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<1>
Accession Number
2035392384
Title
Robotic-assisted versus conventional median sternotomy for the surgical
excision of cardiac myxomas: a systematic review and meta-analysis.
Source
Cardiothoracic Surgeon. 33(1) (no pagination), 2025. Article Number: 24.
Date of Publication: 01 Dec 2025.
Author
Santos K.; Albuquerque L.G.; Consoli L.; Gamarra-Valverde N.; Abdelmajeed
A.; Plonek T.
Institution
(Santos) New Vision University School of Medicine, Tbilisi, Georgia
(Albuquerque, Consoli) Faculty of Medicine, Federal University of Bahia,
Bahia, Brazil
(Gamarra-Valverde) Faculty of Medicine, Universidad Peruana Cayetano
Heredia, Lima, Peru
(Abdelmajeed) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Plonek) Medisch Spectrum Twente, Enschede, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Cardiac myxoma constitutes the most prevalent primary heart
tumour, often necessitating surgical resection to prevent complications.
While median sternotomy is the standard approach, it is associated with
significant morbidity. Robotic-assisted myxoma excision (RA-ME) has
emerged as a minimally invasive alternative, but comparative data on their
outcomes remain limited. Our meta-analysis aimed to compare postoperative
outcomes of RA-ME versus conventional median sternotomy myxoma excision
(MS-ME). Method(s): We systematically searched MEDLINE, Scopus, and
Cochrane Library, focusing on studies that compared RA-ME and MS-ME.
Pooled odds ratios (OR) and mean differences (MD) with 95% confidence
intervals (CI) were calculated using RevMan 8.13.0. Result(s): Seven
studies comprising 447 patients, with 180 (40.3%) undergoing RA-ME, were
included. RA-ME was associated with significantly longer cardiopulmonary
bypass times [MD 23.0 min; 95% CI 11.1 to 35.00; p = 0.0001] and aortic
cross-clamp times [MD 11.4 min; 95% CI 4.6 to 18.2; p = 0.001]. However,
it demonstrated reduced hospital stay [MD - 2.00 days; 95% CI - 2.6 to -
1.4; p < 0.001], ICU stay [MD - 0.3 days; 95% CI - 0.5 to - 0.01; p =
0.04], blood loss [MD - 115.2 mL; 95% CI - 230.4 to - 0.02; p = 0.05], and
blood transfusion requirements [OR 0.4; 95% CI 0.2 to 0.8; p = 0.01].
Other outcomes, including mechanical ventilation time, surgical
re-exploration, arrhythmias, pneumonia, and surgical wound infections,
were comparable. Conclusion(s): RA-ME may be a safe and effective
alternative to MS-ME, offering improved recovery metrics with no
compromise in safety despite longer operative times. However, high-quality
prospective trials are needed for further validation. Trial registration:
PROSPERO CRD42025633712. Copyright © The Author(s) 2025.

<2>
Accession Number
2039709583
Title
Efficacy of N-acetylcysteine in reducing the risk of postoperative atrial
fibrillation in cardiothoracic surgery: a systematic review and
meta-analysis of randomized controlled trials.
Source
Minerva Cardiology and Angiology. 73(3) (pp 387-396), 2025. Date of
Publication: 01 Jun 2025.
Author
Hassan A.A.; Ismail N.R.; Rezk A.E.; Elfeky H.M.; Mady A.M.; Allam A.G.;
Abbas K.S.
Institution
(Hassan, Ismail, Rezk, Elfeky, Mady, Allam, Abbas) Medical Research Group
of Egypt (MRGE), Arlington, MA, United States
(Hassan, Mady, Allam) Faculty of Medicine, Al-Azhar University, Cairo,
Egypt
(Ismail) Faculty of Medicine, University of Zagazig, Zagazig, Egypt
(Rezk) Faculty of Medicine, 6th of October University, Cairo, Egypt
(Elfeky) Critical Care Medicine, University of Menoufia, Shibin El Kom,
Egypt
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: New-onset postoperative atrial fibrillation (POAF) is a
common complication following cardiac surgeries. N-acetylcysteine (NAC)
showed a significant reduction in the incidence of POAF. This review aimed
to systematically summarize and Meta-analyze data from previously
published Randomized Controlled Trials (RCTs). EVIDENCE ACQUISITION:
Electronic databases: PubMed, Cochrane, Embase, Scopus, and Web of Science
were searched. Data was extracted and the quality of the included studies
was assessed. A random-effects DerSimonian Laird model was employed for
meta-analysis. EVIDENCE SYNTHESIS: Fifteen RCTs were included in this
study (NAC, N.=940; control, N.=935). In the NAC group, 16.38% developed
POAF compared with 23.53% in the control group. NAC supplementation was
associated with a decreased incidence of POAF in patients undergoing
cardiothoracic surgery (RR 0.69; 95% CI 0.52, 0.91; P=0.008).
Meta-regression of randomized trial data showed that the incidence of POAF
was not related to the NAC dose (P=0.439). A subgroup analysis in terms of
the time of NAC administration revealed that preoperative and
postoperative NAC administration was the only subgroup that demonstrated a
statistically significant difference (RR 0.48, 95% CI 0.32, 0.71;
P=0.0003) compared with placebo and showed no heterogeneity.
 CONCLUSION(S): Atrial fibrillation is a significant postoperative
complication, particularly in cardiothoracic surgery. This study
highlights the need for further research on optimal NAC dosing and timing,
with evidence suggesting that preoperative and postoperative NAC
administration may significantly decrease postoperative atrial
fibrillation in cardiothoracic surgery patients, although limitations and
variability in study designs need to be considered. Copyright ©
2024 EDIZIONI MINERVA MEDICA.

<3>
Accession Number
2039627646
Title
EFFECT OF A SINGLE DOSE OF DEXMEDETOMIDINE ADMINISTERED BEFORE EXTUBATION
ON EXTUBATION CONDITIONS IN ADULT PATIENTS UNDERGOING GENERAL ANESTHESIA
IN INGUINAL HERNIA SURGERIES.
Source
International Journal of Academic Medicine and Pharmacy. 6(4) (pp
1170-1174), 2024. Date of Publication: 2024.
Author
Arora M.; Gupta A.; Singh P.
Institution
(Arora) Department of Anaesthesia, Rajshree Medical Research Institute
Bareilly., Rajshree Medical Research Institute, U.P., Bareilly, India
(Gupta) Department of Anaesthesia, Rajshree Medical Research Institute
Bareilly., Rajshree Medical Research Institute, U.P., Bareilly, India
(Singh) Department of Surgery, Department of Anaesthesia, Rajshree Medical
Research Institute Bareilly., Rajshree Medical Research Institute, U.P.,
Bareilly, India
Publisher
Society for Healthcare and Research Development
Abstract
Background: To evaluate the effect of a single dose of dexmedetomidine
given prior to extubation on extubation conditions in adult patients
following general anesthesia. Material(s) and Method(s): This
prospective, randomized study involved 80 patients, aged 18 to 85 years,
classified as ASA class I or II. Patients were randomly assigned to either
Group A (dexmedetomidine 0.75 microg/mL, n = 40) or Group B (normal
saline, n = 40). Premedication included midazolam and glycopyrrolate, and
general anesthesia was induced with propofol and maintained with
isoflurane. Dexmedetomidine was administered 30 minutes before extubation
in Group A, while Group B received saline. Hemodynamic parameters, cough
scores, heart rate, postoperative nausea and vomiting (PONV), and sedation
levels were monitored and analyzed. Result(s): Demographic
characteristics, including age, gender, ASA classification, BMI, and
duration of surgery, were similar between groups. Postoperative cough
scores showed no significant difference between Group A (65% Grade 0) and
Group B (60% Grade 0, p = 0.90). Group B exhibited higher mean arterial
pressure (MAP) at several time points, with significant differences noted
3 minutes post-surgery (p = 0.03). Heart rates were consistently higher in
Group B, with significant differences observed at T0 (p = 0.03) and 3
minutes (p = 0.02). The incidence of PONV was significantly lower in Group
A (p = 0.03). Sedation levels were comparable, with no significant
differences between groups (p = 0.18). Conclusion(s): Dexmedetomidine
administration prior to extubation significantly enhances extubation
conditions by stabilizing hemodynamic parameters, reducing PONV, and
minimizing postoperative cough. Although sedation levels were comparable
between groups, careful monitoring for potential complications, such as
bradycardia and hypotension, remains essential. Dexmedetomidine is a
promising adjunct for improving patient outcomes during
extubation. Copyright © 2024 Society for Healthcare and Research
Development. All rights reserved.

<4>
Accession Number
2039607847
Title
Permanent pacemaker implantation following mitral valve surgery.
State-of-the-art scoping review.
Source
European Journal of Cardio-thoracic Surgery. 67(7) (no pagination), 2025.
Article Number: ezaf210. Date of Publication: 01 Jul 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.; De Piero M.E.;
Mariani S.; Makhoul M.; Massimi G.; Litwinowicz R.; Ronco D.; Wanha W.;
Perazzo A.; Jiritano F.; Chiarini G.; Malvindi P.G.; Matteucci M.; Raffa
G.M.; Pilato M.; Maesen B.; La Meir M.; De Asmundis C.; Meani P.
Institution
(Finke, Pasierski, Braczkowski, Stec, Kuzma, Suwalski, Kowalewski)
Department of Cardiac Surgery and Transplantology, National Medical
Institute, Ministry of Interior and Administration, Warsaw, Poland
(Finke, Pasierski, Braczkowski, Drzazdzynska, Benny, Kozlowski, Pawelczak,
Kuzma, Urbanowicz, 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
(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, De Piero, Mariani, Maesen) Cardio-Thoracic Surgery
Department, Heart and Vascular Centre, Maastricht University Medical
Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM),
Maastricht, Netherlands
(Makhoul) Department of Cardiac Surgery, Harefield Hospital, London,
United Kingdom
(Massimi) Cardiac Surgery Unit, Santa Maria della Misericordia Hospital,
Perugia, Italy
(Litwinowicz) Department of Cardiac Surgery, Regional Specialist Hospital,
Grudziadz, Poland
(Ronco, Matteucci) Department of Cardiac Surgery, Circolo Hospital,
University of Insubria, Varese, Italy
(Wanha) Department of Cardiology and Structural Heart Diseases, Medical
University of Silesia, Katowice, Poland
(Perazzo) Department of Cardiac Surgery, Pronto-Socorro Cardiologico de
Pernambuco (PROCAPE), Universidade de Pernambuco, Pernambuco, Recife,
Brazil
(Jiritano) Department of Experimental and Clinical Medicine, Magna Graecia
University, Catanzaro, Italy
(Chiarini) Division of Anaesthesiology, Intensive Care and Emergency
Medicine, Spedali Civili University, Affiliated Hospital of Brescia,
Brescia, Italy
(La Meir) Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali
Riuniti Delle Marche, Polytechnic University of Marche, Ancona, Italy
(Malvindi) Cardiac Surgery Unit, Department of Precision Medicine in
Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo,
Palermo, Italy
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
(Pilato) Cardiac Surgery Department, Vrije Universiteit Brussel,
Universitair Ziekenhuis Brussel, Brussels, Belgium
(De Asmundis) Heart Rhythm Management Centre, Postgraduate Program in
Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis
Brussel-Vrije Universiteit Brussel, European Reference Networks
Guard-Heart, Brussels, Belgium
(Meani) Department of Cardiothoracic and Vascular Anesthesia, Intensive
Care Unit, IRCCS Policlinico, San Donato Milanese, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES This scoping review investigates the prevalence, indications,
risk factors, timing and outcomes related to permanent pacemaker
implantation following mitral valve surgery. METHODS 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 2 decades.
RESULTS 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 centres. 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% and 60%, with increased
rates observed in patients with atrioventricular block or those operated
in the setting of infective endocarditis. CONCLUSIONS 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 permanent pacemaker during
long-term follow-up. Copyright © 2025 The Author(s).

<5>
Accession Number
2029171584
Title
The impact of long-term antihypertensive treatment on wound healing after
major non-cardiac surgery in patients with cardiovascular diseases: A
meta-analysis.
Source
International Wound Journal. 21(4) (no pagination), 2024. Article Number:
e14858. Date of Publication: 01 Apr 2024.
Author
Liu Y.; Ma C.; Tang X.; Liu S.; Jin Y.
Institution
(Liu, Ma, Tang, Liu, Jin) Department of General Practice, Zhongnan
Hospital of Wuhan University, Wuhan, China
Publisher
John Wiley and Sons Inc
Abstract
Hypertension is a prevalent condition that poses significant challenges in
the perioperative management of patients undergoing major non-cardiac
surgery, particularly concerning wound healing and scar formation. This
meta-analysis assesses the impact of long-term antihypertensive treatment
on postoperative wound healing, examining data from seven studies
involving patients who received such treatments compared to untreated
controls. Our findings reveal that long-term antihypertensive therapy is
associated with significantly improved wound healing outcomes, as
indicated by lower REEDA scores (I2 = 96%, SMD = -25.71, 95%
CI: [-33.71, -17.70], p < 0.01) 1 week post-surgery and reduced scar
formation, demonstrated by lower Manchester Scar Scale scores
(I2 = 93%, SMD = -37.29, 95% CI: [-44.93, -29.64], p < 0.01) 2
months post-surgery. These results underscore the potential benefits of
antihypertensive treatment in enhancing surgical recovery and offer
insights into optimising perioperative care for hypertensive
patients. Copyright © 2024 The Authors. International Wound
Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<6>
Accession Number
2027251621
Title
Impact of preoperative chemotherapy on cutaneous wound healing in lung
cancer patients: A meta-analysis.
Source
International Wound Journal. 21(4) (no pagination), 2024. Article Number:
e14518. Date of Publication: 01 Apr 2024.
Author
Zhao J.; Cui H.; Qu M.; Xu Z.; Zhang Y.; Ma C.
Institution
(Zhao, Qu, Xu, Zhang, Ma) Department of Cardiothoracic Surgery,
Heilongjiang Provincial Hospital, Harbin, China
(Cui) Department of Respiratory Medicine, Heilongjiang Provincial
Hospital, Harbin, China
Publisher
John Wiley and Sons Inc
Abstract
As part of their treatment, lung cancer patients frequently endure
thoracic oncological surgery, with preoperative chemotherapeutic
interventions being the common approach. However, the potential impact of
these chemotherapeutic regimens on cutaneous wound healing outcomes
following surgery remains the topic of considerable clinical interest.
This meta-analysis sought to evaluate comprehensively the effect of
preoperative chemotherapeutic regimens on cutaneous wound healing in lung
cancer patients following thoracic oncological surgery. Extensive
literature searches were conducted using the leading databases PubMed,
Embase, Cochrane Library and Scopus. Eight studies out of 1342 identified
satisfied the inclusion criteria. Consideration was given to both
randomized controlled trials (RCTs) and observational studies. Data
pertaining to study characteristics, patient demographics,
chemotherapeutic regimens and wound healing outcomes were extracted with
great attention to detail. The examination of these varied studies
provided insights into the fluctuations in rates of recovery following
treatment, incidences of wound infections and frequencies of surgical
complications. The research studies provided odds ratios for recovery that
varied significantly in magnitude from 0.95 to 0.38, with regard to the
probability of wound infection. Furthermore, a range of odds ratios for
complications were disclosed, with certain odds ratios displaying narrow
confidence intervals. The complexity of the effect of preoperative
chemotherapy on wound closure subsequent to thoracic oncologic surgery is
highlighted by our findings. The results underscore the need for
individualized treatment strategies for lung cancer patients undergoing
surgical procedures that strike a balance between patient safety and
optimal clinical outcomes. Copyright © 2023 The Authors.
International Wound Journal published by Medicalhelplines.com Inc and John
Wiley & Sons Ltd.

<7>
Accession Number
2032714008
Title
Evaluating air leakage from staple line reinforcements in anatomical
pulmonary resection (AIRSTOP): a prospective randomized controlled trial
protocol.
Source
General Thoracic and Cardiovascular Surgery. 73(8) (pp 616-621), 2025.
Date of Publication: 01 Aug 2025.
Author
Yusa J.; Tanaka K.; Takahashi K.; Shiko Y.; Sugawara T.; Yoshino I.;
Suzuki H.
Institution
(Yusa, Tanaka, Yoshino, Suzuki) Department of General Thoracic Surgery,
Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Japan
(Takahashi, Shiko) Biostatistics Section, Clinical Research Center, Chiba
University Hospital, Chiba, Japan
(Shiko) Department of Biostatistics, Graduate School of Medicine, Saitama
Medical University, Saitama, Japan
(Sugawara) Clinical Research Center, Chiba University Graduate School of
Medicine, Chiba, Japan
(Yoshino) Department of Thoracic Surgery, International University Health
and Welfare School of Medicine, Narita, Japan
Publisher
Springer
Abstract
Background: Air leakage during pulmonary resection is a major complication
in thoracic surgery. It frequently occurs at sites of adhesion dissection,
due to lung manipulation, and along the staple lines of automatic suturing
devices, particularly in cases of pulmonary fragility such as those of
emphysema and interstitial pneumonia. Persistent postoperative air leakage
prolongs chest tube indwelling and extends hospitalization time. Staplers
with absorbable tissue reinforcements have been introduced for pulmonary
resection to prevent intraoperative stapler-related air leakage. This
phase II prospective, open-label, randomized, parallel-group trial aims to
validate the efficacy of staplers with or without absorbable tissue
reinforcements in controlling stapler-related air leakage during
anatomical pulmonary resections. Method(s): Overall, 120 patients
will be randomized into two groups: one that will undergo conventional
anatomical pulmonary resection and the other in which staplers with
absorbable tissue reinforcements will be used. The primary endpoint will
be intraoperative stapler-related air leakage. Data will be analyzed
between 2024 and 2025. Discussion(s): This trial will validate the
effectiveness and safety of staple line reinforcements in controlling
intraoperative air leakage during anatomical pulmonary resections,
potentially leading to optimized strategies for patients with conditions
such as emphysema and interstitial pneumonia. Trial registration: This
trial has been registered with the Japan Registry of Clinical Trials
1032220620
(https://jrct.niph.go.jp/latest-detail/jRCTs031230224). Copyright
© The Author(s) 2024.

<8>
Accession Number
2024958253
Title
Effect of thoracoscopic and thoracotomy on postoperative wound
complications in patients with lung cancer: A meta-analysis.
Source
International Wound Journal. 20(10) (pp 4217-4226), 2023. Date of
Publication: 01 Dec 2023.
Author
Qiu B.; Han J.; Zhao J.
Institution
(Qiu, Zhao) Department of Thoracic Surgery, Affiliated Hospital of Weifang
Medical University, Weifang, China
(Han) Department of Interventional Oncology, Affiliated Hospital of
Weifang Medical University, Weifang, China
Publisher
John Wiley and Sons Inc
Abstract
Because of the difficult surgical procedures, patients with lung cancer
who have received thoracic surgery tend to have postoperative
complications. It may lead to postoperative complications like wound
infection, wound haematoma and pneumothorax. A lot of research has
assessed the effect of various surgery methods on postoperative
complications in pulmonary cancer. The purpose of this meta-analysis is to
establish if thoracoscopic is superior to that of thoracotomy in the rate
of post-operative complications. From the beginning to the end of June
2023, we performed an exhaustive search on four main databases for key
words. The Hazard of Bias in Non-Randomized Interventional Studies
(ROBINS-I) was evaluated in the literature. In the end, 13 trials that
fulfilled the eligibility criteria underwent further statistical analyses.
The results showed that thoracoscopic intervention decreased the risk of
post operative wound infection (dominant ratio [OR], 3.00; 95% confidence
margin [CI], 1.98, 4.55; p < 0.00001) and air-leakage after operation (OR,
1.30; 95% CI, 1.04, 1.63; p = 0.02). There was no statistically
significant difference between the two groups in terms of the rate of
haemorrhage after operation (OR, 0.10; 95% CI, 0.73, 1.66; p = 0.63). Our
findings indicate that thoracoscopic is less likely to cause post
operative infection and gas leakage than thoracotomy, and it does not
decrease the risk of postoperative haemorrhage. As some of the chosen
trials are too small to conduct meta-analyses, care must be taken when
handling the data. In the future, a large number of randomized, controlled
trials will be required to provide additional evidence for this
research. Copyright © 2023 The Authors. International Wound
Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<9>
Accession Number
2035022521
Title
Commando procedure in cardiac surgery: a narrative review.
Source
General Thoracic and Cardiovascular Surgery. 73(8) (pp 567-578), 2025.
Date of Publication: 01 Aug 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. 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. 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.
 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. Copyright © The Author(s), under exclusive
licence to The Japanese Association for Thoracic Surgery 2025.

<10>
Accession Number
2034852565
Title
Safety and efficacy of riociguat in patients with pulmonary arterial
hypertension and cardiometabolic comorbidities: Data from interventional
clinical trials.
Source
Journal of Heart and Lung Transplantation. 44(2) (pp 135-146), 2025. Date
of Publication: 01 Feb 2025.
Author
Rosenkranz S.; Ghofrani H.-A.; Hoeper M.M.; Langleben D.; Hegab S.; Rahner
C.; Richard J.-F.; McLaughlin V.V.
Institution
(Rosenkranz) Department of Cardiology - Internal Medicine III, Heart
Center, University Hospital Cologne, Cologne, Germany
(Rosenkranz) Cologne Cardiovascular Research Center (CCRC), University of
Cologne, Cologne, Germany
(Ghofrani) University of Giessen and Marburg Lung Center, Member of the
German Center for Lung Research (DZL), Giessen, Germany
(Ghofrani) Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim,
Germany
(Ghofrani) Department of Medicine, Imperial College London, London, United
Kingdom
(Hoeper) Clinic for Respiratory Medicine, Hannover Medical School, Member
of the German Center for Lung Research (DZL), Hannover, Germany
(Langleben) Division of Cardiology, Center for Pulmonary Vascular Disease,
Jewish General Hospital, McGill University, Montreal, Canada
(Hegab) Bayer U.S. LLC, Medical Affairs, Whippany, NJ, United States
(Rahner) Chrestos Concept GmbH & Co KG, Essen, Germany
(Richard) Merck & Co, Inc, Medical Affairs, Rahway, NJ, United States
(McLaughlin) Division of Cardiology, Department of Internal Medicine,
Frankel Cardiovascular Center University of Michigan Medical School, Ann
Arbor, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: There is limited evidence to support treatment recommendations
in patients with pulmonary arterial hypertension (PAH) and comorbidities.
To investigate the impact of riociguat treatment in this patient
population, we analyzed pooled data from randomized controlled trials of
riociguat. Method(s): This post hoc analysis included data from the
PATENT-1, PATENT-2, PATENT PLUS, and REPLACE studies. Safety, efficacy
(6-minute walk distance [6MWD], World Health Organization functional class
[WHO-FC], and N-terminal probrain natriuretic peptide [NT-proBNP]), and
COMPERA 2.0 risk status were assessed in patients with 0, 1 to 2, or 3 to
4 cardiometabolic comorbidities (obesity, systemic hypertension, diabetes
mellitus, coronary artery disease) in the main phase of the studies.
Safety was also assessed in the long-term extensions. Result(s): The
analysis included 686 patients (riociguat, n = 440; placebo, n = 132;
phosphodiesterase type 5 inhibitors [PDE5i], n = 114), of whom 55%, 39%,
and 6% had 0, 1 to 2, and 3 to 4 comorbidities, respectively. In the main
phase, rates and severity of adverse events (AEs) were similar in
riociguat-treated patients across comorbidity subgroups. After 2 years,
discontinuations of riociguat due to AEs were also similar across
subgroups. Compared with placebo and PDE5i, riociguat improved 6MWD and
NT-proBNP across comorbidity groups and improved WHO-FC and COMPERA 2.0
risk status in patients with 0 or 1 to 2 comorbidities.
 Conclusion(s): Riociguat had an acceptable safety profile in PAH
patients with cardiometabolic comorbidities. Efficacy and risk assessment
results suggest that riociguat can be beneficial for patients with PAH,
irrespective of the presence of comorbidities. Copyright © 2024
The Authors

<11>
Accession Number
2032095824
Title
The effect of spironolactone in reducing the risk of postoperative atrial
fibrillation in patients undergoing coronary artery bypass graft surgery:
randomized single-blind placebo-controlled study.
Source
General Thoracic and Cardiovascular Surgery. 73(8) (pp 579-584), 2025.
Date of Publication: 01 Aug 2025.
Author
Farzaneh A.; Moradi M.; Safarpoor G.; Karamian A.
Institution
(Farzaneh, Moradi) Department of Cardiology, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Safarpoor) Department of Cardiac Surgery, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Karamian) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Springer
Abstract
Background: Postoperative atrial fibrillation (POAF), one of the most
common cardiac arrhythmias following coronary artery bypass graft (CABG)
surgery is associated with unfavorable outcomes. Objective(s): This
study investigated the effect of spironolactone administered two weeks
before surgery on the incidence of POAF in patients undergoing CABG.
 Method(s): This randomized single-blind placebo-controlled study was
conducted on 130 CABG patients. All patients were randomly divided into
intervention and control groups including 65 cases for each group. In the
intervention group, patients received 50 mg of spironolactone orally daily
for 2 weeks before surgery, and in the control group patients received
placebo daily from 2 weeks before surgery. All patients were continuously
monitored for the occurrence of POAF for two weeks postoperatively.
 Result(s): The mean age of the patients in the intervention and
control groups was 61.7 +/- 5.4 and 60 +/- 6.7 years, respectively. The
incidence of POAF in the intervention and control groups was 7.7% and 20%,
respectively (Odds Ratio = 0.33, P = 0.042). All demographic and clinical
variables were similar in patients with and without POAF (all P > 0.05).
 Conclusion(s): Our findings revealed that in comparison to placebo,
the use of spironolactone is associated with reduced incidence of POAF in
CABG candidates. Copyright © The Author(s), under exclusive
licence to The Japanese Association for Thoracic Surgery 2024.

<12>
Accession Number
2025159834
Title
Effect of right anterolateral thoracotomy versus median sternotomy on
postoperative wound tissue repair in patients with congenital heart
disease: A meta-analysis.
Source
International Wound Journal. 21(1) (no pagination), 2024. Article Number:
e14343. Date of Publication: 01 Jan 2024.
Author
He R.; Zhang K.; Zhou C.; Pei C.
Institution
(He, Zhang, Zhou, Pei) Maternal and Child Health Hospital of Hubei
Province, Wuhan, China
Publisher
John Wiley and Sons Inc
Abstract
Right anterolateral thoracotomy (RAT) and median sternotomy (MS) are two
major methods for treatment of congenital cardiac disease. But there are
various types of surgery that provide a better operative outcome for the
patient. Therefore, we carried out a meta-analysis to investigate the
effects of these two methods in the treatment of wound tissue,
hospitalization and so on, to find out which surgery method could provide
the best short-term effect. In this research, we chose an English
controlled trial from 2003 to 2022 to evaluate the influence of right
anterolateral thoracotomy and median sternotomy on the short-term outcome
of Cardiopulmonary bypass (CPB), time of operation, time spent in the
hospital, and the time of scar formation. Our findings suggest that the
RAT method was associated with a shorter surgical scars for congenital
heart disease operations compared to MS with respect to post-operation
scars (WMD, 3.55; 95% CI, 0.04, 7.05; p = 0.05). The RAT method is better
suited to the needs of patients who care about their injuries.
Nevertheless, in addition to other surgery related factors which might
affect post-operative wound healing, we discovered that MS took a shorter
time to perform CPB compared with RAT surgery (WMD, - 1.94; 95% CI, -3.39,
-0.48; p = 0.009). Likewise, when it comes to the time taken to perform
surgery, MS needs less operational time compared to RAT methods (WMD,
-12.84; 95% CI, -25.27, -0.42; p = 0.04). On the other hand, the time
needed for MS to recover was much longer compared to the RAT (WMD, 0. 60;
95% CI, 0.02, 1.18; p = 0.04). This indicates that while RAT is
advantageous in terms of shortening the duration of post-operative scar,
it also increases the time needed for surgical operations and
CPB. Copyright © 2023 The Authors. International Wound Journal
published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<13>
Accession Number
2031895379
Title
Comparable bleeding and inflammation outcomes between heparin-coated and
uncoated minimal invasive extracorporeal circuits in isolated coronary
artery bypass surgery - A double-blinded randomized control trial.
Source
Perfusion (United Kingdom). 40(5) (pp 1248-1257), 2025. Date of
Publication: 01 Jul 2025.
Author
Jenni H.; Kovacic B.; Mihalj M.; Huber M.; Rieben R.; Carrel T.; Siepe M.;
Kadner A.; Erdoes G.
Institution
(Jenni, Mihalj, Carrel, Siepe, Kadner) Department of Cardiac Surgery,
University of Bern, University Hospital Bern, Bern, Switzerland
(Kovacic, Rieben) Department of BioMedical Research, University of Bern,
Bern, Switzerland
(Mihalj) Department of Advanced Cardiopulmonary Therapies and
Transplantation, University of Texas Health Science Center, Houston, TX,
United States
(Huber, Erdoes) Department of Anesthesiology and Pain Medicine, University
of Bern, University Hospital Bern, Bern, Switzerland
Publisher
SAGE Publications Ltd
Abstract
Objective: Minimally invasive extracorporeal circulation has been shown to
be non-inferior or even superior to conventional cardiopulmonary bypass
circuits in isolated coronary artery bypass grafting, but there is little
evidence whether the addition of a heparin-coated circuit can further
reduce the inflammatory response and amount of bleeding in these patients.
 Method(s): A single-center randomized control trial enrolled 49 adult
patients scheduled to undergo isolated coronary artery bypass grafting
with minimally invasive extracorporeal circulation (MiECC) between January
2015 and December 2018. Patients were randomized 1:1 to either the
heparin-coated circuit group, or the uncoated (control) circuit group. The
primary outcome was chest tube output 18 h after weaning from MiECC, and
secondary outcomes included inflammatory (TNF-alpha, IL-6, IL-8, IL-10)
and complement (C3a, C4d, C5a, sC5b-9) biomarkers, platelet count and
function (D2D, TAT, SDC1, PF4), number of transfused blood products, and
30-day survival. Result(s): Patients were randomized to undergo
myocardial revascularization using heparin-coated circuits (n = 25), and
to the uncoated MiECC circuit (n = 24), with comparable baseline
demographics. No significant difference was observed in chest tube output
and for all secondary outcomes. IL-6 and IL-8 were increased from baseline
at 18 h after weaning (effect size 0.29 and 0.05, respectively) and sC5b-9
was lower (effect size 0.11) in the heparin-coated than in the uncoated
MiECC, although not significantly different. Conclusion(s): Compared
with an uncoated MiECC circuit, heparin-coated MiECC circuit was not
associated with a reduction in postoperative bleeding, transfusion,
inflammation, complement activation, and platelet biomarkers, following
isolated coronary artery bypass grafting. Copyright © The
Author(s) 2024

<14>
Accession Number
2038910576
Title
Custodiol-N versus Custodiol: Results from a prospective noninferiority
randomized single blind, multicenter phase 3 trial in patients undergoing
heart transplantation.
Source
Journal of Heart and Lung Transplantation. 44(8) (pp 1262-1272), 2025.
Date of Publication: 01 Aug 2025.
Author
Aliabadi-Zuckermann A.; Osorio-Jaramillo E.; Knosalla C.; Gummert J.;
Szabo G.; Wittmann F.; Yeter R.; Schramm R.; Goekler J.; Hennig F.;
Morshuis M.; Zuckermann A.
Institution
(Aliabadi-Zuckermann, Osorio-Jaramillo, Wittmann, Goekler, Zuckermann)
Department of Cardiac Surgery, Medical University of Vienna, Vienna,
Austria
(Knosalla, Yeter, Hennig) Department of Cardiothoracic and Vascular
Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
(Knosalla, Yeter, Hennig) Charite-Universitatsmedizin Berlin, corporate
member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin,
Berlin, Germany
(Knosalla, Hennig) German Center for Cardiovascular Research (DZHK),
Partner Site Berlin, Berlin, Germany
(Gummert, Schramm, Morshuis) Department for Cardiac Surgery, Herz und
Diabeteszentrum NRW, Bad Oeynhausen, Germany
(Szabo) Department of Cardiac Surgery, University of Heidelberg,
Heidelberg, Germany
Publisher
Elsevier Inc.
Abstract
Background: Custodiol is a well-established preservation solution for
organ transplantation and was the basis for the development of Custodiol-N
to improve graft preservation. Previous results in coronary artery bypass
graft surgery have shown effective cardiac protection without safety
concerns. This study aimed to evaluate the safety and ability of
Custodiol-N to preserve cardiac grafts for heart transplantation.
 Method(s): This prospective, randomized, single-blind, multicenter,
noninferiority study was conducted at three centers in Austria and
Germany. The primary end-point was creatine kinase (CK-MB) peak value from
4 to 168 hours after opening of the aortic cross clamp, with a 30%
noninferiority margin. Key secondary efficacy end-points include patient
and graft survival, incidence of primary graft failure, or length of stay
in the intensive care unit. The primary and secondary end-points were
analyzed in both the treated and per protocol populations. Result(s):
A total of 105 randomized patients received Custodiol (n = 52) or
Custodiol-N (n = 53) preserved hearts. Average donor age and ischemic
times were comparable. Average CK-MB peak values were 176.94 +/- 189.61
U/L for the Custodiol versus 130.51 +/- 69.60 U/liter for the Custodiol-N
group (p-value for noninferiority of Custodiol-N by 30% <0.0001). Patient
survival was comparable 1-year post transplantation (90.4% for Custodiol
versus 88.7% for Custodiol-N). The incidence of primary graft failure and
median length of intensive care unit stay were higher for Custodiol group.
Safety assessment showed evenly distributed adverse events.
 Conclusion(s): This study shows that Custodiol-N is safe,
noninferior, and provides similar cardiac graft protection as the
established Custodiol solution. Copyright © 2025

<15>
Accession Number
2029910275
Title
Effect of concomitant tricuspid annuloplasty on postoperative wound
complications in heart failure patients undergoing mitral valve repair.
Source
International Wound Journal. 21(5) (no pagination), 2024. Article Number:
e14835. Date of Publication: 01 May 2024.
Author
Hou Y.; Guo L.; Li Y.; Cai J.
Institution
(Hou, Cai) Department of Infectious Diseases, Naval Medical Center, Naval
Medical University, Shanghai, China
(Hou) Department of Second Internal Medicine, Naval Hospital of Eastern
Theater Command, Zhejiang, Zhoushan, China
(Guo) Department of Cardiology, Changde First People's Hospital, Hunan,
Changde, China
(Li) Department of Respiratory and Critical Care Medicine, The 906rd
Hospital, Joint Logistic Support Force of Chinese People's Liberation
Army, Zhejiang, Ningbo, China
Publisher
John Wiley and Sons Inc
Abstract
Tricuspid valve repair (TVR) combined with mitral valve surgery (MVS) has
been a controversial issue. It is not clear whether the combined surgery
has any influence on the occurrence of postoperative complications. The
aim of this study was to compare the occurrence of complications including
wound infection, wound bleeding, and mortality after MVS combined with or
without TVR. By meta-analysis, a total of 1576 papers were collected from
3 databases, and 7 of them were included. We provided the necessary data
of 7 included studies such as the authors, publication date, country,
surgical approach and case number, patient age, and so on. Statistical
analysis was carried out with RevMan 5.3 software. We found that patients
with heart failure accepting MVS combined with or without TVR, performed
no statistically significant difference in postoperative wound infection
(OR: 0.88; 95% CI: 0.29, 2.62; P = 0.81), wound bleeding (OR: 0.74; 95%
CI: 0.3, 1.48; P = 0.39), and mortality (OR: 1.05; 95% CI: 0.42, 2.61; P =
0.92). In conclusion, current evidence indicated that the combined surgery
had no additional risk of postoperative complications, and might be an
effective alternative surgical approach to mitral valve diseases accompany
with tricuspid regurgitation. However, for the limited case size, it was
required to support the findings with a large number of cases in further
studies. Copyright © 2024 The Authors. International Wound
Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<16>
Accession Number
2030550767
Title
Intentional coronary revascularization versus conservative therapy in
patients after peripheral artery revascularization due to critical limb
ischemia: the INCORPORATE trial.
Source
Clinical Research in Cardiology. 114(8) (pp 991-999), 2025. Date of
Publication: 01 Aug 2025.
Author
Toth G.G.; Brodmann M.; Kanoun Schnur S.S.; Bartus S.; Vrsalovic M.;
Krestianinov O.; Kala P.; Bil J.; Gil R.; Kanovsky J.; Di Serafino L.;
Paolucci L.; Barbato E.; Mangiacapra F.; Ruzsa Z.
Institution
(Toth, Kanoun Schnur) Department of Cardiology, University Heart Center
Graz, Medical University Graz, Graz, Austria
(Brodmann) Division of Angiology, Department of Internal Medicine, Medical
University Graz, Graz, Austria
(Kanoun Schnur, Ruzsa) Department of Cardiology, Faculty of Medicine,
Doctoral School of Clinical Medicine, University of Szeged, Szeged,
Hungary
(Kanoun Schnur) Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
(Bartus) II Dept of Cardiology, Medical College, Jagiellonian University,
Krakow, Poland
(Vrsalovic) Department of Cardiology, University of Zagreb School of
Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
(Krestianinov) E. Meshalkin National Medical Research Center of the
Ministry of Health of the Russian Federation, Novosibirsk, Russian
Federation
(Kala, Kanovsky) University Hospital Brno and Medical Faculty of Masaryk
University, Brno, Czechia
(Bil) Department of Invasive Cardiology, Centre of Postgraduate Medical
Education, Warsaw, Poland
(Bil, Gil) National Medical Institute of the Internal Affairs and
Administration Ministry, Warsaw, Poland
(Di Serafino) Department of Advanced Biomedical Sciences, University of
Naples Federico II, Naples, Italy
(Paolucci, Mangiacapra) Department of Medicine and Surgery, Research Unit
of Cardiovascular Science, Universita Campus Bio-Medico Di Roma and
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
(Barbato) Department of Clinical and Molecular Medicine, Sapienza
University of Rome, Rome, Italy
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: INCORPORATE trial was designed to evaluate whether default
coronary-angiography (CA) and ischemia-targeted revascularization is
superior compared to a conservative approach for patients with treated
critical limb ischemia (CLI). Registered at clinicaltrials.gov
(NCT03712644) on October 19, 2018. Background(s): Severe peripheral
artery disease is associated with increased cardiovascular risk and poor
outcomes. Method(s): INCORPORATE was an open-label, prospective 1:1
randomized multicentric trial that recruited patients who had undergone
successful CLI treatment. Patients were randomized to either a
conservative or invasive approach regarding potential coronary artery
disease (CAD). The conservative group received optimal medical therapy
alone, while the invasive group had routine CA and fractional flow
reserve-guided revascularization. The primary endpoint was myocardial
infarction (MI) and 12-month mortality. Result(s): Due to COVID-19
pandemic burdens, recruitment was halted prematurely. One hundred
eighty-five patients were enrolled. Baseline cardiac symptoms were scarce
with 92% being asymptomatic. Eighty-nine patients were randomized to the
invasive approach of whom 73 underwent CA. Thirty-four percent had
functional single-vessel disease, 26% had functional multi-vessel disease,
and 90% achieved complete revascularization. Conservative and invasive
groups had similar incidences of death and MI at 1 year (11% vs 10%;
hazard ratio 1.21 [0.49-2.98]). Major adverse cardiac and cerebrovascular
events (MACCE) trended for hazard in the Conservative group (20 vs 10%;
hazard ratio 1.94 [0.90-4.19]). In the per-protocol analysis, the primary
endpoint remained insignificantly different (11% vs 7%; hazard ratio 2.01
[0.72-5.57]), but the conservative approach had a higher MACCE risk (20%
vs 7%; hazard ratio 2.88 [1.24-6.68]). Conclusion(s): This trial
found no significant difference in the primary endpoint but observed a
trend of higher MACCE in the conservative arm. Copyright © The
Author(s) 2024.

<17>
Accession Number
2027668315
Title
Utility of dexmedetomidine on surgical site wound pain undergoing
thoracoscopic surgery: A meta-analysis.
Source
International Wound Journal. 21(4) (no pagination), 2024. Article Number:
e14629. Date of Publication: 01 Apr 2024.
Author
Li M.; Zhang K.; Lu H.; Liang Y.; Zhang Y.; Feng G.
Institution
(Li, Lu, Liang, Zhang, Feng) Department of Pharmacy, Gaozhou People's
Hospital, Guangdong, Gaozhou, China
(Zhang) Department of Cardiovascular Surgery, Gaozhou People's Hospital,
Guangdong, Gaozhou, China
Publisher
John Wiley and Sons Inc
Abstract
We conducted this study aimed to evaluate the analgesic effect of
dexmedetomidine in thoracoscopic surgery on postoperative wound pain, and
to provide a reference for clinical use of the drug. We searched PubMed,
Embase, Cochrane Library, Web of Science, Wanfang, Chinese Biomedical
Literature Database and China National Knowledge Infrastructure databases,
and supplemented with manual searching. We searched from database
inception to October 2023, to collect the randomised controlled trials
(RCTs) on dexmedetomidine application in thoracoscopic surgery. Two
researchers screened all the literature according to the inclusion and
exclusion criteria and the literature included in the study was evaluated
for quality, extracted information and required data. Stata 17.0 software
was employed for data analysis and the outcomes were 2 6, 12, 24 and 48 h
postoperative wound visual analog scores (VAS). Twenty-four RCTs totalling
2246 patients undergoing thoracoscopic surgery were finally included. The
analysis revealed dexmedetomidine applied to thoracoscopic surgery
significantly reduced the postoperative wound VAS scores at 2 h (SMD:
-0.96, 95% CI: -1.57 to -0.36, p = 0.002), 6 h (SMD: -0.98, 95% CI: -1.27
to -0.69, p < 0.001), 12 h (SMD: -1.19, 95% CI: -1.44 to -0.94, p <
0.001), 24 h (SMD: -0.91, 95% CI: -1.16 to -0.66, p < 0.001) and 48 h
(SMD: -0.75, 95% CI: -1.02 to -0.48, p < 0.001). Our results suggest
dexmedetomidine applied to thoracoscopic surgery can significantly reduce
postoperative wound pain, which is worthy of clinical
application. Copyright © 2023 The Authors. International Wound
Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

<18>
Accession Number
2038554008
Title
Surgical neuromodulation therapies to prevent postoperative atrial
fibrillation: A meta-analysis, meta-regression, and trial sequential
analysis of randomized controlled trials.
Source
Heart Rhythm. 22(8) (pp e301-e308), 2025. Date of Publication: 01 Aug
2025.
Author
Consoli L.N.; Cetinel E.; Lajczak P.; Koziakas I.G.; Majeed M.W.; Wijaya
P.; Salha I.; Samanidis G.
Institution
(Consoli) Federal University of Bahia, Salvador, Brazil
(Cetinel) San Raffaele University, Milan, Italy
(Lajczak) Medical University of Silesia, Katowice, Poland
(Koziakas, Samanidis) Department of Cardiac Surgery, Onassis Hospital,
Athens, Greece
(Majeed) Government Medical College Srinagar, Jammu and Kashmir, India
(Wijaya) Universitas Indonesia, Depok, Indonesia
(Salha) Trinity Centre for Global Health, Trinity College Dublin, Dublin,
Ireland
Publisher
Elsevier B.V.
Abstract
Background: Postoperative atrial fibrillation (POAF) occurs frequently
after cardiac surgery and is associated with increased mortality.
 Objective(s): Surgical neuromodulation therapies (SNMTs) have been
explored as a preventive strategy, but their efficacy and safety remain
uncertain. Method(s): We searched PubMed, Embase, and the Cochrane
Library for eligible randomized controlled trials. Meta-analysis was
performed for primary (POAF) and secondary (hospital stay, complications,
atrial fibrillation at 1 year, operation time, POAF burden, intensive care
unit stay) end points. Subgroup analysis was conducted for each technique.
We compared end points using risk ratio for binary outcomes and mean
difference for continuous outcomes. We calculated 95% confidence intervals
for all outcomes. We carried out a trial sequential analysis for primary
(POAF) and secondary (hospital stay, complications) end points. We
conducted meta-regression for all covariates with at least 10
observations. Result(s): We included 20 trials (n = 3348): 7 studied
anterior fat pad (AFP) preservation; 5, pulmonary vein isolation (PVI); 2,
ganglionated plexus ablation; 1, partial cardiac denervation (PCD); and 5,
epicardial injections. POAF incidence was lower in the SNMT group (risk
ratio, 0.62 [0.48-0.79]; P < .001), driven by the AFP preservation, PCD,
and PVI subgroups. Epicardial injections were effective only in patients
undergoing coronary surgery. SNMTs also reduced hospital stay (P = .03).
All meta-regression analyses were insignificant. In the trial sequential
analysis, a positive effect for POAF was observed. Conclusion(s):
This meta-analysis found a significant reduction in POAF incidence with
implementation of AFP preservation, PCD, and PVI. Epicardial injections
were effective only for patients undergoing coronary bypass. Copyright
© 2025 Heart Rhythm Society

<19>
Accession Number
2035215299
Title
Efficacy and Safety of Bupivacaine Liposomal in Intercostal Nerve Block
for Postoperative Pain Management Following Uniportal Thoracoscopy: A
Randomized Trial.
Source
Pain Research and Management. 2025(1) (no pagination), 2025. Article
Number: 8816879. Date of Publication: 2025.
Author
Dong L.; Wang X.; Fu L.; Jiang Z.; Wang Y.; Chen A.; Ding J.; Yu G.
Institution
(Dong, Wang, Fu, Ding, Yu) Department of Thoracic Surgery, Shaoxing
People's Hospital, 568-Zhongxing North Road, Zhejiang, Shaoxing, China
(Jiang, Wang) Department of Anesthesiology, Shaoxing People's Hospital,
568-Zhongxing North Road, Zhejiang, Shaoxing, China
(Chen) Department of Nursing, Shaoxing People's Hospital, 568-Zhongxing
North Road, Zhejiang, Shaoxing, China
Publisher
John Wiley and Sons Ltd
Abstract
Background: Postoperative pain in thoracic surgery often requires opioids,
yet can be poorly managed with short-acting anesthetics. Liposomal
bupivacaine (LB) offers prolonged analgesia, potentially improving pain
control and reducing opioid use. This study evaluates LB's effectiveness
and safety in thoracic postoperative pain management, aiming to provide an
alternative to current practices. Method(s): In this single-center,
double-blind, prospective, randomized controlled trial, patients
undergoing uniportal lobectomy, segmentectomy, or wedge resection from
November 2023 to May 2024 were enrolled. Participants were randomly
assigned in a 1:1 ratio to receive either 0.375% ropivacaine (control
group, n = 57) or LB (LB group, n = 56) for intercostal nerve blocks
(ICNBs). Postoperative visual analog scale (VAS) scores, opioid
consumption, overall benefit of analgesia score (OBAS), chest tube
duration, length of hospital stay, and adverse events (AEs) were recorded
and analyzed. Result(s): Data from 57 patients in the control group
and 56 patients in the LB group were included in the analysis, with no
significant demographic differences between the groups. The LB group
demonstrated lower VAS scores at rest and during activity (p > 0.05),
reduced opioid consumption (p = 0.021), and higher OBAS (p < 0.01)
compared with the control group. No significant differences were observed
in chest tube duration, length of hospital stay, or AEs between the
groups. Conclusion(s): LB is safe and effective for ICNB, providing
significant postoperative pain relief for patients undergoing uniportal
thoracoscopic surgery. Trial Registration: Chinese Registry of Clinical
Trials: chiCTR2300075463. Copyright © 2025 Lingjun Dong et al.
Pain Research and Management published by John Wiley & Sons Ltd.

<20>
Accession Number
2034205093
Title
Treatment of and outcomes from hypotension in the post-anaesthesia care
unit: A single-centre retrospective cohort study.
Source
Anaesthesia and Intensive Care. 53(4) (pp 231-237), 2025. Date of
Publication: 01 Jul 2025.
Author
Douglas N.; Gilbert S.; Ong J.; Kave B.; Leslie K.; Darvall J.N.
Institution
(Douglas, Gilbert, Ong, Kave, Leslie, Darvall) Department of Anaesthesia
and Pain Management, The Royal Melbourne Hospital, Parkville, Australia
(Douglas, Leslie, Darvall) Department of Critical Care, Melbourne Medical
School, University of Melbourne, Parkville, Australia
Publisher
SAGE Publications Inc.
Abstract
Hypotension after non-cardiac surgery is common and associated with harm.
Anaesthetists treat hypotension in the post-anaesthesia care unit (PACU)
with intravenous (IV) fluids and vasopressor medications. Our aim was to
determine the incidence of hypotension after these treatments. We
conducted a single centre retrospective cohort study of all adult patients
who were hypotensive (systolic blood pressure less than 90 mmHg) in the
PACU after non-cardiac, non-obstetric surgery over a one-year period. The
primary outcome was a composite of hypotension or vasopressor infusion in
the 24 h after PACU discharge. During the study 459 patients were
hypotensive in the PACU. No treatment was administered in 232 (51%)
episodes, IV fluid alone was administered in 138 (30%) episodes,
vasopressors alone were administered in 22 (5%) episodes, and both fluid
and vasopressors were administered in 67 (14%) patients. A total of 167
patients (36%) met the primary outcome, of which 118 (25%) were
hypotensive and 49 (11%) required vasopressor infusions. The treatment
group was significantly associated with the primary outcome (P < 0.001),
with 36 (15%) patients who received no treatment becoming hypotensive,
compared with 67 (46%, P < 0.001) patients who received IV fluid alone, 12
(55%, P < 0.001) who received vasopressors alone and 52 (75%, P < 0.001)
who received both IV fluid and vasopressors. Patients who were hypotensive
in the PACU frequently developed later hypotension or required
vasopressors in the 24 h after PACU discharge. Treatments delivered in the
PACU had limited long-term effectiveness. Novel treatments to protect
patients from subsequent hypotension are urgently needed. Copyright
© The Author(s) 2025

<21>
Accession Number
2039638064
Title
Rationale and design of randomized noninferiority clinical trial to
compare the safety and efficacy of ticagrelor monotherapy with dual
antiplatelet therapy in chronic coronary syndrome patients post
percutaneous coronary intervention (TICALONE-TAHA10 Protocol).
Source
PLOS ONE. 20(7 July) (no pagination), 2025. Article Number: e0325663. Date
of Publication: 01 Jul 2025.
Author
Mirhosseini S.A.; Akbari M.; Aldavood D.; Zarifkar H.; Attar A.; Kojuri J.
Institution
(Mirhosseini, Aldavood, Attar) Department of Cardiovascular Medicine, TAHA
Clinical Trial Group, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Mirhosseini) MD-MPH Department, School of Medicine, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Akbari) Shiraz Nephro-Urology Research Center, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Zarifkar, Kojuri) Department of Cardiology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Public Library of Science
Abstract
Background Despite the wide variety of antiplatelet regimens and
durations, the optimal treatment approach for chronic coronary syndrome
(CCS) patients remains a subject of ongoing debate. While current
guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and
clopidogrel, the development of drug-eluting stents (DES) and more potent
agents has sparked interest in shorter DAPT regimens, followed by P2Y12
inhibitor monotherapy, as a potential alternative. Recent trials and
meta-analyses have shown that this approach may provide similar protection
against thrombotic events with reduced bleeding risk. Despite promising
data, the safety and efficacy of Ticagrelor monotherapy specifically in
CCS patients have not been rigorously tested in randomized trials. Methods
TICALONE is a non-inferiority, two-arm, double-blinded, randomized
controlled clinical trial designed to evaluate the safety and efficacy of
ticagrelor monotherapy compared to DAPT in CCS patients following PCI.
Eligible patients undergoing PCI with drug-eluting stents will be randomly
assigned to receive either conventional DAPT (aspirin and clopidogrel) or
ticagrelor monotherapy for six months. Follow-up visits will be conducted
at 1, 3, 6, and 12 months post-PCI to assess efficacy and safety
endpoints. The primary efficacy endpoint is a composite endpoint of
cardiac death, myocardial infarction, stroke, stent thrombosis, and the
need for revascularization. The primary safety endpoint is the occurrence
of Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding
events. The secondary endpoints include components of the primary efficacy
endpoint, any bleeding event (BARC type 1-5), and all-cause mortality.
Ancillary endpoints are other adverse events including dyspnea, drug
adherence, and reaction. All endpoints will be monitored by a Data Safety
Monitoring Board (DSMB) and Trial Management Committee (TMC). Statistical
analysis and reporting of trial results will follow the estimand
framework. Kaplan-Meier estimates will be used to assess event rates,
while the log-rank test and Cox regression analysis will be employed to
compare safety and efficacy outcomes between the groups. Discussion This
trial may serve as a crucial step toward eliminating aspirin from post-PCI
regimens, specifically in CCS patients. By comparing the safety and
efficacy of Ticagrelor monotherapy with the conventional DAPT regimen and
addressing potential risks of aspirin-free therapy and adverse events like
dyspnea, this study could offer valuable insights into the possibility of
P2Y12 monotherapy's safe adoption in this population. Copyright ©
2025 Mirhosseini et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<22>
[Use Link to view the full text]
Accession Number
2038728383
Title
Efficacy and Safety of Edoxaban in Anticoagulant Therapy Early After
Surgical Bioprosthetic Valve Replacement: A Randomized Clinical Trial.
Source
Circulation: Cardiovascular Interventions. 18(7) (pp e015108), 2025.
Article Number: e015108. Date of Publication: 01 Jul 2025.
Author
Izumi C.; Amano M.; Yoshikawa Y.; Fukushima S.; Yaku H.; Eishi K.;
Sakaguchi T.; Ohno N.; Hiraoka A.; Okada K.; Saiki Y.; Miura T.; Komiya
T.; Minami M.; Yamamoto H.; Omae K.
Institution
(Izumi, Amano) Department of Heart Failure and Transplantation, National
Cerebral and Cardiovascular Center, Suita, Japan
(Yoshikawa) Department of Bio-statistics, National Cerebral and
Cardiovascular Center, Suita, Japan
(Fukushima) Department of Cardiovascular Surgery, National Cerebral and
Cardiovascular Center, Suita, Japan
(Minami, Yamamoto, Omae) Department of Data Science, National Cerebral and
Cardiovascular Center, Suita, Japan
(Yaku) Department of Cardiovascular Surgery, Kyoto Prefectural University
of Medicine, Japan
(Eishi) Department of Cardiovascular Surgery, Hakujyuji Hospital, Fukuoka,
Japan
(Sakaguchi) Department of Cardiovascular Surgery, Hyogo Medical
University, Nishinomiya, Japan
(Ohno) Department of Cardiovascular Surgery, Kokura Memorial Hospital,
Kitakyushu, Japan
(Hiraoka) Department of Cardiovascular Surgery, Sakakibara Heart Institute
of Okayama, Japan
(Okada) Department of Cardiovascular Surgery, Kobe University Graduate
School of Medicine, Japan
(Saiki) Department of Cardiovascular Surgery, Tohoku University Graduate
School of Medicine, Sendai, Japan
(Miura) Department of Cardiovascular Surgery, Nagasaki University Graduate
School of Biomedical Sciences, Japan
(Komiya) Department of Cardiac Surgery, Kurashiki Central Hospital, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Anticoagulant therapy with vitamin K antagonists is
recommended in the current guidelines for 3 to 6 months following
bioprosthetic valve replacement. However, in the era of direct oral
anticoagulants, there is a paucity of evidence regarding the efficacy and
safety of direct oral anticoagulants in this patient group.
 METHOD(S): The ENBALV trial (Edoxaban in Anticoagulant Therapy After
Surgical Bioprosthetic Valve Replacement) was an investigator-initiated,
phase 3, randomized, open-label, multicenter study that aimed to evaluate
the efficacy and safety of edoxaban compared with warfarin within 3 months
following bioprosthetic valve replacement at the aortic or mitral position
or both. The primary outcome was stroke or systemic embolism. The
secondary outcomes included major bleeding, intracardiac thrombus, and a
composite of stroke, systemic embolism, or major bleeding. Given the
limited study period and the low event rate of the primary outcome, this
study assessed the difference in the point estimates of the event rate.
 RESULT(S): Of the 410 enrolled patients, 389 were included in the
final analysis (73+/-6 years, 56.8% male, 79.4% sinus rhythm; edoxaban
group: n=195, warfarin group: n=194). The primary outcome occurred in 0.5%
(n=1) in the edoxaban group, whereas in 1.5% (n=3) in the warfarin group
(risk difference, -1.03% [95% CI, -4.34 to 1.95%]). Major bleeding
occurred in 4.1% (n=8) in the edoxaban group and in 1.0% (n=2) in the
warfarin group (risk difference, 3.07% [95% CI, -0.67 to 7.27%]). No fatal
bleeding or intracranial hemorrhage was observed in patients treated with
edoxaban, whereas 1 fatal intracranial hemorrhage occurred in the warfarin
group. Intracardiac thrombus did not occur in any of the patients in the
edoxaban group, but did occur in 1.0% (n=2) in the warfarin group.
 CONCLUSION(S): Edoxaban is a potential alternative anticoagulant
therapy early after bioprosthetic valve replacement. Copyright ©
2025 American Heart Association, Inc.

<23>
Accession Number
2036867852
Title
Left atrial appendage occlusion in patients with atrial fibrillation and
intracerebral haemorrhage associated with cerebral amyloid angiopathy: a
multicentre observational study and pooled analysis of published studies.
Source
Journal of Neurology, Neurosurgery and Psychiatry. 96(6) (pp 528-536),
2025. Date of Publication: 01 Jun 2025.
Author
Thiankhaw K.; Best J.; Srivastava S.; Prachee I.; Agarwal S.; Tan S.;
Calvert P.A.; Chughtai A.; Ang R.; Segal O.R.; Werring D.J.
Institution
(Thiankhaw, Best, Srivastava, Werring) Stroke Research Centre, Department
of Brain Repair and Rehabilitation, UCL Queen Square Institute of
Neurology, London, United Kingdom
(Thiankhaw) Department of Internal Medicine, Chiang Mai University, Chiang
Mai, Thailand
(Prachee, Ang, Segal) Department of Cardiac Electrophysiology, Saint
Bartholomew's Hospital Barts Heart Centre, London, United Kingdom
(Agarwal, Tan) Department of Stroke Medicine, Clinical Neurosciences,
Addenbrooke's Hospital, Cambridge, United Kingdom
(Calvert, Chughtai) Department of Cardiology, Royal Papworth Hospital,
Cambridge, United Kingdom
(Calvert) University of Cambridge, Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Cerebral amyloid angiopathy (CAA) is a common cause of
intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial
appendage occlusion (LAAO) is a method for ischaemic stroke prevention in
patients with atrial fibrillation (AF), potentially reducing the risk of
intracranial bleeding in CAA-associated ICH. We aimed to determine the
outcomes of patients with AF with CAA-associated ICH undergoing LAAO.
Methods We conducted a multicentre study of patients with CAA-associated
ICH who underwent LAAO for stroke prevention. We pooled our findings with
data from a systematic review of relevant published studies of LAAO for AF
in ICH survivors reporting CAA diagnosis. Results We included data from
two published studies (n=65) with CAA-specific data and our cohort study
(n=37), providing a total of 102 participants (mean age 76.2+/-8.0 years,
74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The
median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural
antithrombotic regimens varied between single (73.0%) or dual antiplatelet
therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a
median duration of 42 days (IQR 35-74). Postprocedural complications were
uncommon, but included transient arrhythmias (2.1%) and
non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic
stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73
(95% CI 0.41 to 13.94) per 100 patient years, respectively. Conclusions
LAAO followed by short-term antithrombotic therapy might be a safe and
effective ischaemic stroke preventive strategy in people with
CAA-associated ICH and AF. However, randomised controlled trials are
needed to determine how LAAO compares with long-term DOAC in this
population. Copyright © Author(s) (or their employer(s)) 2025. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<24>
Accession Number
2036789235
Title
Intravenous Amino-acid Infusion to Prevent Acute Kidney Injury after
Cardiac Surgery: A Review of the Evidence.
Source
Annals of Thoracic Surgery. 120(2) (pp 256-266), 2025. Date of
Publication: 01 Aug 2025.
Author
Losiggio R.; Redaelli M.B.; Landoni G.; Bellomo R.
Institution
(Losiggio, Redaelli, Landoni) Department of Anesthesia and Intensive Care,
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan,
Italy
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Monash University, Melbourne, Australia
(Bellomo) Data Analytics Research and Evaluation Centre, Austin Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Bellomo) Centre for Clinical Informatics, Royal Melbourne Hospital,
Melbourne, Australia
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, Australia
Publisher
Elsevier Inc.
Abstract
Background: Acute kidney injury (AKI) is a frequent and important
complication of cardiac surgery. Decreased perfusion is a key mechanism.
This decreased perfusion may be attenuated by intravenous amino acids
(AAs) through recruitment of renal functional reserve. Method(s): The
study investigators performed a PubMed search of all articles published
from 1980 to August 30, 2024, with combined search criteria of "renal
functional reserve," "amino acids," "cardiac surgery," and
"cardiopulmonary bypass" by using MEDLINE (PubMed), Embase, and the
Cochrane Central Register of Clinical Trials. Included were studies
describing the effect of AAs on renal functional reserve and studies of
adult cardiac surgery patients with information on renal function. A
narrative review was developed. Result(s): Multiple experimental and
human studies over >40 years have recurrently and consistently shown that
the administration of an oral protein load or intravenous AAs increase
renal blood flow and glomerular filtration rate by >30%. Moreover, several
pilot investigations in cardiac surgery with cardiopulmonary bypass
consistently showed renal benefits with intravenous AAs. Finally, a
pivotal trial of 3511 cardiac surgery patients (the PROTECTION trial)
recently confirmed such beneficial effects in a double-blind multicenter
international setting. Conclusion(s): Intravenous AAs consistently
recruit renal functional reserve and improve kidney function in cardiac
surgery patients. These findings have been confirmed by the PROTECTION
(Intravenous Amino Acid Therapy for Kidney Protection in Cardiac Surgery)
trial. Intravenous AA therapy is the only proven treatment to prevent
and/or attenuate the severity of cardiac surgery-associated
AKI. Copyright © 2025 The Society of Thoracic Surgeons

<25>
Accession Number
2038843472
Title
Escalation and De-escalation of Temporary Mechanical Circulatory Support:
Joint Consensus Report of the PeriOperative Quality Initiative and the
Enhanced Recovery After Surgery Cardiac Society.
Source
Annals of Thoracic Surgery. 120(2) (pp 213-224), 2025. Date of
Publication: 01 Aug 2025.
Author
Spelde A.E.; Barron L.M.; Cangut B.; Hickey G.W.; Lorusso R.; Silvestry
S.C.; Tong M.Z.; Engelman D.T.; Shaw A.D.; Chatterjee S.
Institution
(Spelde) Department of Anesthesiology & Critical Care, University of
Pennsylvania, Philadelphia, Pennsylvania, United States
(Barron, Chatterjee) Division of Cardiothoracic Surgery, Michael E.
DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,
United States
(Barron, Chatterjee) Department of Cardiovascular Surgery, Texas Heart
Institute, Houston, Texas, United States
(Cangut) Department of Cardiovascular Surgery, Mount Sinai School of
Medicine, New York, New York, United States
(Hickey) Division of Cardiology, University of Pittsburgh School of
Medicine, Pittsburgh, PA, United States
(Lorusso) Department of Cardio-Thoracic Surgery, Maastricht University
Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
(Silvestry) Division of Cardiothoracic Surgery, Department of Surgery,
University of Arizona School of Medicine, Phoenix, Arizona, United States
(Tong) Department of Thoracic and Cardiovascular Surgery, Heart, Vascular
and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Engelman) Heart and Vascular Program, Baystate Health, University of
Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts,
United States
(Shaw) Department of Intensive Care and Resuscitation, Cleveland Clinic,
Cleveland, Ohio, United States
(Chatterjee) Division of Acute Care Surgery/Trauma, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, Houston, Texas, United
States
Publisher
Elsevier Inc.
Abstract
Background: Temporary mechanical circulatory support (tMCS) for
cardiogenic shock (CS) is increasing despite knowledge gaps and variations
in management practices. This document was created to provide clinicians
with guidance regarding initiation, escalation, and de-escalation of tMCS
in patients with CS. Method(s): An interdisciplinary, international
expert panel using a structured literature appraisal and modified Delphi
method derived consensus statements regarding triggers for prompt patient
assessment and initiating tMCS in CS, assessing adequacy of support,
readiness for tMCS weaning, and next steps in nonrecovery. Individual
statements were graded on the basis of the quality of available evidence.
 Result(s): The panel addressed 4 main questions aimed at initiation,
escalation, and de-escalation of tMCS. On the basis of available
literature review and expert consensus, 11 recommendations were
formulated. Key principles included recognition of the need for patients
with CS who have ongoing hemodynamic compromise, tissue hypoperfusion, and
metabolic derangements to be considered for early tMCS initiation. An
interdisciplinary shock team should be involved in management, with early
referral when patient conditions require care beyond center capabilities.
Discussions providing anticipatory guidance should be performed with
patients and decision makers before initiating tMCS. Management of tMCS
involves frequent, timely hemodynamic and tissue perfusion reassessments
to determine the need for escalation or weaning. For patients unable to be
weaned from tMCS, evaluation should include interdisciplinary assessment
for advanced therapies, with palliation included as a consideration in
care discussions. Conclusion(s): A practical guide to initiation,
escalation, and de-escalation of tMCS is provided. Center-specific
approaches that are based on local capabilities should be
implemented. Copyright © 2025 The Society of Thoracic Surgeons

<26>
Accession Number
626168912
Title
Comparison of clinical outcomes between intravascular ultrasound-guided
and angiography-guided drug-eluting stent implantation: A meta-analysis of
randomised control trials and systematic review.
Source
International Wound Journal. 16(3) (pp 649-658), 2019. Date of
Publication: 01 Jun 2019.
Author
Tan Y.-Y.; Man X.-X.; Liu L.-Y.; Xu H.
Institution
(Tan, Xu) Department of Echocardiography, The First Hospital of Jilin
University, Changchun, China
(Man) Department of Gynecologic Oncology, The First Hospital of Jilin
University, Changchun, China
(Liu) Department of Andrology, The First Hospital of Jilin University,
Changchun, China
Publisher
John Wiley and Sons Inc
Abstract
This systematic review was designed to evaluate the overall efficacy of
angiography-guided drug-eluting stent (DES) implantation vs intravascular
ultrasound-guided (IVUS) implantation for percutaneous coronary
intervention. The electronic databases CENTRAL, PubMed, Cochrane, and
EMBASE were searched for systematic reviews to investigate
angiography-guided and IVUS-guided DES implantation. We measured the
following six parameters in each patient: cardiovascular death, stent
thrombosis, target lesion revascularisation (TLR), myocardial infarction
(MI), major adverse cardiac events (MACEs), and all-cause death. Twelve
studies involving 6268 subjects were included, with 2984 receiving
IVUS-guided DES implantation and 3284 using angiography-guided DES
implantation. With regard to MACEs, TLR, MI, cardiovascular death, and
all-cause death, the IVUS-guided DES implantation group had remarkably
improved clinical outcomes. However, there was no significant statistical
difference in stent thrombosis between the two groups. Dramatic decrease
in MACEs through IVUS guidance was presented by trial sequential analysis.
Remarkably improved clinical outcomes, including MACEs, cardiovascular
death, all-cause death, and TLR, were identified through IVUS-guided DES
implantation in comparison with angiography-guided DES implantation.
Nonetheless, the effect on stent thrombosis and MI required further
confirmation. In this meta-analysis, eligible randomised clinical trials
were warranted to verify the findings and to determine the beneficial
effect of IVUS guidance for patients. Copyright © 2019
Medicalhelplines.com Inc and John Wiley & Sons Ltd

<27>
Accession Number
2039596536
Title
Response to: Correspondence on "incidence of chronic postsurgical pain
after cardiac surgery and the effect of bilateral erector spinae plane
block: A randomized controlled trial" by Zhao et al.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2025. Article
Number: rapm-2025-106901. Date of Publication: 2025.
Author
Dost B.; Kaya C.; Turunc E.; De Cassai A.
Institution
(Dost, Kaya, Turunc) Department of Anesthesiology and Reanimation, Ondokuz
Mayis University, Samsun, Turkey
(De Cassai) Institute of Anesthesia and Intensive Care, University
Hospital of Padua, Padua, Italy
(De Cassai) Department of Medicine, University of Padua, Padua, Italy
Publisher
BMJ Publishing Group

<28>
Accession Number
2039449695
Title
Incidence and Risk Factors for Early Postoperative Arrhythmias in
Congenital Heart Disease - Systematic Review.
Source
Journal of Cardiovascular Emergencies. 11(2) (pp 43-53), 2025. Date of
Publication: 01 Jun 2025.
Author
Mayaya P.-C.; Tinica G.; Chistol R.O.; Moraru L.; Damian S.I.; Frasinariu
O.E.; Furnica C.
Institution
(Mayaya) Doctoral School, Grigore T. Popa University of Medicine and
Pharmacy, Iasi, Romania
(Mayaya, Chistol, Furnica) Department of Anatomy, Grigore T. Popa
University of Medicine and Pharmacy, Iasi, Romania
(Tinica) Department of Cardiac Surgery, Grigore T. Popa University of
Medicine and Pharmacy, Iasi, Romania
(Tinica, Chistol) Prof. Dr. George I.M. Georgescu Cardiovascular Diseases
Institute, Iasi, Romania
(Moraru) Department of Anatomy, Faculty of Medicine, George Emil Palade
University of Medicine, Pharmacy, Science and Technology, Targu Mures,
Romania
(Moraru) Cardiovascular and Transplant Emergency Institute of Targu Mures,
Targu Mures, Romania
(Damian) Department of Forensic Medicine, Grigore T. Popa University of
Medicine and Pharmacy, Iasi, Romania
(Damian, Furnica) Institute of Forensic Medicine, Iasi, Romania
(Frasinariu) Department of Mother and Child Medicine-Pediatric, Grigore T.
Popa University of Medicine and Pharmacy, Iasi, Romania
(Frasinariu) Sfanta Maria Emergency Clinical Hospital for Children, Iasi,
Romania
Publisher
Sciendo
Abstract
Postoperative arrhythmias are commonly seen in pediatric cardiac intensive
care units and are linked to higher rates of both morbidity and mortality
in children with congenital heart disease. However, the incidence of early
postoperative arrhythmias in the pediatric population is unclear, varying
from 7.3% to 48% in the literature. We searched the PubMed, Embase, and
Web of Science databases from 2000 to 2025 with the aim to perform a
systematic review of the existing literature on the incidence and risk
factors of early arrhythmias following heart surgery. A total of 16
cross-sectional observational studies, including 5,563 patients who
underwent surgery for congenital heart disease and 901 patients who
developed early postoperative arrhythmias, met the inclusion criteria.
Patients developing early postoperative dysrhythmias were younger, with a
lower body weight, and the duration of cardiopulmonary bypass was
significantly longer. Other incriminated risk factors for the occurrence
of early postoperative arrhythmias were hemodynamic instability,
complexity of the surgical procedure, and higher vasoactive-inotropic
scores. Pediatric patients with congenital heart disease who undergo
cardiac surgery face increased morbidity and mortality due to the risk
associated with the multifactorial complication of early postoperative
arrhythmias. The reported incidence of these arrhythmias varies greatly
among different studies and a better understanding of risk factors and
pathophysiological mechanisms would improve postoperative outcomes for
this notably exposed population. Copyright © 2025 Petra-Caroline
Mayaya et al., published by Sciendo.

<29>
[Use Link to view the full text]
Accession Number
2037328674
Title
Role of Renin-Angiotensin System Inhibitors After Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-analysis.
Source
American Journal of Therapeutics. 32(4) (pp e382-e385), 2025. Date of
Publication: 29 Jan 2025.
Author
Burhan M.; Noor S.; Ahmed M.; Shafiq S.; Ahmed R.; Shahid F.
Institution
(Burhan, Noor, Ahmed, Shafiq) Rawalpindi Medical University, Rawalpindi,
Pakistan
(Ahmed) Department of Cardiology, Royal Brompton Hospital, London, United
Kingdom
(Ahmed) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Shahid) Department of Interventional Cardiology, Queen Elizabeth
Hospital, Birmingham, United Kingdom
Publisher
Lippincott Williams and Wilkins

<30>
Accession Number
2039570708
Title
Impact of superficial and deep parasternal blocks on recovery after
cardiac surgery with sternotomy: a randomised controlled trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Demarquette A.; Jeanneteau A.; Blanchard-Daguet A.; Fouquet O.;
Parot-Schinkel E.; Lasocki S.; Rineau E.; Leger M.
Institution
(Demarquette, Jeanneteau, Blanchard-Daguet, Lasocki, Rineau, Leger)
Departement d'Anesthesie Reanimation, Centre Hospitalier Universitaire
d'Angers, Angers, France
(Fouquet) Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire
d'Angers, Angers, France
(Fouquet, Lasocki, Rineau) Univ Angers, INSERM, CNRS, MITOVASC, Equipe
CARME, SFR ICAT, Angers, France
(Parot-Schinkel) Departement de Biostatistique et Methodologie, Centre
Hospitalier Universitaire d'Angers, Angers, France
(Leger) INSERM UMR 1246 - SPHERE, Nantes University, Tours University,
Nantes, Centre Hospitalier Universitaire d'Angers, Angers, France
(Leger) UCSF Medical Center, Department of Anesthesia and Perioperative
Care, San Francisco, CA, United States
Publisher
Elsevier Ltd
Abstract
Background: Pain is common after cardiac surgery and can impair recovery.
Regional anaesthesia has been proposed to limit pain, but its impact on
recovery is unknown. This study compared the impact of superficial or deep
parasternal intercostal plane blocks (SPIP or DPIP) in addition to
standard care vs standard care alone on postoperative quality of recovery
(QoR) after cardiac surgery with sternotomy. Method(s): In this
single-centre, randomised, single-blind, controlled trial, adult patients
undergoing cardiac surgery with sternotomy were randomly assigned to one
of three groups (with a 1:1:1 allocation ratio): control group (standard
care without regional anaesthesia), SPIP group, or DPIP group. The primary
endpoint was QoR assessed using a French validated version of the Quality
of Recovery-15 questionnaire at 24 h after surgery. Secondary outcomes
included postoperative pain scores, analgesic consumption, ICU and
hospital length of stay, and adverse events. Result(s): Between July
1, 2022, and August 30, 2023, we randomised 254 patients (81.1% men, 65.5
[27-85] yr). The French validated version of the Quality of Recovery-15
scores did not significantly differ between any parasternal block group
(SPIP or DPIP) and the standard care group (P=0.248). Postoperative pain
and analgesic consumption were similar across groups, with low pain scores
(median [interquartile range] 24-h numerical rating scale: 2.0 [3.0-0.0]).
There were more pneumothoraces in the DPIP group (P=0.032). No significant
differences were observed for other complications. Conclusion(s):
Regional anaesthesia by parasternal intercostal plane blocks after
sternotomy did not improve QoR at 24 h compared with standard care.
Clinical trial registration: NCT05345639. Copyright © 2025
British Journal of Anaesthesia

<31>
[Use Link to view the full text]
Accession Number
2039579064
Title
Perioperative dexmedetomidine reduces the risk of postoperative
complications in high-risk patients undergoing non-cardiac surgery: A
randomized controlled trial.
Source
Chinese Medical Journal. (no pagination), 2025. Article Number:
10.1097/CM9.0000000000003648. Date of Publication: 2025.
Author
Meng Z.; Ding T.; Zhao W.; Guo L.; Li M.; Zhao Z.; Zhang Y.; Li C.; Mu D.;
Wang D.
Institution
(Meng, Ding, Li, Li, Mu, Wang) Department of Anesthesiology, Peking
University First Hospital, Beijing, China
(Meng) Department of Anesthesiology, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Zhao, Zhao) Department of Anesthesiology, The Fourth Hospital of Hebei
Medical University, Shijiazhuang, Hebei, China
(Guo, Zhang) Department of Anesthesiology, Liaocheng People's Hospital in
Shandong Province, Liaocheng, Shandong, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Dexmedetomidine may suppress the surgery-induced inflammatory
response, which is considered the underlying mechanism of postoperative
complications. This study was designed to investigate whether
perioperative dexmedetomidine could decrease the risk of postoperative
complications among high-risk patients. Method(s): This multicenter
randomized controlled trial is a superiority trial. Central randomization
was used. Elderly patients (age >=60 years) with revised cardiac risk
index (RCRI) >=3 and scheduled for major non-cardiac surgery were
enrolled. Patients in dexmedetomidine group received intraoperative
dexmedetomidine (a loading dose of 0.5 mug/kg followed by 0.3 mug kg-1
h-1) as adjuvant to general anesthesia and postoperative dexmedetomidine
(2 mug/h for 72 h) as supplementation to patient-controlled analgesia with
sufentanil. Patients in the control group received an equivalent dose of
normal saline as placebo during anesthesia and sufentanil only for
postoperative analgesia. The primary outcome was the incidence of major
postoperative complications including neurologic, cardiovascular, acute
kidney injury pulmonary, coagulation, infectious, and gastrointestinal
systems within postoperative 30 days. Secondary outcomes included pain
intensity, sleep quality, postoperative length of in-hospital stay, and
medical expenses during hospitalization. Neutrophil-to-lymphocyte ratio
(NLR) was used to monitor inflammatory response. Result(s): This
study included 272 patients, with similar median age (70 years vs. 69
years) and median RCRI (both 3) between dexmedetomidine and control
groups. The incidence of major postoperative complications in the
dexmedetomidine group was significantly lower than that in the control
group (38.2% [52/136] vs. 52.9% [72/136], relative risk [RR] = 0.722, 95%
confidence interval (CI) 0.554-0.942, P = 0.015). Postoperative
in-hospital stay was shorter in the dexmedetomidine group than that in the
control group (mean difference [MD] = -1 day, 95% CI: -2 to 0 days, P =
0.013). Other secondary outcomes were comparable between the two groups.
The highest NLR within postoperative first 3 days in the dexmedetomidine
group was lower than that in the control group (MD = -2.1, 95% CI: -4.1 to
-0.3, P = 0.037). The proportion of all drug-related adverse events were
comparable between the two groups. Conclusion(s): Dexmedetomidine,
infused from the beginning of anesthesia to postoperative 72 h, decreased
the risk of postoperative complications in high-risk elderly patients
undergoing non-cardiac surgery. Copyright © 2025 Lippincott
Williams and Wilkins. All rights reserved.

<32>
Accession Number
2039602194
Title
Impact of olive oil consumption on surgical outcomes in patients
undergoing open heart surgery: A randomized clinical trial.
Source
Journal of Complementary and Integrative Medicine. (no pagination), 2025.
Date of Publication: 2025.
Author
Bahrami R.; Ebadi A.; Saeed Y.; Farzam S.S.; Gomrokchian E.; Moayed M.S.
Institution
(Bahrami) Student Research Committee, Faculty of Nursing, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Ebadi, Saeed, Moayed) Nursing Care Research Center, Clinical Sciences
Institute, Faculty of Nursing, Baqiyatallah University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Farzam) Department of Cardiology, School of Medicine Bu Ali Sina,
Teaching Hospital Qazvin University of Medical Sciences, Qazvin, Iran,
Islamic Republic of
(Gomrokchian) Teaching Hospital Qazvin University of Medical Sciences,
Qazvin, Iran, Islamic Republic of
Publisher
Walter de Gruyter GmbH
Abstract
Introduction: The incidence of post-surgery outcomes, such as pain and
constipation, in patients undergoing coronary artery bypass surgery can
impact the healing process and the quality of life of patients. This study
aimed to investigate the effect of olive oil consumption on pain and
constipation in adult coronary bypass surgery patients. Method(s): A
randomized controlled trial in Qazvin, Iran (2022-2023) assigned 110
patients scheduled for coronary artery bypass surgery to two groups using
four-block randomization. In the intervention group, patients received
30cc of extra virgin olive oil daily with food from the day before the
operation to 30 days after. The control group received usual care. Pain
and constipation levels were measured before and after surgery and up to
30 days post-surgery using the visual pain scale (VAS) and Bristol stool
form scale (BSFS). Result(s): With similar background variables
between the two groups, the results indicated that the average pain and
constipation scores in the intervention group decreased more than in the
control group (p-value < 0.05). Conclusion(s): Based on the study's
findings and the positive impact of olive oil consumption on reducing pain
and constipation, incorporating olive oil into the diet of heart surgery
patients is recommended. Copyright © 2025 Walter de Gruyter GmbH,
Berlin/Boston.

<33>
Accession Number
2035237876
Title
Management of analgesia in cardiac surgery.
Source
Pain Management. (no pagination), 2025. Date of Publication: 2025.
Author
Strumia A.; Lusini M.; Costa F.; Stefani E.; Cipollone E.; Cusimano L.;
Libri F.; Ricci M.; Ruggiero A.; Sarubbi D.; Mattei A.; Schiavoni L.;
Barbato R.; Mastroianni C.; Jawabra M.; Agro F.E.; Chello M.; Cataldo R.;
Carassiti M.; Pascarella G.
Institution
(Strumia, Costa, Sarubbi, Mattei, Schiavoni, Agro, Cataldo, Carassiti,
Pascarella) Operative Research Unit of Anesthesia and Intensive Care,
Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
(Lusini, Jawabra, Chello) Research Unit of Cardiac Surgery, Department of
Cardiovascular Surgery, University Campus Bio-Medico di Roma, Roma, Italy
(Lusini, Barbato, Mastroianni, Chello) Operative Research Unit of Cardiac
Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma,
Italy
(Stefani, Cipollone, Cusimano, Libri, Ricci, Ruggiero, Agro, Cataldo,
Carassiti) Research Unit of Anaesthesia and Intensive Care, Department of
Medicine, University Campus Bio-Medico di Roma, Roma, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Background: Pain management in cardiac surgery remains a critical
component of perioperative care, influencing recovery, patient
satisfaction, and outcomes. Traditional opioid-based analgesia is
associated with significant adverse effects, prompting the exploration of
multimodal strategies, including regional anesthesia (RA), non-opioid
analgesics, and enhanced recovery after surgery (ERAS) protocols. This
review evaluates the evolution of cardiac surgery pain management, from
conventional opioid-based regimens to multimodal approaches with regional
anesthesia. Method(s): A comprehensive analysis of existing
literature was conducted, assessing the efficacy, safety, and integration
of different pain management strategies in cardiac surgery on PubMed,
Google Scholar, MEDLINE, UpToDate, Embase and Web of Science until 1
November 2024. Studies on opioids, adjunct analgesics (e.g. NSAIDs,
acetaminophen, ketamine, dexmedetomidine), RA techniques, and ERAS
frameworks were reviewed to provide a comparative perspective.
 Result(s): Multimodal analgesia significantly reduces opioid
consumption, enhances pain control, and minimizes complications such as
respiratory depression and postoperative nausea. RA techniques, including
fascial plane blocks, offer promising opioid-sparing benefits. ERAS
protocols further optimize recovery, yet challenges remain in
standardizing approaches across institutions. Conclusion(s): The
future of cardiac surgery pain management lies in individualized,
multimodal strategies following ERAS principles. Standardized guidelines
and further research are needed to refine these protocols for widespread
adoption. Copyright © 2025 Informa UK Limited, trading as Taylor
& Francis Group.

<34>
Accession Number
2033382376
Title
Perioperative Mechanical Circulatory Support for Cardiac Assistance in
Thoracic Surgery: A Scoping Review.
Source
Artificial Organs. 49(8) (pp 1249-1264), 2025. Date of Publication: 01 Aug
2025.
Author
Agosta V.T.; D'Andria Ursoleo J.; Bottussi A.; Bugo S.; Monaco F.
Institution
(Agosta, D'Andria Ursoleo, Bottussi, Bugo, Monaco) Department of
Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute,
Milan, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Patients with pre-existing severe cardiovascular comorbidities
are often deemed ineligible for potentially life-saving thoracic surgeries
and are referred to other conservative therapies. However, this patient
population may theoretically benefit from the timely perioperative
implantation of temporary mechanical circulation support (tMCS) to both
mitigate the surgical stress and stabilize hemodynamics. We performed a
scoping review to summarize the evidence regarding the use of tMCS in
thoracic surgery. Method(s): We conducted a systematic search across
PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials,
Web of Science, Scopus, and Google Scholar from their inception, aided by
a search string encompassing a combination of terms for the key research
concepts: i) tMCS devices; ii) thoracic surgery procedures (except lung
transplantation); and iii) the adult population. Result(s): Fifteen
studies pertinent to the research question, which summarized data from 28
patients, were retrieved for inclusion. In 14 patients, tMCS implantation
occurred as a "pre-emptive" strategy, while the remaining patients had
tMCS implanted either intra and/or postoperatively as a "bail-out"
strategy. Specifically, 14 patients required an intra-aortic balloon pump,
10 veno-arterial extracorporeal membrane oxygenation, two required a
multidevice strategy, and one cardiopulmonary bypass. The relative risk
analysis revealed that the mortality rate in the pre-emptive group was
half that of the bail-out group. Additionally, the risk of both infectious
and vascular complications was lower in the pre-emptive group compared to
the bail-out tMCS strategy. Conclusion(s): We found that the timely
implantation of tMCS in thoracic surgery-either to mitigate patients'
heightened cardiovascular risk or as a rescue strategy in the event of
life-threatening surgical complications-may lead to better patient
outcomes, as well as allowing them to undergo curative surgery with an
acceptable safety profile, characterized by overall good survival rates
and a low incidence of device-related complications. Copyright ©
2025 The Author(s). Artificial Organs published by International Center
for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals
LLC.

<35>
Accession Number
2035241685
Title
A novel dura splitting technique for surgical resection of anterior spinal
meningioma: a case series and systematic review of the literature.
Source
European Spine Journal. (no pagination), 2025. Date of Publication: 2025.
Author
Elashaal A.; Ibdah A.; Hulliel A.; Almomani A.
Institution
(Elashaal) Windsor Regional Hospital, Windsor, Canada
(Ibdah) Hashemite University, Zarqa, Jordan
(Hulliel, Almomani) Jordan University of Science and Technology, Irbid,
Jordan
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: Recent research indicates that the extent of tumor resection
impacts the recurrence rate of spinal meningiomas, with Simpson grade II
resection potentially being inadequate. Simpson grade I resection, which
involves full-thickness dura resection, carries a high risk of
cerebrospinal fluid (CSF) leak and neurological complications. To mitigate
these issues, Saito et al. introduced the dura split (DS) technique in
2001. This method separates the dura into inner and outer layers, allowing
the tumor to be removed with the inner layer while preserving the outer
layer for primary closure. This approach reduces the risk of CSF leaks and
avoids the need for dural graft reconstruction. The DS technique's safety
and efficacy have been validated by subsequent studies. Method(s): We
retrospectively reviewed medical records for six patients with spinal
meningiomas who underwent dura-splitting technique surgeries between 2018
and 2022. A systematic literature review was conducted following the
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
guidelines. Result(s): The case series included six patients treated
between 2018 and 2022 for ventral or ventrolateral spinal meningiomas,
predominantly in the thoracic region (4 thoracic, 2 cervical). Surgical
approaches included posterior laminectomy in five cases and anterior
cervical corpectomy (C4-5) in one. No perioperative complications were
reported. The systematic review encompassed nine studies involving 69
patients, with a mean age of 63 years (range: 36-82) and 80.4% female
predominance. Most tumors were thoracic (75-82.5%), followed by cervical
(15-17.5%) and lumbar (2.5%). The dural splitting technique was the most
common surgical approach, minimizing complications and preserving dura
integrity. CSF leakage occurred in 1.4% of cases, while tumor recurrence
was reported in 5.8%. Neurological recovery was observed in multiple
studies, with follow-up durations ranging from 4 months to 19 years.
 Conclusion(s): Our study confirms the dura-splitting technique as an
effective alternative to Simpson grade I and II resections, providing a
safer method for radical resection with reduced CSF leak
risk. Copyright © The Author(s), under exclusive licence to
Springer-Verlag GmbH Germany, part of Springer Nature 2025.

<36>
Accession Number
2035477823
Title
Artificial Intelligence in Risk Stratification and Outcome Prediction for
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
Journal of Personalized Medicine. 15(7) (no pagination), 2025. Article
Number: 302. Date of Publication: 01 Jul 2025.
Author
Shojaei S.; Mousavi A.; Kazemian S.; Armani S.; Maleki S.; Fallahtafti P.;
Arashlow F.T.; Daryabari Y.; Naderian M.; Alkhouli M.; Rana J.S.; Mehrani
M.; Jenab Y.; Hosseini K.
Institution
(Shojaei, Mousavi, Kazemian, Maleki, Fallahtafti, Mehrani, Jenab,
Hosseini) Tehran Heart Center, Cardiovascular Diseases Research Institute,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shojaei, Mousavi) School of Medicine, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Shojaei, Mousavi) Students' Scientific Research Center, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Armani) Heart Failure Research Center, Cardiovascular Research Institute,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Arashlow) Medical Students Research Centre, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Daryabari) Pediatric Urology and Regenerative Medicine Research Center,
Children's Medical Center, Gene, Cell & Tissue Research Institute, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Naderian, Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Alkhouli) Division of Cardiovascular Diseases, Department of Medicine,
West Virginia University, Morgantown, WV, United States
(Rana) Department of Cardiology, Oakland Medical Center, Kaiser Permanente
Northern California, Oakland, CA, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Transcatheter aortic valve replacement (TAVR) has
been introduced as an optimal treatment for patients with severe aortic
stenosis, offering a minimally invasive alternative to surgical aortic
valve replacement. Predicting these outcomes following TAVR is crucial.
Artificial intelligence (AI) has emerged as a promising tool for improving
post-TAVR outcome prediction. In this systematic review and meta-analysis,
we aim to summarize the current evidence on utilizing AI in predicting
post-TAVR outcomes. Method(s): A comprehensive search was conducted
to evaluate the studies focused on TAVR that applied AI methods for risk
stratification. We assessed various ML algorithms, including random
forests, neural networks, extreme gradient boosting, and support vector
machines. Model performance metrics-recall, area under the curve (AUC),
and accuracy-were collected with 95% confidence intervals (CIs). A
random-effects meta-analysis was conducted to pool effect estimates.
 Result(s): We included 43 studies evaluating 366,269 patients (mean
age 80 +/- 8.25; 52.9% men) following TAVR. Meta-analyses for AI model
performances demonstrated the following results: all-cause mortality (AUC
= 0.78 (0.74-0.82), accuracy = 0.81 (0.69-0.89), and recall = 0.90
(0.70-0.97); permanent pacemaker implantation or new left bundle branch
block (AUC = 0.75 (0.68-0.82), accuracy = 0.73 (0.59-0.84), and recall =
0.87 (0.50-0.98)); valve-related dysfunction (AUC = 0.73 (0.62-0.84),
accuracy = 0.79 (0.57-0.91), and recall = 0.54 (0.26-0.80)); and major
adverse cardiovascular events (AUC = 0.79 (0.67-0.92)). Subgroup analyses
based on the model development approaches indicated that models
incorporating baseline clinical data, imaging, and biomarker information
enhanced predictive performance. Conclusion(s): AI-based risk
prediction for TAVR complications has demonstrated promising performance.
However, it is necessary to evaluate the efficiency of the aforementioned
models in external validation datasets. Copyright © 2025 by the
authors.

<37>
Accession Number
2039749445
Title
Impact of Electroencephalography-guided Anesthesia in Cardiothoracic
Surgery: A Systematic Review and Updated Meta-analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Silva B.D.M.; Alves e Gomes A.D.; Marcolin Miranda L.; Albuquerque L.G.;
Defante M.L.R.; Miranda N.D.C.D.; De Lima P.E.C.; Damiao V.P.
Institution
(Silva) Department of Medicine, Santo Amaro University, Sao Paulo, Brazil
(Alves e Gomes) Department of Medicine, Federal University of Ceara,
Ceara, Brazil
(Marcolin Miranda) Department of Medicine and Health Sciences, Pontifical
Catholic University of Parana, Parana, Brazil
(Albuquerque) Department of Medicine, Federal University of Bahia, Bahia,
Brazil
(Defante) Redentor University Center, Department of Medicine, Itaperuna,
Brazil
(Miranda) Department of Medicine, Bahiana's School of Medicine and Public
Health, Bahia, Brazil
(De Lima) Department of Medicine, Federal University of Latin American
Integration, Parana, Brazil
(Damiao) Department of Medicine and Health Sciences, Pontifical Catholic
University of Campinas, Campinas, Brazil
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the impact of electroencephalography (EEG)-guided
anesthesia versus non-EEG-guided anesthesia on postoperative delirium and
adverse outcomes in patients undergoing cardiothoracic surgeries.
 Design(s): A systematic review and meta-analysis were performed using
PubMed, Embase, and Cochrane Library. Setting(s): All randomized
clinical trials (RCTs). Participant(s): Eight RCTs with 2,666
patients: 1,304 received EEG-guided anesthesia and 1,362 received usual
care. Intervention(s): Anesthesia guided by EEG in cardiothoracic
surgery. Measurements and Main Results: Mean differences (MDs) were
used to pool continuous outcomes while risk ratios (RRs) were used for
binary outcomes, using 95% confidence intervals (CIs). A random-effects
model was used to examine the treatment. Statistical analysis was
performed using R Studio. EEG-guided anesthesia was associated with a
trend toward reduced ventilatory support duration (MD: -25.08, 95% CI:
-50.12 to -0.04, p = 0.05, I2 = 0%). No significant differences were found
in postoperative delirium (RR: 0.93, 95% CI: 0.79-1.09, p = 0.35, I2 =
42.6%), hospital length of stay (MD: -0.22, 95% CI: -0.53 to 0.09, p =
0.17, I2 = 4.7%), intensive care unit length of stay (MD: -0.24, 95% CI
-0.59 to 0.12, p = 0.19, I2 = 71.7%), mortality (RR: 0.82, 95% CI:
0.54-1.25, p = 0.36, I2 = 42%), or intraoperative blood transfusion (RR:
0.96, 95% CI: 0.74-1.25, p = 0.79, I2 = 0%). Conclusion(s): The
findings demonstrated that EEG-guided anesthesia was associated with a
shorter duration of respiratory support. However, this study did not
identify any significant comparative advantage over standard practices for
the other outcomes analyzed. Copyright © 2025 Elsevier Inc.

<38>
Accession Number
2035472332
Title
Surgical vs. Medical Management of Infective Endocarditis Following TAVR:
A Systematic Review and Meta-Analysis.
Source
Journal of Cardiovascular Development and Disease. 12(7) (no pagination),
2025. Article Number: 263. Date of Publication: 01 Jul 2025.
Author
Magouliotis D.E.; Sicouri S.; Baudo M.; Cabrucci F.; Yamashita Y.; Ramlawi
B.
Institution
(Magouliotis, Sicouri, Baudo, Cabrucci, Yamashita, Ramlawi) Department of
Cardiac Surgery Research, Lankenau Institute for Medical Research, Main
Line Health, Wynnewood, PA, United States
(Baudo, Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Infective endocarditis after transcatheter aortic valve
replacement (TAVR-IE) is a rare but severe complication associated with
high morbidity and mortality. The optimal treatment strategy-surgical
explantation versus medical therapy-remains uncertain, particularly given
the technical demands of TAVR removal and the advanced age of many
affected patients. Method(s): We conducted a systematic review and
meta-analysis of studies comparing the surgical and medical management of
TAVR-IE. Primary outcomes included 30-day mortality and 1-year survival.
Secondary analyses explored microbiological profiles, patient
demographics, prosthesis type, postoperative complications, and surgical
indications. A qualitative synthesis of surgical explantation techniques
and reconstructive strategies was also performed based on recent consensus
recommendations. Result(s): Three studies comprising 1557 patients
with TAVR-IE were included; 155 (10.0%) underwent surgical treatment.
Thirty-day mortality was comparable between groups (surgical: 9.7%;
medical: 8.4%), while the pooled odds ratio for one-year survival did not
reach statistical significance (OR: 1.91, 95% CI: 0.36-10.22;
I2 = 88%). However, single-center outcomes demonstrated
markedly improved survival with surgery (96% vs. 51%). The most common
surgical indications included severe valvular dysfunction (50.3%), aortic
root abscess (26.5%), and large vegetations (21.3%), in line with current
guideline recommendations. Postoperative complications included acute
renal failure (10%) and longer hospitalizations (19.8 vs. 18 days),
although these were not statistically different. Contemporary explant
strategies-such as the Double Kocher, Tourniquet, and Y-incision aortic
enlargement techniques-were highlighted as critical tools for surgical
success. Conclusion(s): While underutilized, surgical intervention
for TAVR-IE may offer significant survival benefits in select patients,
particularly when guided by established indications and performed at
high-volume centers. Outcomes depend heavily on timing, surgical
expertise, and appropriate patient selection. As TAVR expands to younger
populations, TAVR-IE will become increasingly relevant, necessitating
early multidisciplinary involvement and broader familiarity with advanced
explant techniques among cardiac surgeons. Copyright © 2025 by
the authors.

<39>
Accession Number
2036904492
Title
Comparative Evaluation of Hemodynamic Responses and Ease of Intubation
with Tuoren Video Laryngoscope Vs Macintosh Laryngoscope in Patients
Undergoing Coronary Artery Bypass Graft Surgery.
Source
International Journal of Pharmacy Research and Technology. 15(2) (pp
363-370), 2025. Date of Publication: 16 Jun 2025.
Author
Vijay M.; Meena R.; Meena S.C.; Goyal S.; Garg A.; Rasha M.
Institution
(Vijay, Meena, Goyal, Garg, Rasha) Department of Anesthesia, SMS Medical
College Jaipur, India
(Meena) Department of Emergency Medicine, SMS Medical College Jaipur,
India
Publisher
Advanced Scientific Research
Abstract
Background: Cardiac patients are highly vulnerable to the hemodynamic
alterations that follow the laryngoscopy and endotracheal intubation
making it beneficial to use methods which can mitigate these effects. This
randomized study aimed to compare the efficacy and associated hemodynamic
variations between the Macintosh and Tuoren Videolaryngoscope for airway
management in patients undergoing coronary artery bypass graftingsurgery.
 Method(s): 60 patients undergoing elective CABG were evenly
distributed into Group A (Tuoren Video laryngoscope) and Group B
(Macintosh laryngoscope). Hemodynamic parameters, including systolic blood
pressure (SBP), diastolicblood pressure (DBP), mean arterial pressure
(MAP), pulse rate (PR), rate-pressure product (RPP) and peripheral oxygen
saturation (SpO2) were recorded. Laryngoscopy and intubation time, ease of
intubation assessed by Krieg's scale, and intubation difficulty score
(IDS) were documented. Result(s): There was a greater increase in
hemodynamic parameters in group B from 1 minute followingintubation until
5 minutes (p<0.05). Group A provided better glottic visualisation as
assessed by CL grade (p<0.05) in significantly shorter laryngoscopy time
(p=0.001). Group A had a significantly lower Krieg's score (p=0.02) and
IDS (p=0.04) than group B. The total intubation time, number of attempts,
and complications were comparable between both groups, but the need for
stylet was higher in group A (p=0.04). Conclusion(s): The use of
Tuoren video laryngoscope has been associated with faster laryngoscopyand
improved glottic visualization, contributing to reduced hemodynamic
alterations duringintubation but using a stylet is recommended to enhance
the first-attempt successrate during intubation. Copyright ©
2025, Advanced Scientific Research. All rights reserved.

<40>
Accession Number
2039758428
Title
Safety of oral intake prior to cardiac catheterization with minimal to
moderate sedation: A systematic review and meta-analysis of randomized
controlled trials.
Source
American Heart Journal. 290 (pp 188-200), 2025. Date of Publication: 01
Dec 2025.
Author
Pir M.S.; Mitchell B.K.; Saqib N.U.; Saleem M.S.; Gertz Z.M.
Institution
(Pir) Christus Heart and Vascular Institute, Christus St. Frances Cabrini
Hospital, Alexandria, LA, United States
(Mitchell) Sentara Health, Norfolk, VA, United States
(Saqib) Tidal Health, Seaford, DE, United States
(Saleem) The Wright Center for Graduate Medical Education, Scranton, PA,
United States
(Gertz) Virginia Commonwealth University, Richmond, VA, United States
Publisher
Elsevier Inc.
Abstract
Fasting prior to percutaneous cardiac procedures is common, despite a lack
of high-quality evidence. We conducted a systematic review and
meta-analysis to assess the safety of a nonfasting strategy. Online
databases Medline, Cochrane CENTRAL, and Google Scholar were searched.
Quantitative analysis was performed using R software (Version 4.1.2) with
meta package. Analyzed outcomes included nausea, vomiting, aspiration,
intubation, hypoglycemia, hypotension, acute kidney injury, patient
satisfaction score, and length of hospital stay. Eight randomized
controlled trials were included with 3,382 patients. There was no
significant difference between fasting and nonfasting for nausea/vomiting
odds ratio (OR) 0.99 (95% CI, 0.68-1.45), hypoglycemia OR 1.28 (95% CI,
0.75-2.18), aspiration OR 0.72 (95% CI, 0.36-1.43), acute kidney injury OR
0.69 (95% CI, 0.38-1.23), and hypotension OR 1.57 (95% CI, 0.47-5.30). No
patient in either group underwent endotracheal intubation. Additionally,
there was no difference in patient satisfaction score and length of
hospital stay with a standardized mean difference (SMD) of 0.23 (95% CI,
-0.62 to 1.07) and 0.0 (95% CI, -0.6 to 0.7) respectively. Sub-group
analysis, however, showed increased odds of nausea/vomiting in the fasting
group compared to nonfasting OR 1.20 (95% CI, 1.04-1.39) and decreased
odds of acute kidney injury in fasting compared to nonfasting group OR
0.50 (95% CI, 0.28-0.89). In conclusion, this analysis shows no
significant difference in most safety outcomes between a fasting and a
nonfasting strategy with potential increase in nausea/vomiting and
decrease in acute kidney injury with fasting. More studies are needed to
better understand these differences. Copyright © 2025 The Authors

<41>
Accession Number
2039749533
Title
Is Prior Cardiac Surgery a Risk Factor for Patients in Aortic Surgery: A
Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Lang Q.; Zhang J.; Li J.; Xiao Z.; Meng W.; Qin C.
Institution
(Lang, Zhang, Xiao, Meng, Qin) Department of Cardiovascular Surgery and
Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan
University, Sichuan, Chengdu, China
(Li) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Sichuan, Chengdu, China
Publisher
W.B. Saunders
Abstract
Background: The rising global incidence of aortic surgical interventions
has increased demand for complex reoperations. However, surgical outcomes
between primary aortic surgery (PAS) and repeat sternotomy aortic surgery
(RAS) remain poorly characterized. This study was designed to evaluate
whether prior cardiac surgery constitutes a risk factor for patients
undergoing aortic surgery. Method(s): A systematic search of PubMed,
Embase, and Web of Science was conducted to identify studies comparing
surgical outcomes between PAS and RAS. The primary outcome was in-hospital
mortality. Secondary outcomes included the incidence of re-exploration for
bleeding, renal failure, deep sternal wound infection, neurologic events,
cardiopulmonary bypass time, and long-term survival rates at 2-year,
4-year, 8-year, and 10-year follow-ups. Result(s): A total of 19
studies involving 31,631 participants were included in this meta-analysis.
Patients undergoing PAS demonstrated significantly lower rates of
in-hospital mortality (9.3% v 16.0%, odds ratio [OR] 0.55, 95% confidence
interval [CI] 0.50-0.60; I2 = 0.0%, p < 0.001) compared with
the RAS cohort. PAS was also associated with a lower incidence of
re-exploration for bleeding (7.2% v 9.4%, OR 0.76, 95% CI 0.68-0.84, p <
0.001), renal failure (13.3% v 15.8%, OR 0.73, 95% CI 0.65-0.81, p <
0.001), and deep sternal wound infection (0.7% v 2.8%, OR 0.47, 95% CI
0.37-0.60, p < 0.001). In anatomical subgroup analyses, patients
undergoing primary aortic root surgery demonstrated significantly lower
mortality odds compared with repeat sternotomy root procedures (5.0% v
8.4%, OR 0.55, 95% CI 0.50-0.61, p < 0.001); while primary aortic arch
surgery demonstrated a mortality benefit compared with repeat sternotomy
for arch interventions, this advantage was less pronounced than that
observed in root procedures (8.4% v 11.9%, OR 0.60, 95% CI 0.39-0.94, p =
0.026). While short-term survival favored the PAS group (62.6% v 55.2%,
2-year OR 0.74, 95% CI 0.58-0.93, p = 0.01), long-term survival converged
between groups (14.8% v 12.7%, 10-year OR 0.82, 95% CI 0.60-1.13, p =
0.23), particularly after propensity score matching. Conclusion(s):
This study shows that RAS is associated with significantly elevated
in-hospital mortality and increased perioperative risks, particularly
pronounced in repeat sternotomy root replacement procedures. However,
prior cardiac surgery did not diminish the long-term benefits of aortic
surgery. Copyright © 2025 Elsevier Inc.

<42>
Accession Number
2035453740
Title
Impact of Obstructive Sleep Apnea in Surgical Patients: A Systematic
Review.
Source
Journal of Clinical Medicine. 14(14) (no pagination), 2025. Article
Number: 5095. Date of Publication: 01 Jul 2025.
Author
Titu I.-M.; Vulturar D.M.; Chis A.F.; Oprea A.; Manea A.; Todea D.A.
Institution
(Titu, Oprea, Manea) Department of Surgery, Iuliu Hatieganu University of
Medicine and Pharmacy, Cluj-Napoca, Romania
(Titu, Vulturar, Chis, Todea) Department of Pneumology, Iuliu Hatieganu
University of Medicine and Pharmacy, Cluj-Napoca, Romania
(Titu, Todea) Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of
Pneumology, Cluj-Napoca, Romania
(Vulturar, Chis) Pneumology Clinic, Leon Daniello Clinical Hospital of
Pneumology, Cluj-Napoca, Romania
(Oprea, Manea) Cardiovascular Surgery Clinic, Niculae Stancioiu Heart
Institute, Cluj-Napoca, Romania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Obstructive sleep apnea is a prevalent, yet often
underdiagnosed, condition characterized by recurrent upper airway
obstruction during sleep, leading to significant perioperative risks in
surgical patients. This systematic review aims to evaluate the incidence
and impact of objectively diagnosed obstructive sleep apnea on
postoperative outcomes across various surgical specialties-including
bariatric, orthopedic, cardiac, and otorhinolaryngologic surgeries-and to
assess the effectiveness of preoperative screening and perioperative
management strategies. Method(s): A comprehensive literature search
of PubMed was conducted for studies published between January 2013 and
December 2024, following Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. Included studies involved adult surgical
patients with OSA confirmed by polysomnography or respiratory polygraphy.
Studies were assessed for methodological quality using the Oxford Centre
for Evidence-Based Medicine Levels of Evidence framework. Result(s):
The findings consistently indicated that obstructive sleep apnea
significantly increases the risk of postoperative complications, such as
respiratory depression, atrial fibrillation, acute kidney injury,
delirium, and prolonged hospital stay. Continuous positive airway pressure
therapy demonstrated a protective effect in bariatric and cardiac
surgeries, though its effectiveness in orthopedic and otorhinolaryngologic
contexts was inconsistent, largely due to adherence variability and
limited implementation. Preoperative screening tools such as the STOP-BANG
questionnaire were widely used, but their utility depended on integration
with confirmatory diagnostics. Conclusion(s): Obstructive sleep apnea
represents a significant, modifiable risk factor in surgical populations.
Preoperative identification and risk-adapted perioperative management,
including CPAP therapy and multimodal analgesia, may substantially reduce
postoperative morbidity. However, further randomized trials and
cost-effectiveness studies are needed to optimize care pathways and ensure
consistent implementation across surgical disciplines. Copyright
© 2025 by the authors.

<43>
Accession Number
2039744107
Title
Society of cardiothoracic surgery in great Britain and Ireland guidance
for adult mitral valve disease and interventions.
Source
BMJ Surgery, Interventions, and Health Technologies. 7(1) (no pagination),
2025. Article Number: e000328. Date of Publication: 23 Jul 2025.
Author
Vohra H.A.; Burton S.; Yadav R.; Sayeed R.; Moorjani N.
Institution
(Vohra, Burton) Bristol Heart Institute, Bristol, United Kingdom
(Yadav) Royal Brompton Hospital, London, United Kingdom
(Sayeed) Cardiothoracic Surgery, John Radcliffe Hospital, Oxfordshire,
Oxford, United Kingdom
(Moorjani) Department of Cardiothoracic Surgery, Papworth Hospital NHS
Foundation Trust, Cambridge, United Kingdom
Publisher
BMJ Publishing Group
Abstract
The Society of Cardiothoracic Surgery (SCTS) in Great Britain and Ireland
provides comprehensive guidelines for the management of adult mitral valve
disease, addressing both surgical and transcatheter interventions. These
guidelines serve as a resource for healthcare professionals, supplementing
existing clinical guidelines. They emphasize the evolving complexity of
mitral valve disease management, influenced by the development of new
technologies, ongoing research, and randomized trials. The guidelines
detail a thorough methodology, incorporating an extensive literature
review and evidence assessment conducted by a clinical guidelines team.
They outline best practices of preinterventional patient assessment and
indications of mitral interventions, while considering the management of
patient comorbidities and concomitant diseases. Detailed repair techniques
for mitral regurgitation and rheumatic valve disease are provided, along
with a summary of indications for emerging transcatheter and hybrid
procedures, including transcatheter edge-to-edge repair, transapical
neo-chordee placement, transcatheter aortic valve mitral implantation, and
percutaneous mitral annuloplasty. The guidelines address postoperative
mitral complications and prosthesis considerations, including up-to-date
recommendations for antithrombotic management. These guidelines aim to
improve patient outcomes through detailed, evidence-based recommendations
and encourage the development of specialized mitral MDTs within UK
practice. They provide an educational resource, clarifying the
implementation of recent technologies and supporting clinical
decision-making in the management of adult mitral valve
disease. Copyright © 2025 Author(s) (or their employer(s)).

<44>
Accession Number
2039522867
Title
Postoperative Infectious Pneumonia in Cardiothoracic Surgery: A Systematic
Review and Meta-Analysis.
Source
F1000Research. 14 (no pagination), 2025. Article Number: 588. Date of
Publication: 2025.
Author
Khallikane S.; Seddiki R.; Serghini I.
Institution
(Khallikane) Cardiothoracic Anesthesia-Cardiovascular ICU,
Anesthesiology-ICU-Emergency Department, Avicenna Military Hospital,
Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech,
Morocco
(Khallikane) Marrakech-Safi, Marrakeck, Morocco
(Seddiki) Hassan II Military Hospital, Anesthesiology-Critical Care,
Avicenna Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad
University, Marrakech, Morocco
(Seddiki) Layun, Layun-Sakia Hamra, Morocco
(Serghini) Intensivist-Anesthesiologist Head of Emergency Department,
Avicenna Military Hospital, Marrakech-Safi, Marrakech, Morocco
Publisher
F1000 Research Ltd
Abstract
Background: Postoperative infectious pneumonia (PIP) is a common and
serious complication following cardiothoracic surgery, including coronary
artery bypass grafting (CABG), valve interventions, and thoracic oncologic
procedures. It is associated with increased morbidity, prolonged intensive
care unit (ICU) stay, and healthcare burden. Method(s): We performed
a systematic review and meta-analysis according to PRISMA 2020 guidelines.
Studies published between January 2021 and December 2023 were identified
from PubMed, Embase, and Scopus. Eligible studies reported the incidence
and/or perioperative risk factors for PIP with odds ratios (ORs) and 95%
confidence intervals (CIs). A random-effects model was used for pooled
estimates. Study quality was assessed using the Newcastle-Ottawa Scale.
The review was prospectively registered in PROSPERO 2025 CRD 420251057914.
Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251057914.
 Result(s): Six high-quality cohort studies involving 4,392 patients
were included. The pooled incidence of PIP was 14.8% (95% CI,
10.6%-19.2%). Incidence was highest after thoracic oncologic surgery
(17.2%), followed by valve surgery (15.8%) and CABG (13.5%). Significant
risk factors included prolonged mechanical ventilation >48 hours (OR:
3.46), age >70 years (OR: 2.71), chronic obstructive pulmonary disease
(OR: 2.95), cardiopulmonary bypass time >120 minutes (OR: 2.63), and left
ventricular ejection fraction <40% (OR: 2.38). Heterogeneity was moderate
(I 2 = 46%) with no publication bias. Conclusion(s): PIP
remains a major postoperative concern. Identification of key risk factors
enables targeted preventive strategies-early extubation, pulmonary
optimization, and standardized care pathways-to reduce PIP incidence and
improve outcomes. Copyright: © 2025 Khallikane S et al.

<45>
Accession Number
2035453732
Title
Total Arch Replacement with Ascyrus Medical Dissection Stent Versus Frozen
Elephant Trunk in Acute Type A Aortic Dissection: A Meta-Analysis.
Source
Journal of Clinical Medicine. 14(14) (no pagination), 2025. Article
Number: 5170. Date of Publication: 01 Jul 2025.
Author
Baudo M.; Rosati F.; D'Alonzo M.; Fiore A.; Muneretto C.; Benussi S.; Di
Bacco L.
Institution
(Baudo) Department of Cardiac Surgery Research, Lankenau Institute for
Medical Research, Main Line Health, Wynnewood, PA, United States
(Rosati, Muneretto, Benussi, Di Bacco) Department of Cardiac Surgery,
Spedali Civili di Brescia, University of Brescia, Brescia, Italy
(D'Alonzo) Department of Cardiac Surgery, Poliambulanza Hospital Brescia,
Brescia, Italy
(Fiore) Department of Cardiac Surgery, Hopitaux Universitaires Henri
Mondor, Assistance Publique-Hopitaux de Paris, Creteil, France
(Fiore) CEpiA Team, IMRB U955, Inserm, Universite Paris Est Creteil,
Creteil, France
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Acute Stanford Type A aortic dissection (ATAAD) often requires
total arch replacement (TAR) with frozen elephant trunk (FET) to address
entry tears and support aortic remodeling. In select cases, AMDS may
provide a simpler option. The present meta-analysis aims to compare
surgical outcomes between these two approaches. Method(s): A
comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and
Cochrane library databases was performed until February 2025. We included
studies that reported the outcomes of patients with ATAAD undergoing TAR
with AMDS or FET. To enable a meaningful comparison, we only included FET
studies where patients met the same inclusion criteria as those with the
AMDS. Result(s): Thirty-eight articles met our inclusion criteria,
with a total of 319 patients in the AMDS group and 4129 in the FET group.
Patients undergoing an AMDS procedure experienced significantly higher
bleeding requiring surgery (21.2% vs. 6.4%, p < 0.001) and a higher
hospital mortality (14.5% vs. 10.0%, p = 0.037) compared to FET. The
individual patient data of 1411 patients were constructed. Overall
survival at 1 and 3 years was 81.9% +/- 3.3% vs. 88.8% +/- 0.9% and 81.9%
+/- 3.3% vs. 85.2% +/- 1.0% between AMDS and FET, respectively. A flexible
parametric survival model demonstrated a significant mortality drawback
for AMDS compared to FET up to 31 days, beyond which the difference was no
longer evident. Conclusion(s): The comparison between AMDS and FET
for ATAAD treatment remains debated, with FET favored for its lower
mortality and stronger long-term evidence. AMDS, as a newer technique,
shows promise but lacks sufficient data to confirm its safety and
efficacy. Copyright © 2025 by the authors.

<46>
Accession Number
2035453386
Title
First Case of Infective Endocarditis Caused by Vibrio metschnikovii:
Clinico-Diagnostic Complexities and a Systematic Literature Review.
Source
Clinics and Practice. 15(7) (no pagination), 2025. Article Number: 118.
Date of Publication: 01 Jul 2025.
Author
Carrozzo A.; Bolcato V.; Martinelli L.; Dodi F.; Vulcano A.; Basile G.;
Tronconi L.P.
Institution
(Carrozzo) Maria Cecilia Hospital, GVM Care & Research, Lugo, Italy
(Carrozzo, Martinelli, Dodi, Tronconi) Department of Cardiac Surgery,
ICLAS, GVM Care & Research, Rapallo, Italy
(Bolcato) Maria Beatrice Hospital, GVM Care & Research, Firenze, Italy
(Vulcano) UOC Microbiologia e Banca Biologica, National Institute of
Infectious Diseases, L. Spallanzani, IRCCS, Rome, Italy
(Basile) Department of Biomedical Sciences and Public Health, University
"Politecnica delle Marche" of Ancona, Ancona, Italy
(Tronconi) Department of Health and Life Sciences, European University of
Rome, Rome, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Non-cholera Vibrio species are rare waterborne pathogens that
can cause severe infections. Among these, few cases of Vibrio
metschnikovii infections have been reported, especially in the
gastrointestinal tract, with no cardiac tissue involvement as a result.
Following the PRISMA checklist, we conducted a literature review, and
thirteen articles for twenty-two cases overall were included: seven cases
of sepsis (in three cases, the echocardiographic results were negative),
seven cases of pneumonia, two skin infections, eleven cases of diarrhoea,
and a gastroenteritis outbreak. This report documents the expanding
clinical spectrum and the role played by V. metschnikovii in infective
endocarditis. Case report: A 28-year-old male patient was referred to the
cardiac surgery unit for urgent mitral valve replacement due to suspicion
of infective endocarditis. Microbiological tests yielded negative results.
Following recovery and discharge with antimicrobial therapy for 6 weeks,
the patient experienced prosthesis detachment, necessitating
re-hospitalisation for an emergency valve replacement. Vibrio
metschnikovii was identified on the prosthesis valve through PCR and
successfully treated with ciprofloxacin. However, a spontaneous rupture of
the ascending thoracic aorta led to a neurological injury.
 Discussion(s): This case represents the first case of valve infection
caused by Vibrio metschnikovii, characterised by diagnostic and
therapeutic challenges and the involvement of the great vessels. Also
considered in this case, for a disease with a median age of 58 years
(11-83) and a male-to-female ratio of 2.2, were one male neonate and six
cases for whom neither sex nor age was indicated. Excluding
gastrointestinal cases, the septic forms are associated with high
morbidity, although the single case described involved a young and healthy
subject. Risk factors for the pathogen or predisposing/pathological
conditions for endocarditis did not emerge. The routes and the time of
infection could not be determined, deepening the possibility of
occupational exposure via the patient's position as a boat worker. Poor
sensitivity to third-generation cephalosporins has been reported in the
literature: the absence of an antibiogram does not allow for a comparison,
although resolution was achieved with ciprofloxacin. Conclusion(s):
The rising global incidence of non-cholera Vibrio infections, driven by
environmental changes, calls for urgent research into the factors behind
their pathogenicity and infection routes. Diagnostic complexities have
emerged together with clinical severity. Copyright © 2025 by the
authors.

<47>
Accession Number
2032466263
Title
Long-term outcomes with medical therapy, transcatheter repair, or surgery
for isolated tricuspid regurgitation: a systematic review and network
meta-analysis.
Source
Clinical Research in Cardiology. 114(2) (pp 272-280), 2025. Date of
Publication: 01 Feb 2025.
Author
Saito T.; Kuno T.; Aikawa T.; Ueyama H.A.; Kampaktsis P.N.; Kolte D.;
Misumida N.; Takagi H.; Ahmad Y.; Kaneko T.; Zajarias A.; Latib A.
Institution
(Saito) Department of Cardiology, Edogawa Hospital, Tokyo, Japan
(Kuno) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, 55 Fruit Street, GRB 800, Boston, MA, United States
(Kuno, Latib) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Aikawa) Department of Cardiovascular Biology and Medicine, Juntendo
University Graduate School of Medicine, Tokyo, Japan
(Ueyama) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Kampaktsis) Structural and Congenital Center, Hackensack Medical Center,
Hackensack, NJ, United States
(Kolte) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Ahmad) Division of Cardiology, Department of Cardiology, University of
California San Francisco, San Francisco, CA, United States
(Kaneko) Cardiothoracic Surgery Division, Department of Surgery,
Washington University in St Louis School of Medicine, St Louis, MO, United
States
(Zajarias) Cardiovascular Division, Department of Medicine, Washington
University in St Louis School of Medicine, St Louis, MO, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Several transcatheter tricuspid valve (TV) repair devices for
tricuspid regurgitation (TR) have emerged. However, few studies have
compared transcatheter TV repair with medical therapy (MT) alone or
isolated TV surgery. Method(s): PubMed and EMBASE were searched in
February 2024. Studies comparing at least any of the following 2 were
included: MT, surgical TV repair, surgical TV replacement, or
transcatheter TV repair. The primary outcome was long-term mortality ( 1
year). The secondary outcomes were short-term mortality (30-day or
in-hospital mortality) and periprocedural complications. We performed a
network meta-analysis using a random effects model. Result(s): A
total of 25,831 patients from 22 studies (one randomized trial and 21
observational studies) were included. MT alone was associated with higher
long-term mortality compared to surgical TV repair (HR [95% CI] 1.72
[1.34-2.23]), surgical TV replacement (HR [95% CI] 1.49 [1.14-1.96]), and
transcatheter TV repair (HR [95% CI] 1.52 [1.30-1.78]). Long-term
mortality was comparable between transcatheter and surgical interventions.
Transcatheter TV repair had a lower risk of short-term mortality (versus
surgical TV repair; RR [95% CI] 0.40 [0.22-0.72], versus surgical TV
replacement; RR [95% CI] 0.35 [0.19-0.66]) and lower rates of
periprocedural complications, including new pacemaker implantation, renal
complications, cardiogenic shock than surgical interventions.
 Conclusion(s): MT alone for TR was associated with higher long-term
mortality compared to surgical or transcatheter TV interventions.
Transcatheter TV repair had better periprocedural outcomes compared to
surgical interventions with similar long-term mortality. Despite the
possibility of selection bias, transcatheter TV repair appears to be an
attractive option for TR treatment. Copyright © Springer-Verlag
GmbH Germany, part of Springer Nature 2024.

<48>
Accession Number
2035472394
Title
Discordant High-Gradient Aortic Stenosis: A Systematic Review.
Source
Journal of Cardiovascular Development and Disease. 12(7) (no pagination),
2025. Article Number: 255. Date of Publication: 01 Jul 2025.
Author
Bismee N.N.; Abbas M.T.; Sheashaa H.; Abdelfattah F.E.; Farina J.M.; Awad
K.; Scalia I.G.; Pietri M.P.; Ali N.B.; Esfahani S.A.; Ibrahim O.H.;
Lester S.J.; Alsidawi S.; Ayoub C.; Arsanjani R.
Institution
(Bismee, Abbas, Sheashaa, Abdelfattah, Farina, Awad, Scalia, Pietri, Ali,
Esfahani, Ibrahim, Lester, Alsidawi, Ayoub, Arsanjani) Department of
Cardiovascular Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix,
AZ, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Aortic stenosis (AS), the most common valvular heart disease, is
traditionally graded based on several echocardiographic quantitative
parameters, such as aortic valve area (AVA), mean pressure gradient (MPG),
and peak jet velocity (Vmax). This systematic review evaluates the
clinical significance and prognostic implications of discordant
high-gradient AS (DHG-AS), a distinct hemodynamic phenotype characterized
by elevated MPG despite a preserved AVA (>1.0 cm2). Although
often overlooked, DHG-AS presents unique diagnostic and therapeutic
challenges, as high gradients remain a strong predictor of adverse
outcomes despite moderately reduced AVA. Sixty-three studies were included
following rigorous selection and quality assessment of the key studies.
Prognostic outcomes across five key studies were discrepant: some showed
better survival in DHG-AS compared to concordant high-gradient AS
(CHG-AS), while others reported similar or worse outcomes. For instance, a
retrospective observational study including 3209 patients with AS found
higher mortality in CHG-AS (unadjusted HR: 1.4; 95% CI: 1.1 to 1.7),
whereas another retrospective multicenter study including 2724 patients
with AS observed worse outcomes in DHG-AS (adjusted HR: 1.59; 95% CI: 1.04
to 2.56). These discrepancies may stem from delays in intervention or
heterogeneity in study populations. Despite the diagnostic ambiguity, the
presence of high gradients warrants careful evaluation, aggressive risk
stratification, and timely management. Current guidelines recommend a
multimodal approach combining echocardiography, computed tomography (CT)
calcium scoring, transesophageal echocardiography (TEE) planimetry, and,
when needed, catheterization. Anatomic AVA assessment by TEE, CT, and
cardiac magnetic resonance imaging (CMR) can improve diagnostic accuracy
by directly visualizing valve morphology and planimetry-based AVA, helping
to clarify the true severity in discordant cases. However, these
modalities are limited by factors such as image quality (especially with
TEE), radiation exposure and contrast use (in CT), and availability or
contraindications (in CMR). Management remains largely based on CHG-AS
protocols, with intervention primarily guided by transvalvular gradient
and symptom burden. The variability among the different guidelines in
defining severity and therapeutic thresholds highlights the need for
tailored approaches in DHG-AS. DHG-AS is clinically relevant and
associated with substantial prognostic uncertainty. Timely recognition and
individualized treatment could improve outcomes in this complex
subgroup. Copyright © 2025 by the authors.

<49>
Accession Number
644871345
Title
PERCUTANEOUS CORONARY INTERVENTION (PCI) IN PATIENTS WITH RHEUMATOID
ARTHRITIS(RA): A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Annals of the Rheumatic Diseases. Conference: European Congress of
Rheumatology, EULAR 2024. Vienna Austria. 83(Supplement 1) (pp 1570-1571),
2024. Date of Publication: 01 Jun 2024.
Author
Piplani S.; Kostojchin A.; Kong S.; Brown D.; Jelic V.; Chaturvedi S.;
Bejugam V.R.; Simpson T.; Xiao W.; Sharma A.; Radulovic M.
Institution
(Piplani, Kong, Brown, Jelic, Chaturvedi, Bejugam, Sharma, Radulovic)
Jacobi Medical Center/North Central Bronx, NYC Health and Hospitals,
Albert Einstein College of Medicine, Internal Medicine, New York, United
States
(Kostojchin) North Central Bronx Hospital/VA Medical Center, Icahn School
of Mount Sinai, Internal Medicine, New York, United States
(Sharma) Yale School of Medicine, Connecticut, United States
(Simpson, Xiao) Jacobi Medical Center/North Central Bronx, NYC Health and
Hospitals, Albert Einstein College of Medicine, New York, United States
Publisher
BMJ Publishing Group
Abstract
Background: Rheumatoid Arthritis (RA) is an inflammatory arthritis linked
to an elevated risk of cardiovascular disease (CVD), including heart
failure, myocardial infarction, stroke, and coronary revascularization.
Recognized as an independent CVD risk factor, RA's accelerated
inflammation contributes to premature ischemic disease. Percutaneous
coronary intervention (PCI) is a common revascularization method, yet
research on its outcomes in autoimmune rheumatic diseases like RA is
sparse and often involves small sample sizes. This Meta-Analysis aims to
comprehensively assess PCI outcomes in RA patients compared to non-RA
counterparts, delving into parameters such as MACE, revascularization
rates, mortality, infarction, and complications to enhance management and
mitigate adverse cardiac events. Objective(s): We aim to assess the
outcomes of Percutaneous coronary intervention (PCI) in patients with
Rheumatoid arthritis (RA). Method(s): A systemic search was conducted
from electronic databases from inception to 15th September 2023. All
statistical analyses were conducted using Review Manager 5.4.1. Studies
meeting inclusion criteria were selected. A random- effect model was used
when heterogeneity was seen to pool the studies, and the result was
reported in the Odds Ratio (OR) and the corresponding 95% confidence
interval (CI). Result(s): Eight observational studies were used to
conduct our analysis. Quantitative analysis on eleven factors was done. A
statistically significant increase in major adverse cardiovascular event
(MACE) was seen in RA patients after undergoing PCI as compared to the
control group (SMD = 1.18 (1.16, 1.21); p < 0.00001; I2 = 0%). There no
significant difference in the long-term revascularization outcome between
the RA and non-RA patients (SMD = 1.18 (0.81, 1.71); p = 0.39; I2 = 93%).
Survival rates of all-cause mortality in the long-term outcome were
statistically insignificant among the two groups (SMD = 1.21 (0.84, 1.74);
p = 0.31; I2 = 99%). Conclusion(s): Percutaneous Coronary
Intervention is an important intervention to reduce morbidity and
mortality but special precautions and attention should be made when it
comes to patients with Rheumatoid Arthritis. .

<50>
Accession Number
2039778904
Title
Cardiac patients' death anxiety: A systematic review and meta-analysis.
Source
Journal of Affective Disorders. 391 (no pagination), 2025. Article Number:
119967. Date of Publication: 15 Dec 2025.
Author
Mollaei A.; Zamanzadeh V.; Ranjbar Noei F.; Kamali M.
Institution
(Mollaei, Ranjbar Noei) Student Research Committee, Golestan University of
Medical Sciences, Gorgan, Iran, Islamic Republic of
(Zamanzadeh) Department of Medical-Surgical Nursing, School of Nursing &
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Kamali) Student Research Committee, School of Nursing and Midwifery,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Elsevier B.V.
Abstract
Death anxiety (DA) is a critical psychological concern among patients with
cardiovascular diseases (CVDs), yet its prevalence and associated factors
remain understudied. This systematic review and meta-analysis aimed to
determine the level of DA in cardiac patients and identify contributing
factors. A comprehensive search of PubMed, Scopus, Web of Science, and
Google Scholar yielded 27 cross-sectional studies (5292 participants).
Studies were assessed using the AXIS tool, with most rated as high
quality. Pooled estimates revealed moderate DA levels across studies, with
mean scores of 8.46 (95 % CI: 7.05-9.86) for the Templer Death Anxiety
Scale (TDAS) 0-15 range and 45.07 (95 % CI: 34.59-55.55) for the 15-75
range. Subgroup analyses indicated higher DA in Turkey (vs. Iran) and
among coronary artery bypass graft (CABG) patients. Key factors linked to
elevated DA included female gender, younger age, economic hardship,
unemployment, reduced resilience, and diminished religious beliefs.
Meta-regression found no significant moderation by age, sample size, or
gender. These findings determine the need for targeted psychological
interventions addressing modifiable factors like socioeconomic support and
resilience-building in cardiac care. Limitations include reliance on
cross-sectional data and heterogeneity in measurement tools. Future
research should explore longitudinal and culturally diverse cohorts to
clarify causal relationships and optimize DA management
strategies. Copyright © 2025

<51>
Accession Number
2035453788
Title
Surgical Management Strategies for Pericardial Effusion-A Systematic
Review.
Source
Journal of Clinical Medicine. 14(14) (no pagination), 2025. Article
Number: 4985. Date of Publication: 01 Jul 2025.
Author
Qasba R.K.; Cangut B.; Alhazmi A.; Naseer J.; Mubasher A.; Talapaneni S.;
Fatima M.; Nasir A.; Shafqat S.; Avilala S.; Hameed I.
Institution
(Qasba, Alhazmi, Naseer, Mubasher, Talapaneni, Fatima, Nasir, Shafqat,
Avilala, Hameed) Division of Cardiac Surgery, Department of Surgery, Yale
University School of Medicine, New Haven, CT, United States
(Cangut) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objectives: Pericardial effusion is the accumulation of excess fluid in
the pericardial sac. The etiology is multi-factorial and different
techniques are used for management, including subxiphoid approaches,
anterior and lateral thoracotomies, video-assisted thoracic surgery
(VATS), and percutaneous pericardiocentesis. We evaluate the surgical
management strategies for pericardial effusion and their outcomes in this
systematic review. Method(s): A systematic literature review was
performed to identify studies on the surgical management of pericardial
effusion from inception to February 2024 using PubMed, Cochrane, and
Scopus. Articles were independently assessed by two reviewers, with
discrepancies resolved by the senior author. Articles were considered for
inclusion if they described different pericardial effusion surgical
management techniques. Baseline patient characteristics and procedural and
outcome variables were extracted. Result(s): A total of 27 studies
comprising 2773 patients were evaluated. The median age was 56.2 years
(interquartile range 47-62.2). The most common etiologies of pericardial
effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and
idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%),
and autoimmune disease (4.2%). The subxiphoid pericardial window was the
most common approach (82.6%), followed by anterior and lateral thoracotomy
(12.0%), and median sternotomy (0.6%). At median follow-up of 24 months,
the most frequent post-procedural complications were recurrence of
effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%).
 Conclusion(s): Subxiphoid pericardial window is the most common
approach for draining pericardial effusions. Prognosis depends on both the
underlying etiology and the chosen drainage strategy. Treatment should be
tailored to individual patients, considering patient comorbidities and the
specific etiology. Copyright © 2025 by the authors.

<52>
Accession Number
2035472378
Title
Cardiac Rehabilitation After Mitral Valve Intervention: Tailored
Assessment, Management, and Exercise Training.
Source
Journal of Cardiovascular Development and Disease. 12(7) (no pagination),
2025. Article Number: 265. Date of Publication: 01 Jul 2025.
Author
Perone F.; Loguercio M.; Sabato F.; Pasquini A.; Ostojic M.; Avagimyan A.;
Sileikiene V.; Popiolek-Kalisz J.; Aleksova A.; Ambrosetti M.
Institution
(Perone) Cardiac Rehabilitation Unit, Rehabilitation Clinic 'Villa delle
Magnolie', Castel Morrone, Caserta, Italy
(Loguercio, Ambrosetti) Cardiovascular Rehabilitation Unit, ASST Crema,
Santa Marta Hospital, Rivolta D'Adda, Italy
(Sabato) Clinica Hildebrand Rehabilitation Center Brissago, Via Crodolo,
Brissago, Switzerland
(Pasquini) Department of Cardiovascular Medicine, Fondazione Policlinico
Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, Rome, Italy
(Ostojic) Cardiology Clinic, University Clinical Center of Serbia,
Belgrade, Serbia
(Avagimyan) Department of Internal Diseases Propedeutics, Yerevan State
Medical University After M. Heratsi, Korun Street 2a, Yerevan, Armenia
(Sileikiene) Clinic of Cardiac and Vascular Diseases, Faculty of Medicine,
Vilnius University, Ciurlionio Str. 21, Vilnius, Lithuania
(Sileikiene) Vilnius University Hospital Santaros Clinics, Santariskiu
Str. 2, Vilnius, Vilnius, Lithuania
(Popiolek-Kalisz) Department of Clinical Dietetics, Medical University of
Lublin, ul. Chodzki 7, Lublin, Poland
(Popiolek-Kalisz) Department of Cardiology, Cardinal Wyszynski Hospital in
Lublin, Al. Krasnicka 100, Lublin, Poland
(Aleksova) Cardiothoracovascular Department, Azienda Sanitaria
Universitaria Giuliano Isontina, Trieste, Italy
(Aleksova) Department of Medical, Surgical and Health Sciences, University
of Trieste, Trieste, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Cardiac rehabilitation should be suggested after mitral valve
intervention. Physical exercise is associated with improved
cardiorespiratory fitness and clinical outcome and reduced
rehospitalization and mortality in patients after heart valve surgery.
Tailored assessment is the first step before starting a cardiac
rehabilitation program. Physical examination, electrocardiogram,
echocardiography, and peak exercise capacity stratify the risk of these
patients when prescribing appropriate supervised aerobic and resistance
exercise training. Cardiac rehabilitation participation impacts physical
capacity, psychosocial function, and prognosis in patients after mitral
valve surgery and transcatheter edge-to-edge repair. However, further
evidence is needed on the efficacy and safety of cardiac rehabilitation
programs, as well as standardization. In this review, we provide a
contemporary and comprehensive update on the role of cardiac
rehabilitation in patients after mitral valve intervention, after both
mitral valve surgery and transcatheter mitral valve implantation.
Specifically, we focus our review on the tailored assessment and
management of these patients from post-operative to cardiac
rehabilitation. Copyright © 2025 by the authors.

<53>
Accession Number
2039776713
Title
A Prospective, Multicentre Randomised Controlled Study of Angiographic and
Clinical Outcomes in Total Arterial Coronary Bypass Grafting: The TA Trial
Protocol.
Source
Heart Lung and Circulation. (no pagination), 2025. Date of Publication:
2025.
Author
Royse A.; Ren J.; Bowyer A.; Reid C.M.; Bellomo R.; Smith J.A.; Bannon P.;
Eccleston D.; Vallely M.; Lui E.; Ludbrook G.; Clarke S.; Tian D.H.; Royse
C.
Institution
(Royse, Ren, Bowyer, Tian, Royse) Department of Surgery, The University of
Melbourne, Melbourne, VIC, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Royse) Department of Surgery, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia
(Bowyer, Royse) Department of Anesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, VIC, Australia
(Bowyer, Royse) Outcomes Research, University of Texas Heath, Houston, TX,
United States
(Reid) Population Health, Curtin University, Perth, WA, Australia
(Bellomo) Department of Critical Care, The University of Melbourne,
Melbourne, VIC, Australia
(Bellomo) Department of Anaesthesia, Austin Health, Melbourne, VIC,
Australia
(Smith) Department of Surgery (School of Clinical Sciences at Monash
Health), Monash University, Melbourne, VIC, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne,
VIC, Australia
(Bannon) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
(Bannon) Faculty of Medicine and Health, Central Clinical School, The
University of Sydney, Sydney, NSW, Australia
(Eccleston) Department of Cardiology, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Eccleston) Department of Medicine, The University of Melbourne,
Melbourne, VIC, Australia
(Vallely) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, NSW, Australia
(Vallely) Faculty of Medicine, Macquarie University, Sydney, NSW,
Australia
(Lui) Department of Medical Imaging, Royal Melbourne Hospital, Melbourne,
VIC, Australia
(Lui) Department of Radiology, The University of Melbourne, Melbourne,
VIC, Australia
(Ludbrook) Discipline of Acute Care Medicine, The University of Adelaide,
Adelaide, SA, Australia
(Clarke) Statistical Consulting Centre, The University of Melbourne,
Melbourne, VIC, Australia
(Tian) Department of Anesthesia and Perioperative Medicine, Westmead
Hospital, Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Background & Aim: Conventional coronary artery bypass grafting (CABG)
procedures typically utilise the left internal mammary artery and
supplementary saphenous vein grafts (SVGs) to re-establish adequate
coronary blood flow to ischaemic territories. However, extensive
observational studies have consistently demonstrated that SVGs are prone
to accelerated atherosclerosis and progressive failure compared to
arterial conduits. These limitations have heightened interest in total
arterial revascularisation (TAR) as a potentially superior strategy.
 Objective(s): The Total Arterial (TA) Trial, fully funded through the
Medical Research Future Fund Cardiovascular Health Mission, aims to
determine the angiographic and clinical outcomes of TAR compared to
conventional non-TAR operations. Method(s): Design: This study is an
open-label, multicentre, randomised controlled trial including 1,000 CABG
patients from multiple cardiac institutions across Australia, with an
allocation ratio of 1:1. Randomisation occurs at a standardised
perioperative time point via computer-generated sequences with variable
block size The trial does not impose specific procedural requirements
regarding the type of arterial conduit, revascularisation or
reconstruction technique, use of sequential or composite methods, or any
perioperative management. Intervention(s): Total arterial CABG with
no use of SVG. Control: Non-total-arterial CABG with at least one SVG.
Main outcomes: The primary endpoint will be perfect graft patency at 24
months postoperatively. The secondary endpoints include patency, major
adverse cardiac and cerebrovascular events, quality of life, all-cause and
cardiac mortality. Clinical follow-up visits will be scheduled at 6-month
intervals, and angiographic assessments at 3 months and 24 months.
Subgroup analyses by diabetes, sex, age, and conduit types are proposed to
examine the potential interactions with treatment effects.
 Conclusion(s): The TA Trial is one of the largest multicentre trials
in the field of coronary revascularisation research, evaluating the graft
status and clinical endpoints of TAR versus non-TAR procedures. The study
design will provide valuable insights into whether differences in graft
failure of SVG translate into differences in survival and cardiac
outcomes. Early postoperative coronary angiography may improve
understanding of the impact of competitive flow on graft function. The
findings from this study will contribute to an improved understanding and
help inform the optimal approach for coronary revascularisation,
supporting evidence-based improvements in patient care. Ethics: Ethical
approval has been granted by the Melbourne Health Institutional Review
Board (HREC/92839/MH-2023), Australia. Trial registration: The trial has
been registered under the Australian New Zealand Clinical Trial Registry
(registration number: ACTRN12623000864628). Dissemination of results: The
analysed results will be published in a peer-reviewed journal on
completion of the clinical trial. Copyright © 2025

<54>
Accession Number
2039745674
Title
Revascularization in Stable Coronary Disease: A Systematic Review and
Meta-Analysis of Randomized Clinical Trials.
Source
International Journal of Angiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Sultana N.; Ha F.J.; White A.; Brown A.J.; Nerlekar N.
Institution
(Sultana, Ha, White, Brown, Nerlekar) Department of Cardiology, Victorian
Heart Hospital, Monash Health, Melbourne, Australia
(White, Brown, Nerlekar) Department of Cardiology, Victorian Heart
Institute, Monash University, Melbourne, Australia
(Nerlekar) Department of Imaging Research, Baker Heart and Diabetes
Institute, Melbourne, Australia
Publisher
Thieme Medical Publishers, Inc.
Abstract
The optimal management strategy for stable coronary artery disease (CAD)
remains contentious. While revascularization benefits acute coronary
syndromes, its role in stable CAD compared with medical therapy (MT) is
less clear. This systematic review and meta-analysis evaluated the safety
and efficacy of coronary revascularization (percutaneous coronary
intervention [PCI] or coronary artery bypass grafting [CABG]) versus MT in
patients with stable CAD. A systematic search identified randomized trials
comparing revascularization with optimal MT in stable CAD. Trials included
documented CAD via angiography and excluded acute coronary syndromes. The
primary safety endpoint was all-cause mortality, non-fatal myocardial
infarction (MI), and stroke. The primary efficacy endpoint also included
unplanned revascularization, cardiac hospitalization, and major bleeding.
The secondary endpoint included the percentage free from angina. Relative
risk (RR) was calculated using random-effects models. Ten trials with
14,171 participants were included. There was no difference in the primary
safety endpoint (RR 0.96 [0.90-1.03], p = 0.23). The primary efficacy
endpoint favored revascularization (RR 0.81 [0.69-0.96], p = 0.01),
primarily driven by unplanned revascularization (RR 0.5 [0.29-0.85], p =
0.01), though with increased procedural MI risk (RR 2.21 [1.44-3.39], p <
0.001). More patients had freedom from angina with revascularization
compared with MT (71.8% vs. 62.9%, p < 0.001). In stable CAD, initial
revascularization did not improve outcomes for the primary safety
endpoint; however, it did reduce unplanned revascularization compared with
MT. More patients had freedom from angina in the revascularization arm, at
the cost of increased procedural MI. Decision regarding optimal management
strategy for stable CAD remains a patient-centered discussion, recognizing
the largely symptomatic rather than prognostic benefit that patients
derive from early revascularization. Copyright © 2025.
International College of Angiology. All rights reserved.

<55>
Accession Number
2035472337
Title
Smaller Bioprosthetic Valves May Be Associated with Worse Clinical
Outcomes and Reduced Freedom from Reoperation in sAVR.
Source
Journal of Cardiovascular Development and Disease. 12(7) (no pagination),
2025. Article Number: 277. Date of Publication: 01 Jul 2025.
Author
Lee O.; Derish D.; Shum-Tim D.
Institution
(Lee) UCL Medical School, University College London, London, United
Kingdom
(Derish, Shum-Tim) McGill University Health Centre, Division of Cardiac
Surgery, Department of Surgery, McGill University Faculty of Medicine,
Montreal, QC, Canada
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Surgical bioprosthetic aortic valve replacement is a
ubiquitous procedure, with several factors identified in affecting
outcomes. We hypothesize that smaller valves may be associated with worse
outcomes and decreased freedom from clinical events, and a shift in
implanting larger valves whenever possible may confer benefit to the
patient. Method(s): A narrative review of the literature was
conducted using a systematic search strategy to evaluate studies examining
the relationship between bioprosthetic valve size and outcomes. Inclusion
criteria focused on studies reporting paired data on valve size and
clinical endpoints in surgical AVR. Result(s): Among the 15 reviewed
studies, smaller valve sizes were consistently associated with higher
post-operative transvalvular gradients (6/7 studies) and increased
reintervention rates (5/8 studies). Associations with accelerated
structural valve degeneration (SVD) (3/5 studies) and reduced survival
(8/11 studies) were also observed, although heterogeneity in study design
and follow-up durations limited definitive conclusions.
 Conclusion(s): Our findings suggest that larger valve sizes may
improve freedom from SVD, reduce reintervention rates, and enhanced
survival. This may also justify the slight increased risk of enlarging the
aortic root to accommodate a larger bioprosthetic valve prosthesis.
Further high-quality, controlled studies are needed to clarify the
independent impact of valve size on long-term outcomes and guide surgical
decision-making. Copyright © 2025 by the authors.

<56>
Accession Number
644839353
Title
Assisted reproductive technology and the risk of minor congenital heart
defects in the newborn.
Source
Human Reproduction. Conference: 40th Annual Meeting of the European
Society of Human Reproduction and Embryology, ESHRE 2024. Amsterdam
Netherlands. 39(Supplement 1) (pp i555), 2024. Date of Publication: 01 Jul
2024.
Author
Kyhl F.; Jensen J.S.; Vassard D.; Vogg R.O.B.; Bundgaard H.; Madsen P.L.;
Pinborg A.
Institution
(Kyhl, Jensen, Vassard, Pinborg) Department of Gynaecology, Fertility and
Obstetrics - Rigshospitalet, Copenhagen University Hospital, Copenhagen O,
Denmark
(Jensen, Vogg, Madsen) Department of Cardiology, Herlev-Gentofte Hospital,
Copenhagen, Denmark
(Bundgaard) Department of Cardiology - The Heart Centre - Rigshospitalet,
Copenhagen University Hospital, Copenhagen O, Denmark
(Bundgaard) Department of Clinical Medicine, Faculty of Health and Medical
Sciences, University of Copenhagen, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Study question: Are children conceived through assisted reproductive
technology (ART) at higher risk of minor congenital heart defects (CHD)
compared with naturally conceived (NC) children? Summary answer: Contrary
to previous studies children conceived through ART had similar risk of
minor CHDs compared with children conceived naturally. What is known
already: Congenital heart defects (CHD) may precipitate cardiac
arrhythmias, lead to thromboembolic events, culminate in heart failure or
even sudden cardiac demise. A systematic review and meta-analysis showed
an elevated odds ratio (OR) for diagnosis of any CHD among children
conceived through in-vitro fertilization (IVF) or intracytoplasmic sperm
injection (ICSI) compared with NC children. Other studies indicate that
ART is associated with an increased arterial blood pressure and vascular
dysfunction in the pulmonary and systemic arterial vasculature. This
association persists throughout childhood, adolescence, and early
adulthood in individuals conceived through ART; this indicates a lasting
impact on the cardiovascular circulatory system. Study design, size,
duration: The present study is a sub-study to the Copenhagen Baby Heart
Study (CBHS), a prospective population-based cohort study of>25 000
children born in the three main maternity wards in Copenhagen, Denmark, in
2016-2018. Transthoracic echocardiography (TTE) was performed on all
children within 60 days of delivery and diagnosis of CHD was reviewed by a
specialist in paediatric cardiology. Information regarding parental
health, pregnancy, delivery, and the newborn was collected through Danish
patient registries. Participants/materials, setting, methods: This study
includes all children conceived by ART in the CBHS (n=1 784), and a
matched group (1:4 by maternal age at birth) of NC children (n=7 141).
Exclusion criteria were genetic or chromosomal syndromes and heart
surgery. Minor CHD was defined as an atrial (ASD) or ventricular septum
defects (VSD), bicuspid aortic valve, coarctation of the aorta, pulmonary
stenosis, or patent ductus arteriosus. We calculated ORs using logistic
regression analyses. Main results and the role of chance: The mean
maternal age at birth was 34.9 (standard deviation [SD] +/- 4.4) and 35.1
years (SD +/- 4.6) and the newborn mean age at TTE was 12.1 (SD +/- 9.3)
and 12.2 days (SD +/- 9.4) in the ART and NC population, respectively.
Parental CHD was registered in 40 (2.2 %) children in the ART group and
121 (1.7 %) in the NC group. Overall, 165 (9.2%) children conceived by ART
and 611 (8.6%) NC children were diagnosed with a minor CHD. The most
prevalent CHDs were VSD and ASD which accounted for 38.8 % and 35.2 % in
children with CHD in the ART group, respectively, and 36.8 % and 33.9 % in
children with CHD in the NC group. The unadjusted OR for minor CHD was
1.09 (95% CI 0.91- 1.30). Adjustments for maternal age and parental CHD
did not change the OR. There were no differences in ORs when stratifying
by minor CHD type. We stratified by the method of ART: ICSI and IVF and
frozen embryo transfer and fresh embryo transfer, and calculated risk of
minor CHD comparing the methods and with NC children. We found no
difference in any ORs, crude or adjusted. Limitations, reasons for
caution: Children born preterm, and children with severe minor and major
CHDs, were underrepresented in the cohort indicating parents of such
children chose not to participate in a research project that would include
another hospital visit. Residual confounding is plausible because parental
CHD diagnoses were retrieved from patient registries. Wider implications
of the findings: The number of children conceived through ART is
increasing each year and previous research have found an increased risk of
CHD in children conceived through ART. Our findings indicate no increased
risk of minor CHD, providing comforting and significant information for
advising individuals considering or undergoing ART treatment.

<57>
Accession Number
2035472345
Title
Iatrogenic Pneumopericardium After Pericardiocentesis: A Systematic Review
and Case Report.
Source
Journal of Cardiovascular Development and Disease. 12(7) (no pagination),
2025. Article Number: 246. Date of Publication: 01 Jul 2025.
Author
Merz A.; Ran H.; Chiu C.-Y.; Dreger H.; Morris D.A.; Schneider-Reigbert M.
Institution
(Merz, Chiu, Dreger, Morris, Schneider-Reigbert) Deutsches Herzzentrum der
Charite, Department of Cardiology, Angiology and Intensive Care Medicine,
Berlin, Germany
(Merz, Chiu, Dreger, Morris, Schneider-Reigbert) DZHK (German Center for
Cardiovascular Research), Partner Site Berlin, Berlin, Germany
(Merz, Chiu, Dreger, Morris, Schneider-Reigbert)
Charite-Universitatsmedizin Berlin, Freie Universitat Berlin and
Humboldt-Universitat zu Berlin, Berlin, Germany
(Ran) Department of Echocardiography, Nanjing First Hospital, Nanjing
Medical University, Nanjing, China
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Pneumopericardium is the presence of air within the
pericardial cavity. We report a case of iatrogenic pneumopericardium
following pericardiocentesis in a patient with primary cardiac
angiosarcoma. Additionally, we provide a systematic review of
pericardiocentesis-associated pneumopericardium to offer a comprehensive
overview and evaluate the role of echocardiography in its diagnosis.
 Method(s): The PubMed database was searched from inception until
January 2025 to perform a systematic review following the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines to evaluate articles on iatrogenic pneumopericardium following
pericardiocentesis published in the English language. The Joanna Briggs
Institute (JBI) Critical Appraisal Checklist for Case Reports was used to
appraise the included case reports. Result(s): Of the 108 search
results obtained, after screening and a backward citation search, 37
articles were selected for inclusion in this review, accounting for a
total of 37 patients. According to the JBI Critical Appraisal Checklist
for Case Reports, 7 case reports were of high quality and 12 of low
quality. The overall evidence of quality of the case reports was moderate,
and 51.6% of patients developed hemodynamic compromise or showed signs of
cardiac tamponade. The main underlying cause for the development of
pneumopericardium was issues relating to the catheter drainage system;
64.9% of cases required decompressive therapy. Conclusion(s):
Pneumopericardium can occur as a complication after pericardiocentesis and
must therefore be considered in symptomatic patients. While detection by
transthoracic echocardiography is difficult and relies on non-validated
signs, chest X-ray and computed tomography can provide a definitive
diagnosis. Copyright © 2025 by the authors.

<58>
Accession Number
2036895162
Title
COMPARISON OF DEXMEDETOMIDINE WITH FENTANYL FOR SEDATION IN TYMPANOPLASTY
(ENT SURGERIES).
Source
International Journal of Medicine and Public Health. 15(3) (pp 255-262),
2025. Date of Publication: 01 Jul 2025.
Author
Kumar M.S.; Cheryala K.; Rahman M.H.
Institution
(Kumar) Department of Anaesthesia, Osmania Medical college, Telangana,
India
(Cheryala) Department of Anaesthesia, GMC Sanga Reddy, Telangana, India
(Rahman) Department of Anaesthesia, GMC Yadagiri, Telangana, India
Publisher
Pink Petals Publications Pvt Ltd
Abstract
Background: The aim is to evaluate the efficacy of dexmedetomidine and
fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in
Tympanoplasty (ENT surgeries). Material(s) and Method(s): A total of
60 patients between the age group of 18-60 years were included in the
study. They were ASA I &II and scheduled for the elective Tympanoplasty
surgery under Monitored anaesthesia care. Patients were randomized into 2
groups, as group F (Fentany group) received Inj.Fentanyl 1mu/kg bodyweight
I.V and group D (Dexmedetomidine) received dexmedetomidine 1mu/kg body
weight infusion over 10 mins. Patients fasted at least 8 hours before
operation and did not receive any pre-operative sedative drug.
 Result(s): Intra operatively & Post operatively SBP levels were
relatively high in Dexmedetomidine group than fentanyl group and
difference was statistically significant. DBP levels high at all times
among dexmedetomidine group than fentanyl and diference was statistically
significant and Post operatively there was statistically insignificant.
MAP levels intra operatively higher at all times noted among
dexmedetomidine group than the fantanyl Group and difference was
statistically significant, Post operatively insignificant. Heart rate and
SPO2 were Statistically insignificant intraoperatively and Post
operatively. Pain and Discomfort scores are less at all times
intraoperatively in dexmedetomidine group and there were statistically
significant. Post operatively insignificant. sedation scores were less in
dexmedetomine group at all till 45 mins s urgery and these were
statistically significant than Fentanyl group. after 45 mins pain scores
were similar and statistically insignificant. Conclusion(s): The
present study demonstrates that dexmedetomidine is a safe and effective
alternative to fentanyl for sedation in patients undergoing tympanoplasty
under monitored anesthesia care. Copyright © 2025, Pink Petals
Publications Pvt Ltd. All rights reserved.

<59>
Accession Number
2039708035
Title
Bicuspid aortic valve disease: Advancements and challenges of
transcatheter aortic valve implantation.
Source
European Heart Journal. 46(28) (pp 2760-2775), 2025. Date of Publication:
21 Jul 2025.
Author
Barbanti M.; Costa G.; Windecker S.; Maisano F.; Laterra G.; Leipsic J.;
Blanke P.; Bapat V.N.; Leon M.B.; Webb J.G.
Institution
(Barbanti, Laterra) Department of Medicine and Surgery, Universita degli
Studi di Enna Kore, Piazza dell'Universita, Enna, Italy
(Barbanti, Laterra) Division of Cardiology, Umberto I Hospital, ASP 4 of
Enna, Contrada Ferrante, Enna, Italy
(Costa) Division of Cardiology, A.O.U. Polilcinico 'G. Rodolico-San Marco,
Catania, Italy
(Windecker) Department of Cardiology, Bern University Hospital,
Inselspital, University of Bern, Bern, Switzerland
(Maisano) Department of Cardiac Surgery, IRCCS San Raffaele Hospital,
Vita-Salute San Raffaele University, Milan, Italy
(Leipsic, Blanke, Webb) Centre for Heart Valve Innovation, St. Paul's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Bapat) Department of Cardiac Surgery, Minneapolis Heart Institute, Abbott
Northwestern Hospital, 800 E 28th St, MN, Minneapolis, MN, United States
(Leon) Department of Internal Medicine, Columbia University,
Cardiovascular Research Foundation, New York City, NY, United States
Publisher
Oxford University Press
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the
treatment of patients with severe aortic stenosis (AS). Initially
developed for patients with tricuspid aortic valve (TAV) anatomy, the
procedural success and expanding indications of TAVI have spurred interest
in its application to more complex aortic valve anatomies, such as the
bicuspid aortic valve (BAV). The growing interest in this specific sub-set
of patients with AS is driven by the recent extension of TAVI indications
to younger individuals, who exhibit a notably higher incidence of bicuspid
anatomy compared with older populations. Bicuspid aortic valves present
distinct anatomical and pathological complexities that pose significant
challenges to the conventional TAVI approach. These include asymmetric
calcification, aortic root dilation (also known as BAV aortopathy), and
variations in cusp fusion patterns, which can affect valve deployment,
transcatheter heart valve sealing, and long-term durability. Despite these
challenges, advancements in imaging techniques, valve design, and
procedural strategies have led to increased adoption of TAVI in BAV
patients. However, surgical aortic valve replacement still retains a more
prominent role in this group compared with patients with TAVs. This
preference is partly due to the exclusion of BAV patients from almost all
previous randomized controlled trials, which limits the available evidence
supporting the use of TAVI in this unique cohort. This state-of-the-art
review aims to provide a comprehensive overview of the current landscape
of TAVI in BAV patients, including an analysis of anatomical
considerations and procedural pitfalls, as well as outcomes' improvements
with new device iterations. It will also explore clinical data, tackling
the risks, benefits, and the evolving role of TAVI in this unique patient
cohort. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved.

<60>
Accession Number
2036895036
Title
Early remote rehabilitation to improve health of the elderly after cardiac
surgery - study protocol for a randomised trial.
Source
Danish Medical Journal. 72(7) (no pagination), 2025. Article Number:
A11240820. Date of Publication: 2025.
Author
Daugaard R.; Sorensen L.; Ingemann-Molden S.; Modrau I.S.
Institution
(Daugaard, Modrau) Department of Clinical Medicine, Aarhus University,
Denmark
(Daugaard, Modrau) Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Denmark
(Sorensen, Ingemann-Molden) Department of Physiotherapy and Occupational
Therapy, Aarhus University Hospital, Denmark
(Ingemann-Molden) Center for Neuroplasticity and Pain (CNAP), Department
of Health Science and Technology, Aalborg University, Denmark
Publisher
Almindelige Danske Laegeforening
Abstract
INTRODUCTION. Early rehabilitation is recommended after cardiac surgery to
enhance recovery. However, due to precautions of sternum healing, the
initiation of cardiac rehabilitation is often postponed for 6-8 weeks
after surgery, leaving patients to face physical and emotional barriers on
their own. This study aims to investigate whether early remote cardiac
rehabilitation can enhance physical function and reduce the emotional
challenges that older patients face after discharge. METHODS. In this
bi-entre, randomised controlled trial, 120 patients older than 65 years of
age undergoing open heart surgery are assigned to individualised exercise
training and step counting supported by a mobile health app and weekly
calls with a physiotherapist as an adjunct to standard care (intervention
group), or standard care alone (control group) for six weeks after
discharge. Outcomes are assessed at baseline, a six-week follow-up and a
six-month follow-up. The primary outcome is change in the 30-second Chair
Stand Test. Secondary outcomes include health-related quality of life,
cost-effectiveness and prevalence of sarcopenia. CONCLUSIONS. This trial
will determine if early remote rehabilitation after cardiac surgery can
accelerate recovery and alleviate emotional distress, advocating for early
post-discharge interventions through digitally delivered
care. Copyright © 2025, Almindelige Danske Laegeforening. All
rights reserved.

<61>
Accession Number
2039746466
Title
Ultra-short-period perioperative pulmonary rehabilitation on short-term
outcomes after surgery in smoking patients with lung cancer: a randomized
clinical trial.
Source
International Journal of Surgery. 111(1) (pp 581-588), 2025. Date of
Publication: 01 Jan 2025.
Author
Han D.; Wang X.; Sun X.; Cao Y.; Li C.; Guo W.; Hu Y.; Hang J.; Li J.; Xie
Q.; Li H.
Institution
(Han, Wang, Cao, Li, Guo, Hu, Hang) Department of Thoracic Surgery, Ruijin
Hospital, Shanghai Jiao Tong University School of Medicine, China
(Sun, Xie) Department of Rehabilitation, Ruijin Hospital, Shanghai Jiao
Tong University School of Medicine, China
(Li) Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China
(Li) Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, 197 Ruijin 2nd Road, Shanghai, China
Publisher
Wolters Kluwer Health Inc
Abstract
Background: Pulmonary rehabilitation (PR) is essential for airway
management after thoracic surgery. Most current PRs are composed of
2-4-week exercises, which require significant consumption of medical
resources and concerns about disease progression. Material(s) and
Method(s): This single-center, prospective, randomized controlled trial
enrolled smoking patients with pulmonary masses or nodules suitable for
lobectomy, aged 18-80, with a smoking history (>= 20 pack-years). Eligible
patients were randomized in a 1:1 ratio into two groups. Patients in the
intervention group underwent perioperative breathing exercises based on
positive pressure vibration expectoration and 3-day preoperative lower
limb endurance training. Patients in the control group received routine
perioperative care. The primary outcome was in-hospital incidence of
postoperative pulmonary complications. Secondary outcomes included
postoperative hospital stay, total hospitalization cost, postoperative
drainage time, drainage volume, semiquantitative cough strength score,
pain score, Borg scale-assessed fatigue, and walking distance on
postoperative days 1 and 2. Result(s): A total of 194 patients were
included in the study, with 94 in the intervention group and 100 in the
control group. Our ultrashort PR program potentially reduced pulmonary
complications incidence (24.5 vs. 33.0%), but without statistical
significance (P = 0.190). No significant differences were found in other
perioperative outcomes, except for postoperative semiquantitative cough
strength score (3 [interquartile range, 3-3.75] vs. 3 [interquartile
range, 2-3], P < 0.001) and change in walking distance from postoperative
days 1 to 2 (60 [interquartile range, 40-82.5] vs. 30 [interquartile
range, 10-60], P = 0.003). Conclusion(s): There were no significant
differences in postoperative complications and other hospitalizations, but
our ultrashort rehabilitation program improved patients' semiquantitative
cough strength score and walking distance, indicating the potential for
better outcomes. This treatment is a safe and effective means of airway
management for thoracic surgery in the era of enhanced recovery
(ClinicalTrials.gov Identifier: NCT03010033). Copyright © 2024
The Author(s).

<62>
Accession Number
2039742429
Title
Percutaneous Cannulation for Minimally Invasive Heart Valve Surgery:
Results from a Multicenter Registry.
Source
European Journal of Cardio-thoracic Surgery. 67(7) (no pagination), 2025.
Article Number: ezaf219. Date of Publication: 01 Jul 2025.
Author
Pausch J.; Weimann J.; Silaschi M.; Alaj E.; Seidiramool V.; Kofler M.;
Kempfert J.; Treede H.; Ghazy A.; Noack T.; Gadelkarim I.; Bleiziffer S.;
Gotte J.; Reichenspurner H.; Conradi L.
Institution
(Pausch, Reichenspurner, Conradi) Department of Cardiovascular Surgery,
University Heart and Vascular Center Hamburg, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Weimann) Department of Cardiology, University Heart and Vascular Center
Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Silaschi, Alaj, Seidiramool) Clinic and Polyclinic for Cardiac Surgery,
University Hospital Bonn, Bonn, Germany
(Kofler, Kempfert) Department of Cardiothoracic and Vascular Surgery,
German Heart Center Berlin, Berlin, Germany
(Kempfert) German Center for Cardiovascular Research, Partner Site Berlin,
Berlin, Germany
(Treede, Ghazy) Clinic and Policlinic for Heart- and Vascular Surgery,
University Hospital Mainz, Mainz, Germany
(Noack, Gadelkarim) University Clinic of Cardiac Surgery, Leipzig Heart
Center, Leipzig, Germany
(Bleiziffer, Gotte) Clinic for Thoracic and Cardiovascular Surgery, Heart
and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Bad
Oeynhausen, Germany
(Conradi) Department of Cardiac Surgery, University Hospital Cologne,
Koln, Germany
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objective To avoid potential groin incision associated complications and
further streamline surgery percutaneous femoral cannulation using
different vascular closure devices (VCDs) has emerged to establish
cardiopulmonary bypass during minimally invasive heart valve surgery
(HVS). Design The Percutaneous peRipheral cannulatiOn for Minimally
InvaSive heart valve surgEry (PROMISE) multicentre registry included
patients, receiving percutaneous vascular access site (VAS) closure during
minimally invasive HVS. Retrospective analyses were performed to evaluate
major and minor VAS-related complications of plug- (group 1) vs
suture-based (group 2) systems according to modified Valve Academic
Research Consortium (VARC) 3 criteria (ie, retrograde dissection, vascular
injury, conversion to surgical cut-down, or vascular intervention).
Results In total, 755 patients (66.1% (499/755) male; median age 61.9
years) were included and treated using a plug- (n = 450) or suture-based
(n = 305) VCD. Most prevalent comorbidities were hypertension (53.8%;
335/755) and atrial fibrillation (29.4%; 222/755), resulting in a median
STS Prom Score of 0.5%. Prevalence of peripheral artery disease was 4.4%
(33/450). Immediate hemostasis was significantly higher in the plug-based
group (99.8% (445/450) vs 77.7% (237/305); P <. 001). Accordingly,
application of a second VCD (0.0% (0/450) vs 34.8% (106/305); P <. 001) as
well as conversion rates to surgical cut-down (1.3% (6/450) vs 3.9%
(12/305); P =. 04) were significantly lower. Prevalence of VAS-related
complications (ie, arterio-venous (AV) fistula (0.2% (1/450) vs 0%
(0/305); P >. 99), pseudoaneurysm (0.4% (2/450) vs 0% (0/305); P =. 66),
or postoperative VAS bleeding (1.6% (7/450) vs 0.7% (2/305); P =. 26)) was
low in both the groups (2.9% (13/450) vs 5.2% (16/305); P =. 14).
Conclusions VAS-related complications were favourably low in both the
groups. Plug-based VCDs are potentially associated with significantly
higher rates of immediate hemostasis and lower incidence for additional
VCD or surgical cut-down. Usage of dedicated VCD (plug- and suture-based)
for VAS closure after percutaneous cannulation is feasible, safe, and
further decreases invasiveness in minimally invasive HVS. Copyright
© 2025 The Author(s). Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery.

<63>
Accession Number
2039708066
Title
Life after Coronary Artery Bypass Grafting: Lifestyle Changes, Secondary
Prevention, and Quality of Life.
Source
International Journal of Angiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Chhabra J.; Mubder M.; Tak N.; Houshmand N.; Siddiqui A.; Cyrus T.; Tak T.
Institution
(Chhabra) Department of Family and Community Medicine, Kirk Kerkorian
School of Medicine at UNLV, Las Vegas, NV, United States
(Mubder) Department of Internal Medicine, University Medical Center, Las
Vegas, NV, United States
(Tak) University of Minnesota Twin Cities, Minneapolis, MN, United States
(Houshmand, Cyrus, Tak) Department of Cardiovascular Medicine, Kirk
Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, United
States
(Siddiqui) Department of Internal Medicine, Kirk Kerkorian School of
Medicine, University of Nevada, Las Vegas, NV, United States
(Cyrus, Tak) Department of Cardiovascular Medicine, Veterans Affairs
Medical Center, North Las Vegas, NV, United States
Publisher
Thieme Medical Publishers, Inc.
Abstract
Approximately 200 million people worldwide suffer from ischemic heart
disease. Coronary artery bypass grafting (CABG) is known as a treatment
option for multivessel and left main coronary artery disease, with better
survival rates and lower major adverse cardiac events compared with
medical therapy or percutaneous cardiovascular intervention alone in
several cases. Lifestyle following CABG has been written about
extensively; however, the creation of a general, evidence-based guide for
both patients and physicians across different specialties appears
necessary, given the overwhelming amount of literature available, the
continued refinement of guidelines, and technological advancements over
time. We reviewed the latest data on CABG in both the United States and
worldwide, utilizing consensus statements from the American Heart
Association/American College of Cardiology and European Society of
Cardiology literature, as well as the PubMed database and UpToDate, to
obtain the most up-to-date information on these topics. We then organized
our findings into multiple categories detailing surgical techniques,
postoperative care, medication types, long-term prognosis, the importance
of cardiopulmonary rehabilitation, as well as future
directions. Copyright © 2025. International College of Angiology.
All rights reserved.

<64>
Accession Number
2039664643
Title
Cost-effectiveness of an intraoperative antibacterial envelope in
preventing cardiac implantable device-associated infections: a systematic
review.
Source
Europace. 27(7) (no pagination), 2025. Article Number: euaf121. Date of
Publication: 01 Jul 2025.
Author
Mudigonda S.; Hagarty E.; Lei L.; Rennert-May E.; Joza J.; Exner D.V.;
Andrade J.; Raj S.R.; Chew D.S.
Institution
(Mudigonda, Hagarty, Exner, Raj, Chew) Department of Cardiac Sciences,
Libin Cardiovascular Institute, University of Calgary, 3280 Hospital Dr
NW, Calgary, AB, Canada
(Lei, Andrade) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Rennert-May, Chew) Department of Community Health Sciences, University of
Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada
(Rennert-May, Chew) Department of Medicine, University of Calgary, 3280
Hospital Dr NW, Calgary, AB, Canada
(Rennert-May, Chew) O'Brien Institute for Public Health, University of
Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada
(Rennert-May) Department of Microbiology, Immunology and Infectious
Diseases, University of Calgary, Calgary, AB, Canada
(Joza) Department of Medicine, McGill University, Montreal, QC, Canada
Publisher
Oxford University Press
Abstract
Aims Intraoperative use of an antibacterial envelope during surgery for
cardiac implantable electronic device (CIED) surgery reduces infection
risk at increased procedural costs. The objective of this systematic
review was to synthesize the published economic literature on the
cost-effectiveness of the antibacterial envelope. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . Methods A systematic
review of the published literature was conducted to identify economic
evaluations (i.e. cost-utility, cost-effectiveness, and results
and cost-benefit studies) comparing the antibacterial envelope compared
with standard of care in preventing post-operative CIED infection.
Systematic review best practices were followed, and study quality was
assessed. Of 142 unique citations, 7 studies met the inclusion criteria
for qualitative synthesis. All cost-effectiveness studies were conducted
from the healthcare payer perspective of high-income countries. The base
case analysis of most economic studies (5/7) reported a cost per
quality-adjusted life year gained that exceeded country-specific societal
thresholds for good value in healthcare. Cost-effectiveness was highly
dependent on the baseline infection risk. That is, at current pricing, the
antibacterial envelope may be cost-effective at base infection rates of
greater than 3%, and cost-savings at infection rates that exceed 6%. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conclusion Routine use of an antibacterial envelope in patients
undergoing CIED procedures (implantation or revision) is unlikely to be
cost-effective except among those at high risk for post-operative
infection. Individualized risk assessment may help guide efficient and
value-based use of this technology. Copyright © The Author(s)
2025. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<65>
Accession Number
2035395216
Title
Indirect comparison of the efficacy and safety of alirocumab and
evolocumab on major cardiovascular events: a systematic review and network
meta-analysis.
Source
Frontiers in Pharmacology. 16 (no pagination), 2025. Article Number:
1555508. Date of Publication: 2025.
Author
Xu L.; Lei M.; Li L.; Li Y.; Gu C.; Zheng P.
Institution
(Xu, Lei, Li, Li, Gu, Zheng) Department of Pharmacy, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Xu, Lei, Li, Li, Gu, Zheng) Clinical Pharmacy Center, Nanfang Hospital,
Southern Medical University, Guangzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Alirocumab and evolocumab are proprotein convertase
subtilisin/kexin type 9 inhibitors that significantly reduce the relative
risk of cardiovascular events. However, the relative efficacy and safety
of alirocumab and evolocumab in different patient groups still warrant
further indirect comparison. This systematic review and network
meta-analysis indirectly compared the efficacy and safety of alirocumab
and evolocumab on major cardiovascular events. Method(s): PUBMED,
EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials
(CENTRAL) databases were comprehensively searched to extract randomized
controlled trials (RCTs) regarding alirocumab and evolocumab published
from inception to 17 August 2024. The meta-analysis was performed using
Software Review Manager 5.4 and R 4.1.0 software. Result(s): This
network meta-analysis included 26 RCTs with 64,921 patients. Among these,
13 RCTs included patients receiving alirocumab or placebo (n = 13,365) and
13 RCTs included patients receiving evolocumab or placebo (n = 22,048).
Compared with the placebo, treatment with alirocumab and evolocumab
significantly reduced the relative risk of major adverse cardiovascular
and cerebrovascular events (MACCE), myocardial infarction, stroke, and
coronary revascularization. Furthermore, alirocumab and evolocumab groups
did not show significant differences in MACCE [relative risk (RR): 0.99,
95% confidence interval (CI): 0.88-1.11], cardiovascular death (RR: 0.83,
95% CI: 0.65-1.06), myocardial infarction (RR: 0.87, 95% CI: 0.74-1.03),
stroke (RR: 0.96, 95% CI: 0.71-1.29), coronary revascularization (RR:
0.88, 95% CI: 0.77-1.01), and any adverse event (RR: 0.91, 95% CI:
0.76-1.09). Moreover, the all-cause mortality rates were lower for
patients treated with alirocumab compared to those treated with evolocumab
(RR: 0.84, 95% CI: 0.70-1.00), but the difference was not statistically
significant. Conclusion(s): Alirocumab and evolocumab demonstrated
comparable efficacy in reducing the relative risk of major cardiovascular
events. The all-cause mortality rates were lower in patients treated with
alirocumab compared to those treated with evolocumab but the differences
were not statistically significant, probably due to heterogeneity in the
sample size and follow-up duration between different studies. Both drugs
exhibited comparable safety profiles. Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier
CRD42024505327. Copyright © 2025 Xu, Lei, Li, Li, Gu and Zheng.

<66>
Accession Number
2039725240
Title
Comparative efficacy and safety of no-touch versus conventional vein
harvesting techniques in coronary artery bypass grafting: a systematic
review and meta-analysis.
Source
Open Heart. 12(2) (no pagination), 2025. Article Number: e003391. Date of
Publication: 21 Jul 2025.
Author
Ali M.A.; Alam U.; Khattak F.; Bacha Z.; Sajjad F.; Khattak A.I.; Afridi
A.; Shahid S.; Sheraz M.; Khan N.A.; Sabir A.; Ahmed R.
Institution
(Ali, Alam, Khattak, Afridi) Khyber Medical College, N.W.F.P, Peshawar,
Pakistan
(Bacha, Sajjad, Khan) Department of Medicine, Khyber Medical College,
Peshawar, Pakistan
(Khattak) Bacha Khan Medical College, Mardan, Pakistan
(Shahid) Department of Medicine, Khawaja Muhammad Safdar Medical College,
Sialkot, Pakistan
(Sheraz) Department of Medicine, Continental Medical College, Lahore,
Pakistan
(Sabir) Department of Cardiac Surgery, Rawalpindi Institute of Cardiology,
Rawalpindi, Pakistan
(Ahmed) Department of Cardiology, Imperial College London, London, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Objective This meta-analysis aims to compare the clinical outcomes of the
no-touch (NT) and conventional (CON) vein harvesting techniques in
patients undergoing coronary artery bypass grafting (CABG). Methods We
conducted a systematic review and meta-analysis following the guidelines
of the Cochrane Handbook and PRISMA (Preferred Reporting Items for
Systematic Review and Meta-Analysis) statement. We searched PubMed, Embase
and Web of Science for randomised controlled trials (RCTs) comparing NT
and CON vein harvesting techniques in CABG patients. Data were extracted
on primary outcomes (graft failure incidence per patient, graft occlusion
incidence per patient and leg infection) and secondary outcomes
(revascularisation, all-cause death, myocardial infarction). Statistical
analysis was performed using Review Manager V.5.4, with risk ratios (RRs)
calculated for binary outcomes. Results Seven RCTs involving 4176 patients
were included. The NT group showed a significantly lower risk of graft
failure incidence per patient (RR=0.74, p=0.0001) and graft occlusion
incidence per patient (RR=0.62, p=0.0002) compared with the CON group.
However, the NT group had a higher risk of leg infection (RR=1.91,
p<0.00001). No significant differences were observed between groups for
revascularisation (p=0.46), all-cause death (p=0.87), or myocardial
infarction (p=0.95). Conclusions The no-touch vein harvesting technique is
associated with reduced graft failure incidence per patient and graft
occlusion incidence per patient compared with conventional harvesting
techniques in CABG, though it increases the risk of leg infection. These
findings suggest NT as a preferable technique for improving graft patency
but highlight the need for caution regarding leg infection. PROSPERO
registration number CRD42025646500. Copyright © World Health
Organization 2025. Licensee BMJ.

<67>
Accession Number
2039728617
Title
Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A
Randomized Trial.
Source
European Journal of Cardio-thoracic Surgery. 67(7) (no pagination), 2025.
Article Number: ezaf226. Date of Publication: 01 Jul 2025.
Author
Kalli A.; Vistbacka J.; Moilanen E.; Jarvela K.; Mennander A.
Institution
(Kalli, Jarvela, Mennander) Faculty of Medicine and Health Technology,
Tampere University, Tampere, Finland
(Kalli, Jarvela, Mennander) Tampere University Hospital, Heart Hospital,
Tampere, Finland
(Vistbacka, Moilanen) The Immunopharmacology Research Group, Faculty of
Medicine and Health Technology, Tampere University, Tampere University
Hospital, Tampere, Finland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives Cardiac surgery via full sternotomy impacts postoperative lung
function. We studied whether ultrasound-guided superficial parasternal
intercostal plane block (SPIP) before surgical aortic valve replacement
via full sternotomy would ameliorate postoperative lung function and
filtration capacity. Methods A total of 74 consecutive patients undergoing
surgical aortic valve replacement were randomized to receive either or not
additional SPIP. Pre- and postoperative lung function tests were compared
among the patients. Venous and arterial blood samples were collected to
calculate lung filtration (venous/arterial) of the inflammatory factors
chemerin, chitinase-3-like protein 1 (YKL-40), resistin, and interleukin-6
(IL6) immediately before (T1), 1 hour after releasing aortic cross-clamp
(T2), and on the following morning (T3) after surgery in 30 age- and
sex-adjusted patients. Results Patients with SPIP were older as compared
to those without (66.7 [10.7] vs 60.2 [13.4], years, respectively, P <
0.04). Neither other patient characteristics nor preoperative lung
functions differed between the patient groups. Forced expiratory volume in
1 second (FEV), forced volume capacity (FVC), and relative FVC changes
decreased less in patients treated with wound analgesia as compared to
those without (P = 0.024, P = 0.042, and P = 0.042). Total oxycodone
consumption (P = 0.634), YKL-40, and resistin did not differ between the
groups. Arterial chemerin decreased and venous/arterial IL6 ratio
increased in patients with SPIP as compared to those without (P = 0.024
versus P = 0.332, respectfully). Conclusions SPIP before aortic valve
surgery via full sternotomy impacts postoperative respiratory function and
venous/arterial IL6 ratio. Clinical registration number The study was
approved by the institutional review board (Ethical Committee of the
Tampere University Hospital, Tampere, Finland, registration number
R18011M) on March 8, 2018, and the study conforms to the ethical
guidelines of the Declaration of Helsinki. Copyright © 2025 The
Author(s).

<68>
Accession Number
2039725358
Title
Restrictive Cardiomyopathy: A Comprehensive Literature Review.
Source
Annals of Clinical Cardiology. 7(1) (pp 5-14), 2025. Date of Publication:
01 Jan 2025.
Author
Fakih Y.; Al Sakan M.; Fawaz N.; El Ghazawi A.; Fawaz A.; Refaat M.M.
Institution
(Fakih, Fawaz, Fawaz, Refaat) Faculty of Medicine, American University of
Beirut Medical Center, Beirut, Lebanon
(Al Sakan, El Ghazawi, Refaat) Department of Cardiology, American
University of Beirut Medical Center, Beirut, Lebanon
(Refaat) Department of Cardiology, Division of Cardiac Electrophysiology,
American University of Beirut Medical Center, Beirut, Lebanon
Publisher
Wolters Kluwer Medknow Publications
Abstract
Cardiomyopathy refers to a spectrum of diseases affecting the heart,
impairing the organ's ability to effectively pump blood to the rest of the
body. The notion encompasses a wide array of conditions, including
dilated, hypertrophic, and restrictive cardiomyopathy (RCM) among many
others. RCM is the least common and least understood subtype of
cardiomyopathies. It is characterized by ventricular stiffening and
diastolic dysfunction, eventually leading to pulmonary and circulatory
congestion. Symptoms such as dyspnea and exercise intolerance develop
gradually, often culminating in fatal arrhythmias and heart failure, thus
eventually requiring cardiac transplantation as the only currently
available curative option. RCM can be classified as primary or secondary,
and the etiology of RCM falls under three main categories: genetic,
nonheritable, and idiopathic. While recent research has significantly
advanced our knowledge of RCM, its genetic basis remains poorly
understood. This review focuses on the pathophysiology, clinical
manifestation, prognosis and diagnosis, molecular genetics, and management
of RCM including related challenges. Through critically examining new
genetic insights, novel diagnostic strategies, and gaps in the treatment
approaches, this review provides a valuable resource for cardiologists and
molecular geneticists to further understand this intricate group of
cardiac disorders. Copyright © 2025 Annals of Clinical
Cardiology.

<69>
Accession Number
2033511324
Title
RETRACTION: Effects of Parasternal Intercostal Block on Surgical Site
Wound Infection and Pain in Patients Undergoing Cardiac Surgery: A
Meta-Analysis (International Wound Journal, (2024), 21, 2, (e14433),
10.1111/iwj.14433).
Source
International Wound Journal. 22(3) (no pagination), 2025. Article Number:
e70297. Date of Publication: 01 Mar 2025.
Author
Li J.-Q.; Li Z.-H.; Dong P.; Liu P.; Xu Y.-Z.; Fan Z.-J.
Publisher
John Wiley and Sons Inc
Abstract
RETRACTION: J.-Q. Li, Z.-H. Li, P. Dong, P. Liu, Y.-Z. Xu, Z.-J. Fan,
"Effects of Parasternal Intercostal Block on Surgical Site Wound Infection
and Pain in Patients Undergoing Cardiac Surgery: A Meta-Analysis,"
International Wound Journal 21, no. 2 (2024): e14433,
https://doi.org/10.1111/iwj.14433. The above article, published online on
17 October 2023, in Wiley Online Library
(http://onlinelibrary.wiley.com/), has been retracted by agreement between
the journal Editor in Chief, Professor Keith Harding; and John Wiley &
Sons Ltd. Following an investigation by the publisher, all parties have
concluded that this article was accepted solely on the basis of a
compromised peer review process. The editors have therefore decided to
retract the article. The authors did not respond to our notice regarding
the retraction. Copyright © 2025 The Author(s). International
Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons
Ltd.

<70>
Accession Number
2039727152
Title
Nefopam for Analgesia Following Cardiac Surgery: A Randomized
Placebo-Controlled Double-Blind Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Vacharaksa K.; Kongkanond T.; Taechawattananan N.; Weinberg L.; Lertkovit
S.; Subtaweesin T.; Saraphang S.; Kitisin N.; Raykateeraroj N.
Institution
(Vacharaksa, Kongkanond, Taechawattananan, Lertkovit, Kitisin,
Raykateeraroj) Department of Anesthesiology, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Kongkanond) Department of Anesthesiology, Charoenkrung Pracharak
Hospital, Bangkok, Thailand
(Weinberg) Department of Anaesthesia, Austin Health, Heidelberg, Australia
(Weinberg) Department of Critical Care, The University of Melbourne,
Parkville, VIC, Australia
(Subtaweesin) Department of Cardiothoracic Surgery, Faculty of Medicine,
Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Saraphang) Division of Nursing, Faculty of Medicine, Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the analgesic efficacy, opioid-sparing effects, and
safety profile of nefopam compared with placebo following elective cardiac
surgery. Design(s): Randomized, double-blind, placebo-controlled
trial at a tertiary care center. Setting(s): Perioperative care.
 Participant(s): A total of 103 adults (mean age, 57.9 +/- 11.3 years)
undergoing elective cardiac surgery via median sternotomy were randomized
to receive nefopam (n = 50) or placebo (n = 53). Intervention(s):
Patients were randomized to receive nefopam (20 mg intravenous [IV] bolus,
followed by an 80 mg continuous infusion over 24 hours) or placebo, with
both groups receiving standardized IV fentanyl via patient-controlled
analgesia. Measurements and Main Results: The primary outcome was
cumulative fentanyl consumption over 48 hours. Secondary outcomes included
pain scores (NRS 0-10), intubation duration, intensive care unit
(ICU)/hospital length of stay, and adverse events. Both fentanyl
consumption and pain scores were assessed at 3, 6, 12, 24, and 48 hours
postoperatively. The nefopam group consumed 25% less fentanyl over 48
hours (mean, 16.3 +/- 1.6 microg/kg vs 21.9 +/- 1.6 microg/kg; p = 0.014),
with significant reductions from 6 hours to 48 hours. Pain scores were
lower in the nefopam group at rest at 48 hours (p = 0.03) and during
movement at 24 and 48 hours (p = 0.04 and 0.01), although overall pain
remained mild. Adverse events (eg, sinus tachycardia, agitation/delirium)
were comparable in the 2 groups. Duration of intubation and ICU/hospital
length of stay did not differ between the 2 groups. Conclusion(s):
Nefopam was well tolerated and associated with statistically significant
but clinically modest reductions in fentanyl use and pain scores after
cardiac surgery, supporting its role as a safe adjunct in multimodal
analgesia. Copyright © 2025 Elsevier Inc.

<71>
Accession Number
2039701119
Title
EFFECTS OF IMPROVED ULTRAFILTRATION ON SERUM LEVEL OF IL-6 AND TNF-alpha,
HCT, AND CARDIOPULMONARY FUNCTION IN PATIENTS WITH EXTRACORPOREAL
CIRCULATION IN VALVE REPLACEMENT.
Source
Journal of Medical Biochemistry. 44(4) (pp 854-862), 2025. Date of
Publication: 2025.
Author
Ning G.; Fu L.; Zhou G.
Institution
(Ning, Fu, Zhou) Department of Anesthesiology, Tangshan Workers Hospital,
Hebei, Tangshan, China
Publisher
Society of Medical Biochemists of Serbia
Abstract
Background: To investigate the effects of modified ultrafiltration in
extracorporeal circulation valve replacement surgery. Method(s): A
total of 62 patients with valvular disease who underwent valve replacement
were included. They were randomly divided into the conventional
ultrafiltration group (CUF group, n=31) and the modified ultrafiltration
group (MUF group, n=31). The hematocrit (Hct) values, volume of pleural
fluid drainage at 24 hours after operation, Intensive Care Unit (ICU) stay
time, postoperative 24-hour blood loss, bank blood usage, postoperative
24-hour urine volume, ventilator support time, cardiac function indexes,
postoperative changes of respiratory function, and levels of inflammatory
factors in both groups were compared. Result(s): After
ultrafiltration, the MUF group showed higher Hct value and reduced volume
of pleural fluid drainage, blood loss, bank blood usage, urine volume and
ventilator support time 24 hours after operation compared with the CUF
group (P<0.05). After surgery, left ventricular ejection fraction (LVEF)
levels were elevated, and those in the MUF group were higher than those in
the CUF group. Left ventricular end-diastolic diameter (LVEDD) and heart
rate (HR) were decreased in both groups after surgery. They were lower in
the MUF group than in the CUF group (P<0.05). After ultrafiltration, the
OI value in the MUF group was higher, and the alveolar-arterial oxygen
partial pressure gradient (P (A-a)O<inf>2</inf>) value was lower than the
CUF group (P<0.05). The plasma concentrations of interleukin 6 (IL-6) and
tumour necrosis factor-alpha (TNF-alpha) were increased after
cardiopulmonary bypass (CPB) in both groups and then decreased after
ultrafiltration, and IL-6 and TNF-alpha levels in MUF group were lower
than those in CUF group (P<0.05). Conclusion(s): MUF attenuates the
postoperative systemic inflammatory response, reduces the lung injury
caused by CPB, and improves the lung function of patients in the early
postoperative period, which benefits patient recovery after surgery and is
valuable in heart valve replacement. Copyright © 2025 Society of
Medical Biochemists of Serbia. All rights reserved.

<72>
Accession Number
2036885729
Title
Effectiveness of bispectral index on clinical outcomes of beating heart
off-pump coronary artery bypass grafting surgeries.
Source
JMS - Journal of Medical Society. 39(1) (pp 71-79), 2025. Date of
Publication: 01 Jan 2025.
Author
Singh L.C.; Singh S.; Deigheidy E.M.; Okyere I.; Boateng N.A.
Institution
(Singh) Department of Anaesthesia and Critical Care, RIMS, Manipur,
Imphal, India
(Singh) Department of Anaesthesiology and Intensive Care, Kwame Nkrumah
University of Science and Technology, Kumasi, Ghana
(Singh, Deigheidy) Collage of Medical Sciences, SAMSRI, Uttar Pradesh,
Lucknow, India
(Singh, Boateng) Directorate of Anaesthesia and Intensive Care, Komfo
Anokye Teaching Hospital, Kumasi, Ghana
(Deigheidy) Center of Surgery, Marie Lannelongue, University Paris-South,
Le Plessis-Robinson, France
(Okyere) Department of Surgery, Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana
Publisher
Regional Institute of Medical Sciences
Abstract
Background: In high-risk patients with low hemodynamic reserve, it can be
challenging to get the optimal level of anesthesia without awareness
during off-pump coronary artery bypass grafting (OP-CABG) surgeries. This
study aimed to test whether the use of bispectral (BIS) Index monitoring
reduces the anesthetic requirements and improves the clinical outcomes
during beating heart CABG without awareness during general anesthesia
(ADGA). Material(s) and Method(s): This study was a single-center,
prospective, randomized clinical comparative study on the American Society
of Anesthesiologists (ASA) three patients booked for elective beating
heart OP-CABG surgeries under general anesthesia (GA). Patients received
sevoflurane anesthesia for the maintenance of anesthesia, and their
consumption was calculated and compared between study groups. The control
groups received conventional sevoflurane anesthesia, and hemodynamic
parameters (+/-20% of initial values) were considered for anesthesia. The
study groups received sevoflurane, and BIS (value 45 +/- 5) was used to
maintain anesthesia. In the study group, keeping the BIS monitor screen
open, and the anesthesia needs were set. However, in the control group,
the monitor screen was closed in such a way that the anesthetist could not
see the BIS value. In addition, hemodynamic parameters, awakening
conditions, length of intubation, inotropic requirements, cardiac care
unit (CCU), and hospital stay were recorded. To explicit ADGA, patients
were interviewed 24 h after extubation. Result(s): The sevoflurane
was used at 59.81 +/- 13.87 mL in the control group and 31.47 +/- 7.91 mL
in the study group, with a 47% reduction in requirement. This difference
was statistically significantly low with BIS-monitored anesthesia in the
study group compared to conventional anesthesia in the control group. The
number of cases in which adrenaline was used was 94.87% in the control
group and 53.65% in the study group. On calculating, there was a reduction
of 54.80% in adrenaline requirement with BIS-monitored anesthesia compared
to conventional anesthesia, and this difference was statistically
significant. In control and study groups, the lengths of endotracheal
intubation were 3.50 +/- 4.72 and 2.17 +/- 1.36 h, respectively. The
intubation time was reduced by 40% with BIS, which was statistically
significantly lower for the BIS groups (P < 0.05). Conclusion(s): BIS
monitoring reduces the anesthetic drug sevoflurane requirement by 47% in
patients undergoing OP-CABG surgeries without ADGA on a BIS level of 45
+/- 5. There was a reduction of 54.80% in adrenaline requirement and 40%
in intubation time with the BIS monitoring, which culminated in ultra-fast
track extubation in high-risk patients undergoing beating heart OP-CABG
surgeries. Copyright © 2025 Journal of Medical Society.

<73>
Accession Number
2039714281
Title
Robustness of Randomized Controlled Trials Evaluating Acute Normovolemic
Hemodilution as a Blood Conservation Strategy in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Bugo S.; Bottussi A.; D'Andria Ursoleo J.; Mongardini E.; Carravetta M.;
Agosta V.T.; Piazza E.; Erdoes G.; Monaco F.
Institution
(Bugo, Bottussi, D'Andria Ursoleo, Mongardini, Carravetta, Agosta, Piazza,
Monaco) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Erdoes) Department of Anesthesiology and Pain Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the robustness of randomized controlled trials
(RCTs) investigating acute normovolemic hemodilution (ANH), a blood
conservation strategy designed to reduce transfusion requirements, in
cardiac surgery using the Fragility Index (FI). Although recommended in
clinical guidelines, high-quality evidence supporting ANH remains limited.
 Design(s): A systematic review of RCTs. Setting(s): A search of
PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, and
EMBASE databases was conducted from their inception. Participant(s):
Adult patients undergoing cardiac surgery. Intervention(s): RCTs
comparing ANH with standard care (without ANH) as a blood conservation
strategy in adult patients undergoing cardiac surgery. The statistical
robustness of RCTs was assessed using the FI, reverse FI, and Continuous
FI (CFI), with higher values indicating stronger evidence.
 Measurements and Main Results: Twenty-eight RCTs were identified. The
median sample size was 75.8 patients. On-pump coronary artery bypass
grafting was the most common procedure (39.3%). The median FI for
perioperative transfusion rates was higher in nonsignificant studies (p >=
0.05) than in significant ones (p < 0.05), suggesting weaker evidence for
reducing transfusions in nonsignificant trials. Conversely, the median CFI
for the number of red blood cell units transfused was higher in
significant studies, supporting ANH's effectiveness in reducing
transfusion requirements. Conclusion(s): RCTs reporting significant
reductions in red blood cell transfusions with ANH exhibited greater
statistical robustness, as indicated by higher FI and CFI values, compared
with nonsignificant studies. The fragility of perioperative transfusion
outcomes highlights the need for larger, methodologically rigorous RCTs to
validate ANH's efficacy in cardiac surgery. Copyright © 2025
Elsevier Inc.

<74>
Accession Number
2039714369
Title
Acute Normovolemic Hemodilution Versus Norepinephrine Infusion During
Autologous Blood Donation in Coronary Artery Bypass Graft Surgery: A
Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Ozgodek H.B.; Aydin M.E.; Oksuz D.A.; Karapinar Y.E.; Ahiskalioglu E.O.;
Celik E.C.; Yayik A.M.; Ahiskalioglu A.
Institution
(Ozgodek) Department of Anesthesiology and Reanimation, University of
Health Sciences, Erzurum, Turkey
(Aydin, Karapinar, Ahiskalioglu, Celik, Yayik, Ahiskalioglu) Department of
Anesthesiology and Reanimation, Ataturk University School of Medicine,
Erzurum, Turkey
(Oksuz) Clinic for Anesthesiology, Intensive Care, Emergency Medicine,
Pain Therapy and Palliative Medicine, Marienhaus Klinikum Hetzelstift,
Neustadt an der Weinstrasse, Germany
Publisher
W.B. Saunders
Abstract
Objective: This study was designed to compare the hemodynamic effects of
acute normovolemic hemodilution (ANH) and norepinephrine infusion during
autologous blood donation, with a particular focus on cardiac cycle
efficiency (CCE), an energy-based parameter of cardiovascular performance.
 Design(s): A prospective, randomized clinical trial. Setting(s):
Single-center, academic hospital. Participant(s): Forty patients
undergoing coronary artery bypass graft surgery. Intervention(s): In
the ANH group, a crystalloid solution was administered simultaneously to
the contralateral upper extremity. The volume of replacement fluid was
calculated at a 3:1 ratio relative to the volume of blood withdrawn. In
the norepinephrine infusion (NA) group, no fluid was administered during
the donation process. Instead, norepinephrine infusion was administered at
a rate of 0.05 microg/kg/min. Measurements and Main Results:
Hemodynamic parameters were monitored at three time points during the
blood donation process. The primary outcome was the comparison of CCE
changes between groups. Secondary outcomes included other advanced
hemodynamic variables, metabolic indicators, and short-term postoperative
clinical results. Changes in CCE during autologous blood donation were
comparable between groups (ANH: 0.20 +/- 0.51, NA: 0.5 +/- 0.57, p =
0.373). Hemodynamic stability was achieved in both groups, with no
relevant differences in cardiac index, stroke volume index, or metabolic
markers (p > 0.05). Dynamic preload parameters showed expected
physiological patterns in the norepinephrine group, consistent with
volume-sparing circulatory support. None of the patients experienced acute
kidney injury. There was no difference between the groups in terms of
intensive care unit or hospital length of stay. Conclusion(s):
Norepinephrine infusion demonstrated hemodynamic equivalence to ANH in the
setting of autologous blood donation during coronary artery bypass graft
surgery. Its ability to preserve circulatory function without fluid
administration suggests it may serve as a viable alternative to ANH,
particularly in patients requiring careful volume
management. Copyright © 2025 Elsevier Inc.

<75>
Accession Number
647950016
Title
Association between sarcopenia and postoperative delirium in elderly
surgical patients: a systematic review and meta-analysis.
Source
BMC geriatrics. 25(1) (pp 520), 2025. Date of Publication: 12 Jul 2025.
Author
Feng Y.; Sun R.; Zhang Y.; Ma L.; Huang Y.; Yu K.
Institution
(Feng, Ma, Huang) Department of Anesthesiology, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
(Feng, Ma, Huang) Joint Laboratory of Anesthesia and Pain, Chinese Academy
of Medical Sciences and Peking Union Medical College, Beijing, China
(Sun, Yu) Department of Clinical Nutrition, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
(Sun) Eight-year Program of Clinical Medicine, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing, China
(Zhang) Institute of Clinical Medicine, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
Abstract
BACKGROUND: Sarcopenia, characterized by the progressive loss of muscle
mass and strength, is common in the elderly and significantly increases
the risk of poor postoperative outcomes. This study aims to examine the
impact of sarcopenia on postoperative delirium and a range of
perioperative outcomes in elderly patients. METHOD(S): A systematic
search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL.
Studies investigating the association between sarcopenia and postoperative
complications in elderly surgical patients were included. The Quality in
Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment.
The primary outcome was the incidence of postoperative delirium. Secondary
outcomes included other postoperative complications and further recovery.
Subgroup analyses were conducted based on surgery types. RESULT(S): A
total of 10,981 records were identified, with 265 studies included in the
systematic review and 242 in the final meta-analysis. A significant
association was found between sarcopenia and postoperative delirium in
both univariable and multivariable analyses (univariable: OR 1.81, 95%
confidence interval [CI] 1.31 to 2.50, P < 0.001, I2 24.0%; multivariable:
OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I2 0.0%). Sarcopenia was also
associated with adverse postoperative outcomes, including increased
complications, mortality, delayed recovery, and reduced overall survival.
However, no significant associations were observed for postoperative
pancreatic fistula or recurrence. Syntheses of multivariable analyses
showed significant differences in postoperative complications, mortality,
overall survival, and recurrence. Subgroup analyses indicated a higher
risk of reduced overall survival among sarcopenic patients undergoing head
and neck or heart and chest surgeries. CONCLUSION(S): Sarcopenia is a
strong independent predictor of postoperative delirium and poor
postoperative outcomes in elderly surgical patients. SYSTEMATIC REVIEW
REGISTRATION: PROSPERO registration number CRD42023424696 (18 May
2023). Copyright © 2025. The Author(s).

<76>
Accession Number
2039712054
Title
Evaluating the Role of Heme in Reducing Discomfort during Radial Artery
Verapamil Administration.
Source
Pakistan Journal of Medical and Health Sciences. 17(12) (pp 428-430),
2023. Date of Publication: 01 Dec 2023.
Author
Khan I.; Saleem M.; Shaikh J.K.; Hashim M.
Institution
(Khan) Qazi Hussain Ahmed Medical Complex, Nowshera Medical College,
Nowshera, Pakistan
(Saleem) Department of Cardiology, Sahiwal Institute of Cardiology,
Sahiwal, Pakistan
(Shaikh) Sindh Institute of Cardiovascular Disease, Sukkur, Pakistan
(Hashim) Dow Institute of Cardiology, DUHS, Karachi, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Background: Radial access is increasingly being adopted for coronary
angiography and percutaneous procedures because it is safe and enables
faster recovery. Splanchnic vascular resistors are frequently administered
to prevent spasm in the radial never receiving artery; however,
intra-arterial injection of splanchnic vascular resistors often induces
regionally focused discomfort and pain. Despite clinical interventions not
adequately relieving pain, this remains an important issue in cardiology
centers with high patient volumes. To determine whether inclusion of heme
in the verapamil injection can alleviate pain and other complications
associated with peripheral and transcutaneous catheterization, as well as
mitigate discomfort levels Methods: This comparative study was carried out
between May 2023 to July 2023 at Qazi Hussain Ahmed Medical Complex/
Nowshera Medical College, Nowshera. Seventy-eight patients undergoing a
cardiac procedure with radial access vertebral artery were included and
divided into two random groups: one receiving verapamil alone and the
other receiving verapamil plus heme. A pain evaluation was conducted using
a numeric pain rating scale immediately after injection. Other outcomes
analyzed were the rate of radial artery spasm, need for rescue analgesia,
and local complications. Data analysis was done on SPSS version 26 and a
p-value of less than 0.05 was considered significant. Result(s): The
group receiving heme with verapamil reported significantly lower pain
scores (mean 2.1 +/- 1.4 vs. 4.6 +/- 1.8, p < 0.001), fewer instances of
moderate-to-severe discomfort (15.4% vs. 46.2%, p = 0.003), and less need
for rescue analgesia (7.7% vs. 25.6%, p = 0.034). Radial artery spasm
occurred in only 5.1% of patients in the heme group compared to 23.1% in
the control group (p = 0.022). No significant differences were observed in
rates of hematoma or vasovagal symptoms. Conclusion(s): Adding heme
to verapamil injections during radial artery access significantly improves
patient comfort and reduces procedural complications without increasing
adverse effects. This simple adjustment may enhance the overall experience
and outcomes of patients undergoing coronary procedures. Copyright
© 2023 Lahore Medical And Dental College. All rights reserved.

<77>
Accession Number
2034427448
Title
Perioperative interdisciplinary optimisation of patients with heart
failure undergoing non-cardiac surgery with intermediate or high surgical
risk: the rationale and study protocol for the multicentre, randomised
interventional PeriOP-CARE HF trial.
Source
Clinical Research in Cardiology. 114(5) (pp 523-531), 2025. Date of
Publication: 01 May 2025.
Author
Zitzmann A.; Willis F.; Welsch T.; Ukena C.; Stork S.; Sasko B.; Riese T.;
Oner A.; Neumann J.T.; Mardian S.; Lehmacher J.; Loser B.L.; Landmesser
U.; Kouz K.; Hecker A.; Hackert T.; Grundmann C.D.; Greiner A.; Germer
C.-T.; Flemming S.; Buchmann N.; Beyer K.; Aldarwish S.; Asgarpur G.;
Rucker V.; Widmann J.; Reese J.P.; Nuernberger C.; Heuschmann P.U.;
Treskatsch S.; Saugel B.; Reuter D.; Meybohm P.; Guder G.; Frey U.; Sander
M.; Assmus B.; Schneck E.; Markmann M.; Koch C.; Reichert M.; Kenz M.;
Herrmann E.J.; Habicher M.; Schmidt G.F.
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aim: Chronic heart failure (HF) is a frequent comorbidity in elderly
patients undergoing major non-cardiac surgery with increasing prevalence.
This trial aims to evaluate a new interdisciplinary, multimodal and
individually optimised treatment strategy in patients with established or
at risk for HF throughout the entire perioperative period. Method(s):
The PeriOP-CARE HF trial is a prospective, multicentre, randomised,
controlled and interventional trial. The primary hypothesis is that an
interdisciplinary, intersectoral and standardised approach to the
preoperative evaluation, optimisation and perioperative management of
patients aged >= 65 years undergoing non-cardiac surgery with intermediate
or high surgical risk and preoperative N-terminal pro-brain natriuretic
peptide levels >= 450 pg/mL, will reduce postoperative morbidity. The
preoperative evaluation includes clinical evaluations by
anaesthesiologists and cardiologists, electrocardiography and
echocardiography, as well as a discussion of these findings by a
perioperative management team, where all involved specialities, including
the speciality surgeon, will decide the perioperative treatment strategy
for each patient. Intraoperative strategies include individualised
haemodynamic optimisation. The interdisciplinary team and specialised HF
nurses will screen patients for HF-related postoperative complications.
The primary end point will be a composite morbidity end point, comprising
any rehospitalisation, acute kidney injury, suspected or proven bacterial
infection requiring treatment and acute decompensated HF at postoperative
day 90. Conclusion(s): The new treatment form can potentially reduce
the morbidity burden after major non-cardiac surgery in patients with
known or unknown HF. If the PeriOP-CARE HF trial yields positive results,
the treatment of patients with HF undergoing major non-cardiac surgery
could be considerably improved. Trial Registration: clinicaltrials.gov:
NCT06381427, registered April 24, 2024. Copyright © The Author(s)
2025.

<78>
Accession Number
2039725919
Title
Cardiopulmonary Bypass-Supported Coronary Artery Bypass Surgery: A
Flexible and Effective Alternative to Off-Pump Surgery.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2025. Date of
Publication: 2025.
Author
Guven H.; Cetintas D.
Institution
(Guven) Department of Cardiovascular Surgery, Bursa Medical Park Hospital,
Bursa, Turkey
(Cetintas) Department of Cardiovascular Surgery, TC Sagllk Bakanllgl Bursa
Sehir Hastanesi, Nilufer, Turkey
Publisher
Georg Thieme Verlag
Abstract
Objective This study aimed to compare the early postoperative outcomes of
cardiopulmonary bypass-supported beating-heart coronary artery bypass
grafting (CPB-BH CABG) and off-pump coronary artery bypass (OPCAB)
surgery. Methods A total of 589 patients who underwent beating-heart CABG
between October 2021 and January 2025 were retrospectively analyzed.
Patients were categorized into two groups based on CPB usage: CPB-BH CABG
(n = 177) and OPCAB (n = 412). Primary outcomes included mortality and
major complications, while secondary outcomes encompassed complete
revascularization rates, number of distal anastomoses, hospital stay, and
transfusion requirements. Results No significant differences were observed
between the groups regarding preoperative characteristics. The CPB-BH
group had longer operative times (268.7 vs. 223.6 minutes, p < 0.001) and
prolonged hospital stays (7 vs. 5 days, p < 0.001). The rates of complete
revascularization and the number of bypass grafts were slightly higher in
the CPB-BH group, but did not reach statistical significance. The CPB-BH
group required more blood transfusions (p < 0.001) and had a higher
incidence of new-onset atrial fibrillation (33.9% vs. 24.0%, p = 0.016).
No significant differences were found for other major complications.
Conclusion CPB-BH CABG is a viable alternative to OPCAB, offering
comparable revascularization outcomes while allowing the flexibility of
cardiopulmonary bypass support when needed. Surgeons should not hesitate
to utilize CPB when necessary to optimize surgical outcomes. Future
prospective, randomized controlled trials are warranted to assess the
long-term outcomes of both surgical techniques and their effectiveness in
specific patient subgroups. Copyright © 2025. Thieme. All rights
reserved.

<79>
[Use Link to view the full text]
Accession Number
2039637760
Title
Gabapentin for pain management following major surgery: a placebo
controlled, double blind, randomized clinical trial (The GAP Study).
Source
Anesthesiology. (no pagination), 2025. Article Number:
10.1097/ALN.0000000000005655. Date of Publication: 2025.
Author
Baos S.; Lui M.; Walker-Smith T.; Pufulete M.; Messenger D.; Abbadi R.;
Batchelor T.; Casali G.; Edwards M.; Goddard N.; Hilal M.A.; Alzetani A.;
Vaida M.; Martinovsky P.; Saravanan P.; Cook T.; Malhotra R.; Simpson A.;
Little R.; Wordsworth S.; Stokes E.; Eu J.J.; Reeves B.; Culliford L.;
Collett L.; Maishman R.; Chauhan N.; McCullagh L.; McKeon H.; Abbs S.;
Lamb J.; Gilbert A.; Hughes C.; Wynick D.; Angelini G.; Grocott M.;
Gibbison B.; Rogers C.A.
Institution
(Baos, Lui, Walker-Smith, Pufulete, Reeves, Culliford, Collett, Maishman,
McKeon, Abbs, Lamb, Gilbert, Hughes, Wynick, Angelini, Gibbison, Rogers)
University of Bristol, United Kingdom
(Messenger, Abbadi, Batchelor, Casali, Simpson, Chauhan, McCullagh,
Wynick) University Hospitals Bristol and Weston NHS Foundation Trust,
United Kingdom
(Edwards, Grocott) University of Southampton, United Kingdom
(Goddard, Hilal, Alzetani) University Hospital Southampton NHS Foundation
Trust, United Kingdom
(Vaida) Somerset Hospitals Foundation NHS Trust
(Martinovsky, Saravanan) University Hospitals Blackpool NHS Trust, United
Kingdom
(Cook) Royal United Hospitals, Bath NHS Trust, United Kingdom
(Malhotra, Little) University Hospitals Liverpool NHS Trust, United
Kingdom
(Wordsworth, Stokes, Eu) University of Oxford, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Gabapentin is an anticonvulsant medication with approval for
use in neuropathic pain and epileptic disorders. It is frequently added to
multimodal analgesic regimens during and after surgery to reduce opioid
use while controlling pain effectively. There is little evidence to show
its effectiveness in major surgery. Method(s): In this multicenter,
double blinded, randomized controlled trial, adults undergoing major
cardiac, thoracic or abdominal surgery were randomized to receive either
gabapentin (600mg before surgery, 300mg twice daily for 2 days after
surgery) or placebo. The primary outcome was length of hospital stay.
Secondary outcomes included acute and chronic pain, total opioid use,
adverse health events and health related quality of life. Patients were
followed up daily in-hospital until discharge and then at 4-weeks and 4
months after surgery. Result(s): 1196 participants were randomized
(500 underwent cardiac, 346 thoracic and 350 abdominal surgery); 596 were
allocated to placebo and 600 were allocated to gabapentin. Median length
of hospital stay was similar in the two groups (gabapentin 5.94 (IQR
4.08-8.04) days, placebo 6.15 (IQR 4.22 - 8.97) days; hazard ratio 1.07,
95%CI 0.95-1.20, p=0.26). Overall, 384 participants experienced one or
more serious adverse events (gabapentin 189/596, 31.7%; placebo 195/599,
32.6%), with some variation across surgical specialties.
 Conclusion(s): Among patients undergoing major cardiac, thoracic and
abdominal surgery, adding gabapentin to multimodal analgesic regimes did
not alter the length of hospital stay, or the number of serious adverse
events. Copyright © 2025 The Author(s). Published by Wolters
Kluwer Health, Inc., on behalf of the American Society of
Anesthesiologists.

<80>
[Use Link to view the full text]
Accession Number
2039653795
Title
Comparison of the Incidence of Arterial Pressure Line Insufficiency
Between Polyethylene and Polyurethane Catheters in the ICU: A Randomized
Study.
Source
Critical Care Medicine. (no pagination), 2025. Article Number:
10.1097/CCM.0000000000006794. Date of Publication: 2025.
Author
Minami K.; Kazawa M.; Shimatani T.; Morinaga M.; Shimokawa A.; Maeda T.;
Takeuchi M.
Institution
(Minami, Kazawa, Shimatani, Takeuchi) Department of Critical Care
Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
(Morinaga, Shimokawa, Maeda) Department of Anesthesiology, National
Cerebral and Cardiovascular Center, Osaka, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: Continuous arterial pressure monitoring is crucial for
critically ill patients. However, the impact of catheter type on arterial
line insufficiency remains unexamined. DESIGN: Double-blinded,
superiority, randomized controlled trial. SETTING: A cardiovascular center
in Japan. PATIENTS: Adult patients scheduled for elective cardiovascular
surgery and postoperative admission to the ICU. INTERVENTIONS: Patients
were randomly assigned either polyethylene or polyurethane catheters.
MEASUREMENTS AND MAIN RESULTS: The outcome of interest was arterial line
insufficiency, defined by one or more of the following four criteria:
flattened or overdamped blood pressure waveform, sluggish free backflow of
blood (> 2 s) when the stopcock was opened to the atmosphere, inability to
draw blood from the arterial line, and inability to flush the catheter.
The frequency of arterial line insufficiency was observed at the first
noon after ICU admission. An interim analysis using the chi-square test
was performed after half of the participants were enrolled, with early
termination if p value of less than 0.005 based on the O'Brien-Fleming
method. Interim analysis of 132 patients revealed significant differences
in primary outcomes, leading to early termination of the trial. Arterial
line insufficiency occurred in four of 69 patients (5.8%) with
polyethylene catheters and 18 of 63 patients (28.6%) with polyurethane
catheters (relative risk, 0.15; 95% CI, 0.05-0.48; p = 0.001).
 CONCLUSION(S): This study demonstrated a lower occurrence rate of
arterial line insufficiency with polyethylene arterial catheters than
polyurethane catheters. Copyright © 2025 by the Society of
Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights
Reserved.

<81>
Accession Number
647937937
Title
The protective effect of pulmonary artery infusion with HTK solution on
the lungs during prolonged cardiopulmonary bypass surgery.
Source
Perfusion. (pp 2676591251351211), 2025. Date of Publication: 11 Jul 2025.
Author
Fei J.; Zhao L.; Wu J.; Yang W.
Institution
(Fei, Zhao, Wu, Yang) Department of Cardiovascular Surgery, Ningbo City,
Ningbo No. 2 Hospital, China
Abstract
BackgroundStudies have proved that artery infusion during CPB operations
can reduce lung injury led by CPB surgery. This study was undertaken to
investigate the effects of HTK solution infusion on pulmonary injury
during prolonged CPB.MethodsBased on the complexity of the surgery, 18 of
55 patients were divided into Group A, whose CPB time would be less than
180 min, The patients whose CPB time was estimiated more than 180 min were
randomly divided in Group H and Group C, patients in Group H recieved
pulmonary artery infusion with 4degreeC HTK solution during aortic
cross-clamping while Group C underwent traditional procedures. Lung
function was assessed by comparing postoperative recovery conditions,
respiratory function, inflammatory response and pathological examination.
Blood samples were collected from all patients at the following time
points: before the start of CPB (T0), 1 hour after aortic declamping (T1),
2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5). The levels
of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) were
measured in these samples.ResultsExtubation time, ICU and the
postoperative hospital stay were shorter in the Group A and Group H (p <
.05). There was a significant increase of TNF-alpha from T2 to T4 in Group
C (p < .05). The level of IL-6 in Group C increased significantly from T1
to T5 (p < .05). Compared to Group H, the mean value of TNF-alpha
increased from T1 to T4 while IL-6 increased from T4 to T5 in Group C (p <
.05) Inflammatory response was more severe when the CPB time exceeds 180
minutes, so did the clinic outcomes.ConclusionsPulmonary artery infusion
with HTK solution is a safe procedure in cardiac surgery with long term
CPB time. It can be used to alleviate lung injury in cardiac surgery
especially when the CPB time exceeds 180 minutes.

<82>
Accession Number
2039714521
Title
Transcatheter edge-to-edge repair in patients with mitral annular
calcification: A systematic review and meta-analysis.
Source
American Journal of the Medical Sciences. (no pagination), 2025. Date of
Publication: 2025.
Author
Idowu A.; Adebolu O.; Siraj B.; Wattanachayakul P.; Balogun O.; Lo K.B.;
Witzke C.; Akintoye E.; Bozorgnia B.; Pressman G.
Institution
(Idowu, Wattanachayakul) Department of Internal Medicine,
Jefferson-Einstein Hospital, Philadelphia, PA, United States
(Adebolu, Siraj) Division of Hospital Medicine, Jefferson-Einstein
Hospital, Philadelphia, PA, United States
(Balogun) Division of Hospital Medicine, Lankenau Medical Centre, PA,
United States
(Lo) Division of Cardiovascular Medicine, Brigham and Women's Hospital
Heart and Vascular Center, Boston, MA, United States
(Witzke, Bozorgnia, Pressman) Department of Cardiology, Jefferson-Einstein
Hospital, Philadelphia, PA, United States
(Akintoye) Cardiovascular Medicine, Department of Internal Medicine, Yale
University School of Medicine, New Haven, CT, United States
Publisher
Elsevier B.V.
Abstract
Background: Mitral annular calcification (MAC) is common in patients with
functional mitral regurgitation undergoing transcatheter edge-to-edge
mitral valve repair (TEER). However, the safety and effectiveness of TEER
systems in patients with MAC is poorly understood. Method(s): We
systematically reviewed multiple online databases to identify studies that
reported outcomes in patients undergoing TEER with underlying
moderate/severe MAC versus those with no/mild MAC. Random-effect model
meta-analysis at a 95 % confidence interval was done via Cochrane Review
Manager 5.4. Result(s): A total of 6 studies with a pooled 2808
patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were
included. Compared to those with no/mild MAC, patients undergoing TEER
with moderate/severe MAC have an insignificant trend towards a lower
immediate procedural success (OR: 0.62, 95 % CI: 0.37 - 1.04, p = 0.07).
After one year of TEER, the two groups had similar rates of repeat mitral
valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 - 3.05, p = 0.09),
sustained clinical improvement (NYHA <= 2) (OR: 0.86, 95 %CI: 0.64 - 1.15,
p = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36,
p = 0.48). All-cause mortality was, however, higher in the moderate/severe
MAC patients (OR: 1.82, 95 %CI: 1.15 - 2.86, p = 0.01).
 Conclusion(s): TEER appears safe and effective in carefully selected
patients with significant MAC. A standardized selection algorithm is
needed to identify MAC patients that would benefit most from
TEER. Copyright © 2025

<83>
Accession Number
647939303
Title
Preemptive left stellate ganglion block reduces the incidence and severity
of cardiac surgery-associated acute kidney injury: a randomized clinical
trial.
Source
International journal of surgery (London, England). (no pagination),
2025. Date of Publication: 11 Jul 2025.
Author
Zhou W.; Yu Y.; Tian S.; Wu H.; Yin J.; Chen C.; Feng S.; Zhang K.; Ma R.;
Xing Z.; Zhang J.; Zhang Z.
Institution
(Zhou, Tian, Zhang, Ma, Xing, Zhang, Zhang) Department of Anesthesiology,
Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou,
Jiangsu, China
(Yu) Department of Anesthesiology, Southeast University Affiliated Xuzhou
Central Hospital, Southeast University, Xuzhou, Jiangsu, China
(Wu, Yin, Chen, Feng) School of Medicine, Yangzhou University, Yangzhou,
Jiangsu, China
Abstract
BACKGROUND: Acute kidney injury is a common and severe complication of
cardiac surgery. A connection might exist between renal sympathetic nerves
and left stellate ganglion. It remains unclear whether preemptive left
stellate ganglion block (SGB) can effectively prevent cardiac
surgery-associated acute kidney injury (CSA-AKI) in clinical practice.
 METHOD(S): Participants were randomly assigned to SGB group with
0.375% ropivacaine 5 ml performed post-general anesthesia induction or
control group (no SGB). The primary outcomes were incidence and severity
of CSA-AKI within 7 days postoperatively. Secondary outcomes were
intraoperative resistive index (RI) and pulsatility index (PI) of left
renal artery via TEE and perioperative IL-6, CRP, and norepinephrine. RR
and 95% CI were calculated to compare outcomes between groups. Sensitivity
analyses were performed to confirm robustness of findings. RESULT(S):
Totally 138 participants were randomized for intention-to-treat (ITT)
analysis (69 SGB, 69 control) and 119 for per-protocol (PP) analysis (59
SGB, 60 control). In the ITT analysis, the incidence of CSA-AKI was
significantly lower in the SGB group than the control group (14.5% [10/69]
vs. 40.6% [28/69], RR 0.351, 95% CI: 0.169-0.728, P = 0.005). The PP
analyses (13.6% [8/59] vs. 41.7% [25/60], RR 0.325, 95% CI: 0.160-0.660, P
= 0.001) demonstrated similar results. The severity of CSA-AKI was
significantly lower in the SGB group than the control group (ITT and PP: P
< 0.001). The RI and PI were significantly lower in the SGB group than the
control group at post-CPB cessation (P < 0.001 and P = 0.005,
respectively). Postoperatively, the SGB group demonstrated significant
reductions in IL-6, CRP, and norepinephrine (all P < 0.05). The
sensitivity analysis confirmed the robustness of the observed effects,
yielding an unadjusted benefit ratio of 0.244 (95% CI: 0.096-0.620, P =
0.003) for the incidence of CSA-AKI and 0.197 (95% CI: 0.082-0.468, P <
0.001) for its severity. CONCLUSION(S): Preemptive left SGB
effectively reduces the incidence and severity of CSA-AKI in patients
undergoing cardiac surgery under CPB. Copyright © 2025 The
Author(s). Published by Wolters Kluwer Health, Inc.

<84>
Accession Number
2039686543
Title
Periprocedural intermittent contralateral arm ischaemia facilitates radial
artery puncture and prevents radial artery spasm.
Source
Cardiovascular Journal of Africa. 36(1) (pp 28-30), 2025. Date of
Publication: 01 Jan 2025.
Author
Korkmaz A.; Ozkan C.; Elalmis O.U.; Guray U.
Institution
(Korkmaz, Elalmis, Guray) Department of Cardiology, Ankara City Hospital,
Ankara, Turkey
(Ozkan) Department of Cardiology, Bursa City Hospital, Bursa, Turkey
Publisher
Clinics Cardive Publishing (PTY)Ltd
Abstract
Background: Transradial access (TRA) is a common technique used for
diagnostic and interventional cardiac procedures. However, there are some
challenges and risks of complications. This study aimed to evaluate the
impact of periprocedural intermittent ischaemia of the contralateral arm
on TRA and radial artery spasm. Method(s): We enrolled 80 patients
with an indication for coronary angiography between December 2017 and June
2018. The patients were randomly grouped into two cohorts: intermittent
contralateral arm ischaemia (n = 40) and control (n = 40) groups.
 Result(s): The radial artery puncture success ratio was higher in the
intermittent contralateral arm ischaemia group than in the control group
(p = 0.025). In multivariable logistic regression analysis, intermittent
contralateral arm ischaemia was significantly associated with radial
artery puncture success (hazard ratio: 8.261, 95% confidence interval:
1.427-47.823, p = 0.018). Conclusion(s): Periprocedural intermittent
contralateral arm ischaemia increased the radial intervention success due
to the remote ischaemic preconditioning, vasodilator factors and autonomic
nervous system role. Copyright © 2025 Clinics Cardive Publishing.
All Rights Reserved.

<85>
Accession Number
2039711760
Title
Impact of early high flow nasal oxygen on diaphragmatic function and
pulmonary complications after thoracic surgery: A randomized clinical
trial.
Source
Journal of Clinical Anesthesia. 106 (no pagination), 2025. Article Number:
111945. Date of Publication: 01 Sep 2025.
Author
Fogagnolo A.; Grasso S.; Dres M.; Azzolina D.; Dalla Corte F.; Dolci G.;
Tamburini N.I.; De Paoli G.; Murgolo F.; Pedarzani E.; Andalo A.; Volta
C.A.; Savino S.
Institution
(Fogagnolo, Volta, Savino) Emergency Department, Section of Anaesthesia
and Intensive Care, Azienda Ospedaliera-Universitaria Sant' Anna, Ferrara,
Italy
(Grasso, Murgolo) Department of Precision-Regenerative Medicine and Jonic
Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine,
University of Bari "Aldo Moro", Bari, Italy
(Dres) Service de Medecine Intensive - Reanimation-SRPR, APHP, Hopital
Pitie-Salpetriere, Sorbonne Universite, Paris, France
(Azzolina, Pedarzani) Department of Environmental and preventive science,
University of Ferrara, Italy
(Azzolina, Pedarzani) Research and Innovation Unit, Biostatistics and
Clinical Trial Area, University Hospital of Ferrara, Ferrara, Italy
(Dalla Corte) Department of Anaesthesia and intensive care medicine, IRCSS
Humanitas research Hospital, Rozzano, Milan, Italy
(Dolci, Tamburini) Department of Thoracic surgery, Azienda
Ospedaliera-Universitaria Sant'Anna, Ferrara, Italy
(De Paoli, Andalo, Volta, Savino) Department of translational medicine,
University of Ferrara. Ferrara, Italy
Publisher
Elsevier Inc.
Abstract
Background: Postoperative pulmonary complications (PPCs) are common after
thoracic surgery, particularly in patients that develop postoperative
diaphragmatic dysfunction. High-flow nasal cannula (HFNC) oxygen therapy
decreases postoperative work of breathing and provides a positive
end-expiratory pressure (PEEP) effect. As a result, it may decrease the
occurrence of diaphragmatic dysfunction and PPCs after thoracic surgery.
 Method(s): Single-centre, open-label, randomized controlled trial.
Patients undergoing video-assisted thoracoscopic lobectomy were randomized
to receive conventional oxygen therapy (COT) or high flow nasal cannula
oxygen therapy. In both groups, inspiratory oxygen fraction was titrated
to reach a peripheral oxygen saturation of >94 %. Diaphragmatic
displacement (DD) and diaphragmatic thickening fraction (TF%) were
measured 2 and 24 h after surgery. Diaphragmatic dysfunction was
identified by DD <10 mm. PPCs occurring within 7 days after study
enrollment were recorded. Result(s): We analyzed 116 patients in the
study. Postoperative diaphragmatic dysfunction occurred in 17/58 patients
(29 %) in the HFNC group compared to 21/58 (36 %) in the COT group (p =
0.55). The rate of PPCs was similar between the two groups: 32/58 (55 %)
in the HFNC group and 37/58 (64 %) in the COT group (p = 0.449). Patients
who developed postoperative diaphragmatic dysfunction experienced fewer
PPCs when treated with HFNC (20/37; 54 %) compared to COT (17/21; 81 %) (p
= 0.037). A post hoc mixed-model analysis confirmed that HFNC reduced the
risk of PPCs in patients with diaphragmatic dysfunction (OR 0.16, 95 % CI
0.02-0.83). Conclusion(s): Early HFNC support does not decrease the
rate of postoperative diaphragmatic dysfunction rate or respiratory
complications. In patients who develop postoperative diaphragmatic
dysfunction, HFNC may play a role in mitigating the risk of PPCs. Clinical
trial registration: NCT05532033 Copyright © 2025 The Authors

<86>
Accession Number
647938070
Title
Left atrial appendage occlusion in patients with atrial fibrillation and
previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: a
systematic review and meta-analysis.
Source
International journal of stroke : official journal of the International
Stroke Society. (pp 17474930251360076), 2025. Date of Publication: 10 Jul
2025.
Author
Mavridis T.; Archontakis Barakakis P.; Chlorogiannis D.-D.; Charidimou A.
Institution
(Mavridis) Department of Neurology, incorporating the National Children's
Hospital (AMNCH), Tallaght University Hospital (TUH)/The Adelaide and
Meath Hospital, Dublin, Ireland
(Archontakis Barakakis) Redington-Fairview General Hospital, Skowhegan,
ME, United States
(Chlorogiannis) Department of Radiology, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Charidimou) Department of Neurology, Boston University Medical Center,
Boston University School of Medicine, MA, United States
Abstract
BACKGROUND: Patients with atrial fibrillation (AF) on oral anticoagulation
(OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral
amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left
atrial appendage occlusion (LAAO) has emerged as a potential alternative
to OAC for stroke prevention in high-bleeding-risk AF patients. Small
observational studies suggest that LAAO may be safe and feasible in
patients with ICrH, when using single or dual antiplatelet therapy or
short-term OAC post-procedure, though data remain limited. This systematic
review and meta-analysis aims to consolidate evidence on the safety and
efficacy of LAAO in patients with prior ICrH or CAA. METHOD(S): We
conducted a systematic review and meta-analysis examining the safety and
efficacy of LAAO in patients with non-valvular AF and prior ICrH and/or
CAA. PubMed/MEDLINE and EMBASE (via Scopus) databases were systematically
searched from inception until 29 February 2024. Eligible studies included
randomized control trials, observational studies, and case series (>=10
participants) reporting stroke events in patients with AF and previous
history of ICrH and/or CAA undergoing LAAO. Pooled incidence rates (IRs)
with corresponding 95% confidence intervals (CIs) were calculated for
primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and
secondary outcomes. RESULT(S): Fourteen studies including 1,235
patients met inclusion criteria. The pooled average follow-up period was
17.1 months. The pooled IRs for ischemic stroke, recurrent ICrH, and major
hemorrhage were 2% (95%CI: 1%-3%, I2=2%), 2% (95%CI: 0.4%-3%, I2=45%) and
3% (95%CI: 1%-5%, I2=54%), respectively. In prespecified subgroup analyses
of studies focusing on patients with intraparenchymal hemorrhage and/or
CAA, pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage
IR of 4% (95%CI: 1%-8%), 4% (95%CI: 0.4%-10%) and 6% (95%CI: 3%-12%),
respectively. CONCLUSION(S): LAAO may be a safe and effective
treatment for selected AF patients with a history of ICrH and/or CAA, but
the quality of evidence is poor. Future randomized controlled trials are
essential to validate LAAO's efficacy and long-term safety.

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