketamine group,
esketamine (2mg/mL) will be administered intravenously at a dosage of
0.3mg/kg over 10min following tracheal intubation, followed by a
continuous infusion at 0.15mg/kg/h until the end of the surgery. Patients
in the control group will receive a placebo following the same dosage and
regimen. The incidence of POD will be the primary outcome and will be
assessed twice daily from the first to the seventh postoperative day. The
postoperative sleep quality, duration of postoperative mechanical
ventilation, and length of hospital and intensive care unit stay will be
the secondary outcomes. Ethics and dissemination Ethical approval was
obtained from the Institutional Review Board of Fuwai Central China
Cardiovascular Hospital (No. 2023068). Public disclosure is guaranteed
post-trial, and the results will be published in a peer-reviewed
scientific journal.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2025.

<69>
Accession Number
2039383459
Title
Comparison of analgesic efficacy and safety of caudal dexmedetomidine
versus intranasal dexmedetomidine in paediatric infraumbilical surgeries:
A randomised controlled trial.
Source
European Journal of Anaesthesiology. (no pagination), 2025. Article
Number: 2228. Date of Publication: 2025.
Author
Agarwal A.; Shah S.B.; Sinha R.; Prasad G.; Prakash K.; Goel P.
Institution
(Agarwal, Shah, Sinha, Prasad, Prakash) Department of Anaesthesiology,
Pain Medicine and Critical Care, All India Institute of Medical Sciences,
New Delhi, India
(Goel) Department of Paediatric Surgery, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND The established analgesic efficacy and safety of
dexmedetomidine in children has demonstrated a rise in its use and various
administration routes have been explored. However, clinical comparisons
between caudal and intranasal dexmedetomidine are lacking. OBJECTIVES We
aimed to compare the analgesic efficacy, postanaesthesia recovery
characteristics and side effects associated with caudal versus intranasal
dexmedetomidine as an adjunct to a single-shot caudal block in paediatric
infraumbilical surgeries. DESIGN A noninferiority randomised controlled
trial. SETTING A tertiary care hospital from November 2022 to May 2024.
PATIENTS Sixty-four children aged 1 to 8 years undergoing infraumbilical
surgeries under general anaesthesia supplemented with caudal analgesia.
INTERVENTIONS Patients were randomised to receive either caudal
dexmedetomidine (1 ml kg^-1 caudal 0.2% ropivacaine + 1 mug
kg^-1 caudal dexmedetomidine) or intranasal dexmedetomidine (1
ml kg^-1 caudal 0.2% ropivacaine + 1 mug kg^-1
intranasal dexmedetomidine). MAIN OUTCOME MEASURES The primary outcome was
the duration of postoperative analgesia. Other outcomes assessed included
postoperative pain scores, peri-operative analgesic consumption,
peri-operative haemodynamics, postoperative recovery profile and adverse
events for 24 h postoperatively. RESULTS The duration of postoperative
analgesia in caudal and intranasal group was 527 +/- 83 and 545 +/- 90
min, respectively (P = 0.422). There was a comparable decrease in the
intra-operative heart rate. The greater number of episodes of
intra-operative hypotension in the caudal group (P = 0.016) did not
warrant vasopressors. Children in the caudal group were more sedated until
2 h postsurgery following which the sedation scores in both the groups
were equivalent. Postoperative pain scores, peri-operative analgesic
consumption and the incidence of emergence delirium was comparable. No
adverse events were reported in either group. CONCLUSION Intranasal
dexmedetomidine can be considered a feasible analgesic adjunct to a
single-injection caudal block in children undergoing infraumbilical
surgeries associated with a smooth recovery profile and no associated
adverse effects. CLINICAL TRIAL REGISTRATION Clinical Trial Registry of
India (CTRI/2022/09/045492; http://www.ctri.nic.in).<br/>Copyright &#xa9;
2025 European Society of Anaesthesiology and Intensive Care.

<70>
Accession Number
2039522298
Title
The impact of pregnancy on bioprosthetic structural valve deterioration: a
systematic review and meta-analysis.
Source
Obstetric Medicine. (no pagination), 2025. Article Number:
1753495X251347767. Date of Publication: 2025.
Author
Wilkie G.L.; Semenov E.; Leung K.; Baltich Nelson B.; Scott N.S.;
Harrington C.M.
Institution
(Wilkie, Semenov, Leung, Baltich Nelson) Division of Maternal-Fetal
Medicine, Department of Obstetrics and Gynecology, University of
Massachusetts Chan Medical School, Worcester, MA, United States
(Scott, Harrington) Department of Medicine, Cardiology Division
Massachusetts General Hospital, Boston, MA, United States
Publisher
SAGE Publications Inc.
Abstract
Objective: This systematic review and meta-analysis sought to assess the
impact of pregnancy on bioprosthetic valve (BPV) structural valve
deterioration. <br/>Method(s): We searched Ovid MEDLINE, Scopus,
Clinicaltrials.gov, and Cochrane Library from inception through October
17, 2022. We included all studies that compared patients with BPV with and
without a pregnancy history. The initial search yielded 1748 unique
citations that were screened in Covidence by two independent reviewers.
Our outcome of interest was structural valve deterioration.
<br/>Result(s): We performed random-effects meta-analyses from nine
eligible studies. Meta-analysis of 321 individuals with a pregnancy
history and 987 control individuals without pregnancy showed there was an
increased odds in development of structural valve deterioration among
those with a pregnancy history (OR 2.34, 95% CI 1.40-3.89) with an
I² of 59.8%. <br/>Conclusion(s): A pregnancy history was
associated with an increased risk of structural valve deterioration;
however, further research is needed due to the heterogeneity of
results.<br/>Copyright &#xa9; The Author(s) 2025

<71>
Accession Number
2039349142
Title
Use of in silico research in the development of abdominal and thoracic
surgical devices: a systematic review.
Source
BMJ Innovations. (no pagination), 2025. Date of Publication: 2025.
Author
Pattani N.; Sanghera J.; Mills E.; Khan A.; Jauniaux B.; Bolton W.; Harji
D.; Burke J.R.
Institution
(Pattani) St George's University Hospitals NHS Foundation Trust, London,
United Kingdom
(Sanghera, Khan) Walsall Manor Hospital, Birmingham, United Kingdom
(Mills) Mid Essex Hospital Services NHS Trust, Essex, United Kingdom
(Jauniaux, Bolton, Harji, Burke) Institute of Medical Research, University
of Leeds, Leeds, United Kingdom
(Harji, Burke) Department of Colorectal Surgery, Manchester University NHS
Foundation Trust, Manchester, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective Surgical innovation has exponentially improved over the past
three decades. However, efficacy assessment of surgical devices through
randomised controlled trials requires significant resources. In silico
modelling may provide a solution, utilising computational simulations to
develop and improve devices. This study aims to evaluate the current use
of in silico modelling for devices used in abdominal and thoracic surgery.
Design A systematic review was conducted following the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. Data Resources
PubMed, MEDLINE and Embase databases from January 2019 to August 2024 were
searched. Eligibility criteria for selecting studies Inclusion criteria
were defined as studies using mathematical/computational models to
investigate invasive devices implanted or incorporated in abdominal and
thoracic surgery. Results The search strategy yielded 2968 studies, with
42 included in the final analysis. Core themes identified included proof
of concept (n=19), device improvement (n=22) and in silico clinical trials
with simulated human patients (n=1). Specialities included: general
surgery (n=4); hepato-pancreato-biliary (n=2); vascular (n=5); paediatric
(n=9) and cardiothoracic (n=22). Most studies were at IDEAL stage 0
(preclinical) and 19 studies validated in silico results with in vitro/in
vivo data. Conclusion In silico modelling can complement preclinical in
vitro and in vivo testing for surgical devices. Its applications include
simulating rare diseases, modelling diverse patient demographics, and
generating early efficacy data for novel or repurposed devices.
Standardising.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2025.

<72>
Accession Number
2039477905
Title
Preemptive regional nerve blocks for sternotomy in pediatric cardiac
surgery: a Bayesian network meta-analysis.
Source
Brazilian Journal of Anesthesiology (English Edition). 75(5) (no
pagination), 2025. Article Number: 844652. Date of Publication: 01 Sep
2025.
Author
Wegner B.F.M.; Wegner G.R.M.; Arias J.A.; Nascimento T.S.
Institution
(Wegner) Universidade Federal do Rio Grande do Sul, RS, Porto Alegre,
Brazil
(Wegner) Universidade Federal da Fronteira Sul, RS, Passo Fundo, Brazil
(Arias) Hospital Ana Nery, BA, Salvador, Brazil
(Nascimento) University of Iowa, Iowa City, United States
Publisher
Elsevier Editora Ltda
Abstract
Background: Effective pain management and expedited recovery are critical
in pediatric cardiac surgery. While regional anesthesia techniques provide
targeted pain control and may reduce opioid use and related complications,
comparative evidence among regional nerve blocks in this population is
limited. This study aimed to conduct a systematic review and network
meta-analysis to support clinical decision-making for optimal analgesia.
<br/>Method(s): We conducted a Bayesian Network Meta-Analysis (NMA)
including Randomized Controlled Trials (RCTs) of pediatric patients (0-12
years) undergoing cardiac surgery by sternotomy and receiving preemptive
regional nerve blocks. Primary outcomes included pain scores, opioid
consumption and extubation time. Both direct and indirect evidence were
synthesized to rank interventions probabilistically. This study was
registered on PROSPERO (CRD42024585785) and followed PRISMA Extension
Statement for Reporting of Systematic Reviews Incorporating Network
Meta-analyses of Health Care Interventions. <br/>Result(s): The NMA
incorporated 12 RCTs, comprising 969 participants, and evaluated seven
regional nerve blocks. Among the techniques studied, transversus Thoracis
Muscle Plane Block (TTPB) consistently ranked among the most effective for
pain relief and recovery. Other blocks, including thoracic retrolaminar
block and thoracic paravertebral block, also demonstrated notable
performances. Adverse events were infrequent but inconsistently reported,
preventing an adequate analysis. <br/>Conclusion(s): This NMA identified
TTPB as a consistently top-performing technique across outcomes. These
findings provide promising support for its inclusion in ERAS protocols,
although further high-quality trials are needed. Registration: PROSPERO
ID: CRD42024585785.<br/>Copyright &#xa9; 2025 Sociedade Brasileira de
Anestesiologia

<73>
Accession Number
2039383451
Title
Continuous positive airway pressure to prevent reintubation in patients
recovering from cardiac surgery: A multicentre randomised clinical trial.
Source
European Journal of Anaesthesiology. (no pagination), 2025. Article
Number: 2229. Date of Publication: 2025.
Author
Pasero D.; Costamagna A.; Filippini C.; Blangetti I.; Cattaneo S.;
Baiocchi M.; Balata A.; Bottiroli M.; Dambruoso P.; De Paulis S.; Grazioli
L.; Locatelli A.; Lorini F.L.; Mascotti A.; Mondino M.G.; Paparella D.;
Salvi L.; Tonetti T.; Tritapepe L.; Ranieri V.M.
Institution
(Pasero, Mascotti) Department of Medicine Surgery and Pharmacy, University
of Sassari, Italy
(Pasero, Costamagna) Cardiac Anesthesia Unit, 'Citta della Salute e della
Scienza' Hospital, Turin, Italy
(Costamagna, Filippini) Department of Surgical Science, University of
Turin, Italy
(Blangetti, Locatelli) Cardiovascular Anesthesia and Intensive Care Unit,
'Santa Croce e Carle' Hospital, Cuneo, Italy
(Blangetti) Ospedale Regina Montis Regalis' ASL CN1 Mondovi, Cuneo, Italy
(Cattaneo) Cardiac Anesthesia Unit, 'Spedali Civili', Brescia, Italy
(Baiocchi) Department of Anaesthesia and Intensive Care, Cardiothoracic
and Vascular Department, IRCSS Sant'Orsola, Bologna, Italy
(Balata) Cardiac Anesthesia Unit, 'AOU Sassari' Hospital, Sassari, Italy
(Bottiroli) Department of Anesthesia and Critical Care Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
(Bottiroli, Mondino) Cardiothoracic and Vascular Anesthesia and Intensive
Care Unit, ASST G.O.M. Niguarda, Milan, Italy
(Dambruoso) Cardiac Anesthesia and Intensive Care, 'Santa Maria' Hospital,
GVM Care and Research, Bari, Italy
(De Paulis) Cardiac Anesthesia, 'IRCSS Policlinico Gemelli' Hospital,
Rome, Italy
(Grazioli, Lorini) Department of Anesthesia, Critical Care and Emergency
Medicine, 'Papa Giovanni XXIII' Hospital, Bergamo, Italy
(Locatelli) Anesthesia and Postoperative Intensive Care Unit, 'Fondazione
IRCCS Policlinico San Matteo' Hospital, Pavia, Italy
(Paparella) Department of Medical and Surgical Science, University of
Foggia, Foggia, Italy
(Paparella) Cardiac Surgery, 'Santa Maria' Hospital, GVM Care and
Research, Bari, Italy
(Salvi) Department of Anaesthesia & ICU, IRCCS Centro Cardiologico
Monzino, Milan, Italy
(Tonetti) Department of Medical and Surgical Sciences (DIMEC), Alma Mater
Studiorum University of Bologna, Bologna, Italy
(Tritapepe) Cardiac Anesthesia, 'Umberto 1' Hospital, Sapienza University
of Rome, Rome, Italy
(Tritapepe) Department of Anesthesia and Intensive Care Medicine, 'San
Camillo' Hospital, Rome, Italy
(Ranieri) University of Bari (VMR), Department of Anesthesia and Critical
Care, Policlinico di Bari, Bari, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Pulmonary complications, including atelectasis and
reintubation, are common after cardiac surgery and are associated with
increased morbidity and mortality. Postoperative continuous positive
airway pressure (CPAP) may reduce these risks, but its effectiveness
remains uncertain. OBJECTIVES To assess whether CPAP reduces the need for
reintubation in hypoxaemic patients after cardiac surgery, and to evaluate
its effect on other postoperative pulmonary complications. DESIGN
Multicentre, open-label, randomised clinical trial. The study was
prematurely terminated due to funding constraints, leading to an
underpowered sample. SETTING Ten university-affiliated hospitals across
Italy. PATIENTS Adults undergoing cardiac surgery with cardiopulmonary
bypass who developed a P<inf>a</inf>O<inf>2</inf>/FiO<inf>2</inf> ratio
200 or less within 1 h of extubation. Exclusion criteria included severe
COPD, previous mechanical ventilation and lack of consent. MAIN OUTCOME
MEASURES The primary endpoint was reintubation within 28 days of surgery.
Secondary endpoints included atelectasis, pneumonia, sepsis, mortality and
oxygenation. RESULTS The incidence of reintubation was 10.8% (95%
confidence interval [CI], 6.52 to 15.15) in the control group and 8.3%
(95% CI, 4.51 to 12.16) in the treatment group (P = 0.3908). In contrast,
the occurrence of atelectasis was significantly higher in the control
group at 24.1% (95% CI, 18.20 to 30.07) compared with 14.2% (95% CI, 9.38
to 19.05) in the treatment group (P = 0.0110). At 48 h, the incidence of
reintubation was significantly lower in the CPAP group 2.94% (95% CI, 0.60
to 5.28) compared with the control group, 7.39% (95% CI, 3.76 to 11.02), P
= 0.0425. No significant differences in pneumonia, sepsis or mortality
were observed. CPAP significantly improved oxygenation (P < 0.0001).
CONCLUSION CPAP did not significantly reduce 28-day reintubation rates
compared with oxygen therapy via Venturi mask. However, CPAP was
associated with a significant reduction in atelectasis and early
reintubation at 48 h. Further research is warranted to confirm these
findings and compare CPAP with other noninvasive support strategies. TRIAL
REGISTRATION ClinicalTrials.gov Identifier: NCT01726140.<br/>Copyright
&#xa9; 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

<74>
Accession Number
2039490866
Title
Intercostal cryoanalgesia for acute pain after video-assisted thoracic
surgery lung resection: A randomized controlled preliminary trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2025.
Date of Publication: 2025.
Author
Koliakos E.; Overbeek C.; Guay J.; Zaouter C.; Jamous J.A.; Nasir B.;
Liberman M.; Abdulnour E.; Ghosn P.; Frigault E.; Glorion M.; Williams S.;
Ferraro P.; Moore A.
Institution
(Koliakos, Nasir, Liberman, Abdulnour, Ghosn, Frigault, Ferraro) Division
of Thoracic Surgery, Centre Hospitalier de l'Universite de Montreal,
Montreal, Quebec, Canada
(Overbeek, Guay, Zaouter, Jamous, Williams, Moore) Department of
Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Montreal,
Quebec, Canada
(Glorion) Department of Thoracic Surgery and Lung Transplantation, Foch
Hospital, Suresnes, France
Publisher
Elsevier Inc.
Abstract
Objective: Video-assisted thoracoscopic surgery (VATS) is associated with
significant postoperative pain. Multimodal analgesia, including
single-shot paravertebral blocks, is widely used but provides limited
analgesic duration. Intercostal cryoanalgesia, which offers prolonged pain
relief, presents a promising adjunctive option. This study aimed to assess
the analgesic benefit of intercostal cryoanalgesia in VATS lung cancer
surgery. The primary outcome was thoracic pain during cough 24 hours
postsurgery, measured via a verbal numerical rating scale. <br/>Method(s):
In a randomized, double-blind, controlled trial, 80 patients undergoing
VATS lobectomy for lung cancer were assigned to either a control group
receiving standard multimodal analgesia with single-shot paravertebral
blocks or a cryoanalgesia group receiving additional transpleural
intercostal cryoanalgesia (Cryoprobe; Erbe). Thoracic pain at rest and
during cough was evaluated at multiple time points up to 6 months
postoperatively. Secondary outcomes included quality of recovery, oral
morphine equivalents consumption, side effects, thoracic sensory loss (Von
Frey filament), and neuropathic pain (Douleur neuropathique 4 score).
<br/>Result(s): Thoracic verbal numerical rating scale during cough at 24
hours showed no significant difference between groups (4.7 +/- 2.7 vs 4.8
+/- 2.9; P = .78). Pain scores, quality of recovery, opioid consumption,
side effects, Douleur neuropathique 4 scores, and sensory loss incidence
were comparable over 7 days. Pain scores during cough were significantly
higher 1 month after surgery (4.7 +/- 2.4 vs 3.4 +/- 2.0; P = .036) but
not at 3-month and 6-month follow-up. <br/>Conclusion(s): In this
double-blind trial, measurable cryoanalgesia was not observed in the
treatment group during cough at 24 hours post-VATS, nor was measurable
thoracic sensory loss or improved acute or chronic recovery
outcomes.<br/>Copyright &#xa9; 2025 The American Association for Thoracic
Surgery

<75>
Accession Number
647771002
Title
The Role of Artificial Intelligence in the Advancement of Mechanical
Circulatory Support: A Systematic Review.
Source
ASAIO Journal. Conference: 71st Annual Meeting of the American Society for
Artificial Internal Organs, ASAIO 2025. New Orleans, LA United States.
71(Supplement 3) (pp 149), 2025. Date of Publication: 01 May 2025.
Author
Woodland E.R.; Matlis G.C.; Palazzolo T.C.; Throckmorton A.L.
Institution
(Woodland, Matlis, Palazzolo, Throckmorton) Biomedical Engineering, Drexel
University, School of Biomedical Engineering, Science, and Health Systems,
North Wales, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In recent years, there has been a notable surge in the ability
of machines to perform complex and intelligent human-centered tasks,
particularly within the domain of cardiovascular health. Transformative
advancements in artificial intelligence (AI) and machine learning (ML)
algorithms reflect the tremendous potential for such analyses to
meaningfully extend into design, translational development, and clinical
usage of medical devices, including mechanical circulatory support (MCS)
therapies. Here, we investigate and report the devices, applications,
limitations, and strategies in which AI is currently being employed in MCS
and the new opportunities of AI approaches to transform the field of MCS.
<br/>Method(s): To effectively assess the scope and impact of AI in MCS,
we conducted a systematic literature review. A comprehensive search of
four recognized research databases (Google Scholar, OVID Medline,
ProQuest, and PubMed) was performed using the following Boolean string:
"(Artificial Intelligence) AND AI AND (Mechanical Circulatory Support) AND
MCS NOT (Heart Transplant) NOT (Cardiogenic Shock) NOT (Critical Care)."
This strategy was designed to identify the application of AI in MCS only.
Database search results were then screened by titles and abstracts to
remove sources that could be identified as beyond the scope of the review
or as duplicates. 271 of the 295 papers were removed during the screening
process, leaving 24 remaining. These were reviewed in their entirety.
<br/>Result(s): The majority of relevant publications covered two main
subjects: the prediction and management of postoperative outcomes, and the
development of personalized device-patient matching and timing. AI
modeling has been instrumental in successful predictions of complications,
recovery trajectories, and long-term survival. It has also been employed
to inform clinical decision-making. Barriers to broad implementation of AI
include the need for sizable, high-quality datasets to achieve algorithm
training benchmarks, the lack of organized and incomplete databases, such
as INTERMACS, and limited computational resources. Emerging frontiers of
MCS recognize the potential for AI and ML techniques to refine and improve
image recognition capabilities, diagnostic assessment, device placement,
and post-implantation monitoring approaches in the future.
<br/>Conclusion(s): AI-driven advancements demonstrate a promising
convergence of computational power and clinical expertise, offering
personalized, efficient, and informed clinical management of MCS patients.
In order to realize broad implementation, we must overcome challenges and
address limitations, including data integrity, model accuracy, resource
access, and clinical acceptance.

<76>
Accession Number
2035157880
Title
Intracardiac echocardiography versus transesophageal echocardiography
guidance on left atrial appendage occlusion in patients with atrial
fibrillation: A systematic review and meta-analysis.
Source
Journal of Arrhythmia. 41(4) (no pagination), 2025. Article Number:
e70115. Date of Publication: 01 Aug 2025.
Author
Khan U.; Amin A.M.; Majeed Z.; Khan M.H.; Shaaban Abdelgalil M.; Mubariz
M.; Ramadan S.; Imran M.; Raza A.; Rehman M.N.U.; Bukhari S.H.Z.; Asif
A.T.; Gunjial F.H.; Ali J.; Nawaz A.
Institution
(Khan) Division of Cardiology, University of Maryland School of Medicine,
Baltimore, MD, United States
(Amin) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Majeed, Asif, Gunjial) Department of Medicine, King Edward Medical
University, Lahore, Pakistan
(Khan) Department of Medicine, Saidu Medical College, Swat, Pakistan
(Shaaban Abdelgalil, Ramadan) Faculty of Medicine, Ain Shams University,
Cairo, Egypt
(Mubariz) Department of Medicine, Akhtar Saeed Medical College, Lahore,
Pakistan
(Imran) Department of Medicine, University College of Medicine and
Dentistry, The University of Lahore, Lahore, Pakistan
(Raza) Department of Medicine, Services Institute of Medical Sciences,
Lahore, Pakistan
(Rehman) Department of Medicine, Mayo Hospital, Lahore, Pakistan
(Bukhari) Clinical Development Fellow, King's Mill Hospital Sherwood
Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom
(Ali) Department of Medicine, Saint Peter's University Hospital, New
Brunswick, NJ, United States
(Nawaz) Department of Radiology, Pakistan Atomic Energy Commission
Hospital, Islamabad, Pakistan
Publisher
John Wiley and Sons Inc
Abstract
Background: Intracardiac echocardiography (ICE) is an innovative technique
that has emerged as an alternative to transesophageal echocardiography
(TEE) to guide the implantation of a left atrial appendage occlusion
(LAAO) device in patients with nonvalvular atrial fibrillation (AF) who
cannot tolerate anticoagulants. <br/>Purpose(s): We aim to review the
clinical efficacy and safety of ICE compared to TEE to guide the
implantation of LAAO devices in patients with AF. <br/>Method(s): We
conducted comprehensive searches across PubMed, CENTRAL, Web of Science,
Scopus, and EMBASE until March 2024. Pooled data were reported using risk
ratio (RR) for dichotomous outcomes and mean difference (MD) for
continuous outcomes, along with a 95% confidence interval (CI). This
systematic review and meta-analysis was registered with PROSPERO ID:
CRD42024542537. <br/>Result(s): We included 19 studies involving 44,706
patients. ICE was associated with a statistically significant high
procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006,
1.0104], p = 0.01), but there was no difference in procedure duration (MD:
3.07 with 95% CI [-4.67, 10.80], p = 0.44) between the two groups.
However, compared to the ICE group, patients undergoing LAAO under TEE
guidance required more than one device more often (RR: 1.39 with 95% CI
[1.23, 1.57], p < 0.01). The TEE group also reported a reduced incidence
of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI
[0.50, 0.85], p < 0.01). <br/>Conclusion(s): Our meta-analysis concluded
that ICE can be a viable alternative to TEE for guiding LAAO, particularly
in patients unsuitable for general anesthesia. It can also reduce the need
for GA and adverse effects and resources associated with it, require fewer
devices, and demonstrate comparable safety and efficacy outcomes, though
it may increase the risk of pericardial effusion. Further prospective
trials are warranted.<br/>Copyright &#xa9; 2025 The Author(s). Journal of
Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of
Japanese Heart Rhythm Society.

<77>
Accession Number
647785712
Title
Permanent pacemaker implantation following mitral valve surgery.
State-of-the-art scoping review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 26 Jun 2025.
Author
Finke J.; Pasierski M.; Dabrowski E.J.; Kurasz A.; Braczkowski J.;
Drzazdzynska A.; Benny A.; Kozlowski L.; Pawelczak K.; Stec S.; Kuzma L.;
Urbanowicz T.; Lorusso R.; Suwalski P.; Kowalewski M.
Institution
(Finke, Pasierski, Stec, Kuzma, Suwalski, Kowalewski) Department of
Cardiac Surgery and Transplantology, National Medical Institute of the
Ministry of Interior and Administration, Warsaw, Poland
(Finke, Pasierski, Kuzma, Kowalewski) Thoracic Research Centre, Collegium
Medicum Nicolaus Copernicus University, Innovative Medical Forum,
Bydgoszcz, Poland
(Dabrowski, Kurasz, Kuzma) Department of Invasive Cardiology, Medical
University of Bialystok, Bialystok, Poland
(Braczkowski, Drzazdzynska, Benny, Kozlowski, Pawelczak) Collegium Medicum
Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz,
Poland
(Stec) Institute for Cardiovascular Science, CardioMedicum Medical Centre,
Cracow, Poland
(Urbanowicz) Cardiac Surgery and Transplantology Department, Poznan
University of Medical Sciences, Poznan, Poland
(Lorusso, Kowalewski) Cardio-Thoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre (MUMC),
Cardiovascular Research Centre Maastricht (CARIM), Maastricht, Netherlands
Abstract
OBJECTIVES: This scoping review investigates the prevalence, indications,
risk factors, timing, and outcomes related to permanent pacemaker
implantation following mitral valve surgery. <br/>METHOD(S): A
comprehensive search of PubMed, Embase, and Cochrane databases was
conducted to identify studies on permanent pacemaker implantation after
mitral valve surgery. Relevant articles discussing prevalence,
indications, risk factors, optimal timing, device choice, and long-term
dependency were included, prioritizing clinical studies and reviews
published in the last two decades. <br/>RESULT(S): The incidence of
permanent pacemaker implantation after isolated mitral valve surgeries
varies from 1% to 10%, with observation periods ranging from 2 to 12 days
across centers. Atrioventricular block is the most common indication. Risk
factors include older age, atrial fibrillation, reduced left ventricular
function, and prior cardiac surgery. Patients undergoing mitral valve
replacement face a higher risk compared to those having mitral valve
repair, while minimally invasive surgery and left atriotomy approach are
linked to a lower permanent pacemaker rate. Long-term pacemaker dependency
ranges between 20% to 60%, with increased rates observed in patients with
atrioventricular block or those operated in the setting of infective
endocarditis. <br/>CONCLUSION(S): This review highlights the complex
interplay of factors influencing permanent pacemaker implantation after
mitral valve surgery. Future research should focus on strategies to reduce
postoperative conduction abnormalities and better identify patients who
may require PPM during long-term follow-up.<br/>Copyright &#xa9; The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<78>
Accession Number
647783884
Title
Multimodal Analgesia and Enhanced Recovery Outcomes in Cardiac Surgical
Patients: An Observational Cohort Study.
Source
Anesthesia and analgesia. (no pagination), 2025. Date of Publication: 25
Jun 2025.
Author
Kleiman A.M.; Tsang S.; Walters S.M.; McNeil J.S.; Yarboro L.; Wu I.;
Kertai M.D.; Glance L.; Mazzeffi M.A.
Institution
(Kleiman, Tsang, Walters, McNeil, Mazzeffi) From the Department of
Anesthesiology, University of Virginia School of Medicine,
Charlottesville, VA, United States
(Yarboro) Department of Surgery, Division of Cardiothoracic Surgery,
University of Virginia School of Medicine, Charlottesville, VA, United
States
(Wu, Glance) Department of Anesthesiology, University of Rochester School
of Medicine, Rochester, NY, United States
(Kertai) Department of Anesthesiology, Vanderbilt University School of
Medicine, Nashville, TN, United States
Abstract
BACKGROUND: Multimodal analgesia, the use of more than 1 pharmacologic
agent targeting different receptors, is a cornerstone of enhanced recovery
after cardiac surgery (ERACS), but there are limited studies to support
its efficacy. We aimed to explore associations between multimodal
analgesia and enhanced recovery outcomes after cardiac surgery.
<br/>METHOD(S): We performed a retrospective cohort study using data from
the Society of Thoracic Surgeons database from 2020 to 2023. Adults
undergoing elective coronary artery bypass grafting (CABG), valve, or
combined CABG-valve surgery were included. Our primary hypothesis was that
multimodal analgesia would be associated with a lower maximum
postoperative pain score on postoperative day 3 (POD3). Secondarily, we
hypothesized that multimodal analgesia would be associated with reduced
mechanical ventilation hours, intensive care unit stay, delirium,
pneumonia, and reintubation. Linear mixed-effects regression models and
generalized linear mixed-effects regression models were used to examine
the extent the use of multimodal analgesia was associated with study
outcomes after controlling for confounders. <br/>RESULT(S): Over the
4-year study period, there were 17,371 eligible cardiac surgical cases and
15,515 patients (89.3%) received multimodal analgesia. There was no
association between multimodal analgesia use and maximum postoperative
pain score on POD3 (b = -0.07, 95% confidence interval [CI], -0.32 to
0.18, P = .57), after adjusting for confounders. There was an association
between multimodal analgesia use and initial mechanical ventilation hours
(b = 0.45 hours, 95% CI, 0.04-0.86, P = .03). Compared to patients who
received multimodal analgesia, those who did not receive multimodal
analgesia had approximately 30 minutes longer of initial mechanical
ventilation time on average. Initial mechanical ventilation time decreased
as the number of multimodal analgesic increased (b= -0.33 hours, 95% CI,
-76 to -0.10, P = .14) for 1 multimodal analgesic; Est = -1.98 hours, 95%
CI, -3.79 to -0.18, P = .03 for 5 multimodal analgesics). Acetaminophen
use was associated with a reduced likelihood of delirium (odds ratio [OR]
= 0.75, 95% CI, 0.57-0.94, P = .02), while use of a regional nerve block
was associated with increased likelihood of unplanned reintubation (OR =
1.59, 95% CI, 1.12-2.27, P = .01). <br/>CONCLUSION(S): In this
retrospective study, multimodal analgesia was not associated with the
primary outcome of reduction in maximum pain score but was associated with
more rapid extubation. Larger prospective observational and randomized
controlled trials of individual analgesic drugs are needed to optimize
ERACS protocols.<br/>Copyright &#xa9; 2025 International Anesthesia
Research Society.

<79>
Accession Number
647769533
Title
Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A
Randomized Noninferiority Trial.
Source
JAMA surgery. (no pagination), 2025. Date of Publication: 25 Jun 2025.
Author
Spaans L.N.; Dijkgraaf M.G.W.; Susa D.; de Loos E.R.; Mourisse J.M.J.;
Bouwman R.A.; Verhagen A.F.T.M.; van den Broek F.J.C.; Meijer P.; Kuut M.;
Hanneman N.; Bousema J.; Franssen A.; Brokx H.; van Duyn E.; Potters
J.-W.; van den Broek R.; van Brakel T.; Rijna H.; Boom A.; Noyez V.;
Hendriks J.M.H.; Yogeswaran S.K.; Dickhoff C.; van Dorp M.
Institution
(Spaans, van den Broek) Department of Surgery, Maxima Medical Center,
Veldhoven, Netherlands
(Spaans, Dijkgraaf) Amsterdam UMC location University of Amsterdam,
Epidemiology and Data Science, Amsterdam, Netherlands
(Dijkgraaf) Amsterdam Public Health, Methodology, Amsterdam, Netherlands
(Susa, Brokx) Department of Surgery, Bravis Hospital, Bergen op Zoom,
Roosendaal, the Netherlands
(de Loos, Franssen) Division of General Thoracic Surgery, Department of
Surgery, Zuyderland Medical Center, Heerlen, Netherlands
(Mourisse, Kuut) Department of Anesthesia, Pain and Palliative Medicine,
Radboud University Medical Center, Nijmegen, Netherlands
(Bouwman, van den Broek) Department of Anesthesiology and Pain Medicine,
Catharina Hospital, Eindhoven, Netherlands
(Bouwman) Department of Electrical Engineering, Signal Processing Systems,
Eindhoven Technical University, Eindhoven, Netherlands
(Verhagen) Department of Cardio-thoracic Surgery, Radboud University
Medical Center, Nijmegen, Netherlands
(Meijer) Department of Anaesthesiology, Maxima Medical Center, Veldhoven,
Netherlands
(Hanneman, Bousema) Department of Surgery, Ikazia Hospital, Rotterdam,
Netherlands
(van Duyn) Department of Surgery, Medisch Spectrum Twente, Enschede,
Netherlands
(Potters) Department of Anesthesiology, Medisch Spectrum Twente, Enschede,
Netherlands
(van Brakel) Department of Cardiothoracic Surgery, Catharina Hospital,
Eindhoven, Netherlands
(Rijna) Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
(Boom) Department of Anesthesiology, Spaarne Gasthuis, Hoofddorp,
Netherlands
(Noyez) Department of Surgery, Algemeen Ziekenhuis Sint-Maarten, Mechelen,
Belgium
(Hendriks, Yogeswaran) Department of Vascular and Thoracic Surgery,
Antwerp University Hospital, Antwerp, Belgium
(Dickhoff, van Dorp) Department of Cardiothoracic Surgery, Amsterdam UMC
Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Abstract
Importance: Effective pain control after thoracic surgery is crucial for
enhanced recovery. While thoracic epidural analgesia (TEA) traditionally
ensures optimal analgesia, its adverse effects conflict with the
principles of enhanced recovery after thoracic surgery. High-quality
randomized data regarding less invasive alternative locoregional
techniques are lacking. <br/>Objective(s): To evaluate the efficacy of
continuous paravertebral block (PVB) and a single-shot intercostal nerve
block (ICNB) as alternatives to TEA. <br/>Design, Setting, and
Participant(s): This randomized clinical trial compared PVB and ICNB vs
TEA (1:1:1) in patients undergoing thoracoscopic anatomical lung resection
at 11 hospitals in the Netherlands and Belgium, enrolled from March 5,
2021, to September 5, 2023. The study used a noninferiority design for
pain and a superiority design for quality of recovery (QoR).
<br/>Intervention(s): Continuous PVB and single-shot ICNB. <br/>Main
Outcomes and Measures: Primary outcomes were pain, defined as mean
proportion of pain scores 4 or greater during postoperative days (POD) 0
through 2 (noninferiority margin for the upper limit [UL] 1-sided 98.65%
CI, 17.5%), and QoR, assessed with the QoR-15 questionnaire at POD 1 and
2. Secondary measures included opioid consumption, mobilization,
complications, and hospitalization. <br/>Result(s): A total of 450
patients were randomized, with 389 included in the intention-to-treat
(ITT) analysis (mean [SD] age, 66 [9] years; 208 female patients [54%] and
181 male [46%]). Of these 389 patients, 131 received TEA, 134 received
PVB, and 124 received ICNB. The mean proportions of pain scores 4 or
greater were 20.7% (95% CI, 16.5%-24.9%) for TEA, 35.5% (95% CI,
30.1%-40.8%) for PVB, and 29.5% (95% CI, 24.6%-34.4%) for ICNB. While PVB
was inferior to TEA regarding pain (ITT: UL, 22.4%; analysis per-protocol
[PP]: UL, 23.1%), ICNB was noninferior to TEA (ITT: UL, 16.1%; PP: UL,
17.0%). The mean (SD) QoR-15 scores were similar across groups: 104.96
(20.47) for TEA, 106.06 (17.94; P = .641) for PVB (P = .64 for that
comparison), and 106.85 (21.11) for ICNB (P = .47 for that comparison).
Both ICNB and PVB significantly reduced opioid consumption and enhanced
mobility compared with TEA, with no significant differences in
complications. Hospitalization was shorter in the ICNB group.
<br/>Conclusions and Relevance: After thoracoscopic anatomical lung
resection, only ICNB provides noninferior pain relief compared with TEA.
ICNB emerges as an alternative to TEA, although risks and benefits should
be weighed for optimal personalized pain control. Trial Registration:
ClinicalTrials.gov Identifier: NCT05491239.

<80>
Accession Number
2035196555
Title
Predictors of Post-TAVR Left Bundle Branch Block: A Systematic Review and
Meta-Analysis.
Source
Journal of Cardiovascular Electrophysiology. (no pagination), 2025. Date
of Publication: 2025.
Author
Alzu'bi H.; Rmilah A.A.; Bahmad H.F.; Urina-Jassir D.; Elajami M.K.;
Rogers E.; Elgozair M.; Ghssein G.; Salami A.; Welty F.K.; Escolar E.;
Mihos C.G.; Beohar N.; Elajami T.K.
Institution
(Alzu'bi, Escolar, Elajami) Columbia University Division of Cardiology,
Mount Sinai Heart Institute, Miami Beach, FL, United States
(Rmilah, Elgozair) Department of Cardiology, Mayo Clinic, Rochester, MN,
United States
(Rmilah) Department of Internal Medicine, Magnolia Regional Health Center,
Corinth, MS, United States
(Bahmad) Department of Pathology and Laboratory Medicine, University of
Miami Miller School of Medicine, Miami, FL, United States
(Urina-Jassir) Department of Cardiology, John W. Deming Department of
Medicine, Tulane University School of Medicine, New Orleans, LA, United
States
(Elajami, Rogers) Department of Internal Medicine, Mount Sinai Medical
Center, Miami Beach, FL, United States
(Ghssein) Department of Biology, Faculty of Sciences, Lebanese University,
Nabatieh, Lebanon
(Salami) Department of Mathematics, Faculty of Sciences, Lebanese
University, Nabatieh, Lebanon
(Welty) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Mihos, Elajami) Echocardiography Laboratory, Columbia University Division
of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
(Beohar) Cardiac Catheterization Laboratory, Columbia University Division
of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, United States
Publisher
John Wiley and Sons Inc
Abstract
Left bundle branch block (LBBB) is the most common conduction abnormality
following transcatheter aortic valve replacement (TAVR) and has been
associated with adverse clinical outcomes. While multiple predictors of
post-TAVR LBBB have been proposed, data remain limited. This systematic
review and meta-analysis aims to identify and summarize predictors of
new-onset LBBB post-TAVR. A systematic literature search was performed to
identify studies that reported predictors of new-onset post-TAVR LBBB.
Extracted data included patient factors, electrocardiographic (ECG) and
anatomic parameters, and device-related factors. A random-effects model
was used to calculate crude risk ratios (RRs), mean differences, and 95%
confidence intervals (CI) of the predictors. Of 450 articles screened, 17
studies comprising a total of 6357 patients were included. Among these,
26.4% developed post-TAVR LBBB. Increased risk was associated with
diabetes mellitus (RR: 1.22, p < 0.001), use of 29-mm valve (RR: 1.59, p <
0.001), and use of Medtronic CoreValve (MCV) (RR: 2.25, p = 0.008).
Significant differences were found between patients with and without LBBB
in interventricular septal thickness (IVS; by -0.66 mm), membranous septal
length (MSL; by -0.9 mm), left ventricular outflow tract (LVOT) diameter
(by -0.48 mm), PR interval (by +13.95 ms), and prosthesis implantation
depth (by +2.6 mm). Diabetes Mellitus, use of 29-mm valve or MCV,
decreased IVS thickness, shorter MSL, smaller LVOT diameter, increased
prosthesis implantation depth, and prolonged PR duration were all
associated with an elevated risk of post-TAVR LBBB. Early identification
of these predictors may help reduce the risk of conduction abnormalities
after TAVR.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<81>
Accession Number
647768472
Title
Comment on "Hypotension after induction of anesthesia with remimazolam or
etomidate: a non-inferiority randomized controlled trial in patients
undergoing coronary artery bypass grafting".
Source
Korean journal of anesthesiology. (no pagination), 2025. Date of
Publication: 24 Jun 2025.
Author
Toker M.K.; Altiparmak B.
Institution
(Toker, Altiparmak) Mugla Sitki Kocman University, Faculty of Medicine
Department of Anesthesiology and Reanimation, Mugla, Turkey

<82>
Accession Number
647770972
Title
Prognostic significance of right bundle branch block after heart
transplantation: a systematic review and meta-analysis.
Source
ASAIO Journal. Conference: 71st Annual Meeting of the American Society for
Artificial Internal Organs, ASAIO 2025. New Orleans, LA United States.
71(Supplement 3) (pp 145), 2025. Date of Publication: 01 May 2025.
Author
Mostafa N.; Almaadawy O.; Elshahat A.; Dervis M.; Hamed B.; Soliman E.;
Mostafa H.A.; Elbenawi H.; Ahmed M.M.
Institution
(Ahmed) Cardiovascular Medicine, University of Florida, Gainesville, FL,
United States
(Mostafa) Ain Shams University, Cairo, Egypt
(Almaadawy) MEdStar Health, Baltimore, MD, United States
(Elshahat, Hamed, Mostafa) Al-Azhar University, Cairo, Egypt
(Dervis) Ankara Yilidirim Beyazit University, Ankara, Turkey
(Soliman) Zagazig University, Zagazig, Egypt
(Elbenawi) Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Right bundle branch block (RBBB) ranks as one of the most
common conduction abnormalities following heart transplantation. However,
the impact of RBBB on post-heart transplantation outcomes is not yet well
established. Our study aims to compare the outcomes of heart transplant
recipients with new RBBB and those without RBBB Methods: PubMed, Scopus,
Web of Science, and Cochrane Library were searched up to 12 October 2024.
The outcomes of interest were mortality, acute graft rejection, and
chronic graft rejection. The dichotomous outcomes were pooled as odd ratio
(OR) with 95% Confidence interval (CI) using a random-effects model. All
statistical analysis was performed using the STATA software.
<br/>Result(s): Seven studies incorporating 1392 patients were included in
our meta-analysis. Our pooled analysis did not favor either the RBBB group
or the non-RBBB group in terms of mortality (OR = 1.93, 95% CI [0.89 to
4.21], P = 0.10). The subgroup analysis based on patients with RBBB and
QRS duration >=120 milliseconds also did not favor either of the groups
(OR = 1.81, 95% CI [0.51 to 6.44], P = 0.36). In the same context, the
pooled OR did not prefer either of the two groups in terms of acute
rejection (OR = 1.04, 95% CI [0.64 to 1.69], P = 0.87) or chronic
rejection (OR = 0.96, 95% CI [0.52 to 1.78], P = 0.89) [Figure 1].
<br/>Conclusion(s): New-onset RBBB is a prevalent complication following
heart transplantation, but it has no statistically significant impact on
mortality or graft rejection. Further research with large-scale studies
focusing on standardizing the population characteristics, timing of RBBB
detection, and the definition of RBBB is recommended to support our
results. (Figure Presented).

<83>
Accession Number
647787766
Title
Comment on "Exercise-based cardiac rehabilitation for patients undergoing
coronary artery operation: a systematic review and meta-analysis based on
current randomized controlled trials".
Source
International journal of surgery (London, England). (no pagination),
2025. Date of Publication: 25 Jun 2025.
Author
Yan J.; Wei J.
Institution
(Yan) Department of Cardology, Sanya People's Hospital, West China (Sanya)
Hospital, Hainan, China
(Wei) Department of Cardology, Dongying People's Hospital, Shandong, China

<84>
Accession Number
647770915
Title
Predictors of new-onset right bundle branch block after heart
transplantation: a systematic review and meta-analysis.
Source
ASAIO Journal. Conference: 71st Annual Meeting of the American Society for
Artificial Internal Organs, ASAIO 2025. New Orleans, LA United States.
71(Supplement 3) (pp 136), 2025. Date of Publication: 01 May 2025.
Author
Mostafa N.; Almaadawy O.; Hamed B.; Dervis M.; Asad A.; Zreigh S.; Mostafa
H.A.; Elbenawi H.; Ahmed M.M.
Institution
(Ahmed) Cardiovascular Medicine, University of Florida, Gainesville, FL,
United States
(Mostafa) Ain Shams University, Cairo, Egypt
(Almaadawy) MedStar Health, Baltimore, MD, United States
(Hamed, Mostafa) Al Azhar University, Cairo, Egypt
(Dervis, Asad, Zreigh) Ankara Yilidirim Beyazit University, Ankara, Turkey
(Elbenawi) Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United
States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: New right bundle branch block (RBBB) has a high prevalence
among heart transplant recipients with several studies finding an
association between RBBB and poor clinical outcomes. Crucially, the
predictors of RBBB development after heart transplantation are not yet
well established. Our study aims to evaluate the pre-operative hemodynamic
and demographic predictors associated with increased risk of new-onset
RBBB following heart transplantation. <br/>Method(s): A systematic
literature search was conducted on PubMed, Scopus, Web of Science, and
Cochrane Library to identify studies comparing heart transplant patients
with RBBB and without RBBB from inception to 15 November 2024.
Random-effects models were used to estimate the pooled mean difference
with 95% confidence interval (CI) using OpenMeta[Analyst] software.
<br/>Result(s): Seven studies incorporating 1310 patients were included in
our meta-analysis. Compared to patients who did not develop conduction
abnormalities, patients who developed RBBB had significantly higher graft
ischemia time (mean difference 10.0; 95% CI: 2.00 - 17.91; P = 0.01) and
pulmonary vascular resistance (mean difference 0.44; 95% CI: 0.21 - 0.68;
P < 0.001) at preoperative catheterization. There was no difference
between the two groups in terms of preoperative mean pulmonary artery
pressure (mean difference 1.83; 95% CI: -0.86 - 4.53; P = 0.18) or the
mean age of donors (mean difference 1.51; 95% CI: -0.30 - 3.31; P = 0.10)
[Figure 1]. There was no statistically significant heterogeneity between
the studies. <br/>Conclusion(s): Our meta-analysis identified that
patients with RBBB after heart transplantation had a prolonged graft
ischemia time and higher pulmonary vascular resistance. There was no
association between RBBB and mean pulmonary artery pressure or donor age.
Larger-scale studies on the pre-operative hemodynamics present before
heart transplantation are needed to support our findings and exclude the
impact of possible confounders. (Figure Presented).

<85>
Accession Number
647782469
Title
Long-term Support Using Surgically Implanted Impella Devices.
Source
Interventional Cardiology: Reviews, Research, Resources. Conference: 4th
Annual Acute Cardiac Unloading and REcovery (A-CURE). Paris France. 14(3
Supplement 2) (pp 17-18), 2019. Date of Publication: 2019.
Author
Bernhardt A.M.
Institution
(Bernhardt) University Heart and Vascular Center, Hamburg, Germany
Publisher
Radcliffe Medical Media
Abstract
Dr Bernhardt began by reminding the audience of the features of the
Impella 5.0. This device is an established transaortic axial flow
ventricular assist device capable of providing forward blood flow of up to
5 l/min. It was originally designed for femoral access, but axillary
access is increasingly used, as it allows for mobilisation of the patient.
Recently, a published meta-analysis of Impella 5.0 reported favourable
survival outcomes and high rates of myocardial recovery in patients with
cardiogenic shock.1 The clinical uses of the surgically implanted Impella
5.0 include haemodynamic support for cardiogenic shock, safer weaning from
extracorporeal membrane oxygenation (ECMO) devices, bridge-tobridge
(pre-left ventricular assist device and pre-heart transplant),
bridge-to-recovery (myocarditis and peripartum cardiomyopathy) and
controlled post-cardiotomy (mitral/aortic valve surgery, coronary artery
bypass graft [CABG]/off-pump CABG with ejection fraction <20%). Impella
5.0 has CE approval in Europe for a maximum 10 days of support. However,
>70% of patients at Dr Bernhardt's hospital require Impella 5.0 support
for >10 days. Potential problems associated with longer duration of
Impella 5.0 support include in-growth of the pigtail catheter, pump
thrombosis and arterial embolisation, due to the presence of a
repositioning sheath in the axillary artery. The Impella 5.5 was developed
to address both the need for a longer duration of support and to avoid the
complications associated with the Impella 5.0. It is designed to provide
haemodynamic support for up to 30 days. Like the Impella 5.0, the Impella
5.5 device is an axial flow transaortic cardiac support device mounted on
a 9 Fr steering catheter with a 21 Fr pump cannula. The pump itself is
shorter and stiffer than the Impella 5.0. Other improved features in the
Impella 5.5 include an optical aortic pressure sensor distal to the
outflow of the device and no pigtail at the tip of the catheter
(eliminating the risk for in-growth of the pigtail and reducing the risk
of thromboembolism and stroke) and improved kink resistance of the
cannula. Importantly, the device provides a higher maximum pump flow of up
to 5.8 l/min. The device is designed for axillary insertion and the
repositioning sheath does not extend into the artery. In addition,
modification of the motor size (37% shorter motor housing and the outlet
area) improves deliverability. Other modifications in the motor include a
modified interior for long-term durability and low purge flows. Dr
Bernhardt mentioned that the first-in-man experience with the new Impella
5.5 in two critically ill patients was performed at his institution.2 His
experience is that the device is easier to implant and reposition. Until
April 2019, a total of 32 patients at five German hospitals received
Impella 5.5, with a survival rate of 68%. Dr Bernhardt presented the case
of a 63-year-old man receiving Impella 5.5 for post-cardiotomy failure. He
had undergone aortic valve replacement (AVR) with a biological valve about
10 years earlier. The replacement valve had deteriorated and had an aortic
valve opening of 0.8 cm2. At presentation, the patient had a left
ventricular ejection fraction (LVEF) of 26% and left ventricular
end-diastolic diameter (LVEDD) of 68 mm. The patient underwent repeat AVR
with a Perimount Magna ease valve of 23 mm. Due to the inability to wean
him off the cardiopulmonary bypass machine, the surgical team placed an
Impella 5.5. The patient was successfully extubated 4 hours after the
surgery; he was fully mobile on postoperative day 1 and Impella 5.5 was
weaned and explanted under anaesthesia on day 8. At discharge, the patient
had an LVEF of 35% and LVEDD of 60 mm. Dr Bernhardt also mentioned that
his institution was the first in Europe to use the Impella Connect, a
cloud-based, remotemonitoring platform. The Impella Connect enables
hospital clinicians and staff, along with Abiomed's clinical support team,
to view the Automated Impella Controller screen (showing ventricular
pressure and Impella alarms, if any) through a secure website, allowing
them to track, review and share that information from any internet-capable
phone, tablet or computer. He highlighted the new heart allocation system
in the US that prioritises patients supported by temporary mechanical
circulatory support (TMCS) devices, such as ECMO, over those with durable,
continuous-flow left ventricular assist devices, which may increase the
number of patients bridged to transplant with TMCS.3 Furthermore, a recent
study by Yin et al. showed that the survival is lowest among patients
bridged to transplant with ECMO compared with durable left ventricular
assist devices.4 Dr Bernhardt proposed that the Impella 5.5 device may
have beneficial outcomes after transplantation compared to ECMO, and
should be considered for the potential lower adverse events and mortality
rates during short-term device therapy on the waiting list.5 In
conclusion, the Impella 5.5 expands the spectrum of available shortterm
mechanical circulatory support devices. New technical design features,
such as the absence of pigtail, helps minimise the risk of thrombus
formation, and the optical pressure sensor aids in easy pump placement and
monitoring. Early experience with Impella 5.5 in patients shows promising
outcomes. Future direction includes the design of the long-term
bridge-to-recovery Impella heart pumps..

<86>
Accession Number
647767939
Title
Inspiratory Muscle Training Improved Cardiorespiratory Performance in
Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial.
Source
Advances in respiratory medicine. 93(3) (no pagination), 2025. Date of
Publication: 27 May 2025.
Author
Kulchanarat C.; Choeirod S.; Thadatheerapat S.; Piathip D.; Satdhabudha
O.; Yuenyongchaiwat K.
Institution
(Kulchanarat, Choeirod, Thadatheerapat) Department of Physical Therapy,
Thammasat University Hospital, Pathum Thani, Thailand
(Piathip) Cardiovascular Thoracic Intensive Care Unit (ICU CVT) Unit,
Thammasat University Hospital, Pathum Thani, Thailand
(Satdhabudha) Division of Cardiovascular Thoracic Surgery, Department of
Surgery, Thammasat University Hospital, Pathum Thani, Thailand
(Yuenyongchaiwat) Department of Physiotherapy, Faculty of Allied Health
Sciences, Thammasat University, Pathum Thani, Thailand
(Yuenyongchaiwat) Thammasat University Research Unit, Physical Therapy in
Respiratory and Cardiovascular Systems, Thammasat University Pathum,
Thailand
Abstract
AIM: This study aimed to evaluate the effects of inspiratory muscle
training on inspiratory muscle strength and cardiorespiratory performance
in patients undergoing open heart surgery. <br/>METHOD(S): This study was
conducted as a randomized controlled trial with two groups. Fifty-eight
patients who underwent open heart surgery were randomly assigned to either
the intervention group or the control group 29 in the control group and 29
in the intervention group. Patients in the intervention group participated
in a physical therapy program combined with inspiratory muscle training
using the Thammasat University (TU) Breath Trainer. Patients in the
control group received only the standard physical therapy program. The
maximum inspiratory pressure, maximum expiratory pressure and 6 min walk
test distance were assessed both before surgery and prior to hospital
discharge. <br/>RESULT(S): The intervention group had a significant
increase in maximum inspiratory pressure (p < 0.001), maximum expiratory
pressure (p < 0.001) and 6 min walk test distance (p = 0.013). The control
group had a significant decrease in maximum inspiratory pressure (p <
0.001), maximum expiratory pressure (p = 0.002) and 6 min walk test
distance (p < 0.001). <br/>CONCLUSION(S): Inspiratory muscle training can
be performed using maximum pressure resistors, such as the TU-Breath
Trainer device. This training has been shown to effectively improve
inspiratory muscle strength and cardiorespiratory performance in patients
undergoing open heart surgery, as well as reduce pulmonary complications
and shorten the length of hospital stay.

<87>
Accession Number
2035168647
Title
Protamine sulphate for heparin reversal in percutaneous cardiac
interventions: a systematic review and meta-analysis of randomized
controlled trials.
Source
Naunyn-Schmiedeberg's Archives of Pharmacology. (no pagination), 2025.
Date of Publication: 2025.
Author
Balbaa E.; Gadelmawla A.F.; Tawfik A.M.; Naeem A.; Elbataa A.; Bazzazeh
M.; Fatiem A.R.; Ali K.; Altobaishat O.; Abuelazm M.
Institution
(Balbaa, Tawfik, Bazzazeh, Fatiem) Faculty of Medicine, Alexandria
University, Alexandria, Egypt
(Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Naeem) Faculty of Medicine, Al-Azhar University, Asyut, Egypt
(Elbataa) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Ali) Internal Medicine, Rosalind Franklin University of Medicine and
Science, Chicago, United States
(Altobaishat) Faculty of Medicine, Jordan University of Science and
Technology, Irbid, Jordan
(Abuelazm) Faculty of Medicine, Tanta University, Tanta, Egypt
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Vascular complications after percutaneous cardiac interventions are a
significant cause of morbidity that affects post-procedural prognosis.
Data about the efficacy and safety of routine protamine sulphate to
prevent these complications remain scarce. Hence, we aim to assess the
efficacy and safety of routine protamine sulphate use for heparin reversal
in patients undergoing percutaneous cardiac interventions. We
systematically searched PubMed, Embase, Cochrane, Scopus, and Web of
Science for randomized controlled trials (RCTs) until September 2024. The
RCTs' quality was assessed using the Cochrane tool (RoB 2). Using R, we
pooled dichotomous outcomes using risk ratios (RR) and continuous outcomes
using mean differences (MD), both along the corresponding 95% Confidence
interval (CI). PROSPERO ID: (CRD42024593002). Six RCTs with 1,076 patients
were eligible. Hemostasis success was significantly higher in the
protamine group (RR, 1.06; 95% CI [1.01-1.10]; P = 0.01), and the length
of hospital stay was significantly shorter (MD, -0.46; 95% CI [-0.65,
-0.26]; P < 0.01). There was no significant difference between both groups
in stroke (RR, 0.60; 95% CI [0.18-2.03]; P = 0.41), major bleeding (P =
0.25), minor bleeding (P = 0.11), life-threatening bleeding (P = 0.65),
time to ambulation (P = 0.13), all-cause mortality (P = 0.92),
hematoma/pseudoaneurysm (P = 0.92), and major vascular complications (P =
0.70). While protamine improved hemostasis success, its effect on reducing
bleeding events and time to ambulation was insignificant. Also, reducing
the length of hospital stay in the protamine group highlights its
potential clinical benefit.<br/>Copyright &#xa9; The Author(s) 2025.

<88>
Accession Number
2035145315
Title
Understanding gastrointestinal bleeding in patients with cardiac disease:
an interdisciplinary approach.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2025. Date of
Publication: 2025.
Author
Gries J.J.; Virk H.U.H.; Birnbaum Y.; Jneid H.; Virani S.S.; Sharma S.;
Krittanawong C.
Institution
(Gries) Department of Internal Medicine, Geisinger Medical Center,
Danville, PA, United States
(Virk) Harrington Heart & Vascular Institute, Case Western Reserve
University, University Hospitals Cleveland Medical Center, Cleveland, OH,
United States
(Birnbaum, Jneid) Section of Cardiology, Baylor College of Medicine,
Houston, TX, United States
(Jneid) Division of Cardiology, University of Texas Medical Branch,
Houston, TX, United States
(Virani) Office of the Vice Provost (Research), The Aga Khan University,
Karachi, Pakistan
(Virani) Section of Cardiology and Cardiovascular Research, Department of
Medicine, Baylor College of Medicine, Houston, TX, United States
(Sharma) Cardiac Catheterization Laboratory of the Cardiovascular
Institute, Mount Sinai Hospital, New York, NY, United States
(Krittanawong) HumanX, Delaware, DE, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Cardiovascular disease remains the leading cause of global
mortality and a significant contributor to disability. The incidence of
gastrointestinal bleeding (GIB) varies across cardiac conditions, with
notable risks observed in patients undergoing complex antiplatelet or
anticoagulant therapy, acute coronary syndrome, hypertrophic
cardiomyopathy, percutaneous coronary interventions, mechanical cardiac
support, acute decompensated heart failure, and post-cardiac surgery.
Areas covered: A comprehensive search of the PubMed/Medline database was
conducted to retrieve articles related to GIB and cardiovascular disease
from 2014 to 2024. The authors then synthesized a narrative review that
endorses an interdisciplinary approach to this challenging paradigm,
drawing from cardiology and gastroenterology perspectives to provide a
comprehensive overview of the current understanding of the risk of GIB in
cardiac patients. Expert opinion: In acute coronary syndrome, upper GIB
significantly increases mortality risk, with early endoscopic intervention
proving beneficial. Post-coronary revascularization presents a low GIB
incidence but a high mortality rate when it occurs. Decompensated heart
failure patients frequently experience GIB due to concomitant conditions.
Cardiogenic shock and mechanical cardiac support also show notable GIB
risks, with mechanical support patients facing higher mortality. Following
transcatheter aortic valve implantation, GIB incidence is low, but
hospitalization rates are significant.<br/>Copyright &#xa9; 2025 Informa
UK Limited, trading as Taylor & Francis Group.

<89>
Accession Number
2035129901
Title
The impact of surgeon specialty and technique on outcomes after esophageal
dilation: a systematic review.
Source
Esophagus. (no pagination), 2025. Date of Publication: 2025.
Author
Wilkins S.G.; Omiunu A.; Haynes C.V.; Simmons K.; Hayashi C.; Malik D.;
Elzamzami A.; Brackett A.; Verma A.; Kohli N.
Institution
(Wilkins, Haynes, Simmons, Hayashi, Malik, Elzamzami, Verma, Kohli) Yale
University School of Medicine, 333 Cedar Street, New Haven, CT, United
States
(Omiunu, Verma, Kohli) Division of Otolaryngology-Head and Neck Surgery,
Department of Surgery, Yale University School of Medicine, New Haven, CT,
United States
(Brackett) Harvey Cushing/John Hay Whitney Medical Library, Yale
University, 333 Cedar Street, New Haven, CT, United States
Publisher
Springer
Abstract
To conduct a systematic review across four article databases to understand
whether outcomes after esophageal dilation are affected by dilator type or
physician specialty. Dilation of the upper esophagus is a commonly used
technique to manage esophageal stenosis, which most commonly manifests as
progressive dysphagia. Strictures arise from a multitude of etiologies; as
such, they are treated by a variety of specialists, including
otolaryngology, gastroenterology, and thoracic surgery. Dilations are
commonly performed using either bougienage or balloon dilators, and there
is a paucity of literature analyzing whether complications differ based on
dilator type or physician specialty. A total of 3491 abstracts were
initially screened using the Covidence reviewer platform. 433 full texts
were assessed, and 15 studies met inclusion criteria. Four studies used
balloon dilators, 8 studies used bougie dilators, and 3 studies used both
techniques. When comparing adverse events between studies using either
balloon or bougie dilators, half of each group (2/4 and 4/8) reported no
perforations. Additional adverse outcomes, such as mediastinitis or
bleeding, remained low with both bougie and balloon dilation; only one
study reported mediastinitis as a complication, and only two studies
reported significant postoperative bleeding (one bougie, one balloon).
While technical success was heterogeneously defined, all studies reported
significant improvement after dilation. While this study was limited by
data heterogeneity, adverse outcomes after esophageal dilation remain low,
regardless of dilation method or physician specialty.<br/>Copyright &#xa9;
The Author(s) under exclusive licence to The Japan Esophageal Society
2025.

<90>
Accession Number
2039465801
Title
Recurrent thrombosis in patients with mechanical prosthetic valves: 3-year
follow-up of a randomized controlled trial.
Source
Thrombosis Research. 253 (no pagination), 2025. Article Number: 109396.
Date of Publication: 01 Sep 2025.
Author
Pasebani Y.; Fashi Z.H.; Birgani A.H.; Mehdizadeh K.; Parsaee M.; Farrashi
M.; Rafati A.; Barati S.; Kohansal E.; Saedi S.; Naderi N.; Maleki M.;
Khajali Z.; De Caterina R.; Sadeghipour P.
Institution
(Pasebani, Mehdizadeh, Farrashi, Rafati, Barati, Kohansal, Naderi, Maleki,
Sadeghipour) Vascular Disease and Thrombosis Research Center, Rajaie
Cardiovascular Institute, Tehran, Iran, Islamic Republic of
(Fashi, Birgani) Rajaie Cardiovascular Medical and Research Center, School
of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Parsaee, Farrashi) Echocardiography Research Center, Rajaie
Cardiovascular Institute, Tehran, Iran, Islamic Republic of
(Rafati) Department of Neurology, Johns Hopkins University, School of
Medicine, Baltimore, MD, United States
(Saedi, Khajali) Rajaie Cardiovascular Institute, Tehran, Iran, Islamic
Republic of
(De Caterina) University of Pisa and Cardiology Division, Pisa University
Hospital, Pisa, Italy
Publisher
Elsevier Ltd

<91>
Accession Number
2039453108
Title
Effectiveness of the hypotension prediction index in non-cardiac
surgeries: a systematic review, meta-analysis and trial sequential
analysis.
Source
Brazilian Journal of Anesthesiology (English Edition). 75(5) (no
pagination), 2025. Article Number: 844649. Date of Publication: 01 Sep
2025.
Author
Felippe V.A.; Pinho A.C.; Barbosa L.M.; Queiroz I.; Tavares A.H.; Diaz R.;
Bersot C.D.; Vincent J.-L.
Institution
(Felippe, Pinho) Instituto Nacional de Cancer (INCA), RJ, Rio de Janeiro,
Brazil
(Barbosa) Universidade Federal de Minas Gerais, Departamento de Medicina,
MG, Belo Horizonte, Brazil
(Queiroz) Universidade Catolica de Pernambuco, Departamento de Medicina,
PE, Recife, Brazil
(Tavares) Universidade de Pernambuco, Departamento de Medicina, PE,
Recife, Brazil
(Diaz) Universidade Federal do Rio de Janeiro, Hospital Universitario
Clementino Fraga Filho, RJ, Rio de Janeiro, Brazil
(Bersot) Escola Paulista de Medicina da Universidade Federal de Sao Paulo
(EPM-UNIFESP), Programa de Pos-Graduacao em Medicina Translacional, SP,
Sao Paulo, Brazil
(Vincent) Universite Libre de Bruxelles, Erasme University Hospital,
Brussels, Belgium
Publisher
Elsevier Editora Ltda
Abstract
Background: The efficacy of the Hypotension Prediction Index (HPI) for
reducing Intraoperative Hypotension (IOH) among patients undergoing
non-cardiac surgeries remains unclear. We aimed to perform a systematic
review, meta-analysis, and trial sequential analysis to determine whether
the HPI is effective for adult patients undergoing non-cardiac surgeries.
This study was prospectively registered in the PROSPERO database
(CRD42024571931). <br/>Method(s): PubMed, Embase, and Cochrane were
systematically searched for Randomized Controlled Trials (RCTs) comparing
HPI-guided therapy with standard care in non-cardiac surgeries. We
computed Mean Difference (MD) and Risk Ratios (RR) for continuous and
binary outcomes, respectively, with 95 % Confidence Intervals (95 % CI).
Statistical analyses were performed using R Software, version 4.2.3.
<br/>Result(s): We included 11 RCTs, comprising a total of 789 patients,
of whom 395 (50.1 %) received HPI-guided management. HPI significantly
reduced the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) <
65 mmHg (MD = -0.23 mmHg.min^-1; 95 % CI -0.35 to -0.10; p <
0.01) and the Area Under the Curve (AUC) of MAP < 65 mmHg (MD = -97.2
mmHg.min^-1; 95 % CI -143.4 to -50.98; p < 0.01). HPI also
decreased the duration of MAP < 65 mmHg (MD = -16.22 min; 95 % CI -25.87
to -6.57; p < 0.01) and the number of hypotensive episodes per patient (MD
= -3.38; 95 % CI -5.38 to -1.37; p < 0.01). No significant differences
were observed in the number of hypotensive events, phenylephrine use, or
AKI incidence (p > 0.05). <br/>Conclusion(s): In adult patients undergoing
non-cardiac surgeries, HPI use was associated with a reduction in the
duration and severity of IOH, with no significant difference for adverse
events. Limitations include significant heterogeneity across studies,
differences in HPI implementation, and lack of long-term outcome
data.<br/>Copyright &#xa9; 2025 Sociedade Brasileira de Anestesiologia

<92>
Accession Number
2035129972
Title
Analgesic efficacy and serum ropivacaine concentration of postoperative
programmed intermittent bolus infusion with serratus anterior plane block
in patients undergoing minimally invasive cardiac surgery: A randomized,
double-blind, controlled trial.
Source
Journal of Anesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Kumagai M.; Kaiho Y.; Sugino S.; Sekine T.; Taguri M.; Inoue H.; Ito J.;
Sato Y.; Sato T.; Maekawa M.; Yamauchi M.
Institution
(Sato, Kaiho, Sugino, Sekine, Yamauchi) Department of Anesthesiology and
Perioperative Medicine, Tohoku University Graduate School of Medicine,
2-1, Seiryo-Machi, Aoba-Ku, Sendai, Japan
(Kumagai) Department of Anesthesiology, Japan Red Cross Ishinomaki
Hospital, Ishinomaki, Japan
(Taguri) Department of Health Data Science, Tokyo Medical University,
Shinjuku City, Japan
(Inoue) Department of Anesthesiology, Southern Tohoku General Hospital,
Iwanuma, Japan
(Ito) Department of Anesthesiology, Sendai Kousei Hospital, Sendai, Japan
(Sato, Sato, Maekawa) Department of Pharmaceutical Sciences, Tohoku
University Hospital, Sendai, Japan
Publisher
Springer
Abstract
Purpose: Minimally invasive cardiac surgery (MICS) involves fewer
complications than median sternotomy. However, difficulties in post-MICS
analgesia can undermine these advantages. The serratus anterior plane
block (SAPB), an effective analgesic for thoracic surgery, could benefit
post-MICS analgesia using programmed intermittent bolus infusion (PIBI).
We investigated whether PIBI with SAPB can reduce post-MICS fentanyl
administration and evaluated its safety profile. <br/>Method(s): This
randomized, double-blind, controlled trial included 20 patients (age 20-80
years; Eastern Cooperative Oncology Group Performance Status 0-II;
scheduled for elective MICS) randomly allocated to two groups (SAPB or
control). All patients underwent preoperative SAPB with catheterization,
followed by either 20 mL 0.25% ropivacaine or saline bolus every 6 h
postoperatively. All patients received intravenous fentanyl via
patient-controlled analgesia. Blood samples were collected 10, 20, 30, and
60 min after preoperative ropivacaine infusion; during and after
cardiopulmonary bypass; and on postoperative days 1-5. The primary outcome
was cumulative fentanyl consumption up to postoperative day 5. Secondary
outcomes included numerical rating scale scores, rehabilitation
preoperatively and postoperatively, postoperative nausea and vomiting,
ropivacaine toxicity, and PIBI with SAPB complications. <br/>Result(s):
After excluding three patients, data from 17 patients were analyzed. No
significant difference in cumulative fentanyl consumption on postoperative
day 5 was observed (SAPB: median [interquartile range], 512 microg
[457-753] vs. control: 654 microg [439-982], P = 0.96). Serum ropivacaine
concentration remained below the toxicity threshold. <br/>Conclusion(s):
PIBI with SAPB did not reduce post-MICS fentanyl consumption, and serum
ropivacaine concentration did not reach the toxicity
threshold.<br/>Copyright &#xa9; The Author(s) 2025.

<93>
Accession Number
2039394785
Title
Time-to-event analysis of the long-term outcome in trials comparing
transcatheter and surgical aortic valve implantation: A meta-analysis.
Source
International Journal of Cardiology. 438 (no pagination), 2025. Article
Number: 133524. Date of Publication: 01 Nov 2025.
Author
Barili F.; Pollari F.; Marin-Cuartas M.; Anselmi A.; de la Cuesta M.;
Brophy J.M.; Boden W.E.; De Caterina R.; Dayan V.; Roda J.R.; Uva M.S.;
Almeida R.M.S.; Tomasi J.; Verhoye J.-P.; Musumeci F.; Mandrola J.; Kaul
S.; Papatheodorou S.; Parolari A.
Institution
(Barili) University Cardiac Surgery Unit, IRCCS Ospedale Galeazzi
Sant'Ambrogio, Milan, Italy
(Barili) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Pollari) Cardiac surgery, Klinikum Nurnberg-Paracelsus Medical
University, Nuremberg, Germany
(Pollari) University of Milan, Milan, Italy
(Marin-Cuartas, de la Cuesta) University Department of Cardiac Surgery,
Leipzig Heart Center, Leipzig, Germany
(Anselmi, Tomasi, Verhoye) Department of Thoracic and Cardiovascular
Surgery, University Hospital of Rennes, France
(Brophy) Department of Medicine, McGill University Health Center,
Montreal, Canada
(Boden) Boston University School of Medicine and Lecture in Medicine,
Harvard Medical School, Boston, MA, United States
(De Caterina) Department of Cardiology, University of Pisa, Pisa, Italy
(Dayan) National Institute of Cardiac Surgery, Montevideo, Uruguay
(Roda) Department of Cardiovascular Surgery, University Hospital Ramon y
Cajal, Madrid, Spain
(Uva) Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide,
Portugal
(Uva) Department of Cardiac Surgery and Physiology, Porto University
Medical School, Porto, Portugal
(Almeida) University Center Assis Gurgacz Foundation, Parana, Cascavel,
Brazil
(Musumeci) Department of Cardiac Surgery, ISMETT, Palermo, Italy
(Mandrola) Baptist Health Louisville, Louisville, KY, United States
(Kaul) Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Papatheodorou) Rutger Health, School of Public Health, New Brunswick,
United States
(Parolari) Department of University Cardiac Surgery, IRCCS Policlinico San
Donato, San Donato, Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Indications for TAVI have been widened, although long-term
device efficacy is still unclear. We aimed to compare the effectiveness of
transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve
replacement (SAVR) on a composite of death from any cause or stroke at
5-year follow-up according to risk profiles. <br/>Method(s): We performed
a systematic literature review for randomized control trials (RCTs)
comparing TAVI or SAVR. The primary endpoint was the composite of
all-cause mortality or stroke at follow-up. Hazard ratios (HRs) and
restricted mean survival time (RMST) differences within high, intermediate
and low-risk profiles were estimated by reconstructing time-to-event data
from these Kaplan-Meier curves. <br/>Result(s): Eight trials were included
(9811 participants). The incidence of composite endpoint increased
concordantly with higher baseline risk profiles for both treatments. A
time-variant effect was present with transcatheter superior to surgery
early, as supported by a cumulative additional time-to-event of 0.77
months at 4 years driven by the high-risk group that is attenuated at 60
months. The benefit of the transcatheter approach increased over time up
to 5 years in high-risk patients (RMST difference = 2.39; 95 %CI =
-0.23;5.02; p-value = 0.07), while the benefit of the transcatheter
approach in intermediate and low-risk patients showed a quadratic
association with a smaller increase and attenuation of the observed
benefit after 60 months postintervention (low-risk = 0.86; 95 %CI =
-0.11,1.84; p-value 0.09; intermediate = 0.45; 95 %CI = -0.66;1.56;
p-value = 0.42). <br/>Conclusion(s): Although an initial benefit of TAVI
over SAVR, there are no significant differences at 5 years follow-up
independently from the risk profile.<br/>Copyright &#xa9; 2025 The Authors

<94>
Accession Number
647749899
Title
An Unusual Case of Pulmonary Venous Thrombosis in a 74-Year-Old Woman
After Breast Mastopexy.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Silva J.; Rapier B.; Qadir F.
Institution
(Silva) Internal Medicine, Summa Health, Akron, OH, United States
(Rapier, Qadir) Pulmonary and Critical Care Medicine, Summa Health, Akron,
OH, United States
Publisher
American Thoracic Society
Abstract
Pulmonary venous thrombosis (PVT) is an exceptionally rare but
life-threatening condition, typically linked to lung surgery, malignancy,
or cardiac conditions like mitral valve stenosis. The available data on
PVT are limited to case reports. To date, no randomized controlled trials
exist to guide treatment. Complications such as pulmonary hypertension and
systemic embolism may arise if untreated. Anticoagulation is the primary
therapy, with thrombolysis or surgery used in select cases. Long-term
management of idiopathic PVT remains unclear. We report the case of a
74-year-old woman with distant past medical history of right breast
adenocarcinoma, traumatic pneumothorax from a motor vehicle accident, and
basal cell carcinoma of the left breast and axilla. The patient had
recently undergone right breast mastopexy and left breast autologous fat
grafting for cosmetic reconstruction. Nine days post-operatively, she
presented to the emergency department with hemoptysis, dyspnea, and chest
pain. On presentation, the patient was hemodynamically stable and not
requiring supplemental oxygen. Physical examination revealed wheezes and
rhonchi in the right upper and middle lung lobes. Laboratory findings
showed an elevated D-dimer of 1.25 mg/L (reference range <0.5 mg/L), while
other serum studies were within normal limits. Chest X-ray revealed
bilateral calcified parenchymal granulomata without significant
abnormalities. Given the clinical suspicion of pulmonary embolism, a CT
angiogram (CTA) of the chest was performed, which identified a thrombus in
the right lower lobe pulmonary vein, 1.7 cm left hilar adenopathy as well
as bilateral lower lobe infiltrates. The patient was started on a heparin
infusion for two days, followed by apixaban for long-term anticoagulation.
A follow-up CTA at three months demonstrated complete resolution of the
pulmonary vein thrombus and hilar adenopathy. This case underscores the
importance of early detection and management of pulmonary vein thrombosis.
A rare condition in general, PVT after non thoracic surgery or lobectomy
is even more unusual. To our knowledge this is the first case occurring
after breast surgery, and was treated successfully with apixaban with no
sequelae.

<95>
Accession Number
647754358
Title
Inspiris RESILIA Valve in Pulmonary Position: Outcomes, Concerns,
Controversies.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Bhandari R.; Raja S.
Institution
(Bhandari) University of Nottingham Medical School, Nottingham, United
Kingdom
(Raja) Harefield Hospital, London, United Kingdom
Publisher
American Thoracic Society
Abstract
Rationale: There are currently no prosthetic valves created specifically
for pulmonary valve replacements, leading to use of prosthetic aortic
valves in the pulmonary position. The use of the Inspiris RESILIATM
bioprosthesis in the pulmonary position lacks consensus due to differing
outcomes in different centres. We conducted a literature review of all
available evidence that analysed early and mid-term outcomes after
surgical pulmonary valve replacement using the Inspiris RESILIATM
bioprosthesis. <br/>Method(s): A systematic literature search was
performed to identify relevant studies on PubMed, Embase via Ovid, Scopus
and Cochrane CENTRAL evaluating early and mid-term outcomes post surgical
pulmonary valve replacement using the Inspiris RESILIATM bioprosthesis
with no restriction on publication date. Any patient who received an
Inspiris RESILIATM bioprosthesis in the pulmonic position was included.
Studies not in English, case reports and outcomes in letters were
excluded. <br/>Result(s): 54 studies were identified. 6 met the
eligibility criteria. The studies included 212 patients with an average
follow-up of 0.5-2.5 years. The average age of patients was 13.8-31 years.
The commonest primary pathology was Tetralogy of Fallot. Mean prosthetic
size used was 23-27 mm. There were no in-hospital or 30-day postoperative
deaths, except one patient. Among studies reporting new pulmonary
regurgitation (PR) as an early-outcome, the average was 14.62%. Early
morbidity was an average of 5.6%. At mid-term follow up, freedom from
all-cause mortality was 99.5%. Among studies reporting new or worsened PR
at mid-term follow up, the average was 25.1%. The average structural valve
deterioration rate was 11.23%. Transcatheter valve-in-valve interventions
were required in 2.8% of patients. Two studies compared the Inspiris to
non-Inspiris prostheses and found that freedom from moderate PR at 6, 12,
and 24 months was significantly lower in the former. Other postoperative
outcomes were similar. Valved-conduit insertion of the Inspiris valve was
protective against early failure. Implantation in the native right
ventricular outflow tract was associated with PR. Freedom from
moderate/severe PR at 2 and 3 years was lesser compared to Mosaic valves.
<br/>Conclusion(s): Early-outcomes after surgical valve replacement using
the Inspiris RESILIATM bioprosthesis are encouraging. There is a
concerning early development and progression of prosthetic regurgitation
in some studies. The Inspiris RESILIATM bioprosthesis is currently not
superior to other prostheses in the pulmonic position. The long-term
durability and safety of the Inspiris RESILIATM bioprosthesis in the
pulmonic position depends on the mechanism for early valve failure and
further studies on different affecting factors. Results from the
COMMENCE-P trial are awaited.

<96>
Accession Number
647753872
Title
Dengue and Severe Myocarditis: A Deadly Viral Attack on the Heart.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Sinokrot D.; Saeed G.; Kumar N.; Abdelrahman A.
Institution
(Sinokrot, Saeed, Kumar, Abdelrahman) Roger Williams Medical Center,
Providence, RI, United States
Publisher
American Thoracic Society
Abstract
Case Description: A 22-year-old female with a past medical history of
scleroderma, whorecently returned from Guatemala, presented to the ED with
worsening shortness of breath,pleuritic chest pain and recurrent fevers of
few days duration. Physical exam showed HR 145bpm, RR 22/min and oral
temperature of 103F. Initial labs were significant for platelets 47k/ul
(150- 450),hematocrit 60.7% (37-47), hemoglobin of 20.4 g/dl (12-16), high
sensitivity troponin 8200 ng/l(0-15), and lactate 5 mol/l (0.5- 2).
Respiratory viral panel was negative for common virusesincluding COVID.
Further viral workup including chikungunya serologies were sent given
herrecent travel history. Had low voltage EKG with sinus tachycardia and
early depolarizationpattern. Chest x-ray showed right middle lobe
infiltrate. Patient was initially treated with IVfluids, ceftriaxone and
azithromycin for suspected pneumonia. Patient condition deteriorated.
Abedside echo revealed small pericardial effusion with a severely reduced
ejection fraction.Follow up troponin was 20,000 ng/l. Unfortunately,
shortly after, patient became pulseless andACLS measures were initiated. A
bedside pericardiocentesis was attempted draining 20 cc.Despite one hour
of ACLS, patient did not have return of spontaneous circulation and
waspronounced dead. Body was sent for autopsy. On follow-up, dengue virus
(1-4) IgM, werepositive with high titers. The case was subsequently
reported to Rhode Island Department ofHealth. <br/>Discussion(s): A recent
meta-analysis suggests 21% of dengue cases experienced
myocarditismanifestations. Viral infections are known to increase
cardiovascular risks both directly andindirectly. Medical signs and
symptoms of dengue can range over the spectrum of beingasymptomatic to
severe disease. Cardiac involvement related to direct viral invasion of
thecardiac myocytes, as well as immunologic damage caused by cytokines. In
early suspected casesof myocarditis, EKG changes, echocardiography
abnormalities and elevated biomarkers ofnecrosis of the myocytes including
troponin are extremely helpful. Management of Denguedepends on its
presentation, including early detection of cardiac involvement and
restoringhemodynamic stability. With ongoing globalization, we are now
increasingly seeing Denguevirus in areas previously deemed safe. The key
strategy remains management of symptomaticdisease and preventing
complications with continuous patient monitoring. Acuity should
beestablished for appropriate triaging of the patient. <br/>Importance:
Although cardiac manifestations are prevalent in dengue cases,
myocarditisremains an understudied and often overlooked complication.
Myocarditis in dengue often hasfatal outcomes if not diagnosed and treated
promptly, therefore, should be considered on thedifferential, even in
non-endemic regions. (Figure Presented).

<97>
Accession Number
647754106
Title
Endometriosis-Associated Pleural Effusion: A Diagnostic Challenge.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Adib K.L.; Wert M.J.
Institution
(Adib) Ohio State Unviersity, Columbus, OH, United States
(Wert) Ohio State University, Columbus, OH, United States
Publisher
American Thoracic Society
Abstract
While rare, a bloody effusion should raise clinical suspicion of pleural
endometriosis in women, especially those who are young or have
infertility. Diagnosis may have implications in management as case reports
showed differences in recurrence rates based on hormonal or surgical
approaches. We present a case of a hemorrhagic pleural effusion in a
patient with an enlarged uterus. Our patient is a 37 year old woman with a
history of endometriosis and infertility who initially presented with a
few months of dyspnea and abdominal pain to an ED, found to have new large
pleural effusion and large uterus on CT. Thoracentesis of the right
pleural effusion drained 1500 cc of a strongly exudative effusion with LDH
of 819 and protein of 5.4. Cytology was negative and she had improved
symptoms post thoracentesis. She was then referred to pulmonary clinic
when her dyspnea returned and found to have reaccumulation of her pleural
effusion within 2 months of drainage. She underwent a second thoracentesis
in which 1700 cc of chocolate brown colored fluid was removed, again found
to be exudative with negative cytology. Uterine biopsies were also
negative for cancer and imaging did not show any other concerns for
malignancy. She was referred to thoracic surgery when her symptoms
recurred and underwent pleural biopsy and pleurodesis with improvement of
symptoms. Pathology showed fibrous and lymphoplasmacytic pleuritis without
endometrial tissues seen. Since pleurodesis she has had improvement in
dyspnea and size of the pleural effusion. She has been referred to an
infertility specialist with no plan as of now for a hysterectomy, although
per OB/GYN may be in her future. Obtaining a bloody pleural effusion
should include endometriosis related pleural effusion in the differential
as it has diagnostic and therapeutic considerations. A meta analysis
reviewed a total of 66 individual cases and found that there was poor
yield in pleural effusion cytology with increasing diagnostic yield with
percutaneous pleural biopsy (45.5%) and surgical lung biopsy (78.7%).
Management differed and those who had pleurodesis had a 25% recurrence in
comparison to 62% recurrence rate in those just treated with hormonal
therapy. The analysis also found that 80% of those with
endometriosis-related pleural effusion were infertile.
Endometriosis-related pleural effusion therefore remains an important
differential for those with bloody pleural effusions in infertile women
and has diagnostic and treatment related challenges to be aware of.

<98>
Accession Number
647752140
Title
Breathing Easy: NIV Interface Comparison in Post-cardiac Surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Paiva D.; Bellini L.L.; Silveira E.C.; Henker E.; Cardoso D.M.; Marinho
P.E.D.
Institution
(Paiva, Bellini, Henker) Universidade de Santa Cruz do Sul, Santa Cruz do
Sul, Brazil
(Silveira) Hospital Santa Cruz, Santa Cruz do Sul, Brazil
(Cardoso) Federal University of Rio Grande do Sul, Porto Alegre, Brazil
(Marinho) Federal University of Pernambuco, Recife, Brazil
Publisher
American Thoracic Society
Abstract
Rationale: Non-invasive ventilation (NIV) is a resource used in the
postoperative period of cardiac surgery, and its interfaces can determine
therapeutic success. The present study evaluated the adverse effects,
comfort perception, and satisfaction levels of using different NIV
interfaces. <br/>Method(s): The present randomized clinical trial
evaluated NIV-submitted individuals in BIPAP ventilation mode (10 cmH2O)
using the conventional orofacial mask (Orofacial Mask Group - OMG) (n= 25)
and the adapted diving mask (Adapted Diving Mask Group - ADMG) (n= 22).
This study was signed in the Brazilian Clinical Trials (RBR-2zky4p9) and
approved by the University of Santa Cruz do Sul Research Ethics Committee
(n 5.164.039). The study evaluated the adverse effects (Adverse Effects
Questionnaire), comfort perception (Visual Analog Scale - VAS), and
satisfaction levels of interface use (Patients' Global Impression of
Change - PGIC). It used the Student's t-test, Chi-square test, and
Mann-Whitney U test. The effect's size was calculated using Cohen's d or
Phi Coefficient (phi), classified as high (d= 0.80<=phi<1), medium (d=
0.5; 0.20<=phi<0.40) and low (d= 0.2; 0.10<=phi<0.20) (SPSS 26.0 version,
IBM, NY, USA) (p<=0.05). <br/>Result(s): 47 individuals were evaluated
(61.70% male), with a mean age of 62+/-10 years and body mass index of
28.1+/-3.4 kg/m2 (OMG) and 26.9+/-3.9 kg/m2 (ADMG). Concerning the adverse
effects, there was no significant difference in forehead pain occurrence
(p= 0.871; phi= -0.019), on the nose (p= 0.871; phi= -0.019), on the cheek
(p= 0.364; phi= 0.154) and, in neither groups patients referred chin pain;
leakage in the eyes (p= 0.069; phi= -0.454), in the mouth and throat (p=
0.081; phi= 0.188); nasal dryness (p= 0.793), pressure (p= 0.767; phi=
-0.143), skin irritation (p= 0.364; phi= -0.154) and claustrophobia (p=
0.325; phi= 0.036) between groups with mean effect size. The perception of
comfort with interface use was similar between the groups OMG (7.1 +/-
2.7) and ADMG (5.9 +/- 3.4) (p= 0.297), with a medium effect size (d=
0.390). As for PGIC, 62.2% of OMG reported 'Moderately better' to 'Much
better' compared to 36.9% of ADMG. <br/>Conclusion(s): The individuals
presented similar levels of adverse effects and comfort perception;
however, the OMG presented more significant results concerning the
satisfaction level.

<99>
Accession Number
647753572
Title
A Case of Triple Diagnosis on Video-Assisted Thoracoscopic Surgery (VATS).
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Naqvi S.M.; Ahmed A.; Wortsman J.; Tokashiki H.; Copur A.S.; Bawaadam
H.S.; Nanavati S.M.; Lenhardt R.
Institution
(Naqvi, Ahmed, Wortsman, Tokashiki, Copur, Lenhardt) Pulmonary Medicine,
Chicago Medical School, Rosalind Franklin University of Medicine and
Science, North Chicago, IL, United States
(Bawaadam, Nanavati) Interventional Pulmonary and Critical Care Medicine,
Advocate Aurora Medical Center, Kenosha, WI, United States
Publisher
American Thoracic Society
Abstract
INTRODUCTION: Interstitial lung disease(ILD), specifically Idiopathic
Pulmonary fibrosis (IPF), is a progressive disease and has a lung cancer
association. In a systematic review of ILD/IPF comorbidities, the
prevalence of lung cancer was between 3% to 48%. Even after considering
smoking, ILD/IPF is found to be an independent risk factor for the
development of lung cancer. Survival is poor who develop lung cancer. CASE
PRESENTATION: Our case is of a 69-year-old male current smoker with a
40-pack-year smoking history, being followed in the pulmonary clinic for
interstitial lung changes found on lung cancer screening Computed
Tomography(CT) scan. There was no definitive diagnosis of ILD. The patient
was evaluated by a thoracic surgeon for surgical lung biopsy, however
biopsy was deferred due to minimal patient symptoms. Eight months later, a
follow-up High-resolution CT(HRCT) scan revealed a 1.4 cm subpleural
cavitary nodule in the left lower lobe(LLL) superior segment[Figure 1]
which was new compared to the last Low-dose CT scan[Figure 2]. It showed
another prominent nodule along the left major fissure[Figure 3], also new
compared to the previous CT scan[Figure 4]. Parenchymal Interstitial
changes were stable[Figure 5]. On Positron Emission Tomography(PET)/CT
scan, the subpleural cavitary nodule in the superior segment of the left
lower lobe, the left fissural 1.1 cm pulmonary nodule with irregular
margins and the left hilar/mediastinal lymph nodes were all found PET
avid. Pulmonary function test(PFT) showed an isolated reduction in the
diffusion capacity. Upon evaluation by thoracic surgery, the patient
underwent Video-assisted thoracoscopic surgery (VATS). A wedge resection
of the left upper lobe and left lower lobe superior segment reported two
positive different ipsilateral primary lung malignancies. The left
fissural nodule was poorly differentiated non-small cell lung
carcinoma(NSCLC) suggestive of large cell carcinoma with the background of
usual interstitial pneumonia(UIP). The LLL cavitary nodule was programmed
death-ligand 1(PD-L1) positive, moderately differentiated Adenocarcinoma,
also with the background of UIP. The patient has established care with
oncology and is scheduled to undergo Endobronchial Ultrasound(EBUS) for
cancer staging. <br/>DISCUSSION(S): Smoking can cause both ILD and lung
cancer. It is important to note that ILD itself is an independent risk
factor for lung cancer. Our case highlights the need for more
well-designed studies to understand the association between lung cancer
and ILD in the setting of current smoking status, and the timeline of lung
cancer development and its progression after the diagnosis of ILD for
early detection and intervention as deemed necessary.

<100>
Accession Number
647754862
Title
A Qualitative Analysis of Clinicians' Approaches to Pulmonary Nodule
Evaluation and Management.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Kim R.Y.; Gupta A.; Bilger A.; Rendle K.A.; Vachani A.
Institution
(Kim, Gupta, Bilger, Rendle, Vachani) University of Pennsylvania,
Philadelphia, PA, United States
Publisher
American Thoracic Society
Abstract
RATIONALE: Pulmonary nodule (PN) evaluation and management requires
complex medical decision-making and poses a diagnostic challenge for
clinicians, who must estimate PN malignancy risk to determine whether the
benefits and risks of lung biopsy or empiric treatment are worthwhile for
patients. In the setting of paradigm-shifting advances in lung cancer
diagnostic techniques and treatment over the past decade, we sought to
characterize clinicians' current PN evaluation and management practices
and perspectives. <br/>METHOD(S): We performed semi-structured qualitative
interviews with 25 clinicians with PN expertise across 16 U.S. healthcare
systems. Interviews probed clinicians' approaches to PN malignancy risk
assessment and management decision-making and their perspectives on PN
clinical care challenges, barriers to optimal care, and current PN
clinical guidelines. Interviews were performed either in-person or via
telephone by either R.Y.K. or A.G. Transcripts of audiorecorded interviews
were analyzed using principles of grounded theory. <br/>RESULT(S): Among
the 25 participants (20 [80%] attendings, 2 [8%] fellows, 3 [12%] advanced
practice providers; 9 [36%] women; 15 [60%] non-Hispanic White), years of
experience ranged from 0 to 30 years (mean: 8 years), 20 (80%) practiced
in an academic setting, 13 (52%) practiced within a dedicated PN clinic,
12 (48%) specialized in general pulmonology, 10 (40%) interventional
pulmonology, and 3 (12%) thoracic surgery. Key themes (Table) included
personal review of PN imaging characteristics as the major driver of
malignancy risk assessment; variable use and perceptions of risk
assessment tools to quantify PN malignancy risk; conflicting opinions on
prioritization of unnecessary invasive diagnostic procedure reduction vs.
sensitivity for lung cancer detection; heterogeneous approaches to
diagnostic evaluation of intermediate- and high-risk PNs; universal belief
in patient preference and overall health strongly impacting PN management
decisions; a belief that a multidisciplinary approach to PN evaluation and
management is critical; a desire to overcome barriers to timely access to
PN care and standardized follow-up; and widely divergent views on the
usefulness and relevance of current PN clinical guidelines.
<br/>CONCLUSION(S): Current PN evaluation and management practices in the
U.S. are highly heterogeneous, reflecting a lack of consensus among
clinicians with PN expertise. Despite this, clinicians agree that personal
PN imaging review, shared decision-making with patients, a
multidisciplinary approach, and a need for improved patient access and
follow-up care are important aspects of modern-day PN clinical care. As
there is no clearly defined standard of care, future prospective,
randomized controlled trials are necessary to determine the optimal
approach to PN evaluation and management.

<101>
Accession Number
647747718
Title
Where Rare Lung Conditions Meet: Idiopathic Pleuroparenchymal
Fibroelastosis and Usual Interstitial Pneumonia.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Kercheval J.; Colamonici M.; Neumeier A.
Institution
(Kercheval, Colamonici, Neumeier) University of Colorado, Aurora, CO,
United States
Publisher
American Thoracic Society
Abstract
Introduction: Idiopathic pleuroparenchymal fibroelastosis (IPPFE) was
first described in 1992 and was only recently added to the 2013 American
Thoracic Society/European Respiratory Society classification of the
idiopathic interstitial pneumonias (IIPs). IPPFE can be seen in tandem
radiographically and histologically with usual interstitial pneumonia
(UIP). Evidence suggests that IPPFE with UIP portends a more aggressive
disease course and a worse prognosis than either phenotype alone. Due to
its rare occurrence, there are no large prospective randomized controlled
trials of IPPFE to date, so the literature describing management options
is limited. The mainstay of treatment remains antifibrotic therapy and
transplant referral. Here, we describe the workup, diagnosis, and
management of a patient with IPPFE with UIP. Case report: A 68-year-old
female with moderate-severe aortic insufficiency was referred to pulmonary
clinic after workup for chronic cough revealed bilateral apical subpleural
reticular abnormalities with bronchiectasis, bibasilar reticulation, and
nodularity along the fissures. Occupational history, exposure history, and
serologic evaluation did not reveal an etiology or associated autoimmune
condition. Following a non-diagnostic transbronchial biopsy and
bronchoalveolar lavage, surgical lung biopsy demonstrated peripheral and
subpleural interstitial fibroelastosis in the upper lobe apical segments,
consistent with PPFE, as well as an interstitial fibrosing process with
chronic inflammation and early honeycomb changes in the middle lobes,
consistent with UIP. The patient was initiated on antifibrotic therapy
with pirfenidone in January 2024 and later transitioned to nintedanib due
to anorexia. A subsequent transplant evaluation determined that she was a
poor transplant candidate due to the need for concomitant aortic valve
repair and overall stable physiology. She continues to follow in pulmonary
clinic for ongoing pulmonary optimization and monitoring for disease
progression (Figure 1). <br/>Discussion(s): IPPFE with UIP is a rare IIP
phenotype whose pathophysiology, clinical course, and management options
have yet to be fully elucidated. It is an irrevocably progressive
condition, and future studies are warranted to further define patient
outcomes and treatment following diagnosis. This case adds to the IPPFE
literature by describing the longitudinal work up and follow up of an
IPPFE patient with concomitant UIP who is receiving antifibrotic therapy.

<102>
Accession Number
647749481
Title
Baby or Breathing? Management of Thoracic Endometriosis in a Patient
Seeking Pregnancy.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Obrien A.; Santone D.; Smith J.
Institution
(Obrien, Santone, Smith) Indiana University, School of Medicine,
Indianapolis, IN, United States
Publisher
American Thoracic Society
Abstract
Introduction: The most common site for endometriosis outside of the
abdominopelvic cavity is the thoracic cavity. We report a case of thoracic
endometriosis (TES) presenting as recurrent pleural effusions, with
treatment confounded by the patient's desire for pregnancy. Case
Presentation: A 41-year-old female with a past medical history of uterine
fibroids and endometriosis complicated by peritoneal nodules and
hemorrhagic ascites was referred to Pulmonology in 2020 for a chronic
right pleural effusion first seen in 2017. Thoracentesis showed an orange,
lymphocyte-predominant, exudative effusion; cytopathology and infectious
work-up were normal. She returned to clinic in September 2021 and
ultrasound showed reaccumulation of the effusion. Thoracic surgery
performed a decortication and pleurodesis in October 2021, and
post-surgical chest radiograph showed resolution of the effusion.
Intraoperative biopsies confirmed thoracic endometriosis. Despite
encouraging her to initiate medications for ovulation suppression, the
patient had a strong desire for pregnancy and declined. Unfortunately, a
CT chest scan in August 2022 showed recurrence of the right sided
effusion. The patient was asymptomatic and her effusion was monitored with
serial imaging and ultrasound. Additional thoracentesis was deferred due
to stability of the effusion, minimal symptomatology, and the increasing
risk associated with serial thoracentesis for an effusion that would
certainly recur without ovulation suppression. The patient continued her
desire for pregnancy and declined medical management. Recently, she became
more dyspneic and developed chest pain. Repeat chest CT scan in October
2024 showed a stable, moderate-sized, loculated pleural effusion. Repeat
drainage is planned but due to the chronicity of the effusion, the patient
is at higher risk for re-expansion pulmonary edema and trapped lung.
<br/>Discussion(s): Postoperative ovulation suppression, often in the form
of GnRH analogues, is used to prevent recurrence of complications of TES,
such as pleural effusions, hemoptysis, and pneumothoraces. For TES,
medical and surgical management alone have an approximately 40% and 25%
recurrence rate, respectively. Although there are no randomized control
trials evaluating combined surgical-medical management, many physicians
use this approach with promising results. One small study demonstrated a
0% recurrence rate of catamenial pneumothorax when GnRH analogues were
used after surgical treatment. Because endometriosis causes complications
in women of child-bearing age, family planning should be addressed in
management of TES. Early combined surgical and medical management is the
most effective approach to prevent recurrence of pleural effusions.

<103>
Accession Number
647753033
Title
Primary Diffuse Large B-cell Lymphoma of the Lung.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Singh B.; Singh A.; Akter F.; Dudiki N.
Institution
(Singh, Singh, Akter) Internal Medicine, IU Ball Memorial Hospital,
Muncie, IN, United States
(Dudiki) Pulmonary Critical Care, IU Ball Memorial Hospital, Muncie, IN,
United States
Publisher
American Thoracic Society
Abstract
Introduction: Primary diffuse large B-cell lymphoma (DLBCL) of the lung is
an extremely rare neoplasm, accounting for only 0.5 - 1% of primary
pulmonary malignancies. It is typically found in elderly or
immunocompromised patients. Clinically, patients often present with
non-specific symptoms, and radiologically, it is challenging to
differentiate from other lung malignancies, such as bronchogenic
carcinoma, due to overlapping features. Case Presentation: A 73-year-old
female presented to the pulmonary clinic following the discovery of a
pulmonary nodule. Initially, she had come to the emergency department due
to worsening dyspnea. A CT scan revealed a 2 cm irregular mass in the apex
of the left upper lobe, along with a smaller 1 cm lobulated nodule in the
inferior base of the right upper lobe, raising concerns for malignancy.
Repeat imaging showed an increase in the size of the left apical nodule,
with mild enlargement in multiple mediastinal lymph nodes, which were
thought to be reactive. A PET scan was ordered, revealing tracer avidity
in the left apical nodule, measuring 1.6 cm, along with prominent,
non-enlarged mediastinal lymph nodes considered reactive. Since a
CT-guided biopsy was not feasible due to the challenging location of the
nodule and the patient lacked significant risk factors, such as smoking or
compromised health, a decision was made to consult cardiothoracic surgery.
A wedge excision biopsy was performed, confirming a diagnosis of diffuse
large B-cell lymphoma. Immunohistochemical stains were positive for CD20,
PAX5, CD10, BCL6, and MUM1. The patient was subsequently referred to
oncology for further management. <br/>Discussion(s): Primary pulmonary
DLBCL is difficult to diagnose due to its rarity and non-specific
presentation, often resulting in misdiagnosis or delayed diagnosis. The
actual incidence of primary DLBCL of the lung may be underestimated due to
its rapid spread to the mediastinum and extra-thoracic sites. Awareness of
this malignancy is essential, as accurate diagnosis has significant
therapeutic and prognostic implications. Primary pulmonary DLBCL generally
requires aggressive early-stage treatment. However, due to its rarity, no
randomized clinical trials have been conducted to determine the optimal
treatment approach. Radiation therapy has limited efficacy and carries
potential lung toxicity. Systemic chemotherapy with the CHOP regimen has
shown promising clinical and radiological responses in primary DLBCL. A
recent study failed to demonstrate improved outcomes with the addition of
rituximab to CHOP, suggesting that the decision to include rituximab
should be individualized based on the patient's overall condition and
treatment goals.

<104>
Accession Number
647748874
Title
Effect of Sigh Ventilation on Postextubation Hypoxemia After Cardiac
Surgery: A Randomized Clinical Trial.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Zhichang W.; Guo F.
Institution
(Zhichang, Guo) Jiangsu Provincial Key Laboratory of Critical Care
Medicine, Department of critical care medicine, Zhongda Hospital,
Southeast University, Nanjing, China
Publisher
American Thoracic Society
Abstract
Rationale: Pulmonary atelectasis remains a frequent event after cardiac
surgery with surfactant alteration or depletion often preceding its
formation. The protective role of adding sigh breaths to conventional lung
protective ventilation among cardiac surgery patients is still uncertain.
<br/>Method(s): An accessor-blind randomized clinical trial of sigh
breaths plus lung protective ventilation was conducted from February 2024
to August 2024 in a single tertiary-care referral hospital in China.
Patients aged over 18 years and planned to receive elective cardiac
surgery requiring conventional cardiopulmonary bypass were included. Sigh
ventilation (sigh breaths plus lung protective ventilation) by producing
plateau pressure of 35 cm H2O (or 40 cm H2O for patients with body mass
index >35) delivered once every 6 minutes. Conventional ventilation (lung
protective ventilation alone) including low tidal volume of 6-8ml/kg
predicted body weight and PEEP set according to the low PEEP/FiO2 table.
The primary outcome was time-weighted average SpO2/FiO2 ratio during the
initial postextubation hour. There were 10 secondary outcomes, including
the severity of postoperative pulmonary complications and use of high-flow
nasal cannula or non-invasive ventilation support computed by
postoperative day 7. <br/>Result(s): Of 452 patients screened, 192
patients were enrolled (mean [SD] age, 61.3 [13.4] years; 102 [53.1%] were
male). 96 patients randomized to the sigh ventilation group received sigh
breaths for a median (interquartile range) duration of 12 (10, 14) hours
with an initial median (interquartile range) sigh volume of 1721 (1507,
2010) ml. The mean (SD) time-weighted average SpO2/FiO2 ratios were 380
(86) in the sigh ventilation group and 338 (96) in the conventional
ventilation group (mean difference 42.1; 95% confidence interval [CI],
16.7 to 67.5; P=0.0013). By postoperative day 7, the severity of pulmonary
complications was lower in sigh ventilation group compared with the
conventional ventilation group with a common odds ratio for lower severity
of 2.3 (95% CI [1.3 to 4.2]; P=0.005). The proportion of patients with use
of high-flow nasal cannula or non-invasive ventilation support was lower
in sigh ventilation group compared with conventional ventilation group (7
[7.3%] vs 20 [20.8]; absolute difference, -13.5%; 95% CI, -23.2% to -3.9%;
P=0.007). No significant differences were observed in adverse events of
interest comparing sigh ventilation with conventional ventilation,
including postoperative barotrauma. <br/>Conclusion(s): Among patients
undergoing cardiac surgery, the addition of sigh breaths significantly
improved the SpO2/FiO2 ratios during the initial hour after extubation.

<105>
Accession Number
647748133
Title
Austrian Syndrome: Are We Truly Aware of the Disease Progression.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2025. San
Francisco, CA United States. 211 (no pagination), 2025. Date of
Publication: 01 May 2025.
Author
Gandhamaneni S.; Talone C.; Patel N.; Al-Ahmad R.; Philip L.; Morrison L.;
Hassan S.; Khawam S.; Patel P.; Goudie M.P.
Institution
(Gandhamaneni, Patel, Al-Ahmad, Philip, Morrison, Hassan, Khawam, Goudie)
Internal Medicine, Inspira Health Network, Mullica Hill, NJ, United States
(Talone) Transitional Year, Inspira Health Network, Mullica Hill, NJ,
United States
(Patel) Cardiology,Inspira Health Network, Mullica Hill, NJ, United States
Publisher
American Thoracic Society
Abstract
Background: Disseminated Streptococcus pneumoniae can lead to Austrian
syndrome, which presents as a triad of endocarditis, meningitis, and
pneumonia. This condition has a 30% mortality rate, even with appropriate
treatment. Case: 60- year-old male with myelodysplastic syndrome on
chronic steroids, end-stage renal disease (ESRD) requiring hemodialysis,
and insulin-dependent diabetes mellitus was brought to the emergency
department with seizures, fevers and altered mental status. A lumbar
puncture was performed, leading to a diagnosis of Streptococcus pneumoniae
meningitis and bacteremia. Additionally he was found to have multifocal
pneumonia and a trans-thoracic echocardiogram (ECHO) revealed aortic
valvular vegetations. He was started on broad-spectrum antibiotics
including ceftriaxone, vancomycin, ampicillin, and ganciclovir, along with
dexamethasone. Treatment was later narrowed down to ceftriaxone following
culture and sensitivity results, with a treatment plan set for four weeks,
along with anti-epileptic medications. The source of infection was
identified as recent dental trauma and mastoiditis. Although the patient
showed significant improvement, he was readmitted three weeks later due to
status epilepticus. There were concerns regarding the development of an
intracranial abscess or septic emboli from aortic valvular endocarditis.
Fortunately, on repeat MRI, no further infectious etiologies were found.
He was diagnosed with recurrent seizures, had his antiepileptic doses
increased, and subsequently discharged back home. <br/>Discussion(s):
Austrian syndrome is a rare but lifethreatening condition that may often
be overlooked due to its infrequency and a general lack of awareness.
While early initiation of appropriate antibiotics and cardiac valvular
surgery can improve patient outcomes, it is crucial to monitor for
deep-seated infections such as an intracranial abscess as suspected in our
patient. This may represent a component of the subacute to chronic
sequelae of the syndrome. Currently, there is limited research regarding
the natural history of Austrian syndrome and its long-term effects,
particularly in patients who are not surgical candidates. This may be
partly attributed to its high mortality rate and the scarcity of
documented cases. Therefore, further research in the form of meta-analyses
or data registries is needed for this deadly disease, especially in an era
marked by increasing antibiotic resistance. Additionally, there is a risk
of underdiagnosis of the syndrome when the components of the triad do not
manifest at once. As such, it would be beneficial to develop quality
improvement projects that leverage electronic medical record (EMR) systems
to alert clinicians about potential cases of Austrian syndrome when there
are records of meningitis, valvular vegetations, and pneumonia.

<106>
Accession Number
2039413076
Title
Transfusion Efficacy and Safety of Amustaline/Glutathione Pathogen-Reduced
Red Blood Cells: Results of a Randomized, Controlled Phase III Trial.
Source
Blood. Conference: 66th ASH Annual Meeting. Orlando United States.
144(Supplement 1) (pp 5592), 2024. Date of Publication: 05 Nov 2024.
Author
Benjamin R.J.; Snyder E.L.; Sekela M.; Welsby I.; Toyoda Y.; Alsammak M.;
Sodha N.; Beaver T.; Pelletier J.P.; Gorham J.; McNeil J.; Sniecinski R.;
Pearl R.; Nuttall G.A.; Sarode R.; Reece T.B.; Kaplan A.; Davenport R.;
Ipe T.; Benharash P.; Lopez-Plaza I.; Sadler P.; Reik R.; Gammon R.;
Corash L.; Liu K.; Mufti N.; Varrone J.T.
Institution
(Benjamin, Corash, Liu, Mufti, Varrone) Cerus Corporation, Concord, CA,
United States
(Snyder) Yale-New Haven Hospital, New Haven, CT, United States
(Sekela) Gill Heart Institute University of Kentucky, Lexington, KY,
United States
(Welsby) Duke University Medical Center, Durham, NC, United States
(Toyoda) Temple University Hospital, Philadelphia, PA, United States
(Alsammak) Temple University Health System, Philadelphia, PA, United
States
(Sodha) Warren Alpert School of Medicine, Providence, RI, United States
(Beaver, Pelletier) University of Florida, Gainesville, FL, United States
(Gorham) University of Virginia Health System, Charlottesville, VA, United
States
(McNeil) Department of Anesthesiology, Division of Cardiothoracic
Anesthesiology, University of Virginia Medical Center, Charlottesville,
VA, United States
(Sniecinski) Emory University Hospital, Atlanta, GA, United States
(Pearl) Stanford University, Stanford, CA, United States
(Nuttall) Department of Anesthesiology, Mayo Clinic College of Medicine,
Rochester, MN, United States
(Sarode) Department of Transfusion Medicine, UT Southwestern Medical
Center, Dallas, TX, United States
(Reece) University of Colorado Hospital, Denver, CO, United States
(Kaplan) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Davenport) University of Michigan Medical School, Ann Arbor, MI, United
States
(Ipe) University of Arkansas For Medical Sciences, Little Rock, AR, United
States
(Benharash) UCLA, Los Angeles, CA, United States
(Lopez-Plaza) Pathology and Transfusion Medicine, Henry Ford Health,
Detroit, MI, United States
(Sadler) Central California Blood Center, Fresno, CA, United States
(Reik) Oneblood, Fort Lauderdale, FL, United States
(Gammon) OneBlood, Orlando, FL, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Red blood cell (RBC) transfusion is a lifesaving
intervention with a low but persistent risk of transfusion-transmitted
infection. Amustaline/glutathione RBC pathogen-reduction (PR) technology
is designed to proactively inactivate a broad spectrum of viruses,
bacteria, protozoa and leukocytes by chemically crosslinking nucleic acids
and preventing replication and transcription. The Red Cell Pathogen
Inactivation (ReCePI) trial was a Phase III, double-blinded, randomized
non-inferiority study comparing PR and conventional RBCs for the support
of acute anemia. Methods/Study Design: Complex cardiac or thoracic-aorta
surgery patients received conventional (Control) or PR RBCs (Test) during
and for 7 days after surgery. The protocol was conducted with ethics
committee approval at all participating centers and written informed
consent from all participants. Hemoglobin levels, blood utilization and
serum creatinine were assessed as indicators of efficacy and oxygenation
of tissues (Karkouti et al. Br J Anaesth. 2012; 109 Suppl 1: i29-i38). The
primary endpoint was the incidence of acute kidney injury (AKI) measured
as change in serum creatinine from baseline within 48 hours of surgery, a
predictor of adverse postoperative outcomes including mortality by Day 30
post-surgery (Lassnig et al. Am Soc Nephrol 2004; 1597-1605). Secondary
endpoints included AKI occurring up to 7 days post-surgery (KDIGO Clinical
Practice Guideline for AKI, Kidney Inter, Suppl. 2012;2:1-138); death or
the need for renal replacement therapy by 30 days post-surgery; PR
RBC-specific antibodies; and death by day 75 post-surgery. With >292
subjects enrolled, the study had 80% power to demonstrate non-inferiority,
assuming an AKI incidence of 30% with conventional RBCs and a
non-inferiority margin of half the conventional RBC rate. Under these
circumstances, an absolute treatment increase of 5% in the AKI rate in the
PR RBC arm would fail the non-inferiority test. This work was supported by
a contract with the US Biomedical Advanced Research and Development
Authority (HHS010020160009c) with Cerus Corporation. <br/>Result(s):
Five-hundred and eighty-one subjects were randomized and 321 (55%)
transfused in 18 US hospitals. In the modified intent-to-treat analysis
subjects receiving Test and Control RBCs had similar median [IQR] total
blood loss (1500 [940-2475] mL Test, 1733 [1060-2880] mL Control, p=0.310)
and comparable median hemoglobin levels at baseline and immediately
post-surgery (9.8 [8.9-10.9] g/dL Test, 9.6 [8.6-10.6] g/dL Control,
p=0.157) and for 7 days after surgery, The PR RBC arm was transfused with
fewer RBCs, measured as total RBC Hb transfused over 7-days (169.0
[102.0-240.0] g Hb PR arm, 188.0 [126.0-295.0] g Hb, conventional RBC arm,
p=0.008). The incidence of AKI was 29.3% (46/157) for Test and 28.0%
(45/161) for Control. The treatment difference was 0.74% (95% CI -8.9,
10.4%, non-inferiority margin 14.0%, p=0.001 for non-inferiority).
Non-inferiority was also achieved by the per protocol analysis. Average
mean change in serum creatinine within 48 hours of surgery was comparable
(Test 0.020, Control 0.23 mg/dL, P=0.515). Adverse events, serious adverse
events and deaths on study were not different. Five of 159 (3.1%) PR RBC
recipients developed low titer PR RBC-specific antibodies without clinical
signs of hemolysis. Flow cytometry analysis revealed persistent
circulating PR RBCs with uniform antigen loss (modulation). Low level
human IgG antibody binding was demonstrated in 3 of 5 subjects.
<br/>Conclusion(s): PR RBCs showed equivalent hemoglobin support for acute
bleeding patients undergoing cardiac or thoracic-aorta surgery while using
less transfused total RBC Hb over 7 days. The incidence of AKI in patients
transfused with PR RBCs was non-inferior to that observed with
conventional RBCs, indicative of effective tissue oxygenation.
Treatment-related antibodies to PR-RBC were observed only in Test
subjects, the antibodies were low titer, transient, without clinical
hemolysis, and persistent circulating PR RBCs were detected with modulated
low level acridine antigen expression (www.clinicaltrials.gov
#NCT03459287).<br/>Copyright &#xa9; 2024 American Society of Hematology.
Published by Elsevier Inc. All rights reserved.

<107>
Accession Number
2035123986
Title
Transcatheter Versus Surgical Approach for the Treatment of Aortic
Stenosis in Patients With Concomitant Coronary Artery Disease: A
Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Bacha Z.; Javed J.; Khattak F.; Qadri M.; Shoaib M.; Shah I.M.; Khan N.A.;
Ali M.A.; Mattumpuram J.; Tariq M.D.; Fakhar M.; Afridi A.; Kakakhel M.Z.;
Rath S.; Henna F.
Institution
(Bacha, Khattak, Shoaib, Shah, Khan, Ali, Afridi) Khyber Medical College,
Peshawar, Pakistan
(Javed, Qadri) Jinnah Sindh Medical University, Karachi, Pakistan
(Mattumpuram) Department of Medicine, University of Louisville School of
Medicine, Louisville, KY, United States
(Tariq, Fakhar) Department of Medicine, Mary Washington Healthcare,
Fredericksburg, VA, United States
(Kakakhel) Rehman Medical College, Peshawar, Pakistan
(Rath) All India Institute of Medical Sciences, Bhubaneswar, India
(Henna) Dubai Medical College for Girls, Dubai, United Arab Emirates
Publisher
John Wiley and Sons Inc
Abstract
Aortic stenosis (AS) with concomitant coronary artery disease (CAD)
requires an approach that addresses both valvular and coronary pathology.
While surgical aortic valve replacement (SAVR) with coronary artery bypass
graft (CABG) has long been the standard treatment, transcatheter aortic
valve replacement (TAVI) with percutaneous coronary intervention (PCI) has
become a less invasive alternative. This meta-analysis compares the
clinical outcomes of TAVI + PCI versus SAVR + CABG in patients with AS and
concomitant CAD. A systematic review and meta-analysis were conducted
according to PRISMA guidelines. Fourteen studies, including two randomized
controlled trials (RCTs) and 12 observational studies, with a total of
187,189 patients (31,298 in the TAVI + PCI group and 155,891 in the SAVR +
CABG group) were included. Outcomes analyzed included 30-day mortality,
stroke, major adverse cardiovascular and cerebrovascular events (MACCE),
coronary reintervention, atrial fibrillation, major bleeding, vascular
complications, acute kidney injury (AKI), perioperative myocardial
infarction MI), permanent pacemaker implantation (PPI), length of hospital
stay, and long-term survival. Patients undergoing TAVI + PCI were
generally older (ranging from 76.3 +/- 3.7 to 83.6 +/- 3.7 years) and had
higher rates of chronic kidney disease (CKD) compared to the SAVR + CABG
group. Other comorbidities, such as diabetes and hypertension, were
comparable between groups. The EuroSCORE varied widely (3 +/- 2.2 to 36.1
+/- 18.1), reflecting a mix of surgical risk profiles. TAVI + PCI was
associated with a lower 30-day mortality rate (OR: 0.63, 95% CI:
0.37-1.07, p = 0.09), though the result was not statistically significant.
Stroke rates were comparable between the two groups (OR: 0.89, 95% CI:
0.70-1.14, p = 0.36). There was no significant difference in MACCE (OR:
0.96, 95% CI: 0.50-1.84, p = 0.91). However, coronary reintervention was
significantly higher in the TAVI + PCI group (OR: 4.32, 95% CI: 2.58-7.23,
p < 0.00001). TAVI + PCI was associated with an 82% lower risk of atrial
fibrillation (OR: 0.18, 95% CI: 0.11-0.30, p < 0.00001) but a similar risk
of major bleeding (OR: 0.71, 95% CI: 0.38-1.31, p = 0.27). Vascular
complications were significantly higher in the TAVI + PCI group (OR: 3.01,
95% CI: 1.52-5.93, p = 0.002), while perioperative AKI was lower (OR:
0.46, 95% CI: 0.21-0.99, p = 0.05). There was no significant difference in
perioperative MI (OR: 0.78, 95% CI: 0.34-1.78, p = 0.55). However, TAVI +
PCI was associated with a higher likelihood of PPI (OR: 2.14, 95% CI:
1.88-2.43, p < 0.00001). The length of hospital stay was significantly
shorter in the TAVI + PCI group (mean difference: -3.45 days, 95% CI:
-5.79 to -1.12, p = 0.004). Long-term survival favored TAVI + PCI (OR:
0.63, 95% CI: 0.49-0.80, p = 0.0002). TAVI + PCI appears to be a viable
alternative to SAVR + CABG, particularly in elderly or high-risk patients,
with advantages such as lower long-term mortality, reduced atrial
fibrillation, shorter hospital stays, and lower AKI rates. However, it
carries a higher risk of coronary reintervention, vascular complications,
and the need for PPI. These findings highlight the importance of
individualized patient selection to balance risks and
benefits.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<108>
Accession Number
2039418631
Title
A Scoping Review of Validated Echocardiographic Methods for Grading Right
Ventricular Dysfunction: Proposal for an Evidence-Based Multiparametric
Framework.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Olive J.K.; Yaport M.; Al-Qudsi O.; Cutrone M.; Abramson L.; Ledbetter L.;
Alvin A.; Vatsaas C.J.; Milano C.A.; Bronshteyn Y.S.
Institution
(Olive, Milano) Division of Thoracic and Cardiovascular Surgery,
Department of Surgery, Duke University School of Medicine, Durham, NC,
United States
(Olive, Vatsaas) Division of Trauma, Acute, and Critical Care Surgery,
Department of Surgery, Duke University School of Medicine, Durham, NC,
United States
(Yaport, Al-Qudsi, Cutrone, Bronshteyn) Division of Critical Care
Medicine, Department of Anesthesiology, Duke University School of
Medicine, Durham, NC, United States
(Cutrone) Division of Cardiothoracic Anesthesiology, Department of
Anesthesiology, Duke University School of Medicine, Durham, NC, United
States
(Abramson) Division of Geriatrics, Department of Medicine, Duke University
School of Medicine, Durham, NC, United States
(Abramson) Geriatric Research Education and Clinical Center, Durham
Veterans Affairs Health Care System, Durham, NC, United States
(Ledbetter, Alvin) Duke University Medical Center Library and Archives,
Duke University School of Medicine, Durham, NC, United States
(Bronshteyn) Department of Anesthesiology, Durham Veterans Affairs Health
Care System, Durham, NC, United States
Publisher
W.B. Saunders
Abstract
Assessing the severity of right ventricular (RV) dysfunction using
echocardiography (echo) remains subjective, in part because current
guidelines do not recommend how to synthesize various echo parameters to
form a global assessment of RV dysfunction. To address this unmet need,
this scoping review aimed (1) to identify all multiparametric RV
dysfunction scoring systems that use routine echo parameters and (2) to
synthesize these models with 2025 guidelines to create a multiparametric
framework for RV dysfunction assessment. MEDLINE, EMBASE, and Web of
Science databases were searched for studies in adult patients that propose
and validate a multiparametric scoring system for grading RV dysfunction.
All studies underwent independent review during abstract and full-text
screening. Screening of 2,229 initial citations yielded 10 observational
studies consisting of diverse cohorts, including, but not limited to,
patients with heart failure, undergoing cardiac surgery, and admitted to
the intensive care unit. Six validated echo parameters were identified: RV
dilation, RV systolic dysfunction (represented by tricuspid annular plane
systolic excursion, S', or fractional area change), tricuspid
regurgitation, elevated right atrial pressure, RV-pulmonary artery
uncoupling (ratio of tricuspid annular plane systolic excursion to
pulmonary artery systolic pressure), and paradoxical interventricular
septal motion. The studies demonstrated that multiparametric RV
dysfunction scores had greater clinical prognostic value than did any
individual RV echo parameter alone. Our proposed simple framework for
assessing RV dysfunction enables clinicians to use routinely obtained echo
data to identify high-risk or subtle RV phenotypes and to guide clinical
decision-making in a variety of perioperative, intensive, and emergency
care settings.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<109>
Accession Number
2039418881
Title
SEPAR Recommendations on Vaccination for Chronic Respiratory Patients.
Source
Archivos de Bronconeumologia. (no pagination), 2025. Date of Publication:
2025.
Author
de Miguel-Diez J.; Torres-Castro R.; Sanz Herrero F.; Menendez Villanueva
R.; Solis Gomez B.; Quiros Fernandez S.; Perez Rojo R.; Mora Cuesta V.M.;
Entrenas Castillo M.; Serrano Fernandez L.; Cabrera Martinez M.M.; Mediano
O.; Garcia-Ortega A.; Garcia Rivero J.L.; de la Rosa-Carrillo D.
Institution
(de Miguel-Diez) Servicio de Neumologia, Hospital General Universitario
Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon
(IiSGM), Facultad de Medicina, Universidad Complutense de Madrid, Madrid,
Spain
(Torres-Castro) Servicio de Neumologia, Hospital Clinic de Barcelona,
Barcelona, Spain
(Torres-Castro) Departamento de Kinesiologia, Universidad de Chile, Chile
(Sanz Herrero) Servicio de Neumologia, Consorcio Hospital General
Universitario de Valencia, Valencia, Spain
(Menendez Villanueva) Instituto de Investigacion Sanitaria La Fe,
Valencia, Spain
(Solis Gomez) Servicio de Pediatria, Seccion Neumologia Pediatrica,
Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
(Quiros Fernandez) Servicio de Neumologia, Hospital Universitario Basurto,
Bilbao, Spain
(Perez Rojo) Servicio de Neumologia Hospital Universitario 12 de Octubre,
Madrid, Instituto de investigacion i+12, Spain
(Mora Cuesta) Unidad de trasplante pulmonar del Servicio de Neumologia,
Hospital Universitario Marques de Valdecilla, Instituto de Investigacion
Valdecilla (IDIVAL), Santander, Spain
(Entrenas Castillo) Servicio de Neumologia, Hospital QuironSalud, Cordoba,
Spain
(Serrano Fernandez) Servicio de Neumologia, Hospital Universitario Cruces,
Instituto de Investigacion Sanitaria Biobizkaia, Bizkaia, Barakaldo, Spain
(Cabrera Martinez) Enfermera de Atencion Primaria, Adeje, Servicio Canario
de la Salud, Gerencia de Santa Cruz de Tenerife, Spain
(Mediano) Unidad de Sueno, Servicio de Neumologia, Hospital Universitario
de Guadalajara, Guadalajara, Spain
(Mediano) Centro de Investigacion Biomedica en Red de Enfermedades
Respiratorias (CIBERES), Madrid, Spain
(Mediano) Departamento de Medicina, Universidad de Alcala, Alcala de
Henares, Madrid, Instituto de Investigacion Sanitaria de Castilla La
Mancha (IDISCAM), Toledo, Spain
(Garcia-Ortega, de la Rosa-Carrillo) Servicio de Neumologia, Hospital
Universitario Doctor Peset, Fundacion para el Fomento de la Investigacion
Sanitaria y Biomedica de la Comunidad Valenciana (FISABIO), Valencia,
Spain
(Garcia Rivero) Servicio de Neumologia, Hospital Universitario Marques de
Valdecilla, Instituto de Investigacion Valdecilla (IDIVAL), Santander,
Spain
(de la Rosa-Carrillo) Servicio de Neumologia, Hospital de la Santa Creu i
Sant Pau, Barcelona, Spain
Publisher
Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR)
Abstract
Vaccines are a fundamental public health tool, particularly effective in
preventing respiratory infections. Their importance is amplified in
patients with chronic respiratory diseases, who are more susceptible to
acute infections such as influenza, pneumococcus, COVID-19, respiratory
syncytial virus (RSV), pertussis, and herpes zoster. These individuals
face an increased risk of severe infections, exacerbations,
hospitalizations, and mortality. Vaccination against influenza,
pneumococcus, and SARS-CoV-2 significantly reduces these adverse outcomes.
Evidence also supports the use of vaccines against RSV, pertussis, and
herpes zoster in this population. In specific cases, tailored immunization
strategies are warranted. The Spanish Society of Pulmonology and Thoracic
Surgery (SEPAR) strongly advocates for systematic vaccination in patients
with chronic respiratory diseases. This document provides clear and
up-to-date recommendations based on the available evidence to support
clinical practice and standardize vaccination strategies. These
recommendations aim to reduce complications, improve quality of life, and
enhance public health outcomes in this vulnerable
population.<br/>Copyright &#xa9; 2025 SEPAR

<110>
Accession Number
647731702
Title
Cardiovascular Outcomes and Efficacy of the PCSK9 Inhibitor Evolocumab in
Individuals With Type 1 Diabetes: Insights From the FOURIER Trial.
Source
Diabetes care. (no pagination), 2025. Date of Publication: 22 Jun 2025.
Author
Kang Y.M.; Giugliano R.P.; Ran X.; Deedwania P.; De Ferrari G.M.; George
J.T.; Gouni-Berthold I.; Paiva da Silva Lima G.; Handelsman Y.; Lewis
B.S.; Ohman E.M.; Wang H.; Lopez J.A.G.; Monsalvo M.L.; Sabatine M.S.;
Leiter L.A.
Institution
(Kang, Giugliano, Ran, Sabatine) TIMI Study Group, Cardiovascular
Division, Department of Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, United States
(Kang) Division of Endocrinology, Diabetes, Hypertension, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Deedwania) University of California San Francisco Fresno, Fresno, CA,
United States
(De Ferrari) Division of Cardiology, Cardiovascular and Thoracic
Department, University of Turin, Citta della Salute e della Scienza
Hospital, Turin, Italy
(George, Paiva da Silva Lima, Ohman, Wang, Lopez, Monsalvo) Global
Development, Amgen, Inc., Thousand Oaks, CA, United States
(Gouni-Berthold) Center for Endocrinology, Diabetes and Preventive
Medicine, Faculty of Medicine, University Hospital Cologne, University of
Cologne, Cologne, Germany
(Handelsman) Metabolic Institute of America, CA, United States
(Lewis) Technion-Israel Institute of Technology and Lady Davis Carmel
Medical Center, Haifa, Israel
(Leiter) Li Ka Shing Knowledge Institute of St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
Abstract
OBJECTIVE: To evaluate the clinical efficacy of intensive LDL cholesterol
(LDL-C) lowering in type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND
METHODS: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in
Subjects With Elevated Risk (FOURIER) randomized participants with
atherosclerotic cardiovascular disease (ASCVD) on statins to evolocumab or
placebo (median follow-up 2.2 years). The primary end point (PEP) was
cardiovascular death, myocardial infarction, stroke, hospitalization for
unstable angina, or coronary revascularization. <br/>RESULT(S): Of 27,564
participants, 10,834 (39.3%) had type 2 diabetes mellitus (T2DM), and 197
(0.7%) had T1DM. In the placebo arm, there was a stepwise increase in the
2.5-year PEP Kaplan-Meier rate from 11.0% to 15.2% to 20.4% in
participants with no diabetes, T2DM, and T1DM, respectively (P < 0.0001).
Hazard ratios for PEP with evolocumab were 0.87 (95% CI 0.79-0.96), 0.84
(0.75-0.93), and 0.66 (0.32-1.38) in the no diabetes, T2DM, and T1DM
groups, and absolute risk reduction was 1.3%, 2.5%, and 7.3%,
respectively. <br/>CONCLUSION(S): Intensive LDL-C lowering may provide
substantial clinical benefit in individuals with T1DM and ASCVD.
Additional randomized controlled cardiovascular outcomes trials are needed
in this population.<br/>Copyright &#xa9; 2025 by the American Diabetes
Association.

<111>
Accession Number
2035123226
Title
Comparing the effect of three levels of end-expiratory pressure during
facemask ventilation on gastric insufflation in patients with obesity: a
randomized controlled trial.
Source
Journal of Anesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Mostafa M.; Hasanin A.; Zakaria M.M.; Kandel H.; Hamimy W.; Abougabal A.;
Elshal M.M.
Institution
(Mostafa, Hasanin, Zakaria, Kandel, Hamimy, Abougabal) Department of
Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
(Elshal) Department of Anesthesia and Critical Care Medicine, National
Cancer Institute, Cairo University, Cairo, Egypt
Publisher
Springer
Abstract
Background: We compared the effect of three levels of end-expiratory
pressure on the incidence of gastric insufflation during face-mask
ventilation in patients with obesity. <br/>Method(s): This randomized
controlled trial included adult obese patients undergoing elective
non-cardiac surgery under general anesthesia with neuromuscular blockade.
Patients were randomized to receive either zero-end-expiratory pressure
(ZEEP group), 4-cmH<inf>2</inf>O positive end-expiratory pressure (PEEP)
(low-PEEP group), or 8-cmH<inf>2</inf>O PEEP (high-PEEP group) during
volume-controlled mask ventilation. Gastric antral cross-sectional area
(CSA) was assessed using ultrasonography before induction of anesthesia
and after intubation. The percentage of change (delta) in the CSA was
calculated and gastric insufflation was considered significant when the
delta CSA was > 30%. The primary outcome was the incidence of gastric
insufflation. Secondary outcomes were antral CSA before induction of
anesthesia and after intubation in addition to ventilatory variables
(end-tidal CO<inf>2</inf>, peak airway pressure, and tidal volume) during
face-mask ventilation. <br/>Result(s): We analyzed data from 160 patients.
The antral CSA increased after intubation in all groups. The incidence of
gastric insufflation was higher in the high-PEEP group (32/54[59%]) than
that in the ZEEP group (6/52[12%]) and low-PEEP group (15/54[28%]). Delta
CSA, antral CSA after intubation, and incidence of gastric insufflation
were not significantly different between the ZEEP and low-PEEP groups.
Ventilatory variables were comparable between the groups.
<br/>Conclusion(s): In obese paralyzed patients, gastric insufflation can
occur during face-mask ventilation whatever the level of end-expiratory
pressure; however, the use of ZEEP or 4-cmH<inf>2</inf>O PEEP was
associated with lower incidence of gastric insufflation compared to
8-cmH<inf>2</inf>O PEEP. Clinical trial registration: Clinical trial
registration at clinicaltrials.gov NCT05979129.
https://classic.clinicaltrials.gov/ct2/show/NCT05979129<br/>Copyright
&#xa9; The Author(s) 2025.

<112>
Accession Number
2039403486
Title
Human Plasma Derived Antithrombin (Atenativ) in Heparin-Resistant Cardiac
Surgery Patients: Protocol Update for an Ongoing Phase 3, Double-Blind,
Placebo-Controlled, Multicenter Study.
Source
Blood. Conference: 66th ASH Annual Meeting. Orlando United States.
144(Supplement 1) (pp 4026.1), 2024. Date of Publication: 05 Nov 2024.
Author
Levy J.H.; Argyle C.; Solomon C.; Knaub S.
Institution
(Levy) Duke University Medical Center, Durham, NC, United States
(Argyle, Solomon, Knaub) Octapharma AG, Lachen, Switzerland
Publisher
Elsevier B.V.
Abstract
Background and Significance: Patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB) require anticoagulation to prevent hemostatic
activation and circuit thrombosis. Unfractionated heparin (UFH) is the
primary anticoagulant used clinically and requires antithrombin (AT) to be
effective. However, heparin resistance can occur in up to 26% of patients
undergoing CPB, often due to reduced AT levels. AT concentrate, used to
manage heparin resistance, is not approved in the US for acquired AT
deficiency. The aim of the ATN-108 study is to assess the efficacy of two
doses of AT concentrate (Atenativ, Octapharma) versus placebo in restoring
and maintaining heparin responsiveness in adult patients undergoing
cardiac surgery requiring CPB. Study Design and Methods: ATN-108
(NCT06096116) is an ongoing, prospective, double-blind, multicenter,
placebo-controlled Phase 3 study that adheres to the ethical principles
outlined in the Declaration of Helsinki. The study will include patients
aged >=18 and <=85 years who are heparin-resistant (pre-CPB Hemochron
activated clotting time [ACT] <480 s between 2 and 5 min following
intravenous administration of 500 U/kg UFH) with planned cardiac surgery
with CPB. Exclusion criteria include patients receiving anticoagulant
therapies (warfarin, direct oral anticoagulants, ticlopidine, prasugrel,
clopidogrel, ticagrelor or a glycoprotein IIb/IIIa antagonist) directly
before the study, pre-existing coagulopathy, renal insufficiency (serum
creatinine level >1.5 mg/dL), a history of bleeding problems or a
laboratory-diagnosed bleeding disorder. Participation in another
interventional clinical trial or previous participation with
investigational product treatment in the current trial within 30 days is
not allowed. Patients will be randomized 2:2:1:1 to receive AT concentrate
(15 IU/kg or 30 IU/kg), or saline (0.3 mL/kg or 0.6 mL/kg). After
administration of AT concentrate or placebo, the need for further pre-CPB
therapy to restore heparin responsiveness in patients failing to achieve a
Hemochron ACT measurement of >=480 s within 2 and 10 min will be analyzed.
The primary endpoint is the proportion of patients requiring no further AT
therapy to restore and maintain pre-CPB heparin responsiveness during CPB,
after administration of AT concentrate or placebo. The groups will be
compared using a one-sided Fisher's Exact Test. Secondary endpoints
include the amount of further AT therapy needed to restore and maintain
pre-CPB heparin responsiveness, the change in ACT values and AT plasma
levels, and heparin usage following infusion of AT concentrate or placebo.
The study will also measure the intraoperative, postoperative, and
cumulative administration of coagulation factor concentrates, other
allogeneic blood products, hemostatic-relevant therapies, and the number
of units of frozen plasma transfused for reasons other than restoring or
maintaining heparin responsiveness. Additional secondary endpoints include
postoperative use of AT concentrates for reasons other than restoring
heparin responsiveness (from surgery end until 24 h after the start of AT
concentrate or placebo infusion and until discharge or 7 d after surgery),
postoperative and total chest tube drainage volume (24 h after the start
of AT concentrate or placebo infusion and until discharge or 7 d
post-surgery, respectively), cell saver volume until surgery end, and the
need for reoperation for bleeding specifying surgical versus non-surgical
causes. Secondary safety endpoints include the incidence of adverse
events, survival status, and standard hematological parameters (i.e., red
blood cell count, white blood cell count, hemoglobin levels, hematocrit,
and platelet count) following AT concentrate or placebo infusion, after
the end of CPB, at the end of surgery, and 24 h after the start of AT
concentrate or placebo infusion. ATN-108 is expected to start recruiting
patients in Q3 2024 and will be conducted across ~20 European and US
centers. Study completion is anticipated in Q3 2026. Target enrollment is
~120 patients. The findings of this study could confirm the efficacy and
safety of AT concentrate in re-establishing and maintaining heparin
responsiveness for acquired AT deficiency in patients undergoing
CPB.<br/>Copyright &#xa9; 2024 American Society of Hematology. Published
by Elsevier Inc. All rights reserved.

<113>
Accession Number
2039401753
Title
Concurrent Coronary Artery Disease and Immune Thrombocytopenia: A
Systematic Review.
Source
Blood. Conference: 66th ASH Annual Meeting. Orlando United States.
144(Supplement 1) (pp 5533), 2024. Date of Publication: 05 Nov 2024.
Author
Rozi W.; Rahhal A.; Provan D.; Shunnar K.; Najim M.; Ahmed A.; Al-Khabori
M.; Marashi M.; Alrasheed M.; Osman H.Y.; Yassin M.A.
Institution
(Rozi) Department of Medicine, Unity Hospital - Rochester Regional Health,
Rochester, NY, United States
(Rahhal, Shunnar, Najim) Hamad Medical Corporation, Doha, Qatar
(Provan) Barts and The School of Medicine and Dentistry, London, United
Kingdom
(Ahmed) Hamad Medical Corporation, Doha, Qatar
(Al-Khabori) Hematology -BMT, Sultan Qaboos University, Muscat, Oman
(Marashi) Dubai Academic Health Corporation and Mediclinic Hospital,
Dubai, United Arab Emirates
(Alrasheed) Hematology Department, AlAdan Hospital, Hadiya, Kuwait
(Osman) Tawam Hospital, Abu Dhabi, United Arab Emirates
(Yassin) Department of Hematology and BMT, National Centre For Cancer Care
& Research, Doha, Qatar
Publisher
Elsevier B.V.
Abstract
Introduction Coronary artery disease (CAD) management in the setting of
immune thrombocytopenia (ITP) remains very challenging to clinicians as a
reasonable balance between bleeding and thrombosis risks needs to be
achieved, and the evidence guiding such management is scarce. Methods We
conducted a systematic review following the PRISMA guidelines to summarize
the available literature on the management and outcomes of CAD coexisting
with ITP. We searched PubMed and Embase for studies published in English
exploring CAD and ITP management until 05 October 2022. Two independent
reviewers screened and assessed the articles for inclusion. Patients'
characteristics, CAD treatment modalities, ITP treatment, and
complications were reported. Results We identified 32 CAD cases, among
which 18 cases were revascularized with percutaneous coronary intervention
(PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and
two cases were managed conservatively. More than 50% were men, with a mean
age of 61 +/- 13 years and a mean baseline platelet count of 52 +/- 59 x
10⁹/L. Irrespective of the revascularization modality, most
patients were treated with either corticosteroids alone, intravenous
immunoglobulins (IVIG) alone, or in combination. Among those who underwent
PCI, two patients had bleeding events, and one patient died. Similarly,
among those with CABG, one patient developed bleeding, and one patient
died. Conclusion We found that revascularization with either PCI or CABG
with the concurrent use of corticosteroids and/or IVIG for ITP was
feasible, with an existing non-negligible risk of bleeding and
mortality.<br/>Copyright &#xa9; 2024 American Society of Hematology.
Published by Elsevier Inc. All rights reserved.

<114>
Accession Number
2039402656
Title
Delivering Transcutaneous Auricular Neurostimulation to Regulate Platelet
Activity in Healthy Human Subjects.
Source
Blood. Conference: 66th ASH Annual Meeting. Orlando United States.
144(Supplement 1) (pp 5407), 2024. Date of Publication: 05 Nov 2024.
Author
Blanc L.; Huston J.; Bravo-Iniguez C.; Papoin J.; Ahmad M.; Mirro I.;
Benner C.; Le B.; McWade M.; Czura C.J.; Covalin A.; Khodaparast N.
Institution
(Blanc, Papoin) Feinstein Institutes for Medical Research, Northwell,
Manhasset, NY, United States
(Huston, Bravo-Iniguez, Ahmad, Mirro) Feinstein Institutes for Medical
Research, Northwell Health, Manhasset, NY, United States
(Benner, Le) Spark Biomedical, Dallas, TX, United States
(McWade, Czura, Khodaparast) Spark Biomedical Inc, Dallas, TX, United
States
(Covalin) Spark Biomedical, Inc., Dallas, TX, United States
Publisher
Elsevier B.V.
Abstract
Background: Implantable cervical vagus nerve stimulation (VNS) is an
accepted therapy for the treatment of refractory epilepsy, depression,
inflammation, and stroke. Recent studies have demonstrated that VNS
reduces bleeding times and shed blood volumes by ~45% in animal models of
soft tissue injury. These results have recently been confirmed in mice,
including hemophilia mice deficient in FVIII, without evidence of systemic
clotting, changes in global blood pressure, bradycardia, or hypotension.
VNS induces a statistically significant upregulation of
thrombin/antithrombin (TAT) complex formation in blood shed from a wound,
but not in the circulation, suggesting enhanced localized, but not
systemic, thrombin production and clot formation. Mechanistic studies
demonstrate that VNS triggers release of acetylcholine in the spleen,
which induces platelet calcium uptake through the alpha 7 subunit of
nicotinic acetylcholine receptor (alpha7 nAChR). This efferent function of
the vagus nerve to "prime" platelets has been termed the "neural
tourniquet." Ex vivo challenge of primed platelets with thrombin leads to
increased surface expression of P selectin. While these preclinical data
indicate that VNS can reduce bleeding time and shed blood volume, no
studies to date have been conducted to determine if these approaches can
modulate hemostasis in humans. Transcutaneous auricular vagus nerve
stimulation (taVNS) is an emerging non-invasive alternative to cervical
VNS and has been applied for headache, migraine, heart failure, asthma,
tinnitus, and other conditions. Transcutaneous auricular neurostimulation
(tAN) is an FDA-cleared technology (Sparrow Ascent System, K230796) that
stimulates branches of the vagus and trigeminal nerves on and around the
ear. tAN stimulates the release of central nervous system endorphins,
shifts circulating monocytes to an anti-inflammatory phenotype, inhibits
pro-inflammatory cytokine release, and has sustained antinociceptive
effects. tAN is currently being tested in a healthy human population to
determine whether it can alter platelet phenotype. This first-in-human
trial will determine whether the neural tourniquet pathway exists in
humans, and whether it can be accessed transcutaneously. Study design and
Treatment: This study is designed as a randomized, double-blind,
sham-controlled, single-center research study in which healthy adults will
be randomized 1:1 into one of two experimental groups, to receive taVNS or
tAN. Participants will receive 30 min of sham stimulation (taVNS or tAN),
followed by 30 min of active stimulation (taVNS or tAN). Blood will be
collected before and after sham stimulation and at several timepoints
after stimulation. Samples will be analyzed by flow cytometry to assess
platelet phenotype and thromboelastography to assess coagulation
characteristics. Eligibility Criteria: Inclusion criteria are participants
between 18-65 years of age. Exclusion criteria include a history of
thrombocytopenia, coagulopathy, abnormal bleeding or blood disorder, or
conditions that can cause coagulopathic conditions (e.g., atrial
fibrillation, heart valve surgery or replacement, hip or knee
replacement); or use of coagulation- or platelet-modifying therapies.
Statistical Methods: Data will be collected at multiple timepoints and
compared using two-way ANOVA Graphpad Prism. Endpoints: * Platelet surface
marker expression of P selectin, activated glycoprotein IIb/IIIa *
Thromboelastography At the time of abstract submission, 23 subjects have
completed the study, and two are in process. Enrollment is expected to
conclude by October 2024.<br/>Copyright &#xa9; 2024 American Society of
Hematology. Published by Elsevier Inc. All rights reserved.

<115>
Accession Number
647727460
Title
SYSTEMATIC REVIEW Ultrasound Guided versus Conventional Closure Device
Deployment following Transfemoral Endovascular Procedures: A Systematic
Review and Meta-analysis.
Source
European journal of vascular and endovascular surgery : the official
journal of the European Society for Vascular Surgery. (no pagination),
2025. Date of Publication: 18 Jun 2025.
Author
Kalaja I.; Smeets R.R.; Wegner M.; Macherey-Meyer S.; Heyne S.;
Espinola-Klein C.; Mees B.M.E.; Meertens M.M.
Institution
(Kalaja, Espinola-Klein) Department for Cardiology III - Angiology,
University Medical Center of the Johannes Gutenberg-University, Mainz,
Germany
(Smeets) Department of Vascular Surgery, Slingeland Hospital, Doetinchem,
the Netherlands; Department of Vascular Surgery, Maastricht University
Medical Center, Maastricht, the Netherlands
(Wegner) Department of Vascular and Endovascular Surgery, Faculty of
Medicine, University Hospital Cologne, University of Cologne, Cologne,
Germany
(Macherey-Meyer, Heyne) Clinic III for Internal Medicine, University of
Cologne, Faculty of Medicine and University Hospital Cologne, Cologne,
Germany
(Mees) Department of Vascular Surgery, Maastricht University Medical
Center, Maastricht, Netherlands
(Meertens) Department for Cardiology III - Angiology, University Medical
Center of the Johannes Gutenberg-University, Mainz, Germany; Clinic III
for Internal Medicine, University of Cologne, Faculty of Medicine and
University Hospital Cologne, Cologne, Germany
Abstract
OBJECTIVE: Femoral access site complications influence short term survival
and outcomes in patients undergoing endovascular procedures. While
ultrasound guided puncture is a reliable method to reduce such
complications, ultrasound guidance is rarely utilised for closure device
deployment. DATA SOURCES: Web of Science, PubMed, and the Cochrane
Library. REVIEW METHODS: A systematic literature search was conducted to
assess the safety and efficacy of ultrasound guided vascular closure
device deployment compared with vascular closure device deployment without
ultrasound guidance, referred to as conventional closure. All studies
reporting on ultrasound guided closure in transfemoral arterial
interventions were eligible, and those directly comparing ultrasound
guided with conventional closure were included in the meta-analysis.
<br/>RESULT(S): Overall, 2 738 patients receiving ultrasound guided
closure were included: 1 025 for introducer sheaths measuring 12 F or
larger and 1 713 for introducer sheaths smaller than 12 F. The incidence
of access complications was 5.7% (0.8 - 21.6%) for large sheath procedures
and 2.6% (0.9 - 4.7%) for small sheath procedures. The meta-analysis,
which included 2 339 patients who received ultrasound guided closure and 1
175 who underwent conventional closure, showed that ultrasound guided
closure was associated with reduced access site complications compared
with conventional closure (odds ratio [OR] 0.49, 95% confidence interval
[CI] 0.37 - 0.65; p < .001). This was consistently seen both for small
sheath (OR 0.45, 95% CI 0.28 - 0.75; p = .002) and large sheath procedures
(OR 0.50, 95% CI 0.37 - 0.71; p < .001), but with a low certainty of
evidence in the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) analysis. <br/>CONCLUSION(S): Ultrasound guided vessel
closure of the femoral artery appeared to be associated with a lower rate
of overall access site complications compared with conventional closure
techniques. Therefore, ultrasound guided closure might offer the potential
to increase procedural and patient safety in percutaneous arterial
access.<br/>Copyright &#xa9; 2025. Published by Elsevier B.V.

<116>
Accession Number
2039397922
Title
Concerns regarding methodology in the publication "flow-controlled versus
pressure-controlled ventilation in thoracic surgery with one-lung
ventilation - A randomized controlled trial".
Source
Journal of Clinical Anesthesia. 106 (no pagination), 2025. Article Number:
111919. Date of Publication: 01 Sep 2025.
Author
Thoma M.; Moresco E.
Institution
(Thoma) Kepler University Hospital, Krankenhausstrase 9, Linz, Austria
(Moresco) Department of Anaesthesiology and Intensive Care Unit, Bolzano
Central Hospital, Bolzano, Italy
Publisher
Elsevier Inc.

<117>
Accession Number
2035114637
Title
Clinical outcomes of anti-inflammatory therapies inhibiting the
NLRP3/IL-1beta/IL-6/CRP pathway in coronary artery disease patients: a
systemic review and meta-analysis of 37,056 individuals from 32 randomized
trials.
Source
Inflammation Research. 74(1) (no pagination), 2025. Article Number: 99.
Date of Publication: 01 Dec 2025.
Author
Pan Y.; Fan F.; Jiang J.; Zhang Y.
Institution
(Pan, Fan, Jiang, Zhang) Department of Cardiology, Peking University First
Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China
(Fan, Jiang, Zhang) Institute of Cardiovascular Disease, Peking University
First Hospital, Beijing, China
(Zhang) State Key Laboratory of Vascular Homeostasis and Remodeling,
Peking University, Beijing, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Treatment effects of anti-inflammatory therapies inhibiting
the NLRP3/IL-1beta/IL-6/CRP pathway in coronary artery disease (CAD) had
conflicting results. The study aims to evaluate efficacy and safety
outcomes of treatments inhibiting this pathway. <br/>Method(s): Cochrane
Library, Embase, Pubmed, and ClinicalTrials.gov were searched for
randomized controlled trials evaluating therapies inhibiting the
NLRP3/IL-1beta/IL-6/CRP pathway in CAD patients. Relative risks (RR) with
95% confidence intervals (CI) were calculated. <br/>Result(s): 32 studies
and 37,056 individuals were included. Anti-inflammatory therapies
inhibiting the pathway reduced the risks of myocardial infarction (MI) (RR
0.85, 95% CI 0.78-0.93) and coronary revascularization (RR 0.80, 95% CI
0.74-0.86), with no benefits in major adverse cardiovascular events
(MACE), heart failure (HF), stroke, cardiovascular or all-cause mortality.
Colchicine reduced the risks of MACE, MI, and coronary revascularization.
IL-1 inhibitors reduced the risks of coronary revascularization, with
potential benefits in MI and HF. Increased risks of infections,
gastrointestinal adverse effects, and injection site reactions were found.
Meta-regression analysis demonstrated that post-treatment hsCRP/CRP was
correlated with MACE (p < 0.001) and MI (p = 0.048) and post-treatment
IL-6 was associated with MI (p = 0.033). <br/>Conclusion(s):
Anti-inflammatory therapies inhibiting the NLRP3/IL-1beta/IL-6/CRP pathway
had satisfying safety profiles and were beneficial in preventing MI and
coronary revascularization in CAD patients despite no benefits in stroke,
cardiovascular, or all-cause mortality.<br/>Copyright &#xa9; The Author(s)
2025.

<118>
Accession Number
2039377367
Title
Impact of Metabolic Surgery on Cardiovascular Disease Outcomes.
Source
Canadian Journal of Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Piche M.-E.; Poirier P.; Wong J.A.
Institution
(Piche) Institut Universitaire de Cardiologie et de Pneumologie de Quebec,
Universite Laval, Quebec City, Quebec, Canada
(Piche, Poirier) Faculty of Medicine, Laval University, Quebec City,
Quebec, Canada
(Poirier) Faculty of Pharmacy, Laval University, Quebec City, Quebec,
Canada
(Wong) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Wong) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Obesity is strongly associated with a range of cardiovascular conditions,
including coronary artery disease, heart failure, atrial fibrillation, and
stroke. Metabolic surgery has emerged as one of the most effective
interventions for individuals with severe obesity, not only by promoting
substantial and durable weight loss but also by improving cardiovascular
risk factors and outcomes. Cardiovascular benefits may also be mediated
via weight-independent mechanisms involving insulin sensitivity,
gastrointestinal hormones, bile acid dynamics, and gut microbiome.
Long-term cohort studies have documented that metabolic surgery is
associated with a reduction in all-cause mortality and major adverse
cardiovascular events in this population. In this narrative review we
examine the role of metabolic surgery in the prevention and management of
cardiovascular disease associated with severe obesity. It provides an
overview of the most common metabolic surgery procedures, including sleeve
gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with
duodenal switch, as well as newer procedures like single-anastomosis
duodenal switch. We also evaluate the impact of these interventions on key
cardiovascular risk factors, such as type 2 diabetes, hypertension,
dyslipidemia, and obstructive sleep apnea, as well as their effects on
cardiac structure and function. Metabolic surgery is associated with
reductions in all-cause mortality and cardiovascular events, including
myocardial infarction and heart failure, especially in individuals with
obesity and pre-existing cardiovascular disease. The current evidence
supporting the link between metabolic surgery and cardiovascular outcomes
is reviewed. Notably, randomized trials specifically focusing on
cardiovascular outcomes after metabolic surgery are lacking, which
highlights an important knowledge gap and the crucial need for these
studies. Addressing this gap is essential for guiding future clinical
practice and optimizing patient care.<br/>Copyright &#xa9; 2025 Canadian
Cardiovascular Society

<119>
Accession Number
647713397
Title
Evidence from a Bayesian reanalysis of the iPROVE-OLV study: is it time to
update our prior assumptions regarding neuromuscular block and reversal?.
Source
British journal of anaesthesia. (no pagination), 2025. Date of
Publication: 09 May 2025.
Author
Colquhoun D.A.; Blobner M.
Institution
(Colquhoun) Department of Anesthesiology, University of Michigan Medical
School, NI, Ann Arbor, United States
(Blobner) Department of Anaesthesiology and Intensive Care Medicine,
Faculty of Medicine, University of Ulm, Ulm, Germany
Abstract
In a Bayesian secondary analysis of a subset of 698 patients in the
iPROVE-OLV study, Mazzinari and colleagues report evidence of benefit for
the use of neuromuscular monitoring and reversal under a range of prior
assumptions (i.e. assumptions of probability of benefit or harm). This is
a secondary analysis of the iPROVE-OLV study, a 1308-patient RCT of
individualised PEEP and postoperative high-flow nasal cannula oxygen in
patients undergoing thoracic surgery. However, detailed information on
monitoring modalities and reversal agent dosage, which could impact
practice, were not available for analysis. Recent practice guidelines,
published by both European and American professional societies have
supported routine use of quantitative neuromuscular block and reversal.
Practice surveys and observational analyses that predate these guidelines
suggest that a significant gap between real world and
guideline-recommended practice exists.<br/>Copyright &#xa9; 2025 British
Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

<120>
Accession Number
647730635
Title
The trials of interpreting clinical trials - A Bayesian perspective on
colchicine following an acute coronary syndrome.
Source
The Canadian journal of cardiology. (no pagination), 2025. Date of
Publication: 19 Jun 2025.
Author
Brophy J.M.
Institution
(Brophy) McGill University Health Center Centre for Health Outcomes
Research (CORE), 5252 Boul. de Maisonneuve West, Montreal, QC, H4A 3S5;
Department of Medicine, McGill University, Montreal, QC; Department of
Epidemiology, Biostatistics and Occupational Health, McGill University,
Montreal, QC
Abstract
BACKGROUND: A 2022 meta-analysis concluded colchicine reduced the cardiac
risk in secondary prevention. Nevertheless, a large, randomized clinical
trial (RCT) continued to randomize patients to colchicine or placebo and
in 2025 published findings of no benefit. Bayesian sequential analyses and
hierarchical meta-analysis can assist in understanding not only the
interpretation of this latest trial but also the totality of the evidence.
<br/>METHOD(S): A systematic review and Bayesian meta-analysis including
the recent CLEAR trial results was performed. The primary outcome was
major adverse cardiovascular events (MACE), a composite of death from
cardiovascular causes, recurrent myocardial infarction, stroke, or
unplanned ischemia-driven coronary revascularization. Bayesian sequential
analyses were performed with vague (result dominated by CLEAR), fully
informative (based on all previous studies), and "focused" (considering
only the largest and most similar previous trial) priors and results
compared with a hierarchical meta-analysis. The probabilities of
clinically meaningful results were based on > absolute 15% MACE reduction.
<br/>RESULT(S): While the 2022 meta-analysis suggested a statistically
significant MACE decrease with colchicine, the Bayesian reanalysis showed
a 95% credible interval (95% CrI 0.26, 1.70) for the next study,
justifying CLEAR continuation. The Bayesian sequential analyses using
vague, all-inclusive, and focused priors showed 58%, 100% and 92%
probabilities respectively of MACE decrease with colchicine. Clinically
meaningful probability decreases, based on > absolute 15% reduction, were
smaller, ranging between 2% to 41%. <br/>CONCLUSION(S): Bayesian analyses
offer advantages in trial design and interpretation, suggesting some
benefit for colchicine in secondary cardiovascular prevention, but
considerably less certainty of its clinical importance.<br/>Copyright
&#xa9; 2025. Published by Elsevier Inc.

<121>
Accession Number
647730182
Title
Filling the Void: The Past, Present, and Future of Left Atrial Appendage
Occlusion.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 19 Jun 2025.
Author
Malik S.A.; Jhand A.; Shabbir M.A.; Ahmad S.; Goldsweig A.M.
Institution
(Malik, Shabbir, Ahmad) Division of Cardiovascular Medicine, University of
Nebraska Medical Center, Omaha, NE, United States
(Jhand) Division of Cardiovascular Medicine, Geisinger Medical Center,
Danville, PA, United States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, USA; Department of Cardiovascular Medicine,
Baystate Medical Center and Division of Cardiovascular Medicine,
University of Massachusetts-Baystate, Springfield, MA, USA. Electronic
address: goldsa04@nyu.edu
Abstract
Left atrial appendage occlusion (LAAO) has emerged as an alternative
strategy to oral anticoagulation (OAC) to mitigate the risk of
thromboembolic events in patients with atrial fibrillation (AF).
Endovascular LAAO devices were first developed in the early 2000s for
patients with relative and absolute contraindications to OAC. Four
randomized controlled trials have demonstrated the safety and efficacy of
LAAO procedures, and two LAAO devices have been approved and are
commercially available in the United States. Procedural complications,
especially pericardial effusion, as well as subsequent peri-device leak
and device-related thrombosis have decreased over time due to improved
device design and implantation techniques. Many aspects of the LAAO
technology continue to evolve. Intracardiac echocardiography (ICE) is used
increasingly and offers distinct advantages and disadvantages compared to
transesophageal echocardiography (TEE) for procedural guidance. The role
of universal post-procedure surveillance imaging remains unclear.
Post-LAAO antithrombotic therapy has shifted from short-term
anticoagulation to immediate dual antiplatelet therapy, with ongoing
research exploring the feasibility of single antiplatelet therapy. Novel
devices with improved design and technology are currently undergoing
clinical trials. Additionally, the patient population eligible for LAAO
may significantly increase in the coming years, as ongoing trials are
evaluating the effectiveness of LAAO devices in a broader population of
patients with AF. In conclusion, the history, current state, and active
research related to LAAO are summarized in this review
article.<br/>Copyright &#xa9; 2025 Elsevier Inc. All rights reserved.

<122>
Accession Number
647718968
Title
NAVIGATING THE SILENCE: RECONSIDERING TREATMENT PARADIGMS IN ASYMPTOMATIC
SEVERE AORTIC STENOSIS.
Source
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese.
(no pagination), 2025. Date of Publication: 16 Jun 2025.
Author
Karampinos K.; Ktenopoulos N.; Apostolos A.; Koliastasis L.; Kachrimanidis
I.; Vlachakis P.; Katsaros O.; Tsalamandris S.; Karanasos A.; Drakopoulou
M.; Synetos A.; Latsios G.; Tsioufis K.; Toutouzas K.
Institution
(Karampinos, Apostolos, Koliastasis, Kachrimanidis, Vlachakis, Katsaros,
Tsalamandris, Drakopoulou, Synetos, Latsios, Tsioufis, Toutouzas) First
Department of Cardiology, National and Kapodistrian University of Athens,
Hippokration General Hospital of Athens, Athens, Greece
(Ktenopoulos) First Department of Cardiology, National and Kapodistrian
University of Athens, Hippokration General Hospital of Athens, Athens,
Greece
(Karanasos) Department of Cardiology, Patras University Hospital, Greece
Abstract
Aortic stenosis (AS) remains the leading valvular heart disease worldwide,
affecting up to 5% of older adults and posing a significant risk if left
untreated. The evolution of transcatheter aortic valve replacement (TAVR)
and its expanding indications for symptomatic patients with severe AS,
coupled with the evolving understanding of the pathophysiology and natural
history of AS, have heightened focus on asymptomatic patients with severe
AS. Although current clinical practice guidelines recommend aortic valve
replacement (AVR) therapy in asymptomatic severe aortic stenosis (ASAS)
only in specific clinical settings, recent studies have challenged
traditional treatment paradigms, advocating for a more individualized
strategy, particularly for patients exhibiting high-risk characteristics.
In this review, we provide an in-depth analysis of ASAS, focusing on the
intricacies of its clinical management, novel risk-stratification
modalities, predictors of symptom onset and disease progression, while
also delving into the role of echocardiography in assessing AS severity,
highlighting inconsistencies in diagnostic criteria and the need for
supplementary testing. Evolving and recently published randomized
controlled trials- namely EARLY-TAVR, EVoLVeD and TAVR-UNLOAD- randomizing
asymptomatic patients to early intervention or watchful waiting strategy
provide significant evidence that has the potential to change treatment
paradigms, lower the threshold for intervention, and pave the way for more
individualized management strategies in ASAS.<br/>Copyright &#xa9; 2025
Hellenic Society of Cardiology. Publishing services by Elsevier Inc. All
rights reserved.