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<1>
Accession Number
2040719235
Title
Statin effect on arrhythmogenic cardiomyopathy disease progression
(SEARCH): Randomized clinical study protocol.
Source
PLOS ONE. 20(9 September) (no pagination), 2025. Article Number: e0332876.
Date of Publication: 01 Sep 2025.
Author
Sommariva E.; Lippi M.; Bruttini F.; Cannata F.; Baggiano A.; Schiavone
M.; Salina G.; Sabatino M.; Vettor G.; Sicuso R.; Pizzamiglio F.; Ribatti
V.; Maragna R.; Carbucicchio C.; DeLuca F.; Catto V.; Iezzi A.; Sale E.O.;
Valeri Y.; Barbarossa A.; Caiazza M.; Monda E.; Frisso G.; Borrelli F.;
Gasperetti A.; Turco A.; De Luca L.; Corino V.D.A.; Galotta A.; Bonomi A.;
Pompilio G.; Pontone G.; Muratori M.; Limongelli G.; Lombardi R.; Casella
M.; Tondo C.
Institution
(Sommariva, Lippi, Bruttini, Cannata, Baggiano, Schiavone, Salina,
Sabatino, Vettor, Sicuso, Pizzamiglio, Ribatti, Maragna, Carbucicchio,
DeLuca, Catto, Iezzi, Sale, Corino, Galotta, Bonomi, Pompilio, Pontone,
Muratori, Tondo) Centro Cardiologico Monzino IRCCS, Milano, Italy
(Lippi) Universita degli Studi di Milano Bicocca, Department of Medicine
and Surgery, Milano, Italy
(Catto, Corino) Politecnico di Milano, Department of Electronics,
Information and Bioengineering, Milano, Italy
(Sale) IEO Istituto Europeo di Oncologia IRCCS, Milano, Italy
(Valeri, Barbarossa, Casella) Azienda Ospedaliera Universitaria delle
Marche, Ancona, Italy
(Valeri, Casella) Department of Clinical Specialties and
Odontostomatology, Universita Politecnica delle Marche, Ancona, Italy
(Caiazza, Monda, Limongelli) Department of Translational Medical Sciences,
Universita Luigi Vanvitelli, Inherited and Rare Cardiovascular Diseases,
Azienda Ospedaliera dei Colli, Monaldi, Napoli, Italy
(Frisso, Borrelli, Lombardi) Universita degli Studi di Napoli Federico II,
Department of Advanced Biomedical Sciences, Napoli, Italy
(Frisso) CEINGE-Biotecnologie Avanzate Franco Salvatore, Napoli, Italy
(Gasperetti) Department of Medicine, Johns Hopkins University, Baltimore,
MD, United States
(Turco, De Luca) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Pompilio, Pontone, Tondo) Department of Biomedical, Surgical and Dental
Sciences, Universita degli Studi di Milano, Milano, Italy
Publisher
Public Library of Science
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disorder that
predisposes affected individuals, especially young patients, to malignant
arrhythmias, sudden cardiac death, and heart failure. The disease is
characterized by myocardial atrophy and fibro-fatty replacement,
predominantly affecting the right ventricle. Current pharmacological
treatments primarily aim to alleviate symptoms by addressing arrhythmias
and heart failure. These approaches are often complemented by invasive
interventions such as implantable cardioverter defibrillators (ICDs) and
radiofrequency ablations. However, none of these strategies effectively
halts disease progression, highlighting the urgent need for novel
disease-modifying therapies. We recently demonstrated that elevated plasma
levels of oxidized low-density lipoprotein (oxLDL) correlate with more
advanced stages of ACM in patients. Moreover, treatment with atorvastatin,
which reduces oxLDL levels, prevented disease manifestation in a mouse
model of ACM. Based on these findings, we hypothesize that statins may
attenuate disease progression in ACM patients not only through their
lipid-lowering effects, but also via pleiotropic actions such as
antioxidant, anti-inflammatory, and autonomic modulation. To test this
hypothesis, we designed SEARCH (Statin Effect on ARrhythmogenic
CardiomyopatHy), an investigator-initiated, multicenter, prospective,
randomized, double-blind, placebo-controlled clinical trial, aimed at
evaluating the efficacy of atorvastatin in preventing ACM progression
(NCT06922994). A total of 102 patients meeting ACM diagnostic criteria
will be enrolled and randomized in a 1:1 ratio to receive either
atorvastatin 80 mg/die or placebo for 18 months. The primary outcome will
be the change in right ventricular global longitudinal strain, a sensitive
echocardiographic measure of ventricular function, from baseline to 18
months. Secondary outcomes will include changes in arrhythmic burden,
electrocardiography parameters, additional structural and functional
cardiac indices, and circulating biomarkers. Tertiary and exploratory
outcomes include the validation of risk scores for ACM progression and the
identification of variables predicting the best responders to
atorvastatin. Participants will undergo a comprehensive evaluation at
baseline, 9 months, and 18 months, including cardiology visits,
echocardiography, electrocardiography, blood testing, ICD or loop recorder
interrogation, and cardiac magnetic resonance imaging (at enrollment and
at 18 months only). Additional safety assessments and telephone follow-ups
will be conducted throughout the study to monitor treatment adherence and
potential adverse events. The SEARCH trial is expected to generate the
first clinical evidence on the efficacy of atorvastatin in slowing ACM
progression, thereby addressing a major unmet therapeutic need. The
findings will shape the design of future large-scale studies and may pave
the way for a novel, disease-modifying treatment strategy to improve
outcomes and quality of life for patients with ACM. Copyright ©
2025 Sommariva 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.

<2>
Accession Number
2040681674
Title
A Segmental Spinal Anesthesia (SSA) in Thoracic Surgical Procedures: A
Randomized Controlled Trial,@ Department of Anesthesia, RKDF Medical
College and Hospital, Bhopal, (M.P.).
Source
International Journal of Life Sciences Biotechnology and Pharma Research.
14(9) (pp 1277-1282), 2025. Date of Publication: 01 Sep 2025.
Author
Pathak D.; Minj B.; Meena A.
Institution
(Pathak) Department of Anaesthesiology, RKDF Medical College Hospital And
Research Center, Bhopal, India
(Minj) Department of Anaesthesiology, RKDF Medical College Hospital And
Research Center, Bhopal, India
(Meena) Department of Anaesthesiology, RKDF Medical College Hospital And
Research Center, Bhopal, India
Publisher
International Journal of Life Sciences Biotechnology and Pharma Research
Abstract
Introduction: Segmental Spinal Anesthesia (SSA) is an evolving regional
anesthetic technique that selectively anesthetizes relevant spinal
segments, minimizing systemic effects. This study evaluates SSA in
thoracic surgical procedures, comparing its efficacy, hemodynamic
stability, and postoperative outcomes with General Anesthesia (GA). Aims
and Objectives: This randomized controlled trial (RCT) aims to assess the
effectiveness and safety of SSA in thoracic surgical procedures, focusing
on anesthesia quality, perioperative hemodynamic stability, postoperative
recovery, and patient satisfaction. Methodology: A randomized controlled
trial was conducted at RKDF Medical College and Hospital, Bhopal, from
November 1, 2023, to April 30, 2024. A total of 42 patients scheduled for
elective thoracic surgeries were randomly assigned to SSA (Group 1) or GA
(Group 2). Intraoperative hemodynamic parameters, anesthesia duration,
recovery time, and adverse effects were recorded and analyzed. Statistical
analysis was performed using SPSS, with a significance threshold of
p<0.05. Result(s): SSA demonstrated a significant reduction in
intraoperative hemodynamic fluctuations (p<0.05) compared to GA. Patients
in the SSA group experienced faster postoperative recovery and higher
satisfaction scores. SSA was associated with fewer adverse effects such as
nausea and respiratory complications. Conclusion(s): SSA offers an
effective alternative to GA in thoracic surgeries, providing hemodynamic
stability, faster recovery, and fewer postoperative complications.
Larger-scale studies are required to validate these findings and
potentially establish SSA as a standard anesthetic
technique. Copyright ©2025 Int. J. Life Sci. Biotechnol. Pharma.
Res.

<3>
Accession Number
2036123848
Title
Single- versus Multiple-Injection Intertransverse Process Block for VATS:
A Randomized Trial on Dermatomal Sensory Blockade.
Source
Journal of Pain Research. 18 (pp 4791-4800), 2025. Date of Publication:
2025.
Author
Supphapipat K.; Samerchua A.; Leurcharusmee P.; Lapisatepun P.;
Pipanmekaporn T.; Konkarn N.; Prapussarakul K.; Jinadech T.; Wanvoharn M.
Institution
(Supphapipat, Samerchua, Leurcharusmee, Lapisatepun, Pipanmekaporn,
Konkarn, Prapussarakul, Jinadech, Wanvoharn) Department of Anesthesiology,
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Publisher
Dove Medical Press Ltd
Abstract
Purpose: While the intertransverse process (ITP) block can enhance chest
wall analgesia, the optimal injection technique remains unclear. This
study compared the efficacy of single versus multiple injections of the
ITP block, hypothesizing that multiple injections would provide superior
sensory blockade. Patients and Methods: Forty patients undergoing
video-assisted thoracic surgery were randomized to receive single or
multiple ultrasound-guided ITP block injections with 30 mL of 0.25%
bupivacaine and 1% lidocaine with epinephrine (5 mug/mL). The
single-injection group received 30 mL at the T4-5 level, while the
multiple-injection group received 10 mL/injection at the T3-4, T4-5, and
T5-6 levels. The primary outcome was dermatomal sensory changes on the
anterolateral chest wall. Secondary outcomes included block performance
time, complications, and postoperative analgesia. Result(s): The
median (interquartile range [IQR]) dermatomal sensory levels were 2 (2-4)
for single-injection and 3 (1.5-3.5) for multiple-injection (median
difference: 0, 95% confidence interval [CI]: -1 to 1, p = 0.91). The
single-injection group had a shorter median (IQR) block performance time
than the multiple-injection group [7 (5.2-8.4) min versus 9.1 (7.8-11.2)
min; median difference: -1.9 min; 95% CI: -4 to -0.1 min; p = 0.01].
Intraoperative hypotension occurred in 63.2% of the single-injection group
and 65% of the multiple-injection group (p = 0.91). There was no
statistically significant difference in postoperative pain intensity
between groups. Conclusion(s): Single- and multiple-injection ITP
blocks showed no significant difference in sensory changes or analgesic
effect. The shorter performance time of the single-injection technique
suggests it may be a more practical option. However, larger, higher
powered studies are required to confirm equivalence and establish
definitive recommendations. Copyright © 2025 Supphapipat et al.

<4>
Accession Number
2038910630
Title
TAVR vs. SAVR for severe aortic stenosis in the low and intermediate
surgical risk population: An updated meta-analysis, meta-regression, and
trial sequential analysis.
Source
Cardiovascular Revascularization Medicine. 79 (pp 78-89), 2025. Date of
Publication: 01 Oct 2025.
Author
Krishna M.M.; Joseph M.; Ezenna C.; Pereira V.; Rossi R.; Akman Z.; Rubens
M.; Mahadevan V.S.; Nanna M.G.; Goldsweig A.M.
Institution
(Krishna, Joseph) Department of Medicine, Medical College
Thiruvananthapuram, India
(Ezenna) Department of Medicine, University of Massachusetts - Baystate
Medical Center, Springfield, MA, United States
(Pereira) Faculty of Medicine, Universidad Austral, Pilar, Argentina
(Rossi, Akman) Department of Medicine, Yale School of Medicine, New Haven,
CT, United States
(Rubens) Office of Clinical Research, Miami Cancer Institute, Baptist
Health South Florida, Miami, FL, United States
(Rubens) Department of Translational Medicine, Herbert Wertheim College of
Medicine, Florida International University, Miami, FL, United States
(Rubens) Department of Health and Sciences, Universidad Espiritu Santo,
Samborondon, Ecuador
(Mahadevan) Department of Cardiovascular Medicine, University of
Massachusetts Chan School of Medicine, Worcester, MA, United States
(Nanna) Section of Cardiovascular Medicine, Yale School of Medicine, New
Haven, CT, United States
(Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center
and Division of Cardiovascular Medicine, University of
Massachusetts-Baystate, Springfield, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Guidelines recommend transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) for patients of age >
65 years. The relative risks and benefits of TAVR vs. SAVR in low and
intermediate surgical risk remain incompletely described. Method(s):
A systematic search of PubMed, Scopus, and Cochrane Central databases
identified randomized controlled trials (RCTs) comparing clinical outcomes
of TAVR vs. SAVR in low and intermediate surgical risk. Result(s):
Ten RCTs (9239 patients, TAVR 50.8 %) were included. TAVR was associated
with lower rates of all-cause death or stroke at 30-day (rate ratio [RR]
0.70; 95%CI 0.55-0.89; p = 0.003; I2 = 26 %) and 1-year (RR
0.77; 95%CI 0.60-0.98; p = 0.033; I2 = 54 %) follow-up.
Bleeding complications, new-onset atrial fibrillation (AF), acute kidney
injury (AKI), and severe patient-prosthesis mismatch (PPM) were lower with
TAVR at 30 days and 1-year. Permanent pacemaker implantation, aortic valve
reintervention, major vascular complications, and paravalvular leak (PVL)
were significantly higher with TAVR at 30-day and 1-year follow-ups. Rates
of all-cause death, stroke, MI, endocarditis, and rehospitalization were
comparable between the groups at 30-day and 1-year follow-up.
 Conclusion(s): In patients with severe AS and low to intermediate
surgical risk, TAVR is associated with reduced rates of all-cause death or
stroke, bleeding, new-onset AF, AKI, and severe PPM compared to SAVR.
However, despite these short-term benefits, higher rates of permanent
pacemaker implantation, PVL, and reintervention raise significant concerns
about the long-term safety of TAVR, particularly for younger, lower-risk
patients. Copyright © 2025 Elsevier Inc.

<5>
Accession Number
2037145839
Title
Aortic Stenosis and Transcatheter Aortic Valve Replacement: A Real or
Illusory Shift in the Landscape?.
Source
Revista Argentina de Cardiologia. 93(2) (pp 144-147), 2025. Date of
Publication: 2025.
Author
Cagide A.; Falconi M.
Institution
(Cagide, Falconi) Cardiology Department, Hospital Italiano de Buenos
Aires, Autonomous City of Buenos Aires, Argentina
Publisher
Sociedad Argentina de Cardiologia

<6>
Accession Number
2036230317
Title
Optimal mean arterial pressure and its objective statistical associations
with clinical outcomes and multimodal monitoring cerebral physiology: A
systematic scoping review.
Source
Physiological Reports. 13(18) (no pagination), 2025. Article Number:
e70545. Date of Publication: 01 Sep 2025.
Author
Hasan R.; Buchel A.; Stein K.Y.; Bergmann T.; Sainbhi A.S.; Vakitbilir N.;
Herath I.; Silvaggio N.; Hayat M.; Moon J.; Zeiler F.A.
Institution
(Hasan, Stein, Bergmann, Sainbhi, Vakitbilir, Herath, Zeiler) Department
of Biomedical Engineering, Price Faculty of Engineering, University of
Manitoba, Winnipeg, MB, Canada
(Buchel, Stein) Undergraduate Medical Education, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, MB, Canada
(Silvaggio) Department of Human Anatomy and Cell Science, Rady Faculty of
Health Sciences, University of Manitoba, Winnipeg, MB, Canada
(Hayat, Moon, Zeiler) Section of Neurosurgery, Department of Surgery, Rady
Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
(Zeiler) Department of Clinical Neuroscience, Karolinska Institutet,
Stockholm, Sweden
(Zeiler) Pan Am Clinic Foundation, Winnipeg, MB, Canada
Publisher
American Physiological Society
Abstract
Optimal mean arterial pressure (MAPopt), also known as optimal arterial
blood pressure (ABPopt), represents a patient-specific blood pressure
range at which cerebral autoregulation is most intact. To date, literature
on this personalized physiological target remains heterogeneous,
scattered, and difficult to follow. This scoping review, following
PRISMA-ScR guidelines, examined studies that explored objective
statistical associations between MAPopt and clinical outcomes and
multimodal monitoring (MMM) cerebral physiology. Fifteen articles met the
inclusion criteria for studies investigating the relationship between
MAPopt and outcome, including seven neonatal studies, five cardiac
arrest/surgery studies, two general ICU (Intensive Care Unit) studies, and
one neurological ICU study. Fourteen of the fifteen studies found that
maintaining blood pressure above or within MAPopt was linked to improved
neurological outcomes, while pressures below MAPopt correlated with worse
outcomes. In neonates with hypoxic-ischemic encephalopathy, deviations
below MAPopt were associated with more severe brain injury. Similarly,
cardiac arrest patients spending more time below MAPopt-5 mmHg had higher
mortality. Only one study evaluated MAPopt in relation to MMM data,
identifying a nonlinear relationship between brain oxygenation and MAP
deviation. This review underscores the need for further standardized
research on MAPopt, particularly its interaction with MMM, to support its
application in personalized critical care. Copyright © 2025 The
Author(s). Physiological Reports published by Wiley Periodicals LLC on
behalf of The Physiological Society and the American Physiological
Society.

<7>
Accession Number
2038818242
Title
Anxiety during transcatheter aortic valve replacement under local
anesthesia - the ART-VR trial.
Source
Cardiovascular Revascularization Medicine. 79 (pp 71-77), 2025. Date of
Publication: 01 Oct 2025.
Author
Chatterjee S.; Ooms J.; de Ronde M.; van Gorsel S.; Mattace-Raso A.M.;
Goudzwaard J.; Mattace-Raso F.; Kardys I.; Nuis R.-J.; Daemen J.; Van
Mieghem N.
Institution
(Chatterjee, Ooms, de Ronde, van Gorsel, Mattace-Raso, Kardys, Nuis,
Daemen, Van Mieghem) Department of Interventional Cardiology,
Thoraxcenter, Erasmus MC University Medical Center, Rotterdam, Netherlands
(Goudzwaard, Mattace-Raso) Department of Internal Medicine, Section of
Geriatrics, Erasmus MC University Medical Center, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: The use of local anesthesia during transcatheter aortic valve
replacement (TAVR) could result in patient discomfort. Application of
immersive virtual reality (VR) during TAVR might distract the patient and
enhance the overall experience. Objective(s): To evaluate the effect
of an immersive VR environment on periprocedural anxiety and patient
discomfort, compared to standard of care in patients undergoing
transfemoral (TF) TAVR under local anesthesia. Method(s): In this
single-center, randomized controlled pilot study, patients were randomized
to either VR immersion during TAVR or standard of care. The intervention
was a VR headset to create 3D experiences during percutaneous transfemoral
TAVR. The main outcome was patient-reported procedural anxiety assessed
directly after the procedure on a visual analog scale (VAS). Secondary
outcomes were procedural satisfaction, pain, and change in anxiety.
Personality scores were obtained at baseline to explore associations
between personality types and relevant outcomes. Result(s): A total
of 75 patients (VR = 37, control = 38) were included between September
2021 and January 2023. The median age was 79 (25th-75th: 75-84) years and
32 patients (43 %) were female. Overall procedural anxiety VAS was 1.0
(0.0-3.0) and satisfaction was 9.0 (8.0-10.0). There was no difference in
procedural anxiety between VR and control (VAS: 1.0 [25th-75th: 0.0-3.0]
versus 1.0 [25th-75th: 0.0-3.0], p = 0.59). Procedural satisfaction, pain
perception and change in anxiety were not affected by VR use.
 Conclusion(s): Patients undergoing TF-TAVR under local anesthesia
experienced mild procedural anxiety and high satisfaction levels.
Procedural VR use did not affect procedural anxiety or pain
perception. Copyright © 2025 The Authors

<8>
Accession Number
2040764849
Title
A Bayesian meta-analysis of transcatheter versus surgical aortic valve
replacement in patients with small aortic annulus.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Oliveira V.M.R.; Nishikubo M.E.P.; Antunes A.G.O.; Barbosa L.M.; de Sousa
P.A.; Lopes L.; Tartuce L.P.; Rassi D.D.C.; Moreira H.G.
Institution
(Oliveira, Nishikubo, Antunes, Rassi, Moreira) Department of Medicine,
Federal University of Goias, Goiania, Brazil
(Barbosa) Department of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(de Sousa) Department of Medicine, Federal University of Uberlandia,
Uberlandia, Brazil
(Lopes) Johns Hopkins Bloomberg School of Public Health, Baltimore, United
States
(Tartuce) Instituto de Cardiologia e Radiologia Intervencionista de Rio
Verde, Rio Verde, Brazil
(Moreira) Einstein Hospital Israelita, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
Background: Small aortic annulus (SAA) is associated to suboptimal results
after aortic valve replacement. The optimal treatment for aortic disease
in SAA remains unclear. Method(s): We conducted a systematic review
and Bayesian random-effects meta-analysis to compare transcatheter (TAVR)
versus surgical aortic valve replacement (SAVR) in patients with small
aortic annulus. A comprehensive search of PubMed, Scopus, and Cochrane
Library was performed through May 2024. Binary outcomes were synthesized
using a binomial-normal hierarchical model to estimate posterior
distributions of log odds ratios (log OR) and corresponding 95 % credible
intervals (CrIs). Posterior probabilities of treatment effects were
calculated to assess the certainty of benefit or harm. All statistical
analyses were performed using R version 4.5.0. Result(s): Nine
studies comprising 2548 patients (50.9 % TAVR) were included. TAVR was
associated with reduced risk of severe patient-prosthesis mismatch (OR
0.47; 95 % CrI 0.31-0.72; posterior probability of benefit 99.8 %) and
moderate mismatch (OR 0.56; 95 % CrI 0.40-0.79; posterior probability 99.7
%). In contrast, SAVR was associated with lower risk of moderate/severe
aortic regurgitation (OR 4.74; 95 % CrI 2.43-9.27; posterior probability
of harm with TAVR 98.1 %) and permanent pacemaker implantation (OR 2.66;
95 % CrI 1.69-4.20; posterior probability of harm with TAVR 98.5 %). No
meaningful differences were observed for stroke at 30 days (OR 1.51; 95 %
CrI 0.69-3.36) or all-cause mortality at 1 year (OR 0.78; 95 % CrI
0.51-1.17). Conclusion(s): TAVR is superior to SAVR regarding severe
and moderate PPM in SAA patients. SAVR is associated with lower risk of
aortic regurgitation and new pacemaker implant, with no significant
differences in mortality and stroke. Copyright © 2025 Elsevier
Inc.

<9>
Accession Number
2037158691
Title
Minimally Invasive or Conventional Sternotomy for Mitral Valve Surgery
With Concomitant Surgical Ablation for Atrial Fibrillation: A Comparative
Systematic Review.
Source
Reviews in Cardiovascular Medicine. 26(8) (no pagination), 2025. Article
Number: 39706. Date of Publication: 01 Aug 2025.
Author
Kashapov R.; Afanasyev A.; Sharifulin R.; Khrushchev S.; Ruzankin P.;
Demin I.; Bogachev-Prokophiev A.
Institution
(Kashapov, Afanasyev, Sharifulin, Demin, Bogachev-Prokophiev) E. Meshalkin
National Medical Research Center, Institute of Cardiovascular Pathology
Research, Novosibirsk, Russian Federation
(Khrushchev, Ruzankin) Sobolev Institute of Mathematics, Novosibirsk,
Russian Federation
Publisher
IMR Press Limited
Abstract
Background: Presently, the availability of single-stage surgical
correction of mitral valve disease combined with atrial fibrillation (AF)
via a mini-access approach remains limited. Moreover, the comparative
effectiveness of this procedure versus conventional sternotomy (CS)
remains poorly understood. Thus, this study aimed to conduct a comparative
assessment of the efficacy and safety of concomitant mitral valve surgery
and AF ablation via a minimally invasive approach (minimally invasive
cardiac surgery, MICS group) versus the standard sternotomy approach (CS
group). Method(s): An extensive literature search was performed to
identify relevant studies. Additionally, for comparative analysis, we
included isolated studies where the combined intervention was conducted
exclusively via either minimally invasive or CS as the primary access.
 Result(s): Freedom from atrial arrhythmia (AA) for MICS and CS was
94.52% [95% CI 91.52, 96.50] vs. 80.76% [95% CI 67.19, 89.59] and 86.22%
[95% CI 80.13, 90.66] vs. 86.33% [95% CI 79.39, 91.19] at 1 and 2 years,
respectively, with no statistically significant differences. Meanwhile,
cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times were
significantly longer in the MICS group compared to CS (CPB: 151.50 vs.
120.01 min ACC: 112.36 vs. 101.43 min p < 0.001). There were no
differences in mortality between groups (p = 0.709). The rate of pacemaker
implantation was significantly higher in the CS group (MICS: 3.32% [95% CI
1.58, 6.87] vs. CS: 5.20% [95% CI 2.80, 9.46] p < 0.001).
 Conclusion(s): This meta-analysis found that the minimally invasive
approach was associated with longer CPB and ACC times but a lower rate of
pacemaker implantation, with no significant differences observed in
mortality and freedom from AA at 1 and 2 years. The PROSPERO registration:
CRD42024570022,
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024570022. Copyright
© 2025 The Author(s). Published by IMR Press.

<10>
Accession Number
2040608290
Title
Forecasting the fall: the role of machine learning in predicting
intraoperative hypotension, a scoping review.
Source
Minerva Anestesiologica. 91(9) (pp 842-848), 2025. Date of Publication: 01
Sep 2025.
Author
Koh A.; Baby D.; Martis W.; Capurro D.
Institution
(Koh, Baby, Capurro) The Royal Melbourne Hospital, Melbourne, Australia
(Martis) Department of Critical Care, The University of Melbourne,
Melbourne, Australia
(Martis) Anesthesia and Pain Department, Peter MacCallum Cancer Center,
Melbourne, Australia
(Martis) Anesthesia and Pain Department, Monash Health, Melbourne,
Australia
(Capurro) Center for Digital Transformation of Health, The University of
Melbourne, Melbourne, Australia
(Capurro) School of Computing and Information Systems, The University of
Melbourne, Melbourne, Australia
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Intraoperative hypotension is associated with increased risk
of postoperative mortality, myocardial injury, acute kidney injury and
stroke. Early identification with machine learning models allows
pre-emptive management to reduce incidence and duration of intraoperative
hypotension. This study aims to assess the accuracy of machine learning
models in predicting intraoperative hypotension and its impact on clinical
outcomes. EVIDENCE ACQUISITION: This scoping review looked at databases
Medline, Embase, PubMed and Cochrane from inception to 25 June 2024.
Inclusion criteria were use of machine learning algorithms predicting
intraoperative hypotension in adult surgical patients (>=18 years of age).
Data extracted were the type and accuracy of machine learning models used,
type of surgery, incidence and duration of hypotension, and patient
relevant outcomes including length of stay, end organ dysfunction and
mortality. EVIDENCE SYNTHESIS: Twenty-six studies were included (N.=48,707
patients). About 92.3% of studies were done in non-cardiac surgeries;
65.4% of studies used a proprietary machine learning algorithm known as
the Hypotension Prediction Index (HPI), followed by neural networks
(19.2%) and logistic regression (19.2%). HPI was the most accurate in
predicting intraoperative hypotension up to 15 minutes prior to the event
with the median area under the receiving operator characteristic curve of
0.912 (0.896-0.930). Machine learning resulted in a statistically
significant difference in dose and incidence of vasopressor use in three
studies and a significant increase in volume of fluids in two studies. Two
studies showed a significant reduction in length of stay, postoperative
complications and quantity of blood transfusion products.
 CONCLUSION(S): Despite the ability of machine learning algorithms to
predict intraoperative hypotension to a high degree of accuracy, practical
implications are not yet fully elucidated. Studies on machine learning
predicting intraoperative hypotension are in their early stages with a
larger emphasis on algorithm accuracy rather than clinical
outcomes. Copyright © 2025 EDIZIONI MINERVA MEDICA.

<11>
Accession Number
2036369149
Title
Rapid Update and Revision of: Thromboelastography or Rotational
Thromboelastometry Guided Algorithms in Bleeding Patients-An Updated
Systematic Review With Meta-Analysis and Trial Sequential Analysis.
Source
Acta Anaesthesiologica Scandinavica. 69(10) (no pagination), 2025. Article
Number: e70127. Date of Publication: 01 Nov 2025.
Author
Kvisselgaard A.D.; Wolthers S.A.; Wikkelso A.; Holst L.B.; Drivenes B.;
Afshari A.
Institution
(Kvisselgaard) Department of Anesthesia and Intensive Care, Copenhagen
University Hospital - Herlev-Gentofte, Copenhagen, Denmark
(Kvisselgaard) Danish Anaesthesia Allergy Centre, Allergy Clinic 1,
Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark
(Wolthers) Prehospital Centre Zealand, Naestved, Denmark
(Wikkelso) Department of Anesthesia and Intensive Care Medicine, Zealand
University Hospital, Roskilde, Denmark
(Holst, Afshari) Department of Anesthesia, Juliane Marie Center,
Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
(Drivenes) Department of Intensive Care, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Afshari) Institute of Clinical Medicine, University of Copenhagen,
Copenhagen, Denmark
Publisher
John Wiley and Sons Inc
Abstract
Background: Bleeding patients face significant morbidity and mortality due
to impaired hemostasis. Hemostatic resuscitation has evolved, yet the
optimal approach remains unclear. The primary objective was to assess the
benefits and risks of transfusion guided by TEG/ROTEM versus standard of
care in bleeding patients in an updated review. Method(s): This
systematic review of randomized controlled trials with meta-analyses and
trial sequential analysis was conducted according to Cochrane
Collaboration methodology, PRISMA, and GRADE guidelines. A literature
search was conducted in five major databases. Both pediatric and adult
patients were included. The primary outcome was mortality, and secondary
outcomes were the administration of blood products, blood loss, surgical
reintervention, and dialysis-dependent renal injury. Result(s): This
systematic review included 35 randomized trials (n = 3096), primarily
elective cardiac surgery. TEG-/ROTEM-guided algorithms led to a
statistically significant reduction in mortality (RR = 0.76, 95% CI
0.63-0.92) I2: 0%. Furthermore, a significant reduction in
transfused fresh frozen plasma (RR = 0.52, 95% CI 0.35-0.76)
I2: 94%, platelets (RR = 0.69, 95% CI 0.55-0.87) I2:
60%, the risk for surgical reintervention (RR = 0.63, 95% CI 0.45-0.88)
I2: 0%, and bleeding with a standard mean difference of -0.31
(95% CI, -0.51 to -0.11) I2: 72% was found. According to GRADE
methodology, the certainty of the evidence was very low for all outcomes.
Trial sequential analysis of mortality analysis indicated that 64% of the
optimal information size was reached with a crossed alpha-boundary.
 Conclusion(s): TEG-/ROTEM-guided transfusion algorithms may reduce
the risk of mortality, bleeding volume, and the need for fresh frozen
plasma, platelets, and surgical reintervention, but the evidence is very
uncertain. Furthermore, the results were primarily based on the adult
population undergoing elective cardiac surgery. Editorial Comment: This
updated systematic review presents a synthesis of evidence for how
thromboelastography or rotational thromboelastometry has been implemented
in study conditions to guide tranfusion in bleeding patients. The
certainty for the evidence is very limited. Copyright © 2025 Acta
Anaesthesiologica Scandinavica Foundation.

<12>
Accession Number
2040602754
Title
Comparative effectiveness of antiplatelet therapies for saphenous venous
graft occlusion and cardiovascular outcomes: a network meta-analysis.
Source
Minerva Cardiology and Angiology. 73(5) (pp 613-625), 2025. Date of
Publication: 01 Oct 2025.
Author
Hasan S.U.; Pervez A.; Afreen M.; Imam B.; Shah S.D.; Shah A.A.; Siddiqui
S.A.; Zubair M.M.; Osho A.
Institution
(Hasan) Ophthalmology Department, Aga Khan University, Karachi, Pakistan
(Pervez) Center for Clinical Best Practices, Aga Khan University, Karachi,
Pakistan
(Afreen) Department of Neurosurgery, Shifa International Hospital,
Islamabad, Pakistan
(Imam) Department of Cardiology, Dr Ruth KM Pfau Civil Hospital, Karachi,
Pakistan
(Shah, Shah) Department of Cardiology, Dow University of Health Sciences,
Karachi, Pakistan
(Siddiqui) Department of Cardiology, Baqai Medical University, Karachi,
Pakistan
(Zubair) Department of Cardiology, Smidt Heart Institute, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(Osho) Department of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The ideal antiplatelet therapy to maintain graft patency
after coronary artery bypass graft surgery (CABG) remains controversial.
This review of randomized controlled trials (RCTs) aims to compare aspirin
monotherapy, ticagrelor monotherapy, dual antiplatelet therapy (DAPT) with
aspirin and ticagrelor (Asp+Tica) or with aspirin and clopidogrel
(Asp+Clopi) to evaluate differences in post-CABG saphenous vein graft
(SVG) occlusion, internal mammary artery (IMA) occlusion, myocardial
infarction (MI), bleeding, and all-cause mortality (ACM) rates. EVIDENCE
ACQUISITION: The literature review was conducted on several electronic
databases, including Medline, Embase, and Cochrane Central, from inception
to August 10, 2022. Data was extracted using a predefined proforma. A
Bayesian random-effects model was used for calculating point effect
estimates (odds ratio and standard deviation). Quality assessment was done
using the Cochrane RoB-2 tool. EVIDENCE SYNTHESIS: Ten RCTs comprising
2139 patients taking anti-platelets post-CABG were included. For
preventing SVG occlusion, Asp+Tica showed the lowest mean AR of
0.144+/-0.068. Asp+Tica also showed a trend toward lesser postoperative MI
risk and lower ACM rates, with a mean AR of 0.040+/-0.053 and
0.018+/-0.029, respectively. For maintaining IMA graft patency, Asp+Clopi
showed the lowest mean AR of 0.092+/-0.053. Ticagrelor had the lowest mean
AR of 0.049+/-0.075, with Asp+Tica showing a similar mean AR of
0.049+/-0.045 for postoperative major bleeding risk. CONCLUSION(S):
Our analysis demonstrates that Asp+Tica can be the ideal therapy for
patients undergoing CABG using SVG as it decreases the risk of post-CABG
SVG occlusion and is not associated with a significantly higher risk for
major bleeding. Copyright © 2024 EDIZIONI MINERVA MEDICA.

<13>
Accession Number
2040529138
Title
The prognostic impact of prevailing definitions of periprocedural
myocardial infarction in patients undergoing coronary artery bypass
grafting.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 11(6) (pp
847-856), 2025. Date of Publication: 01 Sep 2025.
Author
Swinnen B.; Kawczynski M.J.; Mingels A.M.A.; Wildberger J.E.; Mihl C.;
Smulders M.W.; Maessen J.G.; Gollmann-Tepekoylu C.; Heuts S.
Institution
(Swinnen, Kawczynski, Maessen, Heuts) Department of Cardiothoracic
Surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25,
Maastricht, Netherlands
(Swinnen, Wildberger, Mihl, Smulders) Department of Radiology and Nuclear
Medicine, Maastricht University Medical Centre (MUMC+), Maastricht,
Netherlands
(Swinnen, Kawczynski, Mingels, Wildberger, Mihl, Smulders, Maessen, Heuts)
Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
(Mingels) Central Diagnostic Laboratory, Maastricht University Medical
Centre (MUMC+), Maastricht, Netherlands
(Smulders) Department of Cardiology, Maastricht University Medical Centre
(MUMC+), Maastricht, Netherlands
(Gollmann-Tepekoylu) Department of Cardiac Surgery, Innsbruck Medical
University, Innsbruck, Austria
Publisher
Oxford University Press
Abstract
Aims Several contradictory definitions have been proposed for the
diagnosis of periprocedural myocardial infarction (PMI) after coronary
artery bypass grafting (CABG). The aim of this study was to assess the
prevalence of PMI and to identify the definition of PMI with the most
relevant prognostic impact. Methods and results In this systematic review
and meta-analysis, the search was conducted in thee electronic databases
(MEDLINE & PubMed Central, Cochrane Library, Embase). The primary
definitions of interest comprised the universal definition of myocardial
infarction (UDMI; UDMI-3/4) and Society for Cardiovascular Angiography and
Interventions (SCAI) definition. The primary outcomes were the prevalence
of PMI and its prognostic impact, expressed in hazard ratios (HRs) and 95%
confidence intervals (CIs). The frequentist framework was employed for the
primary analysis, and a secondary analysis was performed under a Bayesian
framework. Ten studies were included (n = 21 203 patients). The prevalence
of PMI was 17.5% (95%CI 9.5-29.8%) according to SCAI, and 3.2% (95%CI
1.6-6.2%) according to UDMI-3/4. The pooled HR of the SCAI definition for
freedom from all-cause mortality was 1.60 (95%CI 1.18-2.16) and the HR was
2.54 (1.62-4.00) for UDMI-3/4 (P-for-interaction = 0.097). The posterior
probability of exceeding an HR of 1 was >99% for both definitions, while
the probability of the UDMI-3/4 exceeding the mean HR of SCAI was 96.4%.
The results were robust across sensitivity analyses. Conclusion The
prevalence of PMI is markedly higher when diagnosed according to SCAI
criteria in CABG patients. The UDMI criteria define PMI with the most
relevant prognostic impact in CABG patients. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<14>
Accession Number
2040579597
Title
Trajectories of Recovery after Intravenous propofol versus inhaled
VolatilE anaesthesia (THRIVE) randomised controlled trial in the USA: A
protocol.
Source
BMJ Open. 15(9) (no pagination), 2025. Article Number: e103836. Date of
Publication: 14 Sep 2025.
Author
Tellor Pennington B.R.; Janda A.M.; Colquhoun D.A.; Neuman M.D.; Kidwell
K.M.; Spino C.; Thelen-Perry S.; Krambrink A.; Huang S.; Ignacio R.; Wu
Z.; Swisher L.; Cloyd C.; Vaughn M.T.; Pescatore N.A.; Bollini M.L.;
Mashour G.A.; Hassett A.; Kent C.D.; Vlisides P.E.; Avidan M.S.; Kheterpal
S.; Stephen G.; Kumar S.; Hyman J.; Chen L.; Drennan E.; Johnson K.; Naik
B.; Pryor K.; Khanna A.; Deiner S.; Ghadimi K.; Chhina A.; Nascimbe L.;
Domino K.; Aziz M.; Bardia A.; Cata J.; Muller G.; Duffy C.; Tom S.;
Drover D.; Saffary R.; Politi M.; Toit L.D.; Henrichs B.; Torres B.;
Kronzer A.; McKinnon S.; Rosen S.; Percich J.; Valdez M.; Karanikolas E.;
Shoemake R.; Patel A.; Campos H.; Hoover D.; Swanson B.; Zukowski L.;
Oberst K.; Geml T.; Fodor K.; Wurst M.; Wijeysundera D.; Spence J.;
Humeidan M.; Colantuoni E.; Schmidt C.; Aslakson R.
Institution
(Tellor Pennington, Swisher, Bollini, Avidan) Department of
Anesthesiology, Washington University School of Medicine, St. Louis, MO,
United States
(Janda, Colquhoun, Cloyd, Vaughn, Pescatore, Mashour, Hassett, Vlisides,
Kheterpal) Department of Anesthesiology, University of Michigan Health
System, Ann Arbor, MI, United States
(Neuman) Department of Anesthesiology & Critical Care, University of
Pennsylvania, Philadelphia, PA, United States
(Kidwell, Spino, Thelen-Perry, Krambrink, Huang, Ignacio, Wu) Department
of Biostatistics, University of Michigan School of Public Health, Ann
Arbor, MI, United States
(Kent) Department of Anesthesiology, University of Washington, Seattle,
WA, United States
(Stephen, Politi, Toit, Henrichs, Torres, Kronzer, McKinnon, Rosen,
Percich, Valdez, Karanikolas, Schmidt) Department of Anesthesiology,
Washington University School of Medicine, St. Louis, MO, United States
(Kumar, Shoemake, Patel) Department of Anesthesiology, University of
Michigan, Ann Arbor, MI, United States
(Hyman) Department of Anesthesiology, Yale School of Medicine, New Haven,
CT, United States
(Chen) Department of Anesthesiology, University of California, San
Francisco, San Francisco, CA, United States
(Drennan, Johnson) Department of Anesthesiology, University of Utah, Salt
Lake City, UT, United States
(Naik) Department of Anesthesiology, University of Virginia,
Charlottesville, VA, United States
(Pryor) Department of Anesthesiology, Weill Cornell University, New York,
NY, United States
(Khanna) Department of Anesthesiology, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Deiner) Department of Anesthesiology, Dartmouth Hitchcock Medical Center,
Lebanon, NH, United States
(Ghadimi) Department of Anesthesiology, Duke University School of
Medicine, Durham, NC, United States
(Chhina) Department of Anesthesiology, Henry Ford Health, Detroit, MI,
United States
(Nascimbe) Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Domino) Department of Anesthesiology, University of Washington Medical
Center, Seattle, WA, United States
(Aziz) Department of Anesthesiology and Perioperative Medicine, Oregon
Health & Sciences University, Portland, OR, United States
(Bardia) Department of Anesthesiology, Massachusetts General Hospital,
Boston, MA, United States
(Cata) Department of Anesthesiology and Perioperative Medicine, University
of Texas MD Anderson Cancer Center, Houston, TX, United States
(Muller) Department of Anesthesiology, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Duffy) Department of Anesthesiology & Critical Care, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
(Tom) Department of Anesthesiology, NYU Langone Health, New York, NY,
United States
(Aziz, Drover, Saffary) Department of Anesthesiology, Stanford Health
Care, Stanford, CA, United States
(Wijeysundera) Department of Anesthesiology, University of Toronto,
Toronto, ON, Canada
(Spence) Population Health Research Institute, Hamilton, Ontario, Canada
(Humeidan) Department of Anesthesiology, The Ohio State University -
Wexner Medical Center, Columbus, OH, United States
(Colantuoni) Department of Biostatistics, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, United States
(Schmidt) Department of Surgery, West Virginia University, Morgantown, WV,
United States
(Aslakson) Department of Anesthesiology, The University of Vermont Medical
Center, Burlington, VT, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Millions of patients receive general anaesthesia every year
with either propofol total intravenous anaesthesia (TIVA) or inhaled
volatile anaesthesia (INVA). It is currently unknown which of these
techniques is superior in relation to patient experience, safety and
clinical outcomes. The primary aims of this trial are to determine (1)
whether patients undergoing (a) major inpatient surgery, (b) minor
inpatient surgery or (c) outpatient surgery have a superior quality of
recovery after INVA or TIVA and (2) whether TIVA confers no more than a
small (0.2%) increased risk of definite intraoperative awareness than
INVA. Methods and analysis This protocol was co-created by a diverse team,
including patient partners with personal experience of TIVA or INVA. The
design is a 13 000-patient, multicentre, patient-blinded, randomised,
comparative effectiveness trial. Patients 18 years of age or older,
undergoing elective non-cardiac surgery requiring general anaesthesia with
a tracheal tube or laryngeal mask airway will be eligible. Patients will
be randomised 1:1 to one of two anaesthetic approaches, TIVA or INVA,
using minimisation. The primary effectiveness endpoints are Quality of
Recovery-15 (QOR-15) score on postoperative day (POD) 1 in patients
undergoing (1) major inpatient surgery, (2) minor inpatient surgery or (3)
outpatient surgery, and the primary safety endpoint is the incidence of
unintended definite intraoperative awareness with recall in all patients,
assessed on POD1 or POD30. Secondary endpoints include QOR-15 score on
POD0, POD2 and POD7; incidence of delirium on POD0 and POD1; functional
status on POD30 and POD90; health-related quality of life on POD30, POD90,
POD180 and POD365; days alive and at home at POD30; patient satisfaction
with anaesthesia at POD2; respiratory failure on POD0; kidney injury on
POD7; all-cause mortality at POD30 and POD90; intraoperative hypotension;
moderate-to-severe intraoperative movement; unplanned hospital admission
after outpatient surgery in a free-standing ambulatory surgery centre
setting; propofol-related infusion syndrome and malignant hyperthermia.
Ethics and dissemination This study is approved by the ethics board at
Washington University, serving as the single Institutional Review Board
for all participating sites. Recruitment began in September 2023.
Dissemination plans include presentations at scientific conferences,
scientific publications, internet-based educational materials and mass
media. Copyright © Author(s) (or their employer(s)) 2025.

<15>
Accession Number
2040468210
Title
Effect of Stent Post Dilatation Versus No Post Dilatation in Patients with
STEMI Treated by Primary PCI on No Reflow and in-hospital Outcome.
Source
International Journal of the Cardiovascular Academy. 11(3) (pp 133-146),
2025. Date of Publication: 01 Sep 2025.
Author
Gamal S.; Shaalan H.; Abu Arab T.M.; Iskandar M.M.
Institution
(Gamal, Shaalan, Abu Arab, Iskandar) Department of Cardiology, Ain Shams
University Faculty of Medicine, Cairo, Egypt
Publisher
Galenos Publishing House
Abstract
Background and Aim: Percutaneous coronary intervention (PCI) remains the
primary modality of choice for achieving reperfusion in patients with
acute coronary syndrome. However, complications such as no-reflow
phenomenon can occur. Stent post-dilatation (SPD) is common in non-infarct
settings, however its use during acute myocardial infarction is
controversial. To investigate impact of SPD versus no SPD in ST elevation
myocardial infarction (STEMI) cases undergoing primary PCI on incidence of
no-reflow phenomenon and in-hospital outcomes. Material(s) and
Method(s): A prospective, single-center, randomized controlled trial was
conducted on 300 STEMI cases who presented to Ain Shams University
Hospitals between February 2024 and August 2024. Following successful
stent implantation, confirmed thrombolysis in myocardial infarction (TIMI)
III flow, and adequate stent expansion, cases were randomly stratified
into two groups: group I (n=150), which underwent SPD, and group II
(n=150), which did not receive SPD. Post-procedural TIMI flow and
myocardial blush grade (MBG) were assessed and compared between the two
groups. In-hospital clinical outcomes were likewise evaluated.
 Result(s): Cases who underwent SPD (group I) showed significantly
lower TIMI flow and MBG than cases in group II; consequently, group I
showed elevated prevalence of transient no-reflow (43.3% vs. 4% in group
II). There is a relation between SPD and occurrence of no-reflow.
In-hospital major adverse cardiac events rates were comparable between two
groups, with no substantial variation detected. Longer chest pain
duration, higher non-compliant (NC) balloon inflation pressure, higher NC
balloon to stent size ratio, and longer stent length were strongly and
negatively correlated with TIMI flow and MBG outcomes, leading to poorer
post procedural results. Conclusion(s): Post-stent dilatation during
primary PCI in STEMI patients was associated with a higher incidence of
transient no-reflow immediately following the procedure. However, this did
not translate into a significant difference in short-term-in-hospital
clinical outcomes-likely due to prompt intra-procedural management of
no-reflow. ©Copyright 2025 by the Cardiovascular.

<16>
Accession Number
2040468207
Title
Coenzyme Q10 in Prevention of Contrast-induced Nephropathy in Patients
with Acute Coronary Syndrome Undergoing Coronary Angiography.
Source
International Journal of the Cardiovascular Academy. 11(3) (pp 107-114),
2025. Date of Publication: 01 Sep 2025.
Author
El-Sheikh R.; El Etriby S.; Bastawy I.; Okasha N.
Institution
(El-Sheikh, El Etriby, Bastawy, Okasha) Department of Cardiology, Ain
Shams University Faculty of Medicine, Cairo, Egypt
Publisher
Galenos Publishing House
Abstract
Background and Aim: Contrast-induced nephropathy (CIN) is a serious
complication of coronary angiography (CA), associated with increased
morbidity and mortality. Coenzyme Q10 (CoQ10), an endogenous antioxidant,
has shown promise in mitigating oxidative renal injury. This study
investigated CoQ10's protective effect against CIN in acute coronary
syndrome (ACS) cases undergoing CA. Material(s) and Method(s): In a
prospective randomized clinical trial (registration number: NCT06429345,
date: 19.03.2024), 300 ACS cases were enrolled between March and September
2024. Cases were randomized into a CoQ10 group (n=200) receiving oral
CoQ10 and a control group (n=100) receiving standard care. Serum
creatinine, estimated glomerular filtration rate (eGFR), and urine output
were monitored for three days post-procedure. CIN was defined as a >=0.5
mg/dL or >=25% increase in serum creatinine or a >=25% decline in eGFR
within 48 hours. Result(s): CIN incidence was significantly lower in
the CoQ10 group (9%) compared to controls (21%) (P = 0.004). Postoperative
serum creatinine levels were markedly lower, and eGFR notably higher, in
the CoQ10 group on days two and three (P < 0.01). Multivariate logistic
regression identified high body mass index [odds ratio (OR) =6.976, P <
0.001], chronic kidney disease (OR =6.288, P = 0.001), and balloon
dilatation (OR =3.116, P = 0.012) as independent predictors of CIN.
 Conclusion(s): CoQ10 supplementation significantly reduced CIN
incidence in ACS cases undergoing CA. CoQ10's antioxidative and
anti-inflammatory properties support its potential as a safe adjunctive
therapy for CIN prevention. ©Copyright 2025 by the
Cardiovascular.

<17>
Accession Number
2039776714
Title
Predictors of Postoperative Atrial Fibrillation in Patients Undergoing
Stress Echocardiography Before Noncardiac Surgery.
Source
Journal of the American Society of Echocardiography. 38(10) (pp 972-975),
2025. Date of Publication: 01 Oct 2025.
Author
Stanko K.M.; Weingarten T.N.; Kane G.C.; Pellikka P.A.; McCully R.B.;
Mauck K.F.; Schroeder D.R.; Cullen M.W.
Institution
(Stanko, Mauck) Department of Internal Medicine, Mayo Clinic, Rochester,
Minnesota, United States
(Weingarten) Department of Anesthesia and Perioperative Medicine, Mayo
Clinic, Rochester, Minnesota, United States
(Kane, Pellikka, McCully, Cullen) Department of Cardiovascular Medicine,
Mayo Clinic, Rochester, Minnesota, United States
(Schroeder) Division of Clinical Trials and Biostatistics, Mayo Clinic,
Rochester, Minnesota, United States
Publisher
Elsevier Inc.

<18>
Accession Number
2036205791
Title
Efficacy of local absolute ethanol injection for the management of ectopic
pregnancy: a systematic review and meta-analysis.
Source
Middle East Fertility Society Journal. 30(1) (no pagination), 2025.
Article Number: 39. Date of Publication: 01 Dec 2025.
Author
Parsaei M.; Asbagh R.A.; Nazari M.A.; Rashidian P.; Hadizadeh A.;
Tarafdari A.
Institution
(Parsaei) Breastfeeding Research Center, Family Health Research Institute,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Asbagh) Colorectal Research Center, Imam Khomeini Hospital Complex,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Nazari) School of Medicine, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Rashidian) Vali-E-Asr Reproductive Health Research Center, Family Health
Research Institute, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Hadizadeh) School of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Tarafdari) Department of Obstetrics and Gynecology, Family Health
Research Institute, Imam Khomeini Hospital Complex, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Current medical and surgical treatments for ectopic pregnancy
are associated with significant adverse effects, highlighting the need for
safer alternatives. This systematic review and meta-analysis evaluate the
efficacy of ultrasonography-guided local absolute ethanol injection into
trophoblastic tissue for managing ectopic pregnancy at various sites,
including tubal, cervical, interstitial, cesarean scar, and peritoneal
locations. Method(s): A systematic search was conducted in PubMed,
Scopus, Embase, Web of Science, and Cochrane Library on January 16, 2024.
The primary outcome was treatment success, defined as declining beta-human
chorionic gonadotropin levels, while ectopic pregnancy resolution time was
the duration from ethanol injection to beta-human chorionic gonadotropin
reaching the negative level for pregnancy (< 5 mIU/mL). Study quality was
evaluated using the Joanna Briggs Institute (JBI) Clinical Appraisal
Tools. Using STATA 18, we conducted a random-effects meta-analysis to
determine pooled success rates and compare them with laparoscopic surgery.
 Result(s): Six retrospective studies encompassing a total of 432
patients were included, with all meeting quality thresholds on JBI
appraisal. The ectopic pregnancy site distribution was as follows: tubal
(n = 3), cervical (n = 3), interstitial (n = 3), cesarean scar (n = 3),
and peritoneal (n = 1). Mean baseline beta-human chorionic gonadotropin
levels ranged from 1641.9 to 35,640.0 mIU/mL, with four studies including
cases of fetal cardiac activity. The procedure's success rate varied
between 84 and 100%, with a pooled estimate of 93.3% (95% CI 89.1-97.6%;
p-value < 0.001; I2 = 66.7%). Only one study reported
self-resolving peritoneal irritation; no other complications were
documented. Furthermore, only one study compared ethanol injection versus
laparoscopic surgery, demonstrating lower success rates in our
meta-analysis (log odds ratio = - 1.803 [95% CI - 3.382, - 0.224]; p-value
= 0.025). Conclusion(s): Local absolute ethanol injection to the
trophoblastic tissue appears to be a potentially effective treatment for
ectopic pregnancy, demonstrating high success rates and minimal side
effects. However, the limited number of studies, small sample sizes, and
heterogeneity necessitate further large-scale comparative trials for
validation. Protocol Registration: The review protocol was registered
in the International Prospective Register of Systematic Reviews (PROSPERO)
on 10/4/2024 under the registration code CRD42024530622. Copyright
© The Author(s) 2025.

<19>
Accession Number
2040604267
Title
Electronic notifications for providers of patients with severe AS vs.
usual care increased aortic valve replacement rates at 1 y.
Source
Annals of Internal Medicine. 178(9) (no pagination), 2025. Date of
Publication: 01 Sep 2025.
Author
Chan K.L.
Institution
(Chan) University of Ottawa Heart Institute, Ottawa, ON, Canada
Publisher
American College of Physicians

<20>
Accession Number
2040602596
Title
Stellate ganglion block for preventing postoperative arrhythmias: a
protocol for a systematic review and meta-analysis.
Source
BMJ Open. 15(9) (no pagination), 2025. Article Number: e104016. Date of
Publication: 22 Sep 2025.
Author
Nunez-Rodriguez E.; Mishima R.; Martinez F.; Aveni-Strafile P.; Zheng G.;
Hicklen R.S.; Tsai E.; Cata J.
Institution
(Nunez-Rodriguez, Aveni-Strafile, Zheng, Tsai, Cata) Department of
Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center,
Houston, TX, United States
(Nunez-Rodriguez, Aveni-Strafile, Cata) Anesthesiology and Surgical
Oncology Research Group, Houston, TX, United States
(Mishima) Department of Emergency Medicine, Sanatorio Allende, Cordoba,
Argentina
(Martinez) Department of Pharmacology, Universidad Catolica de Cordoba,
Cordoba, Argentina
(Hicklen) Research Medical Library, MD Anderson Cancer Center, Houston,
TX, United States
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative arrhythmias are common and clinically
significant complications. They are a cause of increased morbidity and
mortality rates in surgical patients. Although various pharmacological and
procedural strategies have been explored for preventing postoperative
arrhythmia, evidence regarding their effectiveness remains inconsistent.
The stellate ganglion block (SGB) has emerged as a promising alternative
to reduce the occurrence of postoperative arrhythmias. By summarising the
existing evidence, this meta-analysis aims to assess the effectiveness of
SGB in preventing postoperative arrhythmias. Methods and analysis We will
review literature from January 1970 to April 2025 using MEDLINE, Cochrane
CENTRAL and Embase. Studies eligible for inclusion will be randomised
controlled trials and observational studies reporting postoperative
arrhythmia incidence in surgical patients who received preoperative or
intraoperative SGB. We will include articles in the following languages:
English, Spanish, Chinese or Portuguese. Secondary outcomes are
SGB-related complications. The risk of bias will be determined by Rob-2
and ROBINS-I tools. Meta-analyses, reporting relative risks or ORs with
95% confidence intervals will be performed when at least three studies
report the same outcome under comparable conditions. Quality of evidence
will be evaluated using GRADE guidelines. Ethics and dissemination We will
use information from previously published manuscripts found in reputable
databases, and ethical approval is not necessary. PROSPERO registration
number CRD420251029643. Copyright © Author(s) (or their
employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ Group.

<21>
Accession Number
648099563
Title
Response to "Comment on Hypotension after induction of anesthesia with
remimazolam or etomidate: a non-inferiority randomized controlled trial in
patients undergoing coronary artery bypass grafting".
Source
Korean journal of anesthesiology. 78(5) (pp 509-510), 2025. Date of
Publication: 01 Oct 2025.
Author
Min J.-J.; Oh E.J.; Cho H.; Kim C.; Lee J.-H.
Institution
(Min, Cho, Kim, Lee) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Oh) Department of Anesthesiology and Pain Medicine, Kangbuk Samsung
Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

<22>
Accession Number
2037162975
Title
Aortic Stenosis and Transcatheter Aortic Valve Replacement: A Real or
Illusory Shift in the Landscape?.
Source
Revista Argentina de Cardiologia. 93(2) (pp 147-150), 2025. Date of
Publication: 01 Aug 2025.
Author
Cagide A.; Falconi M.
Institution
(Cagide, Falconi) Cardiology Department, Hospital Italiano de Buenos
Aires, Autonomous City of Buenos Aires, Argentina
Publisher
Sociedad Argentina de Cardiologia

<23>
Accession Number
2040607816
Title
Sustainable Employability in Cardiothoracic Surgery: A Systematic Review
Identifying Job Demands and Resources.
Source
European Journal of Cardio-thoracic Surgery. 67(9) (no pagination), 2025.
Article Number: ezaf275. Date of Publication: 01 Sep 2025.
Author
Langmuur S.J.J.; Veen K.M.; Derks D.; Mokhles M.M.; Versteegh M.I.M.;
Kluin J.; Brandon Bravo Bruinsma G.J.; Takkenberg J.J.M.; Bredee J.J.
Institution
(Langmuur, Veen, Kluin, Takkenberg) Department of Cardiothoracic Surgery,
Erasmus Medical Center, Rotterdam, Netherlands
(Derks) Erasmus School of Social and Behavioural Sciences, Erasmus
University Rotterdam, Rotterdam, Netherlands
(Mokhles, Bredee) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Versteegh) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Brandon Bravo Bruinsma) Department of Cardiothoracic Surgery, Isala,
Zwolle, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: To provide an overview of job satisfaction, quality of life,
work-life balance, attrition, burnout, and several mental health issues
among cardiothoracic surgeons, residents, and fellows, and to identify
factors that have a favourable or unfavourable association with their
career. Method(s): A systematic literature review (Medline, EMBASE,
Web of Science, Cochrane Library, and Google Scholar) was performed to
identify articles in the last 25 years concerning cardiothoracic surgeons
and topics surrounding their career. The job-demands resources model was
used to categorize the outcomes. Result(s): Sixty-nine articles were
included, comprising of 30 427 responses. Cardiothoracic surgeons had a
high job satisfaction and 22 job resources were identified, regarding
social, psychological, physical, and organizational support. These
protective factors included mentorship, camaraderie, adequate hospital
support, and designated teaching and research time. However, quality of
life was relatively low, as compared with other (surgical) specialties,
and attrition and mental health issues occur relatively often. Nineteen
job demands were acknowledged as potentially modifiable risk factors that
may negatively influence the well-being of cardiothoracic surgeons, such
as a high workload, difficult work-life balance, social constructs in the
workplace, and sexual harassment. Conclusion(s): Cardiothoracic
surgery is a profession that is both highly demanding as well as very
rewarding. In addition to enhancing job resources such as mentorship and
adequate support, modifiable risk factors related to workload, work-life
balance, and social safety need to be addressed urgently to create a
community where all cardiothoracic surgeons can thrive and provide optimal
care. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
2040473053
Title
Multidomain Rehabilitation for Older Patients with Myocardial Infarction.
Source
New England Journal of Medicine. 393(10) (pp 973-982), 2025. Date of
Publication: 11 Sep 2025.
Author
Tonet E.; Raisi A.; Zagnoni S.; Chiaranda G.; Pasanisi G.; Aschieri D.;
D'Intino P.E.; Pavasini R.; Cimaglia P.; Campana R.; Vitali F.; Piva T.;
Casella G.; Caglioni S.; Zerbini V.; Bugani G.; Cocco M.; Menegatti E.; De
Raffele M.; Mandini S.; Martella D.; Pesenti N.; Mazzoni G.; Biscaglia S.;
Volpato S.; Grazzi G.; Campo G.
Institution
(Tonet, Pavasini, Cimaglia, Vitali, Caglioni, Cocco, De Raffele,
Biscaglia, Campo) Cardiology Unit, Azienda Ospedaliero-Universitaria di
Ferrara, Ferrara, Italy
(Raisi, Piva, Zerbini, Menegatti, Mandini, Mazzoni, Grazzi) Center for
Exercise Science and Sport, University of Ferrara, Ferrara, Italy
(Zagnoni, Casella, Bugani) Cardiology Unit, Ospedale Maggiore, Bologna,
Italy
(Chiaranda) Department of Public Health and Sport Medicine Service,
Azienda Unita Sanitaria Locale di Piacenza, Piacenza, Italy
(Pasanisi) Cardiologic Rehabilitation, Ospedale del Delta, Lagosanto,
Italy
(Aschieri) Cardiology Unit of Emergency Department, Guglielmo da Saliceto
Hospital, Piacenza, Italy
(D'Intino) Sports Medicine, Azienda Unita Sanitaria Locale di Bologna,
Casalecchio di Reno, Italy
(Campana) Cardiovascular Department, Infer-mi Hospital, Rimini, Italy
(Martella, Pesenti) We4 Clinical Research, Milan, Italy
(Volpato) Ge-riatrics Unit, Azienda Ospedaliero-Universitaria di Ferrara,
Ferrara, Italy
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The benefit of rehabilitation interventions in patients who are
65 years of age or older with myocardial infarction and impaired physical
performance remains unclear. METHODS In this multicenter, randomized trial
conducted in Italy, we assigned older patients with impaired physical
performance 1 month after myocardial infarction in a 2:1 ratio to receive
either an intervention consisting of control of cardiovascular risk
factors, dietary counseling, and exercise training (intervention group) or
usual care (control group). The primary outcome was a composite of
cardiovascular death or unplanned hospitalization for cardiovascular
causes within 1 year. RESULTS A total of 512 patients underwent
randomization (342 to the intervention group and 170 to the control
group). The median age of the patients was 80 years, and 36% were women. A
primary-outcome event occurred in 43 patients (12.6%) in the intervention
group and in 35 patients (20.6%) in the control group (hazard ratio, 0.57;
95% confidence interval [CI], 0.36 to 0.89; P=0.01). Cardiovascular death
occurred in 14 patients (4.1%) in the intervention group and in 10
patients (5.9%) in the control group (hazard ratio, 0.69; 95% CI, 0.31 to
1.55). Unplanned hospitalization for cardiovascular causes occurred in 31
patients (9.1%) in the intervention group and in 30 patients (17.6%) in
the control group (hazard ratio, 0.48; 95% CI, 0.29 to 0.79). There were
no serious adverse events associated with the intervention. CONCLUSIONS
Among older patients with impaired physical performance 1 month after
myocardial infarction, a multidomain rehabilitation intervention resulted
in a lower incidence of cardiovascular death or unplanned cardiovascular
hospitalization within 1 year than usual care. (Funded by the Italian
Health Ministry; PIpELINe Clinical-Trials.gov number,
NCT04183465.) Copyright © 2025 Massachusetts Medical Society.

<25>
Accession Number
2036250943
Title
Risk prediction models for prolonged mechanical ventilation following
coronary artery bypass grafting surgery: a systematic review and
meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1616003. Date of Publication: 2025.
Author
Jia Y.; Pei Z.; Zhang X.; Zhang C.; Kang X.
Institution
(Jia, Pei, Zhang, Kang) School of Nursing, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Zhang) Department of Nursing, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
Publisher
Frontiers Media SA
Abstract
Objective: Prolonged mechanical ventilation (PMV) results in significant
morbidity, mortality, and associated hospital costs. Models predicting PMV
following Coronary artery bypass grafting (CABG) surgery were growing.
However, the reliability, validity and clinical applicability of these
models remain unclear. This systematic review and meta-analysis aim to
provide a comprehensive quality assessment of PMV-risk prediction models
for patients after CABG. Method(s): Nine relevant domestic and
international databases were systematically searched from inception until
November 4, 2024 using PICOTS format. The Prediction Model Risk of Bias
Assessment Tool (PROBAST) checklist was employed to evaluate the risk of
bias and applicability of each study. A meta-analysis of the area under
the curve (AUC) values from model external validations was conducted using
R software. Result(s): Fifteen studies detailing 12 PMV-risk
prediction models were included, with AUC values ranging from 0.561 to 0.
875. In the meta-analysis, the pooled AUC was 0.696 (95% CI: 0.553, 0.839,
I-squared = 90.4%) for externally validated studies of three Society of
Thoracic Surgeons (STS) models. The most frequently used predictors in the
models were grouped into demographics, medical history, examination, and
supportive therapy. Conclusion(s): Although studies were judged as
high overall risk of bias according to PROBAST guidelines evidence from
our review indicates that risk factors of PMV in Post CABG Patients
include age, BMI, history of cardiac surgery, history of cardiovascular
disease, COPD, EF/LVEF, IABP, and cardiopulmonary bypass. Systematic
Review Registration: PROSPERO CRD42024608639. Copyright 2025 Jia, Pei,
Zhang, Zhang and Kang.

<26>
Accession Number
2038674520
Title
Digital integration of research conduct into clinical care: results of the
PROSPECTOR randomised feasibility study.
Source
BMJ Evidence-Based Medicine. 30(5) (pp 323-332), 2025. Date of
Publication: 01 Oct 2025.
Author
Wilson M.G.; Asselbergs F.W.; Saleem N.; Jeilani L.; Brealey D.; Sydes
M.R.; Harris S.
Institution
(Wilson, Asselbergs, Saleem, Jeilani, Brealey, Sydes, Harris) University
College London, London, United Kingdom
(Brealey) National Institute of Health Research Central London Patient
Safety Research Collaboration, London, United Kingdom
(Sydes) BHF Data Science Centre, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives To evaluate the feasibility of conducting a clinically
integrated randomised comparative effectiveness trial using digital
clinical trial infrastructure within an electronic patient record (EPR).
Design A mixed-methods, unblinded, feasibility study of digital clinical
trial system incorporating testing of two designs of electronic
point-of-care randomisation prompt. Setting The study was conducted at
University College London Hospitals NHS Trust between March and November
2022. The study used a real clinical research question for context,
comparing liberal vs restrictive strategies for magnesium supplementation
to prevent new-onset atrial fibrillation in critical care. Participants
Adult patients undergoing elective, non-cardiac surgical procedures
expecting postoperative admission to critical care were recruited.
Interventions A digital trial system screened participants continuously
against eligibility criteria. Participants were automatically randomised
(1:1) to (1) magnesium supplementation strategy and (2) one of two
electronic randomisation prompt designs (nudge or preference). Electronic
point-of-care randomisation prompts displayed to clinicians at regular
intervals, inviting them to follow a randomised magnesium supplementation
suggestion. Main outcome measures The primary outcome measure was a
composite determination of study design feasibility (including
recruitment, technical performance and concordance between the randomised
suggestion and the observed clinician action). Results 23 patients were
recruited and 11 successfully randomised. The implemented digital systems
for automated eligibility screening, randomisation, data collection and
follow-up demonstrated technical feasibility. 47 electronic point-of-care
randomisation prompts successfully deployed across 11 patients. Clinician
actions were concordant with randomised suggestions in 32 prompts (68%).
Technical and implementational barriers to delivering the electronic
point-of-care randomisation prompts were identified.
Patients Copyright © Author(s) (or their employer(s)) 2025.

<27>
Accession Number
2031845553
Title
Uniform or Sex-Specific Cardiac Troponin Thresholds to Rule Out Myocardial
Infarction at Presentation.
Source
Journal of the American College of Cardiology. 83(19) (pp 1855-1866),
2024. Date of Publication: 14 May 2024.
Author
Li Z.; Lowry M.T.H.; Mills N.L.; Shah A.S.V.; Strachan F.E.; Tuck C.;
Anand A.; Akinlade O.M.; Barker S.; Blades J.; Boeddinghaus J.; Bularga
A.; de Bakker M.; Chapman A.R.; Doudesis D.; Ferry A.V.; Fujisawa T.;
Georgiev K.; Kimenai D.M.; Lee K.K.; Lyell I.; Lowry M.T.; McKinlay L.;
McDermott M.; McPherson J.; Mendusic F.; Sorbie A.; Souter G.; Schulberg
S.D.; Taggart C.; Thurston A.J.; Tew Y.Y.; Perez-Vicencio D.; Wang Y.;
Wereski R.; Williams K.; Newby D.E.; Fox K.A.; Berry C.; Walker S.; Weir
C.J.; Ford I.; Gray A.; Collinson P.O.; Apple F.S.; Reid A.; Cruikshank
A.; Findlay I.; Amoils S.; McAllister D.A.; Maguire D.; Stevens J.; Norrie
J.; Shah A.S.; Andrews J.P.; Adamson P.D.; Moss A.; Anwar M.S.; Hung J.;
Malo J.; Fischbacher C.M.; Croal B.L.; Leslie S.J.; Keerie C.; Parker
R.A.; Walker A.; Harkess R.; Wackett T.; Weir C.; Armstrong R.; Stirling
L.; MacDonald C.; Sadat I.; Finlay F.; Harrison K.
Institution
(Li, Wereski, Anand, Lowry, Doudesis, McDermott, Ferry, Tuck, Chapman,
Lee, Mills, Kimenai) BHF Centre for Cardiovascular Science, University of
Edinburgh, Edinburgh, United Kingdom
(Chapman) Department of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Shah) Department of Non-Communicable Disease, London School of Hygiene
and Tropical Medicine, London, United Kingdom
(Mills) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Myocardial infarction can be ruled out in patients with a
single cardiac troponin measurement. Whether use of a uniform rule-out
threshold has resulted in sex differences in care remains unclear.
 Objective(s): The purpose of this study was to evaluate
implementation of a uniform rule-out threshold in females and males with
possible myocardial infarction, and to derive and validate sex-specific
thresholds. Method(s): The implementation of a uniform rule-out
threshold (<5 ng/L) with a high-sensitivity cardiac troponin I assay was
evaluated in consecutive patients presenting with possible myocardial
infarction. The proportion of low-risk patients discharged from the
emergency department and incidence of myocardial infarction or cardiac
death at 30 days were determined. Sex-specific thresholds were derived and
validated, and proportion of female and male patients were stratified as
low-risk compared with uniform threshold. Result(s): In 16,792
patients (age 58 +/- 17 years; 46% female) care was guided using a uniform
threshold. This identified more female than male patients as low risk (73%
vs 62%), but a similar proportion of low-risk patients were discharged
from the emergency department (81% for both) with fewer than 5 (<0.1%)
patients having a subsequent myocardial infarction or cardiac death at 30
days. Compared with a uniform threshold of <5 ng/L, use of sex-specific
thresholds would increase the proportion of female (61.8% vs 65.9%) and
reduce the proportion of male (54.8% vs 47.8%) patients identified as low
risk. Conclusion(s): Implementation of a uniform rule-out threshold
for myocardial infarction was safe and effective in both sexes.
Sex-specific rule-out thresholds should be considered, but their impact on
effectiveness and safety may be limited. Copyright © 2024

<28>
Accession Number
2038673566
Title
Defining centres of expertise for minimally invasive mitral valve surgery:
a systematic review and volume-outcome meta-analysis.
Source
Heart. 111(20) (pp 984-991), 2025. Date of Publication: 01 Oct 2025.
Author
Heuts S.; Hjij W.; Kawczynski M.J.; Olsthoorn J.R.; Tjon Joek Tjien A.;
van Kuijk S.M.J.; Maessen J.G.; Sardari Nia P.
Institution
(Heuts, Hjij, Kawczynski, Maessen, Sardari Nia) Maastricht University
Medical Centre (MUMC+), Maastricht, Netherlands
(Heuts, Kawczynski, Maessen) Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University, Maastricht, Netherlands
(Olsthoorn, Tjon Joek Tjien) Catharina Hospital, Eindhoven, Netherlands
(Olsthoorn) Isala Hospital Zwolle, Zwolle, Netherlands
(van Kuijk) Maastricht University Medical Centre (MUMC+), Maastricht,
Netherlands
Publisher
BMJ Publishing Group
Abstract
Background Minimally invasive mitral valve surgery (MIMVS) is increasingly
performed, but outcomes such as repair rate, mortality and survival likely
depend on expertise. Still, the definition of a high-volume centre varies
in the literature and lacks an evidence-based substantiation.
Consequently, this study aims to determine the volume-outcome relation in
MIMVS in conjunction with a volume threshold, in order to define
'high-volume centres', applying a novel statistical concept. Methods The
study was preregistered in PROSPERO (CRD42022376293, registered 26
November 2022). A systematic search was applied to three databases,
including consecutive patients undergoing MIMVS. Studies describing
patients undergoing transcatheter procedures were excluded. Restricted
cubic spline analyses were applied and the elbow method was used to
retrieve the threshold volume. Long-term outcomes were analysed using
reconstructed Kaplan-Meier curves and a novel statistical concept to
assess the volume-outcome relation for time-to-event outcomes was applied.
The primary outcome was early mortality, secondary outcomes were repair
rate, stroke, and long-term survival, freedom from reoperation, and
freedom from more than moderate mitral regurgitation. Leave-one-out
analyses were performed for sensitivity purposes. Results Data from 68
unique centres were included (n=23495 patients). Early mortality was 1.3%
(95% CI 1.1% to 1.6%), without a statistically significant non-linear
relation for this endpoint, nor for stroke. There was a statistically
significant volume-outcome relation for mitral valve repair rate
(p=0.018). Based on the repair rate, the threshold to define a high-volume
centre was 60 cases/year (number needed to treat to prevent a replacement
<=7). A significant volume-outcome relation was observed for long-term
outcomes as well, with a threshold of 53 and 54 cases/year for long-term
survival and freedom from reoperation, respectively. These results were
robust across the sensitivity analyses for the various endpoints.
Conclusions The threshold to define a high-volume centre ranges between 53
and 60 cases/year based on repair rate, long-term survival and
freedom-from reoperation. These findings have the potential to facilitate
centralisation of MIMVS. Copyright © Author(s) (or their
employer(s)) 2025. No commercial re-use. See rights and permissions.
Published by BMJ Group.

<29>
Accession Number
2039287860
Title
Once-weekly insulin efsitora alfa versus once-daily insulin glargine U100
in adults with type 2 diabetes treated with basal and prandial insulin
(QWINT-4): a phase 3, randomised, non-inferiority trial.
Source
The Lancet. 405(10497) (pp 2290-2301), 2025. Date of Publication: 28 Jun
2025.
Author
Blevins T.; Dahl D.; Perez Manghi F.C.; Murthy S.; Ortiz Carrasquillo R.;
Li X.; Chang A.M.; Carr M.C.; Katz M.
Institution
(Blevins) Texas Diabetes & Endocrinology, Austin, TX, United States
(Dahl) Gemeinschaftspraxis fur Innere Medizin und Diabetologie, Hamburg,
Germany
(Perez Manghi) Centro de Investigaciones Metabolicas, Buenos Aires,
Argentina
(Murthy) Lifecare Hospital and Research Centre, Bangalore, India
(Ortiz Carrasquillo) Manati Center for Clinical Research, Manati, Puerto
Rico
(Li, Chang, Carr, Katz) Eli Lilly and Company, Indianapolis, IN, United
States
Publisher
Elsevier B.V.
Abstract
Background: Insulin efsitora alfa (efsitora), a once-weekly basal insulin,
has the potential to reduce the treatment burden of people with type 2
diabetes who require insulin. We aimed to assess the efficacy and safety
of once-weekly efsitora compared with insulin glargine U100 in adults with
type 2 diabetes treated with basal and prandial insulin. Method(s):
This phase 3, randomised, 26-week, parallel-design, open-label,
treat-to-target, non-inferiority study was done at 78 outpatient clinics
and hospitals in Argentina, Germany, India, Italy, Mexico, Spain, and the
USA (including Puerto Rico). Participants with type 2 diabetes (glycated
haemoglobin [HbA<inf>1c</inf>] 7.0-10.0%) treated with basal and prandial
insulin and up to three non-insulin glucose-lowering agents were randomly
assigned (1:1) to efsitora or glargine U100, both with prandial insulin
lispro. Randomisation was stratified by country, baseline HbA<inf>1c</inf>
(<8% vs >=8%; <63.9 mmol/mol vs >=63.9 mmol/mol), and routine use of
personal continuous glucose monitoring or flash glucose monitoring at
randomisation (yes vs no). The primary endpoint was HbA<inf>1c</inf>
change from baseline to week 26 (non-inferiority margin 0.4%). The
completed trial is registered at ClinicalTrials.gov (NCT05462756).
 Finding(s): Between Aug 11, 2022, and Feb 27, 2024, 1037 study
participants were screened and 730 were randomly assigned to efsitora
(n=365) or glargine U100 (n=365). 369 (51%) of 730 participants were
female and 361 (49%) were male, the mean participant age was 58.9 years
(SD 10.5), and the mean participant BMI was 31.85 kg/m2 (SD
5.47). Using the treatment regimen estimand, the least-squares mean
baseline HbA<inf>1c</inf> was 8.18% (SE 0.04; 65.9 mmol/mol [SE 0.47]) in
the efsitora group and 8.18% (0.04; 65.9 mmol/mol [0.47]) in the glargine
U100 group. At week 26, the least-squares mean HbA<inf>1c</inf> was 7.17%
(SD 0.05; 54.8 mmol/mol [0.51]) in the efsitora group and 7.18 (0.05; 55.0
mmol/mol [0.51]) in the glargine U100 group. The change from baseline to
week 26 using the treatment regimen estimand was -1.01 percentage points
for the efsitora group and -1.00 percentage points for the glargine U100
group, indicating non-inferiority of efsitora versus glargine U100. Rates
of overall and nocturnal level 2 (<54 mg/dL; 3.0 mmol/L) or level 3
(severe) hypoglycaemia during the treatment period were similar for
efsitora versus glargine U100 (6.6 vs 5.9 events per patient-year of
exposure, estimated rate ratio [ERR] 1.11, 95% CI 0.85-1.44; p=0.44; 0.67
vs 1.00 events per patient-year of exposure, ERR 0.67, 95% CI 0.44-1.01;
p=0.058), respectively. Adverse event occurrence was similar between
efsitora and glargine U100. Serious adverse events were reported by 25
(7%) of 365 participants in the efsitora group and 23 (6%) of 365
participants in the glargine U100 group. Interpretation(s): Efsitora
showed non-inferior HbA<inf>1c</inf> reductions and similar rates of
combined clinically significant or severe hypoglycaemia versus glargine
U100 in participants with type 2 diabetes treated with basal and prandial
insulin. These findings show that efsitora is a well tolerated and
efficacious once-weekly alternative to daily basal insulin, with a reduced
injection frequency, for the treatment of adults with type 2 diabetes.
 Funding(s): Eli Lilly and Company. Copyright © 2025 Elsevier
Ltd

<30>
Accession Number
2039110979
Title
When absence of evidence equates to evidence of absence: the case of
routine use of cerebral embolic protection devices in transcatheter aortic
valve implantation.
Source
Heart. 111(20) (pp 947-951), 2025. Date of Publication: 01 Oct 2025.
Author
Heuts S.; Kawczynski M.J.; Maesen B.; Vriesendorp P.A.
Institution
(Heuts, Kawczynski, Maesen) Department of Cardiothoracic Surgery,
Maastricht University Medical Center, Maastricht, Netherlands
(Heuts, Kawczynski, Maesen, Vriesendorp) Cardiovascular Research Institute
Maastricht, Maastricht University, Maastricht, Netherlands
(Vriesendorp) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
BMJ Publishing Group
Abstract
Objectives This updated hierarchical Bayesian meta-analysis aims to
integrate the latest randomised controlled trials (RCTs) on the use of
cerebral embolic protection (CEP) in transcatheter aortic valve
implantation (TAVI) into previously available data, providing a definite
answer to the clinical effectiveness of CEP in TAVI patients. Methods A
systematic search was updated on 31 March 2025. RCTs were included when
comparing transfemoral TAVI with use of CEP versus transfemoral TAVI
without CEP. The primary outcome was all stroke, while the secondary
outcome was disabling stroke. A hierarchical Bayesian meta-analysis was
performed on the (log) relative risk (RR) scale and transformed to
absolute risk differences (ARDs) and numbers needed to treat (NNTs). The
threshold for clinical relevance was based on published expert consensus
and established on 1.1% ARD (NNT 91). Results The study was updated with
one new RCT, totalling a number of eight RCTs (n = 11590, CEP n = 5921
patients, control n = 5669 patients). The prevalence of all stroke and
disabling stroke was 2.9% and 1.4% in the control group. The median RR for
all stroke was 0.94 (95% credible interval (CrI) 0.72-1.25), translating
to a mean of -0.17% ARD (NNT 588), and a posterior probability of a
clinically relevant CEP effect of <1%. The median RR for disabling stroke
was 0.76 (95% CrI 0.44-1.23), translating to a mean of -0.36% ARD (NNT
278), and a posterior probability of a clinically relevant CEP effect of
<1%. Conclusion Current-generation CEP devices are ineffective in reducing
periprocedural TAVI-stroke risk to a clinically relevant degree, rendering
future trials with these devices futile. Copyright © Author(s)
(or their employer(s)) 2025. No commercial re-use. See rights and
permissions. Published by BMJ Group.

<31>
Accession Number
2040637232
Title
Trade-Off Between Bleeding and Ischemic Events From Left Ventricular
Assist Devices: A EUROMACS Registry Analysis.
Source
Journal of the American College of Cardiology. 86(15) (pp 1111-1123),
2025. Date of Publication: 14 Oct 2025.
Author
Gallone G.; Baldetti L.; Veen K.M.; Bernhardt A.M.; Caliskan K.; Fiane A.;
Najjar E.; Netuka I.; Ozbaran M.; Pya Y.; Scandroglio A.M.; Spitaleri A.;
Sangiorgi D.; Zimpfer D.; Farber G.; Gummert J.; Meyns B.; de By T.M.M.H.;
Schoenrath F.; De Ferrari G.M.; Rinaldi M.; Potapov E.; Loforte A.
Institution
(Gallone, Spitaleri, De Ferrari, Rinaldi, Loforte) Cardiovascular and
Thoracic Department, Citta della Salute e della Scienza Hospital, Turin,
Italy
(Gallone, De Ferrari) Department of Medical Sciences, University of Turin,
Turin, Italy
(Baldetti, Scandroglio) Cardiac Intensive Care Unit, Istituto di Ricovero
e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan,
Italy
(Veen) Thorax Center, Department of Cardiothoracic Surgery, Erasmus
Medical Center, Rotterdam, Netherlands
(Bernhardt) University Heart and Vascular Center Hamburg, Department of
Cardiovascular Surgery, Hamburg, Germany
(Caliskan) Thorax Center, Department of Cardiology, Cardiovascular
Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
(Fiane) Department of Cardiothoracic Surgery, Oslo University Hospital and
Faculty of Medicine, Oslo, Norway
(Najjar) Karolinska University Hospital, Stockholm, Sweden
(Najjar) Department of Medicine, Karolinska Institutet, Stockholm, Sweden
(Netuka) Institute for Clinical and Experimental Medicine, Prague, Czechia
(Ozbaran) Ege University Hospital, Izmir, Turkey
(Pya) Heart Center, Corporate Fund University Medical Center, Astana,
Kazakhstan
(Spitaleri, Rinaldi, Loforte) Department of Surgical Sciences, University
of Turin, Turin, Italy
(Spitaleri) PhD Programme in Bioengineering and Medical-Surgical Sciences,
University of Turin, Politecnico di Torino, Turin, Italy
(Sangiorgi) Cardiovascular Department, Maria Cecilia Hospital, Gruppo
Villa Maria Care and Research, Cotignola, Italy
(Zimpfer) Vienna Medical University, Vienna, Austria
(Farber) Department of Thoracic and Cardiovascular Surgery, University
Hospital Wurzburg, Wurzburg, Germany
(Gummert) Herz- und Diabeteszentrum North Rhine-Westphalia, Bad
Oeynhausen, Germany
(Meyns) Katholieke Universiteit Leuven, Leuven, Belgium
(de By) EUROMACS (European Registry for Patients With Mechanical
Circulatory Support), EACTS House, Windsor, United Kingdom
(Schoenrath, Potapov) Department of Cardiothoracic and Vascular Surgery,
Deutsches Herzzentrum der Charite, Berlin, Germany
(Schoenrath, Potapov) Charite-Universitatsmedizin Berlin, Corporate Member
of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin,
Germany
(Schoenrath, Potapov) German Centre for Cardiovascular Research, Partner
Site Berlin, Berlin, Germany
Publisher
Elsevier Inc.
Abstract
Background: A fully magnetically levitated centrifugal-flow pump
(HeartMate 3 [HM3]) has significantly reduced thromboembolic events in
left ventricular assist device (LVAD) patients, potentially modifying the
trade-off of ischemic and bleeding events with current management
strategies. Objective(s): The authors sought to characterize the
opposing risk of ischemic and bleeding hemocompatibility-related adverse
events (HRAEs) in LVAD carriers with contemporary practice.
 Method(s): We included 4,320 patients undergoing centrifugal-flow
LVAD implantation (HeartWare [HVAD] cohort: 2,088, HM3 cohort: 2,232) in
EUROMACS (European Registry for Patients with Mechanical Circulatory
Support). First ischemic HRAEs (ischemic stroke, pump thrombosis, and
arterial noncentral nervous system thromboembolism) and first major
nonsurgical bleeding HRAEs (intracranial and non-intracranial) occurring
between 2 weeks and 2 years from LVAD implantation were evaluated.
 Result(s): A lower incidence in ischemic (2.9% vs 15.3% per 100
patient-years; P < 0.001) and bleeding (11.8% vs 18%; P < 0.001) HRAEs was
observed in the HM3 cohort as compared to the HVAD cohort, with the
decrease being particularly pronounced for ischemic HRAEs. The results
were consistent for all subtypes of events and by subperiods (15-90,
91-365, >365 days). Despite higher absolute risks in the HVAD cohort, the
trade-off between ischemic and bleeding HRAEs was better matched in the
HVAD as compared to the HM3 cohorts (bleeding events - ischemic events:
2.7% vs 8.9% per 100 patient-years; P < 0.001), with a persistently
prevalent bleeding risk in HM3 carriers across subperiods. Ischemic and
bleeding HRAEs were associated with all-cause death in both cohorts.
 Conclusion(s): Advances in pump technology have significantly reduced
HRAEs in real-world LVAD carriers and have reshaped the balance between
ischemic and bleeding risks under current management. The ongoing
exceeding bleeding risk observed in contemporary practice underscores the
urgent need for novel antithrombotic strategies that better align with the
residual ischemic and bleeding profiles of LVAD patients. Copyright
© 2025 American College of Cardiology Foundation

<32>
Accession Number
2036130041
Title
Systematic review and network meta-analysis of outcomes of transcatheter
strategies and surgical shunts for treatment of duct-dependent cyanotic
congenital heart disease.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1594779. Date of Publication: 2025.
Author
Chee Q.Z.; Buvaneswarran S.; Chen C.K.; Shen L.; Quek S.C.
Institution
(Chee, Chen, Quek) Division of Cardiology, Department of Paediatrics, Khoo
Teck Puat-National University Children's Medical Institute, National
University Health System, Singapore, Singapore
(Buvaneswarran) Department of Neonatology, Khoo Teck Puat-National
University Children's Medical Institute, National University Health
System, Singapore, Singapore
(Buvaneswarran, Chen, Quek) Department of Paediatrics, Yong Loo Lin School
of Medicine, National University of Singapore, Singapore, Singapore
(Shen) Biostatistics Unit, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore
Publisher
Frontiers Media SA
Abstract
Introduction: Cyanotic congenital heart disease with duct-dependent
pulmonary blood flow requires initial palliation before definitive repair.
Traditionally, these were surgical systemic-to-pulmonary shunts (SPS) such
as the modified Blalock-Taussig-Thomas shunt. Transcatheter procedures are
recently emerging as alternative options. Previous reviews have compared
ductal stenting (DS) or right ventricular outflow tract (RVOT)
intervention to surgical SPS, but none compared all three strategies in a
single meta-analysis. Method(s): We performed a systematic review and
network meta-analysis for a three-way comparison of DS, RVOT intervention,
and surgical SPS as initial palliation in children aged 0-3 with cyanotic
congenital heart disease. Primary outcomes were mortality rates,
complication rates, and re-intervention rates. MEDLINE, EMBASE, and
Cochrane databases were searched for publications from 2003 to 2023.
References of previous systematic reviews were screened. Result(s):
Twenty publications were included for analysis, for a total of 4,441
patients. Transcatheter options consistently ranked superior to surgical
SPS for Early and Overall Mortality. DS also outperformed surgical SPS for
Procedural Complications. Surgical SPS was worst for Early
Re-interventions, but outperforms both transcatheter options for Overall
Re-interventions and Intra-procedural Mortality. Both DS and RVOT stenting
conferred a shorter overall hospitalization duration compared to surgical
SPS, and DS also gave a shorter length of stay in intensive care compared
to surgical SPS. Conclusion(s): Transcatheter options are viable,
safe, and attractive alternatives to traditional surgical shunts in the
treatment of duct-dependent cyanotic heart disease. With wider adoption,
increased collective expertise will help to further improve patient
outcomes of these less-invasive techniques. Systematic Review
Registration: PROSPERO (CRD42024489748). Copyright 2025 Chee,
Buvaneswarran, Chen, Shen and Quek.

<33>
Accession Number
2034454647
Title
Intravenous leiomyomatosis: A case report and narrative literature review.
Source
International Journal of Gynecology and Obstetrics. 171(1) (pp 170-176),
2025. Date of Publication: 01 Oct 2025.
Author
Teixeira B.; Neves M.C.; Fonseca F.; Torres J.P.; Teixeira J.; Costa A.
Institution
(Teixeira, Neves, Costa) Gynecological Unit, Centro Hospitalar
Universitario de Sao Joao, Porto, Portugal
(Fonseca, Torres) Department of Cardiothoracic Surgery, Centro Hospitalar
Universitario de Sao Joao, Porto, Portugal
(Teixeira) Department of Vascular Surgery, Centro Hospitalar Universitario
de Sao Joao, Porto, Portugal
(Costa) Department of Obstetrics and Gynecology, Faculdade de Medicina da
Universidade do Porto, Porto, Portugal
Publisher
John Wiley and Sons Ltd
Abstract
In the present study, we report a case of intravenous leiomyomatosis with
intracardiac extension. A subsequent extensive literature review was
initiated in order to characterize this entity in terms of clinical
manifestations, diagnosis and treatment strategies. We performed a
literature search in PubMed, Webscience and Scopus using the MeSH term
"intravenous leiomyomatosis" and included case reports, case series and
retrospective studies published in the last 10 years. A total of 74
articles, with a total of 672 cases of intravenous leiomyomatosis were
included. The average age at diagnosis was 45.5 years and 92% of the cases
were reported in Asian countries. A total of 21% of the patients were
asymptomatic. The most frequent symptoms included perception of pelvic
mass, dyspnea, abnormal uterine bleeding and palpitations. In 55% of cases
there was a preoperative suspicion of the diagnosis. In 61%, the lesion
was confined to the pelvic cavity and in 35% there was extension beyond
the renal veins (including intracardiac extension). When there was a
preoperative diagnosis, the surgical team usually included elements from
gynecology, vascular surgery and/or cardiac surgery. The treatment
consisted of one-stage surgery in 86% of cases, with complete resection in
90%. The recurrence rate was 12%. Intravenous leiomyomatosis can have a
nonspecific presentation which, combined with its rarity, requires a high
degree of suspicion. The challenges in its treatment and follow-up arise
from its surgical complexity and the absence of guidelines. The objective
of this review was to compile the most recent cases reported to better
characterize this rare entity thereby achieving optimal
management. Copyright © 2025 International Federation of
Gynecology and Obstetrics.

<34>
Accession Number
2036211041
Title
Preventive Efficacy of Oxygenation on Contrast-Associated Acute Kidney
Injury in Chronic Kidney Disease (stages 3-5) Patients Undergoing Elective
Coronary Angiography +/- Revascularisation: An Open Label Bicentric
Randomised Controlled Trial.
Source
Nephrology. 30(9) (no pagination), 2025. Article Number: e70122. Date of
Publication: 01 Sep 2025.
Author
Bhatia I.S.; Murari T.; Dogra P.M.; Ananthakrishnan R.; Dhillon G.S.;
Hasvi J.
Institution
(Bhatia, Murari, Hasvi) Department of Medicine, Armed Forces Medical
College, Pune, India
(Dogra) Department of Nephrology, Army Hospital (R&R), Delhi, India
(Ananthakrishnan) Department of Cardiology, Army Institute of
Cardiothoracic Sciences, Pune, India
(Dhillon) Department of Community Medicine, Armed Forces Medical College,
Pune, India
Publisher
John Wiley and Sons Inc
Abstract
Aim: Contrast-associated acute kidney injury (CA-AKI) has higher mortality
in coronary artery disease (CAD) with chronic kidney disease (CKD),
undergoing coronary angiography +/- revascularisation (CAG +/- R). We
conducted a clinical superiority trial with dichotomous outcomes to
evaluate the impact of renal hypoxia mitigation with oxygen therapy (OT)
on CA-AKI incidence. Method(s): CKD stages 3-5 patients undergoing
CAG +/- R were assigned to the OT group (OTG) and the control therapy
group (CTG). CTG received hydration only, whereas OTG received 2 L/min of
pure oxygen in addition to hydration. The primary endpoint was the
incidence of CA-AKI at 48 h. Secondary endpoints included patient and
renal survival (doubling of serum creatinine or dialysis dependency) at 30
days, as well as intervention complications. Result(s): Of the 395
patients, 321 patients qualified for the per-protocol analysis (OTG: 160
and CTG: 161). CA-AKI incidence was 5.6%, and OTG observed an effective
prevention (1.25% vs. 9.93%, CTG, p = 0.004). Renal and patient survival
at 30 days was 100%. Three CTG patients required dialysis and were
dialysis-independent at 30 days. The risk of CA-AKI incidence was high
among ages > 65 years (p = 0.007), previous acute myocardial infarction (p
= 0.02), CKD stage-3 (p = 0.01) and avoidance of OT use (p = 0.02). OTG
had a favourable serum creatinine trend (p = 0.05). Absolute risk
reduction of CA-AKI with OT was 8.7%, and the number needed to treat was
12. Interventional complications were zero. Conclusion(s): Oxygen
supplementation and saline hydration effectively prevented CA-AKI in CKD
stages 3-5 patients undergoing elective CAG +/- R. Hence, oxygen therapy
should be a standard CA-AKI protective strategy during CAG +/- R and
radiocontrast-related procedures. Copyright © 2025 Asian Pacific
Society of Nephrology.

<35>
Accession Number
2040603729
Title
Factors predicting the outcome of thoracic ossification of ligamentum
flavum (OLF) surgery: A systematic review and meta-analysis.
Source
Journal of Clinical Neuroscience. 142 (no pagination), 2025. Article
Number: 111649. Date of Publication: 01 Dec 2025.
Author
Tayal A.; Mitra P.; Modak A.; Asri S.; Garg K.
Institution
(Tayal, Mitra, Modak) University College of Medical Sciences and Guru Teg
Bahadur Hospital, Delhi, India
(Asri) Shree Guru Gobind Singh Tricentenary Medical College Hospital and
Research Institute, Gurugram, India
(Garg) Department of Neurosurgery and Gamma Knife, All India Institute of
Medical Sciences, Delhi, India
Publisher
Churchill Livingstone
Abstract
Background: The study aimed to determine the association between
demographics, clinical presentation, radiological findings, and
intraoperative characteristics of patients with thoracic ossification of
ligamentum flavum (OLF) surgery and their postoperative outcomes.
 Method(s): PubMed, Ovid, Embase, and Web of Sciences databases were
searched until July 2023 to include articles regarding the prognostic
factors for thoracic OLF surgery. The risk of bias was assessed using the
Quality In Prognosis Studies (QUIPS) tool. The outcome of surgery was
evaluated by calculating the recovery rate (RR), as follows: RR =
(postoperative Japanese Orthopedic Association (JOA) score - preoperative
JOA score)/(11 - preoperative JOA score). Meta-analyses Of Observational
Studies in Epidemiology (MOOSE) and Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.
Furthermore, factors associated with outcome were assessed separately
within open and minimally invasive surgery (MIS) subgroups.
 Result(s): Thirty-six studies with 1,511 patients were included. RR
was associated with age (p-value = 0.012), JOA score (p-value < 0.001),
ossified region (middle vs. lower thoracic spine: p-value = 0.042),
intramedullary signal intensity change on T2-weighted magnetic resonance
imaging (p-value < 0.001), and occurrence of dural ossification (p-value =
0.006). On subgroup analysis, JOA score (p-value < 0.001) and operation
time (p-value = 0.014) were associated with outcomes for patients managed
with an open surgical approach, while none for those operated with the MIS
technique. Conclusion(s): Although surgery is the cornerstone of the
management of OLF, careful patient prognostication should be performed
considering the aforementioned factors. Further, high-quality research is
warranted to confirm the findings of this study. Copyright © 2025
Elsevier Ltd

<36>
Accession Number
2039904438
Title
SCAI/HRS technical review on transcatheter left atrial appendage
occlusion.
Source
Heart Rhythm. 22(10) (pp e1064-e1074), 2025. Date of Publication: 01 Oct
2025.
Author
Cronin E.M.; Filby S.; Field M.E.; Huded C.; Indik J.H.; Sharma A.; Armah
C.; Firestone S.; Fix A.M.; Senerth E.; Morgan R.L.; Falck-Ytter Y.
Institution
(Cronin) Lewis Katz School of Medicine at Temple University, Philadelphia,
Pennsylvania, United States
(Filby) University Hospitals Cleveland Medical Center, Cleveland, Ohio,
United States
(Field) Roper St. Francis Healthcare, Charleston, South Carolina, United
States
(Huded) Saint Luke's Mid America Heart Institute, Kansas City, Missouri,
United States
(Indik) Sarver Heart Center, University of Arizona, Tucson, AZ, United
States
(Sharma) Rutgers New Jersey Medical School, Newark, New Jersey, United
States
(Armah, Firestone) Society for Cardiovascular Angiography & Interventions,
Washington, DC, United States
(Fix) Heart Rhythm Society, Washington, DC, United States
(Senerth, Morgan, Falck-Ytter) Evidence Foundation, Cleveland Heights, OH,
United States
(Morgan) School of Medicine, Case Western Reserve University, Cleveland,
Ohio, United States
(Morgan) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Falck-Ytter) Case Western Reserve University, Cleveland, Ohio, United
States
(Falck-Ytter) Division of Gastroenterology and Hepatology, Veterans
Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, United States
Publisher
Elsevier B.V.
Abstract
Background: Nonvalvular atrial fibrillation (NVAF) is associated with an
increased risk of stroke due to thrombus formation in the left atrial
appendage, where over 90% of thrombi originate. While oral anticoagulation
(OAC) is the standard therapy for stroke prevention, many patients cannot
tolerate long-term OAC due to bleeding risks. Percutaneous left atrial
appendage occlusion (LAAO) has emerged as an alternative strategy. Despite
its rapid adoption, substantial variability exists in clinical practice
regarding patient selection, imaging techniques, procedural guidance, and
postprocedural management. This systematic review aims to collect and
synthesize evidence to inform the development of new Society for
Cardiovascular Angiography & Interventions and the Heart Rhythm Society
guidelines on LAAO. Method(s): We searched PubMed, Embase, and
Cochrane Library from inception through January 5, 2024, for studies of
the percutaneous LAAO procedure. Eligible studies were conducted in adults
with NVAF undergoing LAAO, or with peridevice leak or device-related
thrombus after an occlusion procedure. Studies of surgical LAAO, double
device or combined procedures, and devices that are not currently marketed
in the United States were excluded. Data were extracted from studies in
duplicate and summarized using meta-analysis and narrative synthesis. Risk
of bias (RoB) was assessed using the RoB in nonrandomized studies of
interventions tool, and version 2 of the Cochrane RoB tool for randomized
trials (RoB 2.0). Overall certainty of evidence was assessed using the
Grading of Recommendations Assessment, Development, and Evaluation
approach. Result(s): Our search identified 3769 titles and abstracts,
of which 27 studies met eligibility criteria and contributed data to the
analysis. Data were abstracted to address outcomes of LAAO for stroke
prevention in patients with NVAF, in comparison to OAC, no therapy, and
across various approaches including preprocedure imaging, intraprocedure
guidance, and postprocedure antithrombotic regimens. Conclusion(s):
Left atrial appendage occlusion is an effective alternative to OAC for
stroke prevention in NVAF patients with bleeding risks, but uncertainties
remain regarding imaging strategies and postprocedural
management. Copyright © 2025 Society for Cardiovascular
Angiography & Interventions Foundation and Heart Rhythm Society.

<37>
Accession Number
2040642703
Title
Effect of Dapagliflozin on Quality of Life of Patients With Aortic
Stenosis Undergoing Transcatheter Aortic Valve Implantation.
Source
Journal of the American College of Cardiology. 86(15) (pp 1128-1138),
2025. Date of Publication: 14 Oct 2025.
Author
Bonanad-Lozano C.; Garcia Blas S.; Amat-Santos I.; Gonzalez-Manzanares R.;
Sanchis J.; Lopez Otero D.; Nombela Franco L.; Gheorge L.; Sanz-Sanchez
J.; Baladron Zorita C.; Iniguez Romo A.; Munoz Garcia A.J.; Vilalta V.;
Ojeda S.; Veiga Fernandez G.; Cordoba Soriano J.G.; Cepas P.; Sandin
Rollan M.; Rios X.F.; Palma-Carbajal R.; Martin Reyes R.; Romaguera R.;
Avanzas P.; Franco-Pelaez J.A.; Martin Moreiras J.; Gonzalez Juanatey
J.R.; Tirado G.; Calle G.; Diez J.L.; Santos-Martinez S.; Dominguez
Erquicia P.; Garcia E.M.; Fernandez-Nofrerias E.; Lopez Pais J.; Gonzalo
N.; Barri A.G.; Asmarats L.; Lopez Perez M.; Dominguez Rodriguez L.M.;
Cobo M.; Gonzalez Bermudez I.; Garcia Alvarez A.; Garcia Pavia P.; Fuster
V.; Ibanez B.; Raposeiras-Roubin S.
Institution
(Bonanad-Lozano, Garcia Blas, Sanchis) Clinic University Hospital of
Valencia, Valencia, Spain
(Bonanad-Lozano, Garcia Blas, Sanchis) INCLIVA Biomedical Research
Institute, Valencia, Spain
(Bonanad-Lozano, Sanchis) Department of Medicine, Faculty of Medicine,
University of Valencia, Valencia, Spain
(Bonanad-Lozano, Garcia Blas, Amat-Santos, Gonzalez-Manzanares, Sanchis,
Lopez Otero, Baladron Zorita, Ojeda, Gonzalez Juanatey, Ibanez) Centro de
Investigacion Biomedica en Red Enfermedades Cardiovasculares (Center for
Biomedical Network Research for Cardiovascular Diseases; CIBER-CV), Spain
(Amat-Santos, Baladron Zorita, Santos-Martinez) Department of Cardiology,
University Clinical Hospital of Valladolid, Valladolid, Spain
(Gonzalez-Manzanares, Ojeda) Department of Cardiology, University Hospital
Reina Sofia, Cordoba, Spain
(Gonzalez-Manzanares, Ojeda) Instituto Maimonides de Investigacion
Biomedica de Cordoba (Maimonides Institute of Biomedical Ressearch of
Cordoba, IMIBIC), Cordoba, Spain
(Lopez Otero) Department of Cardiology, University Hospital Montecelo,
Pontevedra, Spain
(Lopez Otero, Gonzalez Juanatey, Lopez Pais) Department of Cardiology,
University Clinical Hospital of Santiago de Compostela, Pontevedra, Spain
(Lopez Otero, Iniguez Romo, Dominguez Erquicia, Gonzalez Bermudez,
Raposeiras-Roubin) Instituto de Investigacion Sanitaria Galicia Sur
(Health Research Institute of Southern Galicia), Vigo, Spain
(Nombela Franco, Tirado, Gonzalo) Department of Cardiology, University
Clinical Hospital San Carlos, Madrid, Spain
(Gheorge, Calle, Barri) Department of Cardiology, University Hospital
Puerta del Mar, Cadiz, Spain
(Sanz-Sanchez, Diez) Department of Cardiology, University Hospital La Fe,
Valencia, Spain
(Iniguez Romo, Dominguez Erquicia, Gonzalez Bermudez, Raposeiras-Roubin)
Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo,
Spain
(Munoz Garcia, Garcia) Department of Cardiology, University Hospital
Virgen de la Victoria, Malaga, Spain
(Vilalta, Fernandez-Nofrerias) Department of Cardiology, University
Hospital German Trias i Pujol, Badalona, Spain
(Ojeda) Universidad de Cordoba, Cordoba, Spain
(Veiga Fernandez) Department of Cardiology, University Hospital Marques de
Valdecilla, Santander, Spain
(Veiga Fernandez) IDIVAL, Santander, Spain
(Cordoba Soriano) Department of Cardiology, University Hospital of
Albacete, Albacete, Spain
(Cepas, Garcia Alvarez) Department of Cardiology, University Clinical
Hospital, Barcelona, Spain
(Sandin Rollan) Department of Cardiology, University General Hospital of
Alicante, Alicante, Spain
(Rios) Department of Cardiology, University Hospital Juan Canalejo, A
Coruna, Spain
(Palma-Carbajal) Department of Cardiology, University Hospital Vall
D'Hebron, Barcelona, Spain
(Martin Reyes) Department of Cardiology, University Hospital Quiron Salud
La Luz, Madrid, Spain
(Romaguera) Department of Cardiology, University Hospital Bellvitge,
Barcelona, Spain
(Avanzas) Department of Cardiology, University Hospital Central de
Asturias, Oviedo, Spain
(Franco-Pelaez, Ibanez) Department of Cardiology, University Hospital
Fundacion Jimenez Diaz, Madrid, Spain
(Martin Moreiras) Department of Cardiology, University Clinical Hospital
of Salamanca, Salamanca, Spain
(Gonzalez Juanatey) Instituto de Investigacion Sanitaria de Santiago
(Santiago Institute of Health Research, IDIS), Santiago de Compostela,
Spain
(Gonzalez Juanatey, Raposeiras-Roubin) University of Santiago de
Compostela, Santiago de Compostela, Spain
(Asmarats) Department of Cardiology, University Hospital Santa Creu i Sant
Pau, Barcelona, Spain
(Lopez Perez) Department of Cardiology, University Hospital San Cecilio,
Granada, Spain
(Dominguez Rodriguez) Department of Cardiology, University Hospital Ramon
y Cajal, Madrid, Spain
(Cobo, Garcia Pavia) Diipartment of Cardiology, University Hospital Puerta
del Hierro, Madrid, Spain
(Fuster, Ibanez, Raposeiras-Roubin) Centro Nacional de Investigaciones
Cardiovasculares Carlos III (Carlos III National Center of Cardiovascular
Research, CNIC), Madrid, Spain
(Fuster) Cardiovascular Institute, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Patients with aortic stenosis who undergo transcatheter aortic
valve implantation (TAVI) experience a great improvement in health status.
Dapagliflozin has been shown to reduce death and heart failure (HF) in
these patients. However, the impact of dapagliflozin on improving health
status after TAVI is unknown. Objective(s): In this prespecified
analysis of the DapaTAVI (Dapagliflozin After Transcatheter Aortic Valve
Implantation) trial, we examined the effects of dapagliflozin on health
status by using the Kansas City Cardiomyopathy Questionnaire (KCCQ).
 Method(s): The DapaTAVI trial randomized patients undergoing TAVI to
receive or not receive dapagliflozin. We assessed the change in KCCQ score
from baseline to 3 and 12 months by using an ordinal logistic regression
model. Additionally, we analyzed the effect of dapagliflozin on the
composite of death or worsening HF by baseline KCCQ score. Result(s):
A total of 964 patients had baseline KCCQ scores (mean 39.5 +/- 22.2).
Patients in both arms of the study exhibited improvements in KCCQ score,
without significant differences between groups in the change in KCCQ score
at 3 or 12 months (3-month OR for improvement: 0.96; 95% CI: 0.72-1.26; P
= 0.745; 12-month OR: 1.03; 95% CI: 0.83-1.27; P = 0.819). At 12 months,
similar proportions of patients in the dapagliflozin and control groups
showed clinically meaningful improvements, with 43.4% vs 45.4%,
respectively, improving by >50 points. The clinical benefits of
dapagliflozin after TAVI appeared to be similar across the full range of
baseline KCCQ scores. Conclusion(s): TAVI was associated with a
substantial improvement in KCCQ scores. However, the addition of
dapagliflozin following the procedure did not confer an additional benefit
in health status compared with standard care. (Dapagliflozin After
Transcatheter Aortic Valve Implantation [DapaTAVI];
NCT04696185). Copyright © 2025 American College of Cardiology
Foundation

<38>
Accession Number
2036221090
Title
Direct Comparison of Urgent Transcatheter Aortic Valve Implantation and
Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Dimitriadis K.; Pyrpyris N.; Aznaouridis K.; Bonnet G.; Beneki E.;
Theofilis P.; Plaites A.; Antonopoulos A.; Chrysohoou C.; Tsioufis K.
Institution
(Dimitriadis, Pyrpyris, Aznaouridis, Beneki, Theofilis, Plaites,
Antonopoulos, Chrysohoou, Tsioufis) First Cardiology Department, School of
Medicine, Hippokration General Hospital, National and Kapodistrian
University of Athens, Athens, Greece
(Bonnet) Hopital Haut Leveque, Bordeaux, France
(Beneki) Department of Cardiology, Lausanne University Hospital, Lausanne,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Objective: Aortic stenosis (AS) may complicate cardiogenic shock (CS) or
acute decompensated heart failure (ADHF) in a small but significant number
of patients. In such cases, urgent treatment is necessary to prevent
mortality and adverse outcomes. Transcatheter aortic valve implantation
(TAVI) and balloon aortic valvuloplasty (BAV) represent the main treatment
options, however, limited studies have compared them directly. Therefore,
this systematic review and meta-analysis aims to synthesize available
studies directly comparing urgent TAVI and BAV, in respect to reported
outcomes. Method(s): We systematically searched MEDLINE/PubMed,
Scopus and Web of Science for studies comparing outcomes in patients with
CS or ADHF undergoing urgent TAVI or BAV. Followingly, a meta-analysis of
all included studies was performed. Result(s): A total of six
studies, including 21,020 patients (10,597 patients undergoing TAVI and
10,423 patients undergoing BAV) were analyzed. Regarding in-hospital
mortality, it was found to be significantly lower in patients undergoing
urgent TAVI, compared to BAV (risk ratio [RR]: 0.53; 95% confidence
interval (CI): 0.32-0.87]. Moreover, urgent TAVI was also associated with
significantly lower all-cause mortality at 30-days follow up (RR 0.51, 95%
CI: 0.31-0.84). Conclusion(s): In this meta-analysis of
observational, retrospective studies including patients undergoing urgent
transcatheter interventions for acute AS, TAVI is associated with
significantly reduced in-hospital and 30-days mortality, in comparison to
BAV. More larger studies, reporting extended follow-up and adverse events'
rates, are needed to safely conclude regarding the benefit of urgent
interventions in the acute care. Copyright © 2025 The Author(s).
Catheterization and Cardiovascular Interventions published by Wiley
Periodicals LLC.

<39>
Accession Number
2036220856
Title
Effect of Diabetes Mellitus on Clinical Outcomes After Transcatheter
Aortic Valve Implantation: An Updated Systematic Review and Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Gomes R.A.P.; Suruagy Motta R.F.O.; Filho E.M.; Cheidde L.; Dos Santos
K.D.A.; Assumpcao J.V.A.; Anselmi L.F.; Neto A.P.D.M.; Pantaleao A.N.;
Harmouch K.M.; Modi K.
Institution
(Gomes, Cheidde) Faculty of Medicine, Pontifical Catholic University of
Sao Paulo, Sorocaba, Brazil
(Suruagy Motta) Department of Medicine, Cesmac University Center, Maceio,
Brazil
(Filho) Santa Casa de Misericordia Hospital, Maceio, Brazil
(Dos Santos, Neto) Faculty of Medicine, Federal University of Roraima, Boa
Vista, Brazil
(Assumpcao) Faculty of Medicine, Pontifical Catholic University of Parana,
Curitiba, Brazil
(Anselmi) Mackenzie Evangelical College of Parana, Curitiba, Brazil
(Pantaleao) School of Medicine, Federal University of Minas Gerais, Belo
Horizonte, Brazil
(Harmouch) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, MI, United States
(Modi) LSU Health, Shreveport, LA, United States
Publisher
John Wiley and Sons Inc
Abstract
Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TARV) is a
widely established treatment for symptomatic severe aortic stenosis (AS)
in patients with high or intermediate surgical risk. Diabetes mellitus
(DM) is prevalent in TAVR patients and is associated with an increased
risk of cardiovascular events, which may elevate procedural risks. A
systematic review and meta-analysis were conducted following PRISMA
guidelines. PubMed, Web of Science, and Cochrane databases were searched.
A random-effects model was applied, with 95% confidence intervals (CIs)
and a 5% significance level. Statistical analyses were performed using
RStudio version 4.4.1. Twelve studies with 214,444 patients were included,
comprising 74,294 diabetic and 140,150 nondiabetic individuals. The
analysis revealed no significant differences in all-cause mortality,
procedure mortality, 30-day mortality, or complications such as bleeding,
myocardial infarction, and major complications. However, 1-year mortality
was significantly higher in the diabetic group (RR: 1.51, 95% CI:
1.08-2.13). Diabetic patients were at higher risk for renal injury (RR:
1.46, 95% CI: 1.40-1.51) and lower risk of stroke (RR: 0.91, 95% CI:
0.83-0.99). The length of hospital stay and other major complications
showed no significant differences. There was an increased risk of 1-year
mortality and renal injury in diabetic patients undergoing TAVI compared
to non-diabetics. Surprisingly, the risk for developing stroke in the
diabetic group was significantly lower. In any case, the study emphasizes
the need for tighter DM control to decrease the risk of such complications
in the future. Copyright © 2025 Wiley Periodicals LLC.

<40>
Accession Number
2036240252
Title
Optimizing left ventricular assist device speed: a systematic review for
the heart failure clinician.
Source
Future Cardiology. (no pagination), 2025. Date of Publication: 2025.
Author
Jimenez Y.; Tsai C.; Mrizigue F.; Ahmed M.M.
Institution
(Jimenez, Tsai, Ahmed) Division of Cardiovascular Medicine, University of
Florida, Gainesville, FL, United States
(Mrizigue) Department of Neuroscience, University of Washington, Seattle,
WA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Left ventricular assist devices have been demonstrated to
improve both quality of life and improve survival in patients with
end-stage heart failure. Ideal speed setting of these devices is necessary
to provide adequate left ventricular unloading while not disadvantaging
the right heart. This highlights the potential utility of speed titration
studies. Method(s): PubMed, Scopus, and the Cumulative Index to
Nursing and Allied Health Literature databases were searched for: (LVAD)
OR (Left Ventricular Assist Device) OR (VAD) OR (Ventricular Assist
Device) AND (Speed Optimization) OR (Ramp Study) from inception to April
2025. Result(s): 22 studies with 749 total patients were included,
45% of whom had a Heart Mate 3. Outcomes of interest included mortality,
readmission, RV function, speed change at conclusion of the study, and
quality of life. Only 1 out of 22 studies reported all 5 outcomes, with
64% reporting 2 or fewer outcomes of interest. Conclusion(s): There
exists limited data on speed optimization in the HM3, and that which has
been reported lacks a standardization regarding method of evaluation as
well as outcomes reporting. Prospective studies, with a standard method of
speed optimization and more detailed outcomes reporting, are necessary in
order to define best practices. Copyright © 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<41>
Accession Number
2038418195
Title
Clinical impact of surgical left atrial appendage occlusion during cardiac
surgery in patients in sinus rhythm: A meta-analysis.
Source
Heart Rhythm. 22(10) (pp 2595-2602), 2025. Date of Publication: 01 Oct
2025.
Author
Burton S.; Ahmed R.; King N.; Reynolds A.; Modi A.; Asopa S.
Institution
(Burton, Reynolds) Bristol Heart Institute, Bristol Royal Infirmary,
Bristol, United Kingdom
(Burton) Bristol Medical School, University of Bristol, Bristol, United
Kingdom
(Ahmed) Keele University School of Medicine, Keele, United Kingdom
(King) Faculty of Health, University of Plymouth, Plymouth, United Kingdom
(Modi, Asopa) Department of Cardiothoracic Surgery, Southampton General
Hospital, Southampton, United Kingdom
Publisher
Elsevier B.V.
Abstract
Background: The clinical efficacy of surgical occlusion of the left atrial
appendage in patients with sinus rhythm undergoing cardiac surgery remains
controversial. Objective(s): This meta-analysis aims to evaluate the
impact of left atrial appendage occlusion (LAAO) on early and late
outcomes in sinus rhythm patients undergoing cardiac surgery.
 Method(s): Screened and selected studies were sourced from PubMed,
Embase, and Web of Science databases, following the Preferred Reporting
Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early
clinical outcomes were pooled using odds ratio, and long-term outcomes
were extracted from Kaplan-Meier curves to reconstruct individual
time-to-event patient data and allow for proportional hazards regression.
Bias-treated data were selected when available. Result(s): Six
studies, comprising 2742 patients, were included from the initial 1431
reports. Pooling of data demonstrated no significant association between
LAAO and the development of postoperative atrial fibrillation (odds ratio
1.157; 95% confidence interval [CI] 0.904-1.481; I2 = 46%; P =
.246). Reconstruction of Kaplan-Meier data revealed greater freedom from
cerebrovascular events in the LAAO group than in the no-LAAO group (hazard
ratio 0.482; 95% CI 0.361-0.643; P < .001). The LAAO group also
demonstrated improved midterm survival (hazard ratio 0.701; 95% CI
0.554-0.886; P = .003). Conclusion(s): This meta-analysis has
demonstrated an improved freedom from cerebrovascular events and a midterm
survival benefit in sinus rhythm patients undergoing cardiac surgery and
surgical LAAO. This meta-analysis does not demonstrate an increased
occurrence of postoperative atrial fibrillation in the LAAO group. Larger
randomized controlled trials, stratified by cardiac pathology, are
required to validate these findings. Copyright © 2025 Heart
Rhythm Society

<42>
Accession Number
2036130013
Title
The impact of comorbidities on surgical outcome and mortality in minimally
invasive mitral valve surgery: a systematic review.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1638217. Date of Publication: 2025.
Author
Zwaans V.I.T.; Stein J.; Goecke S.; Pitts L.; Akansel S.; Kofler M.;
Jacobs S.; Falk V.; Kempfert J.; Wert L.
Institution
(Zwaans, Stein, Goecke, Pitts, Akansel, Kofler, Jacobs, Falk, Kempfert,
Wert) Deutsches Herzzentrum der Charite, Department of Cardiothoracic and
Vascular Surgery, Berlin, Germany
(Zwaans, Stein, Goecke, Pitts, Akansel, Kofler, Jacobs, Falk, Kempfert,
Wert) Charite - Universitatsmedizin Berlin, Corporate Member of Freie
Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany
(Falk) DZHK (German Center for Cardiovascular Research), Partner Site
Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich, Zurich,
Switzerland
Publisher
Frontiers Media SA
Abstract
Background: We sought to outline perioperative patient data to analyse
surgical, clinical and echocardiographic outcomes and mortality of
patients undergoing minimally invasive mitral valve surgery.
 Method(s): Systematic literature research was performed in
MEDLINE/PubMed according to PRISMA guidelines. Our research considered
original works published until January 31, 2025. A pooled meta-analysis of
studies reports early and late follow-up data of mitral valve repair for
complex mitral valve regurgitation. In order to outline possible adverse
events and comorbidities, we compared patients' mortality by
differentiating preoperative, intraoperative and postoperative data.
 Result(s): This review analysed publications involving 222,947
patients, of which 43.4% were female and 56.6% were male, who underwent
minimally invasive mitral valve surgery (MIMVS). The patients had a median
age of 63.40 years (IQR: 60.42, 68.00), an average BMI of 25.1
kg/m2 (+/-7.9) and BSA of 1.7 m2 (+/-0.2). Severe
mitral insufficiency was present in 86.4% of patients, 10% showed mild to
moderate mitral insufficiency and 3.8% had mitral stenosis. The average
EuroSCORE II showed a median value of 1.75% (IQR: 1.20, 2.95) and NYHA
class III was most frequent. Comorbidities such as pulmonary hypertension
were present in 35.37% of patients, diabetes mellitus in 8.57% (IQR: 4.76,
19.41), arterial hypertension was seen in 57.58% (IQR: 40.66, 68.79) with
a significantly increased risk of mortality (p = 0.018). Coronary artery
disease exhibited a prevalence of 17.41% (IQR: 10.78, 34.04),
hypercholesterolaemia of 29.13% (IQR: 23.12, 49.74) and chronic kidney
disease of 8.93% (IQR: 1.90, 20.00). New-onset atrial fibrillation
occurred in 19.2% of patients. Besides this, 4% of patients required
postoperative pacemaker implantation. Left atrial (LA) diameter decreased
significantly from 50.37 mm preoperatively to 40.41%mm postoperatively (p
< 0.001), LVDD was significantly reduced after MIMVS (p < 0.001). Mitral
valve repair (75.83%) was considerably more common than replacement
(21.09%). Applied techniques included annuloplasty (67.87%) and neochordal
reconstruction (42.71%). Average mechanical ventilation was 540.8 min
(+/-439.8), with a significant positive correlation between 30-day
mortality and ventilation duration. In-hospital death occurred in 8
patients (+/-25), the average length of stay was 8.6 days (+/-3.9) and the
mean postoperative ICU stay was 35.1 h (+/-15.9). Revision surgery was
necessary in 4.1% of patients due to postprocedural bleeding.
Postoperatively, 92% of patients showed no signs of MR, whereas 8%
exhibited residual MR. Of those with residual MR, 78% continued to have
mild MR, 14.9% had moderate MR and 7.1% showed severe mitral regurgitation
after MIMVS. Conclusion(s): Postoperative mortality was associated
with comorbidities like chronic kidney disease, diabetes mellitus and
hypercholesterolaemia. Patients with a history of smoking, arterial
hypertension or coronary artery disease showed variable risks, indicating
that these factors may be associated with elevated in-hospital death or
death within the first postoperative month. MIMVS shows favourable
outcomes concerning echocardiographic measurements and haemodynamics such
as LVEF, as well as length of hospital stay, ICU stay, postprocedural
bleeding and complications such as wound infection or the need for blood
transfusions. Copyright 2025 Zwaans, Stein, Goecke, Pitts, Akansel,
Kofler, Jacobs, Falk, Kempfert and Wert.

<43>
Accession Number
2035908850
Title
Sugammadex or Neostigmine for prevention of post-operative pulmonary
complications after major abdominal or thoracic surgery: study protocol
for the SINFONIA (Sugammadex for preventioN oF pOst-operative pulmonary
complIcAtions) randomised controlled superiority trial.
Source
Trials. 26(1) (no pagination), 2025. Article Number: 319. Date of
Publication: 01 Dec 2025.
Author
Silversides J.A.; Savic L.; Hiller L.; Hopkins A.; Booth K.; Dorey J.;
Smithson R.; Mason J.; Frempong S.; May C.; Moonesinghe R.; O'Donnell
C.M.; Creagh-Brown B.; Kandiyali R.; Yeung J.; Pearse R.; Kaur D.;
Padfield E.; Vass D.; McNeill H.; Harris K.
Institution
(Silversides) Wellcome-Wolfson Institute for Experimental Medicine,
Queen's University Belfast, Belfast, United Kingdom
(Silversides, O'Donnell) Division of Anaesthesia, Theatres and Critical
Care, Belfast Health and Social Care Trust, Belfast, United Kingdom
(Savic) Leeds Teaching Hospitals National Health Service Trust, Leeds,
United Kingdom
(Hiller, Hopkins, Booth, Mason, Frempong, May, Kandiyali, Yeung) Warwick
Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
(Dorey) Patient and Public Involvement Representative, London, United
Kingdom
(Smithson) Patient and Public Involvement Representative, Belfast, United
Kingdom
(Moonesinghe) University College London, London, United Kingdom
(Creagh-Brown) University of Surrey, Guildford, United Kingdom
(Pearse) Queen Mary University of London, London, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Post-operative pulmonary complications (PPCs) are an important
source of morbidity and mortality after major abdominal and thoracic
surgery. The use of neuromuscular blocking drugs in general anaesthesia is
an important risk factor for PPCs. The incomplete reversal of this
neuromuscular blockade at the end of surgery leads to residual weakness of
respiratory muscles and predisposes to aspiration of pharyngeal contents,
hypoventilation, and thus to PPCs such as atelectasis and pneumonia. Two
reversal drugs for neuromuscular blocking agents are available:
neostigmine and sugammadex. Compared with neostigmine, sugammadex use
results in more rapid reversal of neuromuscular blockade, and small
clinical efficacy studies have suggested an associated lower incidence of
PPCs. The comparative clinical effectiveness of the two drugs in reducing
length of hospital stay or mortality is uncertain. Moreover, a potential
safety concern with sugammadex is the relatively high incidence of
life-threatening allergic reactions in countries where this drug has been
widely used over the last decade. Method(s): SINFONIA is a pragmatic,
randomised, open-label, parallel group, superiority trial with an internal
pilot which aims to compare the clinical and cost effectiveness of the two
available drugs for reversal of neuromuscular blockade, sugammadex and
neostigmine, in patients aged 50 years or older undergoing major abdominal
or non-cardiac thoracic surgery. The trial will randomise 2500 patients
from approximately 40 centres in the UK. The primary outcome will be days
alive and out of hospital at 30 days (DAH-30), with key secondary outcomes
of PPC incidence, quality of life, and mortality up to 180 days. An
embedded observational study will investigate the rate of allergic
sensitisation following exposure to sugammadex. Discussion(s): The
SINFONIA trial addresses an important question for anaesthetists and for
patients undergoing major abdominal and thoracic surgery. The choice of
reversal agent for neuromuscular blockade between sugammadex and
neostigmine is currently largely a matter of anaesthetist preference. A
growing body of evidence suggests that sugammadex may reduce the incidence
of post-operative pulmonary complications relative to neostigmine. This
pragmatic clinical effectiveness trial will provide robust evidence as to
the effects of the two drugs on patient-centred outcomes such as DAH-30,
as well as on cost effectiveness and the incidence of allergic
sensitisation. Trial registration: The trial was registered on the ISRCTN
database (https://www.isrctn.com) prior to opening to recruitment
(registration no 15109717). Copyright © The Author(s) 2025.

<44>
Accession Number
2032916381
Title
Effect of del Nido cardioplegia in patients with reduced left ventricular
ejection fraction: A meta-analysis.
Source
Perfusion (United Kingdom). 40(7) (pp 1612-1621), 2025. Date of
Publication: 01 Oct 2025.
Author
Yamashita Y.; Baudo M.; Magouliotis D.E.; Cabrucci F.; Sicouri S.; Ramlawi
B.
Institution
(Yamashita, Ramlawi) Department of Cardiothoracic Surgery, Lankenau Heart
Institute, Wynnewood, PA, United States
(Yamashita, Baudo, Magouliotis, Cabrucci, Sicouri, Ramlawi) Department of
Cardiothoracic Surgery Research, Lankenau Institute for Medical Research,
Wynnewood, PA, United States
Publisher
SAGE Publications Ltd
Abstract
Purpose: Research on the safety and efficacy of del Nido cardioplegia in
adult patients with reduced left ventricular ejection fraction (LVEF) is
limited. We evaluated the effect of del Nido cardioplegia on early
outcomes of cardiac surgery in this cohort. Method(s): PubMed,
Scopus, and the Cochrane Central Register of Controlled Trials were
searched through August 2024 to conduct a meta-analysis comparing del Nido
to other cardioplegia in adult patients with reduced LVEF (<=50%). Primary
endpoint was early mortality, and secondary endpoints included
morbidities, aortic cross-clamp time and postoperative LVEF before
discharge. A random-effect model was used to estimate the pooled effect
size. Result(s): Seven studies met our eligibility criteria,
including three propensity score-matched studies with a total of 1160
patients. Conventional blood cardioplegia was used exclusively as a
control solution in the included studies. The incidence of early mortality
was similar between the del Nido and control groups, with a pooled odds
ratio of 0.94 [95% confidence interval: 0.52; 1.71] (p = .822).
Postoperative stroke (p = .680), renal failure (p = .832), atrial
fibrillation (p = .412), and aortic cross-clamp time (p = .153) were also
comparable between the two groups. Postoperative LVEF was significantly
higher in the del Nido group compared to the control group, with a
standardized mean difference of 0.52 [95% confidence interval: 0.07; 0.96]
(p = .034). Conclusion(s): In adult patients with reduced LVEF
undergoing cardiac surgery, del Nido cardioplegia provides comparable
mortality and morbidity rates compared to conventional blood cardioplegic
solutions, with the potential to offer protective effects on myocardial
function. Copyright © The Author(s) 2025

<45>
Accession Number
2038940347
Title
Comparison of left atrial appendage closure and oral anti-coagulation
after catheter ablation for atrial fibrillation: Concomitant and
sequential cohorts of the OPTION randomized controlled trial.
Source
Heart Rhythm. 22(10) (pp 2585-2594), 2025. Date of Publication: 01 Oct
2025.
Author
Saliba W.; Nair D.; Swarup V.; Hall T.; Iyer V.; Perez G.C.; Weiner S.;
Shah M.; Islam N.; Grygier M.; Schuler B.; Ibanez Criado J.L.; Duthoit G.;
Reddy Y.M.; Reddy V.Y.; Mansour M.; Natale A.; Leger K.; Christen T.;
Stein K.; Sutton B.; Wazni O.
Institution
(Saliba, Wazni) Cleveland Clinic, Cleveland, Ohio, United States
(Nair) St. Bernards Medical Center & Arrhythmia Research Group, Jonesboro,
AR, United States
(Swarup) Arizona Arrhythmia Research Center, Phoenix, Arizona, United
States
(Hall) Q Cardiology, East Brisbane, QLD, Australia
(Iyer) MarinHealth Medical Center, Greenbrae, California, United States
(Perez) H. Puerta Del Mar, Cadiz, Spain
(Weiner) Christus Trinity Mother Frances Health System, Tyler, TX, United
States
(Shah) Washington Hospital Center, Washington, DC, United States
(Islam) University of Maryland St. Joseph Medical Group, Towson Maryland,
United States
(Grygier) Poznan University of Medical Sciences, Poznan, Poland
(Schuler) York Hospital, York, Pennsylvania, United States
(Ibanez Criado) Arrhythmia Unit, Cardiology Department, Hospital
Universitario Doctor Balmis, Alicante, Spain
(Ibanez Criado) Instituto de Investigacion Sanitaria y Biomedica de
Alicante (ISABIAL), Alicante, Spain
(Duthoit) Hopital Pitie-Salpetriere, APHP, Paris, France
(Reddy) University of Kansas Hospital, Kansas City, Kansas, United States
(Reddy) Cardiac Electrophysiology, Mount Sinai Fuster Heart Hospital
School of Medicine, New York, United States
(Mansour) Massachusetts General Hospital, Boston, Massachusetts, United
States
(Natale) Texas Cardiac Arrhythmia Institute, St. David's Medical Center,
Austin, Texas, United States
(Natale) Department of Biomedicine and Prevention, Division of Cardiology,
University of Tor Vergata, Rome, Italy
(Natale) Metro Health Medical Center, Case Western Reserve University,
Cleveland, Ohio, United States
(Leger, Christen, Stein, Sutton) Boston Scientific Corporation,
Marlborough, Massachusetts, United States
Publisher
Elsevier B.V.
Abstract
Background: Left atrial appendage closure (LAAC) can be performed in
separate procedures with cardiac ablation (sequentially) or concomitantly
in the same operative session. Objective(s): The OPTION trial aims to
compare the efficacy and safety of LAAC with oral anticoagulation (OAC) in
patients who have undergone catheter ablation for atrial fibrillation
(AF). The objective of this sub-analysis is to evaluate LAAC vs OAC within
concomitant and sequential ablation timings. Method(s): OPTION is a
multicenter, prospective randomized clinical trial. Patients with AF and
an elevated CHA<inf>2</inf>DS<inf>2</inf>-VASc score undergoing catheter
ablation were randomly assigned (1:1) to catheter-based LAAC (Device) vs
OAC (Control). Randomization was stratified by AF catheter ablation
procedure timing: Sequential (90-180 days prior to randomization) or
Concomitant (within 10 days of randomization, 99% of procedures happened
the same day). The primary safety end point was non-procedural major or
clinically-relevant non-major bleeding. The primary efficacy end point was
the composite of all-cause death, stroke, or systemic embolism at 36
months. Result(s): In both the Concomitant (n = 654) and Sequential
(n = 946) groups, the Device arm compared with Control had fewer primary
safety end point events and similar rates of primary efficacy events and
secondary safety events. Rates of acute safety events were low and similar
between the Device and Control arms within the Concomitant group; the
addition of LAAC to cardiac ablation sessions did not result in increased
procedural events. Conclusion(s): For both Concomitant and Sequential
ablation timing strategies, LAAC has similar efficacy compared with OAC
and a lower risk of clinically important post-procedure bleeding in
high-risk patients following AF ablation. Copyright © 2025 Heart
Rhythm Society

<46>
Accession Number
648708305
Title
The Impact of Prothrombin Complex Concentrate Versus Fresh Frozen Plasma
for Hemorrhage Management in Cardiac Surgery: A Systematic Review and
Meta-analysis of Randomized Clinical Trials.
Source
Journal of cardiothoracic and vascular anesthesia. (no pagination), 2025.
Date of Publication: 06 Sep 2025.
Author
Grillo I.T.C.; Katsuyama E.; Aguiar C.C.; Passos F.S.; Costa B.S.; Treml
R.E.; Ehler J.; Kirov H.; Doenst T.; Caldonazo T.
Institution
(Grillo, Aguiar) Department of Medicine, University of Buenos Aires,
Buenos Aires, Argentina
(Katsuyama) Department of Medicine, ABC School of Medicine University
Center, Sao Paulo, Brazil
(Passos) Department of Thoracic Surgery, Mater Dei Hospital, Salvador,
Brazil
(Costa) Department of Medicine, Nove de Julho University, Bauru, Brazil
(Treml) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, CA, United States
(Ehler) Department of Anesthesiology and Intensive Care Medicine, Jena
University Hospital, Jena, Germany
(Kirov, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Jena, Germany
(Caldonazo) Department of Cardiothoracic Surgery, Jena University
Hospital, Jena, Germany; Department of Cardiothoracic Surgery, Weill
Cornell Medicine, New York, NY
Abstract
OBJECTIVE: To clarify the efficacy and safety endpoints, comparing
prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) for
hemorrhage management in cardiac surgery. DESIGN: Systematic review and
meta-analysis of randomized clinical trials (RCTs). SETTING: Tertiary
care. PARTICIPANTS: Adult patients who developed hemorrhage related to
coagulation factor deficiency during cardiac surgery. INTERVENTIONS: PCC
or FFP for hemorrhage management in cardiac surgery. MEASUREMENTS AND MAIN
RESULTS: A systematic search was conducted in PubMed, Embase, and Cochrane
Library and identified RCTs comparing PCC with FFP for hemorrhage
management in cardiac surgery. The primary outcome was postintervention
hemoglobin levels. Secondary outcomes included 30-day mortality,
transfusion requirements, adverse events, postintervention international
normalized ratio, and reoperation rates. Categorical values were analyzed
using risk ratios with 95% confidence intervals (CIs), whereas continuous
values were compared using the mean difference and standardized mean
difference with 95% CIs. Statistical analyses were conducted using R
software, version 4.4.2. Four RCTs (671 patients) were included, with 343
(51.1%) patients receiving PCC. PCC was associated with higher
postintervention hemoglobin levels (mean difference 1.17 g/dL, 95% CI
0.93-1.41, p < 0.01). Compared with FFP, the PCC group required fewer red
blood cell transfusions at 24 hours, had reduced use of recombinant factor
VII, and demonstrated improved postintervention international normalized
ratio. CONCLUSION(S): In patients undergoing cardiac surgery with
significant bleeding, PCC was associated with higher postintervention
hemoglobin levels and reduced transfusion needs compared with FFP, without
an increase in adverse events. Copyright © 2025 The Authors.
Published by Elsevier Inc. All rights reserved.

<47>
Accession Number
648711779
Title
Mechanical circulatory support in high-risk elective PCI: rationale and
design of the PROTECT IV trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2025. Date of Publication: 30 Sep 2025.
Author
Mangner N.; Sharma S.K.; O'Connor C.; Kaki A.; Dangas G.D.; Moses J.W.;
Mahmud E.; Tarantini G.; Achenbach S.; Pocock S.J.; O'Neill W.W.; Grines
C.L.; Lansky A.J.; Wollmuth J.R.; Narula J.; Karmpaliotis D.I.; Faraz
H.A.; Basir M.B.; Bharadwaj A.S.; Ali Z.A.; Simonton C.; Bilazarian S.D.;
Kapur N.K.; Chapman R.C.; Bentley D.; Popma J.J.; Maehara A.; Windecker
S.; Stone G.W.
Institution
(Mangner) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technische Universitat Dresden, Dresden, Germany
(Sharma, Stone) Icahn School of Medicine at Mount Sinai, New York, NY, USA
(O'Connor) Inova Heart and Vascular Institute, Falls Church, VA, United
States
(Kaki) Department of Cardiology, Henry Ford St. John Hospital, Detroit,
MI, United States
(Dangas) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Dangas, Popma, Maehara) Cardiovascular Research Foundation, New York, NY,
USA
(Moses) Division of Cardiology, Columbia University Medical Center, New
York, NY, USA and Division of Cardiology, St. Francis Heart Center,
Roslyn, NY, USA
(Mahmud) Division of Cardiovascular Medicine, University of California San
Diego, La Jolla, CA, United States
(Tarantini) Department of Cardiac, Thoracic and Vascular Sciences,
Division of Cardiology, University of Padova, Padua, Italy
(Achenbach) Department of Medicine 2 - Cardiology and Angiology,
Friedrich-Alexander University Erlangen-Nurnberg (FAU)
Universitatsklinikum, Erlangen, Germany
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(O'Neill, Basir) Division of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Grines) Northside Hospital Heart Institute, Atlanta, GA, United States
(Lansky) Yale New Haven Hospital, New Haven, CT, United States
(Wollmuth) Providence Heart Institute, Portland, OR, USA
(Narula) University of Texas Health Science Center, UTHealth Houston,
Houston, TX, United States
(Karmpaliotis) Division of Cardiology, Morristown Medical Center,
Morristown, NJ, United States
(Faraz) Department of Cardiology and Cardiothoracic Surgery, Hackensack
University Medical Center, Hackensack, NJ, United States
(Bharadwaj) Division of Cardiology, Loma Linda University Medical Center,
Loma Linda, CA, United States
(Ali) St. Francis Hospital, NY, United States
(Simonton, Bilazarian, Kapur, Chapman, Bentley) Abiomed, Danvers, MA,
United States
(Windecker) Department of Cardiology, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
Abstract
Coronary artery disease (CAD) is the leading cause of heart failure with
reduced ejection fraction (HFrEF). Coronary artery bypass grafting (CABG)
improves long-term mortality in HFrEF. Percutaneous coronary intervention
(PCI) is often performed as an alternative to CABG in patients at high
surgical risk. However, in patients with HFrEF and limited myocardial
reserve, PCI may result in haemodynamic instability, increasing risk and
precluding optimal revascularisation. Mechanical circulatory support (MCS)
during high-risk PCI may enhance haemodynamic stability during the
procedure and enable complete revascularisation. We thus performed the
PROTECT IV trial to determine whether PCI with routine use of the Impella
CP microaxial flow pump improves early and late outcomes in patients with
HFrEF and complex CAD compared with PCI with or without use of an
intra-aortic balloon pump (IABP). PROTECT IV is a prospective,
multicentre, randomised, parallel-controlled, open-label, superiority
trial with an adaptive design. Patients with complex CAD and left
ventricular ejection fraction <=40% (n=1,252) deemed at excessive surgical
risk for bypass grafting by the Heart Team will be randomised in a 1:1
ratio to PCI with Impella CP versus PCI with or without an IABP. The
primary endpoint is the composite of all-cause death, stroke, myocardial
infarction, unplanned clinically driven revascularisation, durable left
ventricular assist device implant or heart transplant, or other
hospitalisation for cardiovascular causes at 3-year follow-up, with at
least 1-year follow-up in all patients. Prespecified substudies will
evaluate the impact of MCS on renal function, the procedural role of right
heart catheterisation, and the utility of myocardial viability assessment.
The PROTECT IV trial will determine whether routine MCS with Impella CP
during high-risk PCI improves the prognosis of patients with complex CAD
and HFrEF.

<48>
Accession Number
2040736350
Title
IMPROVED OUTCOMES WITH OFF-PUMP CABG: THE CORONARY STUDY RESULTS IN CANADA
AT 5 YEARS.
Source
Canadian Journal of Cardiology. Conference: Canadian Journal of
Cardiology. Quebec Canada. 41(10 Supplement) (pp S11), 2025. Date of
Publication: 01 Oct 2025.
Author
Lamy A.; Cartier R.; Cheung A.; Stevens L.; Dyub A.; Browne A.; Noiseux
N.; Kieser T.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The CABG Off or On Pump Revascularization Study (CORONARY) was
a landmark randomized controlled trial comparing off-pump with on-pump
coronary artery bypass grafting (CABG) in 4,752 patients. There were no
significant differences between the off-pump and on-pump groups in the
rate of the primary composite outcome at 30 days, 1 year and 5 years.
Although both strategies were demonstrated to be safe and effective, their
benefits and risks varied across geographic regions. METHODS AND RESULTS:
We conducted a post hoc analysis of 822 CORONARY trial patients randomized
to receive off-pump or on-pump CABG at 10 Canadian centres. The primary
outcome was a composite of cardiovascular death, stroke, myocardial
infarction, or new renal failure requiring dialysis at 30 days, 1 year,
and 5 years. The mean age of the cohort was 69 years, 83% were men, 40%
had diabetes, and the mean follow-up was 5.0 +/- 1.7 years. Overlap
weighting was applied using covariates such as age, sex, previous
myocardial infarction, stroke, renal failure, peripheral artery disease,
smoking status, and diabetes. Baseline characteristics were similar
between off-pump and on-pump groups after weighting. The risk of the
primary outcome was reduced after off-pump compared with on-pump CABG at
30 days (weighted hazard ratio [HR], 0.59; 95% CI, 0.39-0.91), 1 year
(weighted HR, 0.66; 95% CI, 0.44-0.99) and 5 years (weighted HR, 0.69; 95%
CI, 0.49-0.95). CONCLUSION(S): In this post hoc analysis of Canadian
patients from the CORONARY trial, off-pump CABG was associated with a
lower risk of major adverse events over 5 years when performed by Canadian
surgeons. [Formula presented] Copyright © 2025

<49>
Accession Number
648716162
Title
Tricuspid Valve Repair in Pediatric Patients Using Artificial Neochordae:
Systematic Review of Current Evidence.
Source
World journal for pediatric & congenital heart surgery. (pp
21501351251369435), 2025. Date of Publication: 29 Sep 2025.
Author
Crea D.; Padalino M.; Bortolotti U.; Stellin G.
Institution
(Crea, Stellin) Division of Pediatric Cardiac Surgery, University of
Padova, Padova, Italy
(Padalino) Department of Precision and Regenerative Medicine and Jonic
Area, University of Bari "Aldo Moro", Bari, Italy
(Bortolotti) Cardiothoracic and Vascular Department, Section of Cardiac
Surgery, University of Pisa, Pisa, Italy
Abstract
Artificial neochordae crafted from expanded polytetrafluoroethylene are
commonly utilized in mitral valve repair. Yet their application in
tricuspid valve repair, particularly in the pediatric demographic, remains
relatively unexplored. Upon reviewing the available literature, we have
identified pediatric patients with tricuspid valve regurgitation,
primarily of congenital origin and diagnosed at birth, who underwent
repair procedures involving artificial neochordal implantation.
Postoperatively, trivial-to-mild tricuspid regurgitation was predominantly
observed in most cases. Operative mortality appears to be low, but a
reliable estimate of operative mortality rates, early failure, and
reoperation was not possible due to incomplete data reporting in the
studies reviewed. Moreover, long-term data are not available since in most
reports, postoperative evaluation was obtained early after repair. Our
review suggests that artificial neochordal repair of the tricuspid valve
may be a feasible surgical option to prosthetic valve replacement in
pediatric patients. However, comprehensive data and further late follow-up
are needed to analyze long-term effectiveness and clinical outcomes.

<50>
Accession Number
2036411046
Title
The value of evaluating cardiac damage in patients with aortic stenosis: a
systematic review and meta-analysis.
Source
Echo Research and Practice. 12(1) (no pagination), 2025. Article Number:
29. Date of Publication: 01 Dec 2025.
Author
Bennett S.; Holroyd E.; Paton M.F.; Leeson P.; Redfors B.; Pibarot P.;
Genereux P.; Kwok C.S.
Institution
(Bennett, Holroyd) Heart and Lung Clinic, University Hospital of North
Midlands NHS Trust, Stoke-on-Trent, United Kingdom
(Bennett, Leeson) Cardiovascular Clinical Research Facility, University of
Oxford, Oxford, United Kingdom
(Paton) Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Paton) Leeds Institute of Cardiovascular and Metabolic Medicine, School
of Medicine, University of Leeds, Leeds, United Kingdom
(Leeson) Oxford University Hospitals NHS Foundation Trust, John Radcliffe,
Oxford, United Kingdom
(Redfors) Department of Molecular and Clinical Medicine, Gothenburg
University, Gothenburg, Sweden
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Redfors) Clinical Trials Centre, Cardiovascular Research Foundation, New
York City, United States
(Pibarot) Laval University, Quebec City, Canada
(Pibarot) Quebec Heart and Lung Institute, Quebec City, Canada
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Kwok) Department of Cardiology, Mid Cheshire Hospitals NHS Foundation
Trust, Crewe, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Aortic stenosis (AS) is a common valvular heart disease where
aortic valve replacement (AVR) is the only treatment. A novel staging
system based on cardiac damage was developed to assess the
pathophysiological consequence of AS and this has been shown to be
associated with outcomes post AVR. Method(s): We conducted a
systematic review of studies which evaluated cardiac damage in patients
with AS. A search of MEDLINE and EMBASE was performed with data being
extracted from relevant studies. The main outcome of interest were
proportion of AS patients with signs of cardiac damage, all-cause
mortality, cardiovascular mortality, and major adverse cardiovascular
events. Result(s): A total of 18 studies were included with 21,876
patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76%
of symptomatic severe AS patients and 88% of asymptomatic moderate/severe
AS patients had signs of cardiac damage, with stage two being the most
commonly reported (25.1% and 32.3% respectively). For symptomatic severe
AS patients, the pooled all-cause mortality and cardiovascular mortality
rates increased along an increase in cardiac damage stage from 9.4% to
2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4.
In patients with asymptomatic moderate / severe AS, all-cause mortality
ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with
symptomatic severe AS undergoing AVR, meta-analysis indicated an increase
in odds of cardiovascular related mortality for stage 4 cardiac damage
only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of
all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR
1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and
OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively). Conclusion(s):
Cardiac damage is a common finding amongst patients with AS irrespective
of AS severity or symptomatic status. Mortality rates appear to increase
alongside an increase in cardiac damage staging. Cardiac damage may
provide prognostic valve when considering the timing of AVR with left
ventricular and right ventricular abnormalities being associated with
increased odds of mortality. Clinical trial number: Not
applicable. Copyright © The Author(s) 2025.

<51>
Accession Number
2040831742
Title
The Effect of Thoracic Paravertebral Block on Postoperative Pain After
Coronary Artery Bypass Graft Surgery: A Retrospective Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Nezir Y.; Cengiz G.; Abdurrahman D.
Institution
(Nezir, Abdurrahman) Department of Anesthesiology and Reanimation,
Adiyaman University, Adiyaman, Turkey
(Cengiz) Department of Cardiovascular Surgery, Adiyaman University,
Adiyaman, Turkey
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the effect of bilateral single-shot thoracic
paravertebral block (PVB) on postoperative analgesia in patients
undergoing coronary artery bypass grafting (CABG) surgery. Design(s):
A retrospective cohort study. Setting(s): A single tertiary
university hospital. Participant(s): Patients who underwent elective
CABG surgery. Intervention(s): Among 110 patients included in the
study, 59 received general anesthesia alone (Group C: control group),
while 51 received general anesthesia combined with a bilateral single-dose
thoracic PVB (Group B: block group). Measurements and Main Results:
Demographic characteristics, intraoperative fentanyl consumption,
postoperative paracetamol requirements, and pain scores-documented in
patient records using the visual analog scale at 2, 4, 16, and 24
hours-along with extubation time, intensive care unit and hospital length
of stay, time to first mobilization, and time to chest drain removal were
retrospectively collected and analyzed. Group B showed significantly lower
intraoperative fentanyl and postoperative paracetamol use compared with
Group C (p < 0.05). Visual analog scale scores were significantly lower in
Group B (p < 0.05). Additionally, extubation time, intensive care unit
length of stay, and time to mobilization were significantly shorter in
Group B (p < 0.05). No significant differences were observed in total
hospital length of stay or chest drain removal time (p > 0.05).
 Conclusion(s): Bilateral single-shot thoracic PVB may be a safe and
effective adjunct to general anesthesia in patients undergoing CABG
surgery. In this retrospective study, PVB was associated with superior
analgesia, decreased opioid consumption, and improved early recovery
parameters. These findings support the integration of PVB into multimodal
analgesia protocols; however, prospective randomized controlled trials are
needed to validate these results. Copyright © 2025 Elsevier Inc.

<52>
Accession Number
2036414593
Title
Circulating biomarkers of vasoplegia: a systematic review.
Source
Annals of Intensive Care. 15(1) (no pagination), 2025. Article Number:
150. Date of Publication: 01 Dec 2025.
Author
Boyer N.; Upadhyay P.; Hicks M.H.; Zarbock A.; Khanna A.K.; Forni L.G.;
Creagh-Brown B.C.
Institution
(Boyer, Forni, Creagh-Brown) Intensive Care Unit, Royal Surrey NHS
Foundation Trust, Guildford, United Kingdom
(Boyer) School of Biosciences, University of Surrey, Surrey, United
Kingdom
(Upadhyay) Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Hicks, Khanna) Department of Anesthesiology, Section on Critical Care
Medicine, Atrium Health Wake Forest Baptist Medical Center, Wake Forest
University School of Medicine, Winston-Salem, United States
(Zarbock) Department of Anesthesiology, Intensive Care and Pain Medicine,
University Hospital Munster, Munster, Germany
(Forni, Creagh-Brown) School of Medicine, University of Surrey, Surrey,
United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Vasoplegia is characterised by persistent hypotension and
reduced systemic vascular resistance despite preserved cardiac output,
commonly arising in sepsis, following major surgery, and within systemic
inflammatory responses. Despite its clinical significance and association
with poor outcomes, there is no universally accepted definition or
standardised biomarker, impeding early diagnosis, stratification, and
targeted therapy. While individual studies have examined biomarkers within
specific clinical contexts such as septic shock or cardiac surgery, no
comprehensive synthesis across all aetiologies of vasoplegia has
previously been undertaken. Objective(s): To systematically evaluate
and synthesise the current evidence regarding circulating biomarkers
associated with the incidence, severity, prediction, and progression of
vasoplegia across diverse critical care and perioperative populations. As
well as review definitions used across literature. Method(s): This
systematic review was conducted in accordance with PRISMA 2020 guidelines
and registered on PROSPERO (CRD42024438786). Studies were included if they
investigated adult patients in critical care or perioperative settings
with vasoplegia defined by reduced vascular resistance and hypotension
requiring vasopressors. Result(s): A total of 43 studies met
inclusion criteria. The included studies examined 39 unique biomarkers,
with renin and adrenomedullin being the most frequently studied.
Heterogeneity in definitions of vasoplegia, outcome measures, and
comparator populations precluded meta-analysis. However, several
biomarkers demonstrated potential clinical utility: elevated renin levels
correlated with vasopressor requirements and haemodynamic instability,
while adrenomedullin levels were predictive of vasoplegia development and
duration. Conclusion(s): The lack of standardisation in biomarker
assay methods and vasoplegia definitions remains a significant barrier to
comparative analysis. Whilst this review highlights renin and
adrenomedullin as promising candidate biomarkers for vasoplegia, the
heterogeneity in study design, biomarker measurement, and diagnostic
criteria underscores the urgent need for a consensus definition of
vasoplegia, standardised sampling protocols, and unified outcome measures.
Future research should focus on biomarker-guided risk stratification and
personalised therapies, with an emphasis on validating predictive and
mechanistic roles across diverse vasoplegic phenotypes. Copyright
© The Author(s) 2025.

<53>
Accession Number
648724744
Title
Existential Needs of Open-Heart Surgery Patients for Holistic-Focused
Patient Education: A Critical Synthesis.
Source
Journal of holistic nursing : official journal of the American Holistic
Nurses' Association. (pp 8980101251380318), 2025. Date of Publication: 01
Oct 2025.
Author
Scheckel M.; Stieve D.
Institution
(Scheckel) Conway School of Nursing, Catholic University of America, WA,
United States
(Stieve) Michigan State University College of Nursing, East Lansing, MI,
United States
Abstract
Background: Patients undergoing open-heart surgery require
holistic-focused patient education to ensure they prepare for and recover
in a manner that addresses all dimensions of well-being. However, patient
education for this population of patients is predominantly
biopsychosocially oriented, overlooking existential needs.
 Objective(s): To conduct a critical synthesis of the literature,
exploring existential experiences of patients undergoing open-heart
surgery, to inform holistic-focused patient education. Method(s): The
literature was searched for research articles, with a focus on qualitative
studies that included the existential experiences of open-heart surgery
patients. Selected papers were appraised using the Critical Appraisal
Skills Programme checklist. Data synthesis was conducted using
interpretive hermeneutics and expressed in themes. Result(s): The
analysis of seven eligible studies yielded three themes: (a) being between
a rock and a hard place: losing freedom, dependence on healthcare
providers, (b) being connected with others: alleviating existential
uncertainty, the nexus of support, and (c) being faithful: preparing and
recovering authentically, trust, belief, and prayer. Conclusion(s): A
focus only on biopsychosocially oriented patient education for open-heart
surgery patients can be overcome through advocating for patients'
existential needs, whereby healthcare providers emphasize empowerment,
incorporate psychological services, and address spiritual and religious
needs. Implications for holistic-focused patient education and holistic
healthcare research are discussed.

<54>
Accession Number
2036408117
Title
Efficacy and safety of colchicine in patients with acute coronary
syndrome: a systematic review and meta-analysis of randomized controlled
trials.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
700. Date of Publication: 01 Dec 2025.
Author
Fallahtafti P.; Farooqi M.; Looha M.A.; Azizpour A.; Mohammadi Y.; Fekri
M.; Jodeiri F.; Hemmati D.N.; Mosayebi F.; Pirmoradian P.; Jenab Y.;
Iskander F.; Kolte D.; Hakim D.; Mohsen A.; Hosseini K.
Institution
(Fallahtafti) Eye Research Center, The Five Senses Health Institute, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Fallahtafti, Mohammadi, Jodeiri, Hemmati, Mosayebi, Pirmoradian, Jenab,
Hosseini) Cardiovascular Disease Research Institute, Tehran Heart Center,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Farooqi) Department of Internal Medicine, Central Michigan University,
MI, United States
(Looha) Gastrointestinal Disorders Research Center, Research Institute for
Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Azizpour) School of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Fekri) School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Jodeiri) School of Medicine, Tehran Medical Branch, Islamic Azad
University, Tehran, Iran, Islamic Republic of
(Iskander) MedStar Union Memorial Hospital, Baltimore, MD, United States
(Kolte) Cardiology Division, Massachusetts General Hospital, Boston, MD,
United States
(Hakim) Department of Cardiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, United States
(Mohsen) Division of Cardiology, Loma Linda University Health, Loma Linda,
United States
Publisher
BioMed Central Ltd
Abstract
Background: The European Society of Cardiology (ESC) recently endorsed
low-dose colchicine for chronic coronary syndrome. However, its role in
acute coronary syndrome (ACS) remains uncertain due to inconsistent trial
outcomes. This systematic review and meta-analysis aimed to assess the
efficacy and safety of colchicine in patients with ACS. Method(s): A
comprehensive search of PubMed, Embase, and the Cochrane Library was
conducted through April 2025 to identify randomized controlled trials
(RCTs) evaluating colchicine in adults with ACS. The primary outcome was
all-cause mortality. Secondary outcomes included cardiovascular mortality,
stroke, myocardial infarction (MI), major adverse cardiovascular events
(MACE), coronary revascularization, and gastrointestinal (GI) adverse
events. Data were pooled using a random-effects model to estimate relative
risks (RRs) with 95% confidence intervals (CIs), using the longest
available follow-up. Result(s): Eleven RCTs encompassing 12,730
patients were included. Among them, 6,844 received colchicine for at least
one month, while 5,886 received placebo or no additional treatment.
Colchicine did not significantly reduce all-cause mortality (RR 0.95, 95%
CI: 0.79-1.14) or cardiovascular mortality (RR 1.03, 95% CI: 0.82-1.29).
No significant reductions were observed in MACE, MI, stroke, or coronary
revascularization. Colchicine was associated with a non-significant trend
toward increased GI adverse events, particularly at higher doses.
 Conclusion(s): This meta-analysis does not support the routine use of
colchicine in ACS management. While generally safe, colchicine did not
confer clear cardiovascular benefits in this setting. However, potential
subgroup effects, such as in longer-term use or among specific high-risk
populations, warrant further investigation in future large-scale,
well-designed trials. Copyright © The Author(s) 2025.

<55>
Accession Number
648716519
Title
Effectiveness of the various revascularization techniques in multivessel
coronary artery disease: a systematic review with network meta-analysis.
Source
Annals of medicine. 57(1) (pp 2566878), 2025. Date of Publication: 01 Dec
2025.
Author
Harta I.K.A.P.; Pertiwi P.F.K.; Julia Arta I.G.; Putu Yasa K.
Institution
(Harta, Putu Yasa) Cardiothoracic and Vascular Surgery Division,
Department of Surgery, Faculty of Medicine, Udayana University, Prof. Dr.
I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
(Pertiwi) Faculty of Medicine, Udayana University, Denpasar, Indonesia
(Julia Arta) Cardiothoracic and Vascular Surgery Residency Program,
Faculty of Medicine, Udayana University, Denpasar, Indonesia
Abstract
BACKGROUND: Multivessel coronary artery disease (MVD) often requires
revascularization. However, the effectiveness of various techniques in
reducing stroke and achieving complete revascularization remains
uncertain. This study aimed to address this gap by comparing key
revascularization strategies in terms of early mortality, stroke, complete
revascularization, postoperative atrial fibrillation (POAF), and renal
failure. METHOD(S): This study is a systematic review and network
meta-analysis of 32 studies including 65,861 patients. Five
revascularization techniques were compared: on-pump coronary artery bypass
(ONCAB), off-pump coronary artery bypass (OPCAB), OPCAB with proximal
anastomotic device (OPCAB-PAD), anaortic OPCAB (anOPCAB), and percutaneous
coronary intervention (PCI). Odds ratios (ORs) with 95% confidence
intervals (CIs) were calculated using a random effects model. Risk of bias
was assessed using the RoB2 and ROBINS-I tools. RESULT(S): Compared
to ONCAB, early mortality was significantly lower with anOPCAB (OR: 0.57,
95% CI: 0.44-0.73), OPCAB-PAD (OR: 0.61, 95% CI: 0.40-0.92), and OPCAB
(OR: 0.64, 95% CI: 0.47-0.87). Stroke risk was lowest with anOPCAB (OR:
0.29, 95% CI: 0.21-0.40) and OPCAB-PAD (OR: 0.32, 95% CI: 0.21-0.49). All
surgical techniques achieved significantly more complete revascularization
than PCI. Both POAF and renal failure were significantly lower with
anOPCAB compared to ONCAB (POAF: OR: 0.72, 95% CI: 0.59-0.89; renal
failure: OR: 0.63, 95% CI: 0.46-0.86). No significant publication bias was
detected for mortality and stroke, though funnel plot asymmetry was noted
for revascularization. CONCLUSION(S): Off-pump techniques,
particularly anOPCAB, significantly reduce stroke risk while achieving
comparable revascularization success to ONCAB. PCI remains limited by
incomplete revascularization, supporting its use primarily in patients at
high surgical risk.

<56>
Accession Number
2040736228
Title
DIRECT ORAL ANTICOAGULATION FOR MECHANICAL VALVES: A SYSTEMATIC REVIEW AND
PAIRWISE META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Journal of
Cardiology. Quebec Canada. 41(10 Supplement) (pp S8-S9), 2025. Date of
Publication: 01 Oct 2025.
Author
Um K.; Jackson Chornenki N.; Kim K.; Fournier R.; Whitlock R.; Belley-Cote
E.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Mechanical valves are durable and preferred in young adults
requiring valve replacement surgery, but necessitates life-long
anticoagulation. We reviewed studies comparing direct oral anticoagulants
(DOACs) to vitamin K antagonists (VKA) in patients with mechanical aortic
or mitral valves. METHODS AND RESULTS: We searched MEDLINE, EMBASE, and
the Cochrane Central Register of Controlled Trials for randomized
controlled trials (RCTs) from inception until March 4, 2024. Two reviewers
independently screened studies, extracted data, and assessed the risk of
bias. Outcomes of interest included major bleeding, valve thrombosis and
valve-related systemic thromboembolism, and all-cause systemic
thromboembolism. We performed fixed- and random-effects meta-analysis with
relative risk (RRs) using DataParty (dataparty.ca, Hamilton, Ontario) and
assessed the certainty of evidence using the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) framework. We included 3
RCTs (n=1159). Compared to VKAs, DOACs showed no significant difference in
major bleeding (RR 0.82, 95% confidence interval [95%CI] 0.32-2.11,
very-low certainty), but increased valve thrombosis and valve-related
thromboembolism (RR 6.18, 95%CI 0.78-48.9, low certainty), and all-cause
systemic thromboembolism (RR 2.44, 95%CI 1.24-4.83, moderate certainty).
 CONCLUSION(S): In patients with mechanical aortic or mitral valves,
DOACs may result in similar rates of major bleeding but increased valve
thrombosis and valve-related thromboembolism, and systemic thromboembolism
when compared with VKAs. Copyright © 2025

<57>
Accession Number
648722608
Title
Postoperative atrial fibrillation and stroke after non-cardiac surgery: a
systematic review and meta-analysis.
Source
European heart journal. Cardiovascular pharmacotherapy. (no pagination),
2025. Date of Publication: 30 Sep 2025.
Author
Donati J.; Morrone D.; Verheugt F.; De Caterina R.
Institution
(Donati, Morrone, De Caterina) Chair of Cardiology, University of Pisa and
Cardiovascular Division, Pisa University Hospital, Pisa, Italy
(Verheugt) Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is common after
non-cardiac surgery. Because often transient, there are uncertainties on
the associated risk of stroke, possibly driving the need for long-term
anticoagulation. METHOD(S): We performed a systematic PubMed search
until January 16th, 2025, related to the incidence of stroke in patients
with POAF after non-cardiac surgery. We included papers reporting
outcomes, excluding studies only dealing with epidemiology, mechanisms,
management and treatment. We excluded studies reporting on POAF after
cardiac surgery. Risk of bias was assessed for each study, and the
certainty of evidence was evaluated using the GRADE methodology.
 RESULT(S): We retrieved and included 40 studies (including review
papers) for the systematic review. These were then further selected to
create a final list of 19 studies included in the meta-analysis. The
reported incidence of stroke after POAF was found to be widely variable,
ranging between 0.4% and 16.7% at 1 year. Stroke incidence also varies
widely according to the type of surgery and patient characteristics. With
only three exceptions, all studies, however, reported a risk of stroke
higher in the POAF group than in the no-POAF group, with a mean Odds Ratio
(OR) of 3.02. CONCLUSION(S): POAF on average triples the risk of
stroke, with variations related to patient characteristics and type of
surgery. Patients after non-cardiac surgery should be monitored at least
during hospitalization to detect POAF. Future studies are necessary to
evaluate optimal duration and modalities of monitoring, as well as to
assess the relevance of symptomatic vs asymptomatic AF
episodes. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of European Society of Cardiology.

<58>
Accession Number
2040736221
Title
NEUTROPHIL-TO-LYMPHOCYTE RATIO AND ADVERSE OUTCOMES FOLLOWING
TRANSCATHETER AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Journal of
Cardiology. Quebec Canada. 41(10 Supplement) (pp S62-S63), 2025. Date of
Publication: 01 Oct 2025.
Author
Khanipour R.; Tavakoli K.; Izadpanahi K.; Narimani-Javid R.; Tahmasbi
Arashlow F.; Azardar T.; Fekri M.; Sayahpour B.; Khorsand Askari M.; Gupta
R.; Hosseini K.; Soleimani H.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become an
established treatment for aortic stenosis. Nevertheless, predicting
post-procedural complications remains challenging. Over recent years the
utilization of inflammatory biomarkers as potential predictors for risk
stratification of cardiovascular patients has become a topic of growing
interest. Among these, the neutrophil-to-lymphocyte ratio (NLR) has
emerged as a promising candidate, although its prognostic value in TAVR
patients remains unclear. This study aimed to evaluate the association
between pre-procedural NLR and adverse outcomes following TAVR. METHODS
AND RESULTS: We conducted a systematic search of PubMed, Embase, Scopus,
Web of Science, and Cochrane Library up to January 1, 2025. Studies
evaluating pre-procedural NLR in relation to post-TAVR complications were
included. Random-effect model (DerSimonian-Laird method) was used to pool
the most adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).
A total of 10 studies comprising 9,898 patients were included, with 8
contributing to the meta-analysis. Elevated NLR (compared to lower NLR)
was associated with increased all-cause mortality (HR: 1.22, 95% CI:
1.06-1.41, I2: 60%) and a higher risk of major adverse cardiovascular
events (MACE) (HR: 1.72, 95% CI: 1.20-2.47, I2: 0%). Furthermore, it was
noticed that each unit increase in NLR was associated with a 22% higher
risk of mortality (HR: 1.22, 95% CI: 1.11-1.33, I2: 31%) and a
16% increased risk of MACE (HR: 1.16, 95% CI: 1.01-1.33, I2: 66%). No
significant association was observed between higher NLR levels and
hospital readmission following TAVR (HR: 1.03, 95% CI: 0.86-1.24, P: 0.72,
I2: 55%). CONCLUSION(S): Our findings underscore the prognostic value
of pre-procedural NLR in predicting adverse outcomes, particularly
mortality and MACE, in TAVR patients. Given its availability and
cost-effectiveness, incorporating NLR into routine pre-TAVR assessments
may enhance risk stratification and facilitate the identification of
high-risk patients. [Formula presented] Copyright © 2025

<59>
Accession Number
2040736386
Title
LONGITUDINAL ANALYSIS OF OUTCOMES AFTER PULMONARY VALVE REPLACEMENT IN
TETRALOGY OF FALLOT: A SYSTEMATIC REVIEW AND META-REGRESSION.
Source
Canadian Journal of Cardiology. Conference: Canadian Journal of
Cardiology. Quebec Canada. 41(10 Supplement) (pp S31-S32), 2025. Date of
Publication: 01 Oct 2025.
Author
Laurence W.; Roy L.; Champagne P.; Dallaire F.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Despite excellent survival following Tetralogy of Fallot
repair, residual right ventricular (RV) outflow tract dysfunction often
persists. Pulmonary valve replacement (PVR) is commonly performed, yet its
efficacy to improve cardiac parameters with time remains unclear. We
performed a meta-regression to summarize the known impact of PVR on key
cardiac outcomes over time. METHODS AND RESULTS: Relevant articles
reporting on at least one outcome of pulmonary regurgitation, left and RV
volumes, QRS length, RV ejection fraction, VO2max, NYHA status in patients
with TOF before and after PVR were retrieved. A multilevel random-effects
meta-regression was conducted using time since PVR as a covariate. Local
regression smoothing was used for visual exploration of outcome
trajectories over time. Seventy-six studies met the inclusion criteria.
Compared to pre-PVR values, PVR was associated with absolute reductions in
RV end-systolic volume (-32.5 mL/m2, 95% confidence interval (CI): -37.4
mL/m2 to -27.7 mL/m2) and end-diastolic volume (-59.6 mL/m2, 95% CI: -67.2
mL/m2 to -52.0 mL/m2) and with small increase of left ventricular
end-diastolic volume (4.6 mL/m2, 95% CI 2.2 mL/m2 to 7.0 mL/m2). NYHA
functional class was also immediately improved (-0.78 class, 95% CI -1.18
to -0.37). PVR had no immediate significant effect on left ventricular
systolic volume, peak VO2, RV ejection fraction or QRS duration. Median
follow-up time was only 12.7 months (IQR 7.3-26.0), and only 2 studies had
median follow-up time longer than 5 years. The estimated change for each
year after PVR for RV end-systolic volume was minimal: -0.4464 mL/m2 (see
Figure 1a; 95% CI -0.9360 mL/m2 to 0.0432 mL/m2). The annual change for RV
end-diastolic volume was also minimal: -0.0504 mL/m2 (see Figure 1b; 95%
CI -0.7416 mL/m2 to 0.6408 mL/m2). There was limited statistical power for
medium or long-term inference, and the effect of time was not
statistically significant for any of the parameter. However, visual
inspection of the regression curves suggested a plateau or a possible
slight increase in RV volumes between 30 and 60 months.
 CONCLUSION(S): The long-term impact of PVR remains uncertain. Despite
many short-term post PVR studies, there was insufficient long-term data or
volume trends to draw firm conclusions. Further research is needed.
[Formula presented] Copyright © 2025

<60>
Accession Number
2040736393
Title
SEX-BASED OUTCOMES OF MITRAL SURGERY FOR ISCHEMIC MITRAL REGURGITATION: A
SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Journal of
Cardiology. Quebec Canada. 41(10 Supplement) (pp S18-S19), 2025. Date of
Publication: 01 Oct 2025.
Author
Rahmouni K.; Kang N.; Ramsay T.; Gauthier N.; Voisine P.; Edwards J.; Chan
V.
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The sex-based prognosis of patients with ischemic mitral
regurgitation (MR) undergoing mitral valve surgery remains unclear. In
this systematic review, we aim to evaluate rates of all-cause mortality,
reoperation, heart failure rehospitalization and MR recurrence in females
who undergo mitral valve surgery for chronic ischemic MR, compared to
males. METHODS AND RESULTS: The MEDLINE, EMBASE, Scopus and Cochrane
Central Register of Controlled Trials databases were searched on June 10,
2024. All studies reporting sex-based surgical outcomes for ischemic MR
were included. Exclusion criteria comprised studies with < 1 year of
follow-up, studies involving transcatheter or medical therapies only, and
studies with < 10 males or 10 females. The primary endpoint was long-term
(>= 1 year) all-cause mortality. Risk of bias was ascertained with the
Newcastle-Ottawa Scale. Meta-analyses with a random-effects model were
conducted. Twenty-five studies were included, with a total of 6,886
patients of which 1,519 (22.1%) were females (Table 1). Twenty-one studies
(84%) were retrospective cohort studies, 2 (8%) were randomized controlled
trials, 1 (4%) was a case-control study and 1 (4%) was a prospective
cohort study. Among the 8 studies reporting a hazard ratio (HR) for the
primary outcome, there was no statistically significant difference in
long-term all-cause mortality between sexes (Pooled HR, 1.27 [95% CI,
0.92; 1.75], P=0.35; Figure 1). Operative mortality was also similar
between sexes (Pooled Odds Ratio, 1.02 [95% CI, 0.66; 1.56], P=0.94), but
females had higher rates of MR recurrence (Pooled HR, 1.80 [95% CI, 1.15;
2.82], P= 0.01). According to the Newcastle-Ottawa risk of bias Scale, 13
studies exhibited an overall high quality, 11 had moderate quality and 1
was deemed low quality. CONCLUSION(S): Although females were
underrepresented in the ischemic MR literature, there was no sex-based
difference in long-term and operative mortality in patients undergoing
mitral valve surgery for ischemic MR, but females were at higher risk of
recurrent MR at follow-up. However, most included studies did not adjust
for baseline characteristic imbalances between sexes. Further high-quality
studies are required to elucidate the sex-based prognosis of patients with
ischemic MR (Funding sources: None; PROSPERO ID: CRD42024560892). [Formula
presented] [Formula presented] Copyright © 2025

<61>
Accession Number
2036431434
Title
Efficacy and safety of left atrial appendage occlusion for atrial
fibrillation in patients with a history of prior intracranial hemorrhage:
a systematic review and meta-analysis of observational studies.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2025. Date of Publication: 2025.
Author
Hammad A.; Ahmad A.; Khalid N.; Munshi H.; Khraisat O.; Kumar V.; Muhammad
H.; Iyer A.; Ozgur S.; Dajani A.R.; Afzal A.; Patel S.; Tiyyagura S.;
Shamoon F.E.; Vasudev R.
Institution
(Hammad, Khraisat, Iyer, Ozgur, Dajani, Afzal) Department of Internal
Medicine, Englewood Hospital Medical Center, Englewood, NJ, United States
(Ahmad, Khalid, Munshi, Tiyyagura, Shamoon, Vasudev) Department of
Cardiology, St. Joseph's University Medical Center, Paterson, NJ, United
States
(Kumar) Department of Critical Care, George Washington University,
Washington, DC, United States
(Muhammad) Department of Cardiology, Newark Beth Israel Medical Center,
Newark, NJ, United States
(Patel) Rowan University School of Osteopathic Medicine, Glassboro, NJ,
United States
Publisher
Springer
Abstract
Background: Left atrial appendage occlusion (LAAO) is emerging as
alternative to anticoagulation in patients with nonvalvular atrial
fibrillation (AF) to reduce ischemic stroke risk, particularly in those at
high bleeding risk. Objective(s): Assess LAAO efficacy and safety in
patients with prior intracranial hemorrhage (ICH). Method(s):
Systematic review was performed using PubMed, Embase, and Cochrane Central
Register of Controlled Trials. Observational studies reporting outcomes of
percutaneous LAAO for AF thromboembolic stroke prophylaxis in patients
with prior ICH were included. Classic meta-analysis with risk ratios (RR)
for outcomes with control groups and proportions for outcomes without
controls were conducted. Result(s): A total of 19 observational
studies (13 retrospective and 6 prospective) involving 1671 patients met
the inclusion criteria. The mean CHA2DS2-VASc score was 4.59 +/- 0.46, and
the mean HAS-BLED score was 3.66 +/- 0.56. The mean follow-up duration was
19.1 +/- 10.2 months, with follow-up ranging from 6 months to 3.7 years.
LAAO was successfully implanted in 99.3% of patients. Periprocedural
complications included ICH (0.4%), ischemic stroke (0.3%), pericardial
effusion/cardiac tamponade (1.3%), device embolization (0.5%), and
device-related thrombosis (0.1%). During follow-up, the incidence of ICH
was 1.9%, ischemic stroke/TIA 2.9%, device-related thrombosis 1.4%, and
all-cause mortality 3.3%. Using the CHA2DS2-VASc score, LAAO significantly
reduced ischemic stroke risk (RR = 0.28, 95% CI 0.21-0.39). Similarly,
using the HAS-BLED score, bleeding events were reduced (RR = 0.61, 95% CI
0.44-0.84). Conclusion(s): LAAO is effective and relatively safe
treatment for reducing ischemic stroke risk in nonvalvular AF patients
with history of ICH. Copyright © The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature
2025.

<62>
Accession Number
2036408313
Title
Current views on topical tranexamic acid in cardiac surgery-literature and
guidelines review.
Source
Cardiothoracic Surgeon. 33(1) (no pagination), 2025. Article Number: 30.
Date of Publication: 01 Dec 2025.
Author
Szymanska E.; Bereza M.; Dembinski M.; Prabucka-Marciniak J.
Institution
(Szymanska) Medical University of Warsaw, Zwirki and Wigury 61, Warsaw,
Poland
(Bereza) Brodno Regional Hospital, Ludwika Kondratowicza 8, Warsaw, Poland
(Dembinski, Prabucka-Marciniak) Praski Hospital, "Solidarnosci" Ave. 67,
Warsaw, Poland
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Tranexamic acid (TXA) is commonly utilized across multiple
medical fields. This review evaluates the efficacy of its topical
administration in cardiac surgery. Main body of the abstract: A
comprehensive search of the PubMed database has been conducted using the
keywords "tranexamic acid local cardiac surgery" and "tranexamic acid
topical cardiac surgery." In addition to PubMed, other relevant sources
were reviewed, resulting in the selection of 23 meta-analyses, systematic
reviews, and randomized controlled trials. This review evaluates the
efficacy of topical TXA compared to intravenous (IV) TXA alone, saline,
and the combination of IV and topical TXA in adult patients undergoing
cardiac surgery. Result(s): In comparisons with placebo, topical TXA
reduced postoperative blood loss; however, its impact on transfusion rates
remains unclear. When compared to IV TXA, topical administration
demonstrated similar efficacy in minimizing blood loss and was associated
with a lower risk of postoperative seizures. However, topical TXA was
linked to a higher incidence of blood transfusions. Studies comparing
combined topical and IV TXA with IV administration alone reported no
significant differences in blood loss or transfusion rates. Variability in
patient populations and study protocols limited the ability to make direct
comparisons. In off-pump coronary artery bypass grafting (OPCAB), topical
TXA may reduce postoperative blood loss, but no studies have directly
compared its effectiveness to IV TXA in this context. Furthermore, graft
patency, a critical measure for assessing the safety of antifibrinolytic
agents, was not evaluated. Conclusion(s): Topical TXA has shown
promising results in reducing blood loss after cardiac procedures.
Nevertheless, further research is needed due to the significant
heterogeneity and limited sample sizes in existing studies. Current
clinical guidelines indicate that topical TXA is less effective than IV
TXA for reducing transfusion requirements, suggesting that topical TXA
should not be administered routinely in every case (Class III, Level B).
Topical TXA may be considered when standard hemostatic methods are
insufficient (Class II, Level B). Furthermore, guidelines recommend the
use of topical TXA after cardiopulmonary bypass (CBP) to decrease
postoperative drainage and transfusion requirements (Class IIA, Level
B-R). Copyright © The Author(s) 2025.

<63>
Accession Number
2040775002
Title
Efficacy of ultrasound-guided bilateral pecto-intercostal fascial plane
block as a pre-emptive analgesic adjunct in patients undergoing cardiac
surgery: A randomized, double-blinded study.
Source
Journal of Anaesthesiology Clinical Pharmacology. 41(4) (pp 658-663),
2025. Date of Publication: 01 Oct 2025.
Author
Powers P.A.; Babu S.; Sreedhar R.; Gadhinglajkar S.V.; Dash P.K.; Sukesan
S.
Institution
(Powers, Babu, Sreedhar, Gadhinglajkar, Dash, Sukesan) Division of
Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Kerala, Trivandrum, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: No studies have assessed the pre-emptive analgesic
efficacy of pecto-intercostal fascial plane block (PIFB). We evaluated the
pre-emptive analgesic efficacy of PIFB by comparing with the routine
in-hospital analgesic protocol for sternotomy pain in patients undergoing
cardiac surgery. Material(s) and Method(s): This prospective,
randomized, double-blinded study was conducted on 90 patients undergoing
elective coronary artery bypass grafting surgery. The patients were
randomized into two groups as follows: 1. PIFB group (n = 45): received
bilateral ultrasound-guided bilateral PIFB with 0.5% levobupivacaine and
2. no PIFB (NPIFB) group (n = 45): received routine in-hospital
perioperative analgesic protocol. The primary outcome of the study was to
assess the effectiveness of PIFB on the requirement of intraoperative and
postoperative fentanyl. The secondary outcomes were to assess the
postoperative pain score, sedation alertness, side effects, and
cooperation with incentive spirometry exercises. The Chi-square test and
Student's t-Test were used to compare the data. Result(s): The total
intraoperative fentanyl consumption was significantly less in the PIFB
group (587.8 +/- 165.7 mug) than in the NPIFB group (935.6 +/- 157.2 mug)
(P < 0.0001). The postoperative pain scores, the need for rescue fentanyl,
and the incidence of nausea and vomiting at different time points were
significantly lower in the PIFB group. Patients in the PIFB group
cooperated well with incentive spirometry exercises at various time
points. There was no difference in sedation score at different time points
between the two groups. No complications were noted in either group.
 Conclusion(s): Ultrasound-guided PIFB is very effective as a
pre-emptive analgesic adjunct for sternotomy pain in patients undergoing
cardiac surgery. Copyright © 2025 Journal of Anaesthesiology
Clinical Pharmacology.

<64>
[Use Link to view the full text]
Accession Number
648706020
Title
Impact of Preoperative Cardiac Computed Tomography Angiography on Left
Atrial Appendage Closure: A Systematic Review and Meta-Analysis.
Source
Journal of computer assisted tomography. (no pagination), 2025. Date of
Publication: 29 Sep 2025.
Author
Lin Q.; Duan H.; Li K.; Ma Z.-Y.
Institution
(Lin) Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming, China
Abstract
OBJECTIVE: Our aim is to evaluate the impact of preoperative cardiac CT on
LAAC. METHOD(S): This research followed the protocols outlined in the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) 2020 checklist, and it adhered to the previously described
established methodologies. A search strategy was designed to utilize
PubMed, EMBASE, Cochrane Library, and Web of Science for studies showing
the effect of preoperative CCTA on LAAC from December 08, 2017, to June
12, 2023. For continuous outcome variables, the weighted mean difference
(WMD) was used to estimate the effect size, whereas the odds ratio (OR)
was used for dichotomous outcomes. We performed meta-regression to explore
the heterogeneity among the included studies. RESULT(S): Eight cohort
studies (including one published only as an abstract) that evaluated the
impact of preoperative CCTA for LAAC were identified and included in this
meta-analysis. Compared with the CCTA negative group, patients in the CCTA
positive group experienced a significantly shorter LAAC procedure time
(WMD: -0.69; 95% CI: -1.11 to -0.28; P=0.00; I2=95.39%). In contrast,
there were no significant differences in implantation success (OR: 1.04;
95% CI: 0.98-1.11; P=0.18; I2=45.61%), contrast volume (WMD: -0.07; 95%
CI: -0.28 to 0.14; P=0.51; I2=77.38%), peri-device leak (OR: 0.56; 95% CI:
0.29-1.11; P=0.10; I2=87.33%), device-related thrombus (OR: 0.70; 95% CI:
0.36-1.35; P=0.29; I2=0%), pericardial effusion requiring intervention
(OR: 1.09; 95% CI: 0.95-1.25; P=0.21; I2=0%), major adverse events (OR:
0.99; 95% CI: 0.89-1.09; P=0.78; I2=0%), and all-cause mortality (OR:
0.79; 95% CI: 0.54-1.16; P= 0.23; I2=0%). CONCLUSION(S): Preoperative
CCTA is associated with a shorter procedure time, but other parameters did
not differ significantly between patients who underwent preoperative CCTA
and those who did not. Copyright © 2025 Wolters Kluwer Health,
Inc. All rights reserved.

<65>
Accession Number
2036310751
Title
The prognostic role of right ventricular-pulmonary arterial coupling in
aortic stenosis patients undergoing TAVR: a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
683. Date of Publication: 01 Dec 2025.
Author
Wu F.; Liao Y.
Institution
(Wu, Liao) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guo Xue Street, Chengdu, China
(Wu, Liao) Cardiac Structure and Function Research Key Laboratory of
Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
(Wu, Liao) Laboratory of Cardiac Structure and Function, Institute of
Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu,
China
(Liao) Department of High Altitude Medicine, Center for High Altitude
Medicine, West China Hospital, Sichuan University, Sichuan, Chengdu, China
Publisher
BioMed Central Ltd
Abstract
Background: The predictive role of right ventricular-pulmonary arterial
(RV-PA) uncoupling following transcatheter aortic valve replacement (TAVR)
in patients with aortic stenosis (AS) is inconsistent. Thus, this
meta-analysis aimed to evaluate the prognostic value of RV-PA coupling in
patients undergoing TAVR. Method(s): We systematically searched
PubMed, Embase, and Web of Science databases for studies reporting the
prognostic relevance of RV-PA coupling in patients undergoing TAVR. Fixed-
or random-effects models were employed according to heterogeneity.
Subgroup analyses were conducted to evaluate the influence of study
characteristics on the analyzed results. Result(s): Eighteen studies
involving 5,905 patients were included. The pooled results demonstrated
that RV-PA uncoupling prior to TAVR was associated with the increased
all-cause mortality risk, with a hazard ratio (HR) of 2.36 (95% CI:
1.76-3.16) in univariate analysis and an adjusted hazard ratio (aHR) of
2.01 (95% CI: 1.40-2.89) in multivariate analysis. Moreover, both
non-severe RV-PA (HR = 1.71, 95% CI: 1.02-2.86) and severe RV-PA
uncoupling (HR = 2.73, 95% CI: 1.50-4.95) were associated with elevated
mortality risk in univariate analysis. Multivariate analysis showed
increased all-cause mortality risk in patients with non-severe/severe
uncoupling, but these findings were not statistically significant.
 Conclusion(s): RV-PA uncoupling was identified as a predictor of
adverse outcomes after TAVR. Incorporating assessment of RV-PA coupling
may enhance risk stratification and prognostic prediction in the TAVR
patient population. Copyright © The Author(s) 2025.

<66>
Accession Number
2036306307
Title
Global challenges of bacterial infections in organ transplantation:
assessment of risk factors and predominant bacterial pathogen profiles
threatening liver, kidney, heart, and lung transplant recipients.
Source
BMC Infectious Diseases. 25(1) (no pagination), 2025. Article Number:
1153. Date of Publication: 01 Dec 2025.
Author
Moradi F.; Bahrami M.; Nasrollahian S.; Shirazi P.S.; Ghoreyshi N.S.;
Ghobadi M.
Institution
(Moradi, Bahrami, Nasrollahian, Shirazi, Ghoreyshi) Department of
Bacteriology & Virology, School of medicine, Shiraz University of Medical
Sciences, Zand St, Imam Hossein Sq, Shiraz, Iran, Islamic Republic of
(Ghobadi) Department of Anesthesia, School of Nursing and Midwifery,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
BioMed Central Ltd
Abstract
Background: Bacterial infections, especially those caused by
multidrug-resistant organisms, remain a major threat to the survival of
organ transplant recipients. This review aimed to systematically assess
the most common bacterial pathogens, risk factors, and prevention
strategies in solid organ transplantation (SOT), focusing on liver,
kidney, heart, and lung transplants. Method(s): A systematic search
was conducted across PubMed, Scopus, Web of Science, and Google Scholar
databases for studies published between 2015 and 2024. Studies were
selected based on inclusion criteria targeting bacterial infections in
human transplant recipients. Data were extracted on infection types,
bacterial species, risk factors, immunosuppressive regimens, and
antimicrobial prophylaxis. Result(s): Among 75 eligible articles, 26
met the inclusion criteria. Escherichia coli, Klebsiella spp., and
Pseudomonas aeruginosa were the predominant pathogens in most transplant
types. Urinary tract infections were most frequent in kidney transplants,
while lung, heart, and liver transplant recipients exhibited broader
pathogen diversity, including MRSA, VRE, and Acinetobacter. Major risk
factors included immunosuppressive therapy, pre-transplant colonization,
prolonged ICU stay, and donor-derived MDR organisms. Antibiotic
prophylaxis and immunosuppressive regimens varied across studies, with no
universal consensus on optimal protocols. Conclusion(s): Bacterial
infections significantly impact graft survival and patient outcomes,
particularly during the early post-transplant period. Efficient infection
prevention, tailored antimicrobial prophylaxis, and optimized
immunosuppressive management are essential for improving transplant
success rates. Copyright © The Author(s) 2025.

<67>
Accession Number
2036369090
Title
The hidden link between HIV and cardiomyopathy: unraveling HIV's impact on
the heart.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1601430. Date of Publication: 2025.
Author
Awoyemi T.; Tolu-Akinnawo O.Z.; Greek A.; Adenuga O.; Asogwa C.; Ekundayo
I.; Odusola O.; Fasehun O.; Ajayi M.; Ugoala O.; Fasehun L.-K.; Adeleke
O.D.; Angarone M.
Institution
(Awoyemi) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Tolu-Akinnawo) Meharry Medical College, Nashville, TN, United States
(Greek) Kansas City University College of Medicine, Joplin, MO, United
States
(Adenuga) Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
(Asogwa, Odusola) University of Ibadan College of Medicine, Oyo, Ibadan,
Nigeria
(Ekundayo) Faculty of Clinical Sciences, University of Ilorin, Ilorin,
Nigeria
(Fasehun) University of Texas Rio Grande Valley-Knapp Medical Center,
Weslaco, TX, United States
(Ajayi) University of Port-Harcourt Teaching Hospital, Port-Harcourt,
Nigeria
(Ugoala) Department of Internal Medicine, Texas Tech University Health
Sciences Center, Amarillo, TX, United States
(Fasehun) Department of Epidemiology, Columbia University Mailman School
of Public Health, New York, NY, United States
(Adeleke) Sumy State University, Sumy, Ukraine
(Angarone) Department of Infectious Disease, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
Publisher
Frontiers Media SA
Abstract
This comprehensive review examines the complex relationship between human
immunodeficiency virus (HIV) and cardiomyopathy, focusing on the
underlying molecular mechanisms, clinical manifestations, diagnostic
approaches, and treatment strategies. It highlights the significant global
health burden posed by HIV and its potential to cause long-term
cardiovascular complications. The review investigates the pathogenesis of
HIV-associated cardiomyopathy. It elucidates the intricate cellular and
molecular pathways involved, including the actions of neutrophils,
monocytes, macrophages, and lymphocytes in cardiac inflammation. Key
signaling pathways such as TNF-NF-kappaB and the caspase-1 inflammasome
are detailed, as they contribute to cardiac infection and injury. The
clinical manifestations of HIV-associated cardiomyopathy are discussed,
including fatigue, dyspnea, peripheral edema, and arrhythmias. The review
outlines essential diagnostic methods, highlighting the importance of
cardiac biomarkers, electrocardiography, and imaging techniques such as
echocardiography and cardiac MRI. Treatment strategies are explored,
encompassing lifestyle modifications, pharmacological interventions, and
advanced therapies. The review underscores the importance of addressing
micronutrient deficiencies, particularly selenium, in the management of
HIV-associated cardiomyopathy. It also discusses the role of
antiretroviral therapy and the potential benefits of intravenous
immunoglobulin therapy. Furthermore, this review addresses the evolving
perspective on heart transplantation for individuals with HIV. It notes
that while HIV was once considered a contraindication for transplantation,
recent advancements in antiretroviral therapy have led to a re-evaluation
of this stance. Finally, the review identifies future research directions,
emphasizing the need for biomarkers to detect at-risk patients,
exploration of nutritional factors predisposing individuals to
cardiomyopathy, and further investigation into advanced therapies for
HIV-associated cardiomyopathy. This review significantly enhances the
understanding of HIV-associated cardiomyopathy, providing valuable
insights for clinicians and researchers in the fields of infectious
diseases and cardiology. Copyright 2025 Awoyemi, Tolu-Akinnawo, Greek,
Adenuga, Asogwa, Ekundayo, Odusola, Fasehun, Ajayi, Ugoala, Fasehun,
Adeleke and Angarone.

<68>
Accession Number
648699154
Title
Administration of mitochondrial fusion promoter during ischemia and at the
onset of reperfusion exert neuroprotective effects in ratswith cardiac
ischemia/reperfusion injury.
Source
Alzheimer's and Dementia. Conference: Alzheimer's Association
International Conference, AAIC 2023. Amsterdam Netherlands. 19(Supplement
13) (no pagination), 2023. Date of Publication: 01 Dec 2023.
Author
Chunchai T.; Apaijai N.; Janjek S.; Arunsak B.; Chattipakorn N.;
Chattipakorn S.C.
Institution
(Chunchai, Apaijai, Janjek, Arunsak, Chattipakorn, Chattipakorn)
Neurophysiology Unit, Cardiac Electrophysiology Research and Training
Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Chunchai, Apaijai, Janjek, Arunsak, Chattipakorn, Chattipakorn) Center of
Excellence in Cardiac Electrophysiology Research, Chiang Mai University,
Chiang Mai, Thailand
(Apaijai, Chattipakorn) Cardiac Electrophysiology Unit, Department of
Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai,
Thailand
(Chattipakorn) Department of Oral Biology and Diagnostic Sciences, Faculty
of Dentistry, Chiang Mai University, Chiang Mai, Thailand
Publisher
John Wiley and Sons Inc
Abstract
Background: Acute myocardial infarction (AMI) is one of the fetal
cardiovascular diseases and a leading cause of death (1, 2). Our previous
study demonstrated that pretreatment of mitochondrial fusion promoter (M1)
provided neuroprotective effects on the brain following cardiac
ischemia/reperfusion (I/R) injury (3). However, the effects ofM1 given
during ischemia and M1 given at the onset of reperfusion on brain
pathologies following cardiac I/R have never been investigated.
 Method(s): Sixteen male Wistar rats were randomly divided into either
a sham-operation (n=8) or cardiac I/R (n=24). In the cardiac I/R group,
rats were then randomly divided into 3 subgroups, including the I/R
operation with vehicle (0.9% sodium chloride solution for 15 minutes
before I/R protocol, intravenous (i.v.) injection), the I/R operation
withM1administration during cardiac ischemia (2 mg/kg, 15 minutes after
left anterior descending (LAD) coronary artery ligation, i.v. injection),
and the I/R operation withM1 administration at the onset of reperfusion
group (2 mg/kg at the beginning of reperfusion, i.v. injection). At the
end of experimental protocol, rats were sacrificed and brains were
obtained for further molecular investigation. Result(s): The results
demonstrated that cardiac I/R increased brain inflammation, caused
microglial dysmorphology, caused brain mitochondrial dysfunction,
increased tau hyperphosphorylation, and increased brain apoptosis (p<0.05,
Figure 1). M1 given during ischemia and M1 given at the onset of
reperfusion effectively attenuated brain pathologies following cardiac I/R
by preserving microglial morphology, improving brain mitochondrial
function, decreasing tau hyperphosphorylation, and decreasing brain
apoptosis (p<0.05, Figure 1). Interestingly, M1 given during ischemia had
better efficacy to suppressing brain inflammation, when compared to M1
given at the onset of reperfusion apoptosis (p<0.05, Figure 1).
 Conclusion(s): These findings suggest the administration of
mitochondrial fusion promoter effectively decreased brain pathologies
following cardiac I/R. The administration of mitochondrial fusion promoter
during ischemia had greater suppression on brain inflammation than
administration at the onset of reperfusion. The novel findings obtained
from the present study provided the therapeutic strategies which can be
translated into clinical settings for cardiac I/R injury.

<69>
Accession Number
2036363775
Title
Unilateral vs. Bilateral Selective Cerebral Perfusion for Acute Type A
Aortic Dissection with Frozen Elephant Trunk: Systematic Review and
Meta-Analysis.
Source
Journal of Clinical Medicine. 14(18) (no pagination), 2025. Article
Number: 6392. Date of Publication: 01 Sep 2025.
Author
Baudo M.; D'Alonzo M.; Muneretto C.; Benussi S.; Di Bacco L.; Rosati F.
Institution
(Baudo) Department of Cardiac Surgery Research, Lankenau Institute for
Medical Research, Main Line Health, Wynnewood, PA, United States
(D'Alonzo) Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Via
Bissolati 57, Brescia, Italy
(Muneretto, Benussi, Di Bacco, Rosati) Department of Cardiac Surgery,
Spedali Civili di Brescia, University of Brescia, Brescia, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Previous studies failed to demonstrate the best
cerebral perfusion option during total aortic arch replacement surgery. We
therefore sought to investigate clinical results of patients who received
unilateral (u) versus bilateral (b) selective antegrade cerebral perfusion
(SACP) during total aortic arch replacement by means of the frozen
elephant trunk (FET) technique for acute type A aortic dissections
(ATAADs). Method(s): A systematic review and meta-analysis was
performed by including relevant studies reporting outcomes of patients
with ATAADs undergoing total arch replacement with the FET technique using
either unilateral or bilateral SACP. Pubmed, ScienceDirect, SciELO, DOAJ,
and Cochrane library databases were searched until May 2023.
 Result(s): A total of 44 papers with 5983 patients were included,
3872 for unilateral SACP and 2111 for bilateral SACP. Although patients
undergoing bSACP presented a higher incidence of preoperative
comorbidities compared to uSACP, there was not a significant difference in
terms of mortality and major postoperative complications between the two
groups. Distal body circulatory arrest time was not associated with any
outcome at meta-regression, while longer SACP times in the whole
population were significantly associated with higher neurological
complications. Significant increased mortality was found in long uSACP.
 Conclusion(s): Our analysis showed that centers already apply the
appropriate perfusion strategy tailored to the complexity of the patient's
condition. It is therefore crucial to tailor the approach to the
complexities of individual patients rather than seeking a definitive
superiority between the two perfusion techniques to optimize outcomes
during FET for ATAAD. Further studies are warranted to confirm these
results. Copyright © 2025 by the authors.

<70>
Accession Number
648695725
Title
Prolonged duration of pharmacological thromboprophylaxis following
oncologic surgery: A systematic review and meta-analysis of RCTs.
Source
Thrombosis research. 255 (pp 109500), 2025. Date of Publication: 25 Sep
2025.
Author
Wang Z.; Yu Z.; Niu T.
Institution
(Wang, Yu) Department of Hematology, West China Hospital, Sichuan
University, Chengdu, China
(Niu) Department of Hematology, West China Hospital, Sichuan University,
Chengdu, 610017, China; State Key Laboratory of Biotherapy, Collaborative
Innovation Center of Biotherapy, West China Hospital, Sichuan University,
Chengdu, 610017, China; National Facility for Translational Medicine
(Sichuan), West China Hospital, Sichuan University, Chengdu, 610017, China
Abstract
BACKGROUND: Venous thromboembolism (VTE) is the leading cause of 30-day
postoperative mortality, with current guidelines recommending
extended-duration thromboprophylaxis despite limited evidence on its
impact on clinically meaningful benefits. OBJECTIVE(S): To evaluate
the efficacy and safety of prolonged anticoagulant prophylaxis versus
in-hospital only prophylaxis in cancer surgery patients using a
meta-analysis of randomized controlled trials (RCTs). METHOD(S): We
conducted a systematic review and meta-analysis of 10 RCTs. The primary
outcomes included overall VTE, symptomatic VTE, pulmonary embolism (PE),
major bleeding, and all-cause mortality. Results were summarized using
relative ratios (RR) and 95 % confidence intervals (CIs). RESULT(S):
Prolonged prophylaxis significantly reduced the 30-day incidence of
overall VTE (4.0 % vs. 10.0 %; RR 0.40, 95 %CI 0.22-0.76). No significant
differences were observed in the 30-day incidence of symptomatic VTE (0.7
% vs. 1.1 %; RR 0.66, 95 %CI 0.29-1.48), PE (0.5 % vs. 0.5 %), or 90-day
mortality (1.4 % vs. 1.6 %). A non-significant increase in major bleeding
occurred (0.9 % vs. 0.2 %; RR 2.37, 95 %CI 0.79-7.11). Subgroup analyses
indicated heterogeneity in primary outcomes based on surgical site
(abdominopelvic vs. thoracic surgery). CONCLUSION(S): While prolonged
duration of pharmacological thromboprophylaxis reduces the incidence of
overall VTE, it does not demonstrate clinically meaningful benefits for
symptomatic events or survival. Current risk-stratification tools may
overestimate thrombotic risk in cancer surgery patients receiving standard
in-hospital prophylaxis. Our findings support a selective, rather than
universal, approach to prolonged prophylaxis, emphasizing individualized
risk assessment. Copyright © 2025 Elsevier Ltd. All rights
reserved.

<71>
Accession Number
2040720808
Title
Pecto-intercostal fascial plane block with or without rectus sheath block
in cardiac surgery: a prospective, randomized, double-blind
placebo-controlled study.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Castro A.L.; Makker H.; Gonzalez L.S.; Jensen A.; Tarima S.S.; Pagryzinski
A.; Thapa R.; Qureshi A.; Fadumiye C.; Weierstahl K.; Pearson P.; Freed
J.K.
Institution
(Castro, Makker, Gonzalez, Pagryzinski, Fadumiye, Freed) Department of
Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
(Jensen) Department of Anesthesiology, Mercy Health, Buffalo, NY, United
States
(Tarima, Qureshi, Weierstahl) Medical College of Wisconsin, Milwaukee, WI,
United States
(Thapa) Anesthesiology, Aurora Medical Center, Grafton, WI, United States
(Pearson) Department of Cardiothoracic Surgery, Medical College of
Wisconsin, Milwaukee, WI, United States
Publisher
BMJ Publishing Group
Abstract
Background Median sternotomy and chest tube sites drive pain following
cardiac surgery. Prior research has demonstrated that pecto-intercostal
fascial plane blocks (PIFBs) reduce median sternotomy pain after cardiac
surgery. Prior studies examining the addition of a rectus sheath block
(RSB) to localize the insertion site of subxiphoid chest tubes have had
mixed results. Methods In this single-center, randomized, double-blind,
placebo-controlled trial, 62 patients undergoing cardiac surgery with
median sternotomy and subxiphoid chest tubes were randomized to receive
PIFB and RSB with local anesthetic versus PIFB with local anesthetic and
RSB with saline placebo. The primary outcome was pain at rest and with
deep breathing in the first 24 hours after surgery. Secondary outcomes
included total opioid consumption at 24 and 48 hours, performance on
incentive spirometry in the first 24 hours, time to extubation, hospital
and intensive care unit length of stay, and Quality of Recovery-15 score.
Results There was no statistically significant difference between groups
for the primary outcome, with mean area under the curve (AUC) for pain at
rest in the first 24 hours 93.37+/-41.38 (sample mean+/-sample SD) in the
placebo group versus 86.11+/-42.78 in the bupivacaine group (p=0.51), and
mean AUC for pain with deep breathing 135.55+/-43.74 in the placebo group
versus 128.78+/-47.08 in the bupivacaine group (p=0.57). There were no
differences in secondary outcomes between groups. Conclusions Adding
bilateral RSB to bilateral PIFB did not improve pain control or other
outcomes for patients undergoing cardiac surgery. Copyright ©
American Society of Regional Anesthesia & Pain Medicine 2025. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<72>
Accession Number
648696769
Title
A Bayesian Re-analysis of the STRESS Trial.
Source
American heart journal. (no pagination), 2025. Date of Publication: 25
Sep 2025.
Author
Hill K.D.; Koerner J.; Hong H.; Li J.S.; Hornik C.; Kannankeril P.J.;
Jacobs J.P.; Baldwin H.S.; Jacobs M.L.; Graham E.M.; Blasiole B.; Vener
D.F.; Husain A.S.; Kumar S.R.; Benscoter A.; Wald E.; Karamlou T.; Van
Bergen A.H.; Overman D.; Eghtesady P.; Butts R.; Kim J.S.; Scott J.P.;
Anderson B.R.; Swartz M.F.; O'Brien S.M.
Institution
(Hill, Li, Hornik) Duke University Pediatric and Congenital Heart Center,
Durham, North Carolina; Duke Clinical Research Institute, Durham, North
Carolina
(Koerner, Hong) Duke University Pediatric and Congenital Heart Center,
Durham, NC, United States
(Kannankeril, Baldwin) Vanderbilt University Medical Center, Nashville,
TN, United States
(Jacobs) University of Florida Congenital Heart Center, Gainesville, FL,
Puerto Rico
(Jacobs) Johns Hopkins University School of Medicine, Baltimore, MD,
Liberia
(Graham) Medical University of South Carolina, Charleston, SC, United
States
(Blasiole) UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United
States
(Vener) Pediatric Cardiac Anesthesiology, Texas Children's Hospital,
Department of Anesthesiology, Baylor College of Medicine, Houston, TX,
United States
(Husain) University of Utah/Primary Children's Hospital, Salt Lake City,
UT, United States
(Kumar) Criss Heart Center, Children's Nebraska and University of Nebraska
Medical Center, Omaha, NE, United States
(Benscoter) University of Cincinnati, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Wald) Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Karamlou) Akron Children's and Cincinnati Children's Hospital, Akron, OH,
United States
(Van Bergen) Advocate Children's Heart Institute, Advocate Children's
Hospital, Division of Pediatric Cardiac Critical Care, Oak Lawn, IL,
United States
(Overman) Division of Cardiovascular Surgery, Children's Minnesota,
Minneapolis, MN, United States
(Eghtesady) Section of Pediatric Cardiothoracic Surgery, Washington
University School of Medicine, St Louis, MO, United States
(Butts) Division of Cardiology, Department of Pediatrics, University of
Texas Southwestern, Dallas, TX, United States
(Kim) Division of Cardiology, Department of Pediatrics, Heart Institute,
Children's Hospital Colorado, University of Colorado School of Medicine,
Aurora, CO, United States
(Scott) Medical College of Wisconsin, Milwaukee, WI, United States
(Anderson) Mount Sinai Children's Heart Center, NY, United States
(Swartz) University of Rochester Medical Center, Rochester, NY, United
States
(O'Brien) Duke Clinical Research Institute, Durham, NC, United States
Abstract
BACKGROUND: Prophylactic steroids are often used to reduce the systemic
inflammatory response to cardiopulmonary bypass in infants undergoing
heart surgery. The STRESS trial found that the odds of a worse outcome did
not differ between infants randomized to methylprednisolone (n=599) versus
placebo (n=601) (adjusted odds ratio [OR], 0.86; P=0.14). However,
secondary analyses showed possible benefits with methylprednisolone. To
investigate further using a different probabilistic approach, we
re-analyzed the STRESS trial using Bayesian analytics. METHOD(S): We
used a covariate-adjusted proportional odds model using the original
STRESS trial primary endpoint, a ranked composite of death, transplant,
major complication and post-op length of stay. We performed Markov Chain
Monte Carlo simulations to assess the probability of benefit (OR <1)
versus harm (OR >1). Primary analysis assumed a neutral probability of
benefit versus harm with weak prior belief strength (nearly
non-informative prior distribution). To illustrate magnitude of effect, we
calculated predicted risk of death, transplant or major complications for
methylprednisolone and placebo. Sensitivity analyses evaluated pessimistic
(5%-30% prior likelihood of benefit), neutral and optimistic (70%-95%)
prior beliefs, and controlled strength of prior belief as weak (30%
variance), moderate (15%) and strong (5%). A secondary analysis derived
empirical priors using data from four previous steroid trials.
 RESULT(S): The posterior probability of any benefit from
methylprednisolone was 92% and probability of harm was 8%. Composite death
or major complication occurred in 18.8% of subjects with an absolute risk
difference of -2% (95% CI -3%, +1%) for methylprednisolone. Each of 9
sensitivity analyses demonstrated greater probability of benefit than harm
in the methylprednisolone group with 8 of 9 demonstrating >80% probability
of benefit and >=1% absolute difference in risk of death, transplant or
major complications. In secondary analysis deriving priors from previous
steroid trials, results were consistent with a 95% posterior probability
of benefit. CONCLUSION(S): Our Bayesian re-analysis of the STRESS
trial, using a range of prior beliefs, demonstrated a high probability
that perioperative methylprednisolone reduces the risk of death or major
complications in infants undergoing cardiopulmonary bypass compared with
placebo. This more in-depth analysis expands the initial clinical
evaluation of methylprednisolone provided by the STRESS trial. TRIAL
REGISTRATION: Clinicaltrials.gov: NCT03229538
(https://clinicaltrials.gov/study/NCT03229538). Copyright © 2025
Elsevier Inc. All rights reserved.

<73>
Accession Number
2036367255
Title
Length and Type of Antibiotic Prophylaxis for Infection Prevention in
Adults Patient in the Cardiac Surgery Intensive Care Unit: A Narrative
Review.
Source
Antibiotics. 14(9) (no pagination), 2025. Article Number: 934. Date of
Publication: 01 Sep 2025.
Author
Barbato R.; Ferraresi B.; Chello M.; Strumia A.; Gagliardi I.; Loreni F.;
Mattei A.; Santarpino G.; Carassiti M.; Grigioni F.; Lusini M.
Institution
(Barbato, Ferraresi, Chello, Gagliardi, Loreni, Lusini) Unit of Cardiac
Surgery, Department of Medicine, Fondazione Policlinico Universitario
Campus Bio-Medico, Rome, Italy
(Strumia, Mattei, Carassiti) Department of Anesthesia and Intensive Care,
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
(Santarpino) Department of Health Sciences, University "Magna Graecia" of
Catanzaro, Catanzaro, Italy
(Grigioni) Unit of Cardiac Science, Department of Medicine, Fondazione
Policlinico Universitario Campus Bio-Medico, Rome, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Infections following cardiac surgery are a significant cause
of morbidity and mortality, particularly in intensive care units (ICUs).
The role of antibiotic prophylaxis (AP) in preventing surgical site
infections (SSIs) and other nosocomial infections is crucial; however, the
optimal approach to agent selection, dosing, and duration remains
controversial. Objective(s): This narrative review aims to summarise
the current evidence and expert recommendations regarding the use of
perioperative antibiotic prophylaxis (AP) in adults undergoing cardiac
surgery, with a particular focus on intensive care settings, transplant
recipients, and adult patients on extracorporeal membrane oxygenation
(ECMO). Method(s): A comprehensive review of recent literature was
conducted, focusing on pharmacokinetic/pharmacodynamic (PK/PD) principles,
microbial epidemiology, antimicrobial resistance (AMR), and practical
strategies for tailored prophylaxis in high-risk populations.
 Result(s): Cefazolin remains the first-line agent for most
procedures, with vancomycin or clindamycin reserved for patients who are
allergic to beta-lactams or who are colonised with MRSA. Redosing is
recommended in cases of prolonged surgery or cardiopulmonary bypass.
Evidence supports limiting prophylaxis to <=24 h, with a potential
extension to 48 h in select high-risk cases; however, continuation beyond
this is discouraged due to the risk of resistance. In heart
transplantation, multimodal prophylaxis against bacteria, fungi, and
viruses is essential but must be tailored to the individual patient. In
the ECMO setting, the current evidence does not support the routine
administration of prophylaxis (AP), and therapy should be tailored based
on pharmacokinetics (PK)/pharmacodynamics (PD) changes and the clinical
context. A multidisciplinary, evidence-based approach to AP in cardiac
surgery is essential. Prophylaxis should be patient-specific,
microbiologically guided, and limited in duration to reduce the emergence
of multidrug-resistant organisms. Integrating antimicrobial stewardship,
non-pharmacological measures, and rigorous surveillance is crucial for
optimising the prevention of infections in this vulnerable
population. Copyright © 2025 by the authors.

<74>
Accession Number
2036376260
Title
Effects of physiotherapy on breathing cycle after thoracic surgery
measured with impedance pneumography in a prospective clinical comparison.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2025. Date
of Publication: 2025.
Author
Lahteenmaki S.; Juutinen M.; Viik J.; Mahrberg H.; Laurikka J.
Institution
(Lahteenmaki, Juutinen, Viik, Laurikka) Faculty of Medicine and Health
Technology, Tampere University, Tampere, Finland
(Mahrberg, Laurikka) Tampere University Heart Hospital, Tampere, Finland
Publisher
Springer
Abstract
Objectives: Impedance pneumography (IP) records respiratory cycle and
provides non-invasive means to evaluate changes after thoracic surgery.
This comparative study evaluated if changes after thoracic surgery can be
modified by two pulmonary rehabilitation modalities. Method(s): 88
patients undergoing thoracic surgery were randomly allocated to either
positive expiratory pressure (PEP) or inspiratory muscle training (IMT)
physiotherapy group. Physiotherapy was performed and IP recorded
preoperatively and at first and second postoperative days (POD1 and POD2)
during tidal breathing. Full three timepoint IP data were collected from
81 patients (42 in the PEP group, 39 in the IMT group). Average
inspiration and expiration time in seconds (TinspAvg and TexpAvg) and
average breathing frequencies (BrthFreqAvg) were calculated from a 10-min
measurement period and assessed as primary outcomes. Results were also
assessed in blocks of different surgical techniques (thoracotomy or VATS)
and the extent of surgery (pulmonary resection or minor thoracic
operation). Result(s): TinspAvg and TexpAvg decreased after surgery
but started to increase in the IMT group between POD1 and POD2 with no
significant difference compared to PEP group. Among patients operated with
thoracotomy TexpAvg was slightly but insignificantly higher in the IMT
group at POD2. The ratio between the time of expiration and the time of
inspiration (EI ratio) was significantly higher in the IMT group with
thoracotomy (difference between groups over three timepoints, (p = 0.044)
and at POD1 (p = 0.015)). Conclusion(s): IMT seemed to enhance
expiration specifically among thoracotomy patients and thus may provide
means for enhancing the recovery after thoracic operations. Clinical trial
registration: NCT02931617/U.S. National Library of Medicine,
ClinicalTrials.gov. Copyright © The Author(s) 2025.

<75>
Accession Number
648679924
Title
Comparative Effectiveness of Exercise Training Modalities in Heart
Transplant Recipients: A Systematic Review and Network Meta-Analysis of
Randomized Controlled Trials.
Source
European journal of preventive cardiology. (no pagination), 2025. Date of
Publication: 26 Sep 2025.
Author
de Lima J.B.; Ferrari F.; Dos Santos Soares D.; Junior N.C.; Carvalho G.;
Leitao S.A.T.; Goldraich L.A.; Ziegelmann P.K.; Clausell N.; Stein R.
Institution
(de Lima, Ferrari, Dos Santos Soares, Carvalho, Leitao, Ziegelmann,
Clausell, Stein) Graduate Program in Cardiology and Cardiovascular
Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clinicas
de Porto Alegre, RS Brazil, Porto Alegre, Brazil
(de Lima, Ferrari, Carvalho, Stein) Exercise Cardiology Research Group,
Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto
Alegre, RS Brazil, Porto Alegre, Brazil
(Junior) Department of Evidence-Based Health, Brazilian Cochrane Center,
Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Leitao) Interdisciplinary Research Group in Translational Cardiology,
Clinical Research Center, Hospital de Clinicas de Porto Alegre, RS Brazil,
Porto Alegre, Brazil
(Goldraich, Clausell) Heart Failure and Cardiac Transplant Unit,
Cardiology Division, Hospital de Clinicas de Porto Alegre, RS Brazil,
Porto Alegre, Brazil
(Ziegelmann) Graduate Program in Epidemiology, Universidade Federal do Rio
Grande do Sul, RS Brazil, Porto Alegre, Brazil
(Stein) Internal Medicine Department, Universidade Federal do Rio Grande
do Sul, RS Brazil, Porto Alegre, Brazil
Abstract
AIMS: Exercise training (ET) provides numerous benefits for heart
transplant (HTx) recipients. However, direct comparisons between ET
modalities remain limited. This study aims to compare the efficacy and
safety of multiple ET modalities on peak oxygen consumption (peak VO2) and
key secondary outcomes in HTx recipients. METHODS AND RESULTS: We
systematically searched eight electronic databases from inception to
September 2024. Traditional random-effects models and Bayesian network
meta-analysis were employed. Confidence in the results was evaluated using
the Confidence in Network Meta-Analysis (CINeMA) tool. Thirteen randomized
controlled trials involving 473 HTx recipients were analyzed. The network
meta-analysis identified high-intensity interval training (HIIT) (mean
difference [MD]: 4.34 ml.kg-1.min-1; 95% credible interval [CrI], 1.41 to
5.6) and combined training (CT) (MD: 3.49 ml.kg-1.min-1; 95%CrI, 1.15 to
7.44) as the most effective interventions for improving peak VO2 compared
to usual care. HIIT was also more effective than moderate-intensity
continuous training (MICT) (MD: 2.09 ml.kg-1.min-1; 95%CrI, 0.05 to 4.03).
No significant differences were observed between MICT, home-based MICT,
home-based CT, and usual care. The certainty of evidence ranged from
moderate to very low across comparisons. No significant differences were
observed between ET modalities regarding heart rate response or
ventilatory efficiency. ET was associated with improvements in specific
quality of life subdomains. No exercise-related adverse events were
reported. CONCLUSION(S): This review demonstrates that ET
significantly improves peak VO2 in HTx recipients, with HIIT and CT
outperforming usual care. HIIT also surpasses MICT in improving peak VO2.
Overall, ET modalities are safe and effective for this
population. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Society of Cardiology. All
rights reserved. For commercial re-use, please contact reprints@oup.com
for reprints and translation rights for reprints. All other permissions
can be obtained through our RightsLink service via the Permissions link on
the article page on our site-for further information please contact

<76>
[Use Link to view the full text]
Accession Number
648681259
Title
Bispectral Index-Guided Anesthesia for Older Patients Having Non-Cardiac
Surgery: A Randomized Multicenter Trial.
Source
Anesthesiology. (no pagination), 2025. Date of Publication: 25 Sep 2025.
Author
Zhou L.; Ding L.; Yang H.; Li C.; Yu Z.; Ma W.; Chen Q.; Zhang Y.; Mao Q.;
Cheng M.; Gong G.; Wang E.; Liu C.; Hao W.; Li H.; Chen C.; Fan Y.; Su Z.;
Cai X.; Zhang X.; Li Z.; Zhang B.; Li Y.; Jiang C.; Yin Q.; Jiao J.;
Sessler D.I.; Li Q.; Liu J.
Institution
(Zhou, Ding, Yang, Li, Ma, Yin, Li, Liu) Department of Anesthesiology,
West China Hospital, Sichuan University, Chengdu, China
(Li) Department of Clinical Research Management, West China Hospital,
Sichuan University, Chengdu, China
(Yu) Department of Bioinformatics and Biostatistics, School of Life
Sciences and Biotechnology and SJTU-Yale Joint Center for Biostatistics,
Shanghai Jiao Tong University, Shanghai, China
(Chen) Department of Anesthesiology, Dazhou Central Hospital, China
(Zhang) Department of Anesthesiology, Liuzhou Worker's Hospital, Fourth
Affiliated Hospital of Guangxi Medical University, China
(Li) Department of Anesthesiology, Second Clinical Medical College of
Guangzhou University of Chinese Medicine, Guangzhou, China
(Mao) Department of Anesthesiology, Army Medical Center of PLA, Chongqing,
China
(Cheng) Department of Anesthesiology, First Affiliated Hospital of Shantou
University Medical College, Shantou, China
(Gong) Department of Anesthesiology, General Hospital of Western Theater
Command, Chengdu, China
(Wang) Department of Anesthesiology, First Affiliated Hospital of Army
Military Medical University, Chongqing, China
(Liu, Chen) Department of Anesthesiology, First Affiliated Hospital with
Nanjing Medical University, Nanjing, China
(Hao) Department of Anesthesiology, First Affiliated Hospital of Hebei
University of Traditional Chinese Medicine, Shijiazhuang, China
(Li) Department of Anesthesiology, Second Affiliated Hospital of Army
Military Medical University, China
(Fan) Department of Anesthesiology, People's Hospital of Leshan, Leshan,
China
(Su) Department of Anesthesiology, China-Japan Union Hospital of Jilin
University, Changchun, China
(Cai) Department of Anesthesiology, Fifth Affiliated Hospital of Xinjiang
Medical University, Urumqi, China
(Zhang) Department of Anesthesiology, Ya'an People's Hospital, China
(Li) Department of Anesthesiology, Affiliated Yantai Yuhuangding Hospital
of Qingdao University Medical College, Yantai, China
(Zhang) Department of Anesthesiology, Third Affiliated Hospital of
Xinjiang Medical University, Urumqi, China
(Li) Department of Anesthesiology, Lanzhou University Second Hospital,
Lanzhou, China
(Jiang) Department of Anesthesiology, Chongqing General Hospital,
Chongqing, China
(Jiao) Institute of Translational Medicine, Shanghai Jiao Tong University,
Shanghai, China
(Sessler) Professor and Vice-president for Clinical and Outcomes Research,
Center for Outcomes Research and Department of Anesthesiology, UTHealth,
Houston, TX, United States
Abstract
BACKGROUND: Older surgical patients are at risk because of age-related
physiologic decline and comorbidities. Some guidelines recommend
Bispectral Index (BIS) monitoring to optimize anesthetic depth, but robust
evidence supporting improved outcomes is lacking. METHOD(S): We
conducted a randomized, multicenter, double-blind trial across 21
tertiary-care hospitals in China (March 17, 2015 to February 5, 2022).
Patients aged 65 years or older scheduled for elective non-cardiac surgery
(ASA I to IV) were randomized 1:1 to BIS-guided or routine anesthetic
management. In patients assigned to BIS guidance, hypnotic depth was
adjusted to maintain BIS between 40 and 60. Hypnotic depth in patients
assigned to routine-care per clinical judgment with masked BIS monitors.
The primary outcome was 1-year all-cause mortality. Secondary outcomes
included moderate-to-severe complications within 30 days, functional
independence, quality of life, the duration of postoperative critical
care, the duration of postoperative hospitalization, unplanned ICU
admission, and hospital cost. RESULT(S): Among 6982 patients (mean
age 71 [SD 5] years), BIS values averaged 47 (BIS-guided) versus 46
(routine). 1-year mortality was similar in BIS-guided patients [10.2%
(356/3485)] and routinely managed patients [10.0% (351/3497)]: HR 1.02,
95% CI 0.88-1.17; P = 0.812). The incidence of complications within 30
days after surgery were also comparable in each group: 10.4% versus 10.6%
(RR 0.99, 95% CI 0.85-1.16; P = 0.938). No significant differences were
observed in functional independence or quality of life.
 CONCLUSION(S): Hypnotic depth, as assessed by BIS, was similar in
patients with or without BIS-guided anesthetic titration.
Anesthesiologists thus apparently titrate hypnotic depth appropriately
even without BIS guidance. Unsurprisingly, outcomes including
postoperative 1-year mortality and 30-day complications were similar in
each group. Copyright © 2025 The Author(s). Published by Wolters
Kluwer Health, Inc., on behalf of the American Society of
Anesthesiologists.

<77>
Accession Number
2040694954
Title
A Systematic Review of the Prognostic Value of Cardiopulmonary Exercise
Testing in Patients with Ischemic and Nonischemic Cardiomyopathy.
Source
CJC Open. (no pagination), 2025. Date of Publication: 2025.
Author
Lowes H.; Brenner I.; Woodend K.; West S.; Sunner M.; Khehra B.;
Orchanian-Cheff A.; Rodriguez Arias J.J.; Foroutan F.; Fan C.P.S.;
Rodenas-Alesina E.; Posada J.D.; Ross H.J.; Moayedi Y.
Institution
(Lowes, Brenner, Woodend, West) Environmental and Life Sciences, Trent
University, Peterborough, ON, Canada
(Lowes, Sunner, Khehra, Orchanian-Cheff, Rodriguez Arias, Foroutan, Fan,
Rodenas-Alesina, Posada, Ross, Moayedi) Ted Rogers Centre for Heart
Research, Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: The prognostic utility of cardiopulmonary exercise testing
(CPET) in heart failure (HF) is well established; however, whether optimal
CPET parameter thresholds differ across HF etiologies remains unclear.
This systematic review aimed to determine how CPET-derived parameters and
their prognostic threshold values differ, and their association with
adverse outcomes, in patients with ischemic vs nonischemic cardiomyopathy.
 Method(s): Eligible studies assessed adult HF patients and reported
outcomes of all-cause mortality, left ventricular assist device
implantation, heart transplantation, or hospitalization. CPET parameters
and associated threshold values were extracted, and risk of bias was
assessed using the Joanna Briggs Institute checklist for cohort studies.
 Result(s): Four studies comprising 491 ischemic and 218 nonischemic
HF patients were included. Peak oxygen consumption (pVO<inf>2</inf>) was
the only CPET parameter unanimously reported. In ischemic HF, the optimal
pVO<inf>2</inf> thresholds, in mL/kg/min, were <= 14.10 (hazard ratio [HR]
3.3; confidence interval [CI]: 1.9-5.8), <= 10.0 (HR 0.76; CI: 0.59-0.98),
<= 15.20, and <= 14.0 (used in one study as a guideline comparator),
yielding a mean threshold of <= 13.33 mL/kg/min ( +/- 2.28). In
nonischemic HF, optimal thresholds in mL/kg/min were <= 14.60 (HR 4.30
[CI: 2.10-8.90]) and <= 14.0, yielding a mean of <= 14.30 mL/kg/min ( +/-
0.42). Conclusion(s): Significant heterogeneity was present in study
design, patient populations, and CPET variables assessed. The few
consistently assessed prognostic thresholds were similar across HF
etiologies. Peak oxygen consumption (pVO<inf>2</inf>) remains a robust
prognostic marker in both ischemic and nonischemic cardiomyopathy.
Although patients with ischemic cardiomyopathy generally have worse
clinical profiles, this review suggests that no meaningful differences
occur in a few key CPET prognostic thresholds, namely pVO<inf>2</inf>,
across etiologies. These findings support continued use of established
guideline-recommended thresholds for risk stratification, irrespective of
HF subtype, but require further confirmation. Copyright © 2025
The Authors

<78>
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Accession Number
648680918
Title
Timing and Safety of Anticoagulation Reinitiation After Intracranial
Hemorrhage in Patients With Mechanical Valves: A Meta-Analysis.
Source
Neurology. 105(8) (pp e214184), 2025. Date of Publication: 21 Oct 2025.
Author
D'Anna L.; Prandin G.; Pirera E.; Sacco S.; Veltkamp R.; Korompoki E.;
Gigli M.; Paciaroni M.; Gorog D.A.; Favruzzo F.; Kanagaratnam P.; Lim B.;
Zhang L.; Simister R.J.; Valente M.; Gigli G.L.; Foschi M.; Merlino G.
Institution
(D'Anna) Department of Stroke and Neuroscience, Charing Cross Hospital,
Imperial College London NHS Healthcare Trust, United Kingdom
(D'Anna, Veltkamp, Korompoki) Department of Brain Sciences, Imperial
College London, United Kingdom
(Prandin) Clinical Unit of Neurology, Department of Medicine, Surgery and
Health Sciences, University Hospital and Health Services of Trieste,
University of Trieste, Italy
(Pirera) Internal Medicine and Stroke Care Ward, Department of Promoting
Health, Maternal-Infant, Excellence and Internal and Specialized Medicine
(ProMISE) "G. D'Alessandro, University of Palermo, Italy
(Sacco, Foschi) Department of Biotechnological and Applied Clinical
Sciences, University of L'Aquila, Italy
(Veltkamp) Department of Neurology, Alfried-Krupp Krankenhaus Essen,
Germany
(Veltkamp) Department of Neurology, University Hospital Heidelberg,
Germany
(Korompoki) Department of Clinical Therapeutics, National and Kapodistrian
University of Athens, Greece
(Gigli) Cardiovascular Department, Trieste, Italy
(Paciaroni) Department of Neurosciences and Rehabilitation, University of
Ferrara, Italy
(Gorog) Faculty of Medicine, National Heart and Lung Institute, Imperial
College, London, United Kingdom
(Gorog) School of Life and Medical Sciences, Postgraduate Medical School,
University of Hertfordshire, United Kingdom
(Favruzzo) Comprehensive Stroke Center, Ospedale dell'Angelo, Mestre,
Italy
(Kanagaratnam, Lim) Department of Cardiology, Hammersmith Hospital,
Imperial College London NHS Healthcare Trust, United Kingdom
(Zhang) Stroke Unit, Department of Neuroscience, George's University of
London, United Kingdom
(Simister) Comprehensive Stroke Service, University College London
Hospital, United Kingdom
(Valente, Gigli, Merlino) Clinical Neurology, Udine University Hospital
and Department of Medicine (DMED), University of Udine, Italy; and
(Merlino) SOSD Stroke Unit, Department Head, Neurosciences, Udine
University Hospital, Italy
Abstract
BACKGROUND AND OBJECTIVES: In patients with mechanical heart valves
(MHVs), anticoagulation (AC) interruption after intracranial hemorrhage
(ICH) poses a clinical dilemma because of competing risks of ischemic
complications and hemorrhagic recurrence. To date, the optimal timing for
resuming vitamin K antagonists (VKAs) remains unclear. The aim of this
meta-analysis was to quantify the risks of ischemic stroke and recurrent
ICH associated with VKA resumption in this population and explore the
temporal risk dynamics. METHOD(S): We systematically searched PubMed,
Embase, and Cochrane Library from inception to December 2023 for studies
reporting ischemic or hemorrhagic outcomes in adults with MHVs who
experienced ICH and were considered for VKA resumption. Primary outcomes
were ischemic stroke before AC resumption and recurrent ICH after AC
resumption. Random-effects meta-analyses were performed. Meta-regressions
assessed whether timing of resumption influenced risk. Risk trajectories
were estimated using a model-based approach. RESULT(S): Nine studies
were included, comprising 435 patients with MHVs with confirmed ICH
included in the pooled analysis. The mean age ranged from 54.1 to 75
years; 31.3% were female. The pooled incidence of recurrent ICH after AC
reinitiation was 11.4% (95% CI 8.2-15.6; I2 = 0%), the incidence of
ischemic stroke during AC suspension was 6.1% (95% CI 4.1-8.9; I2 = 0%),
valve thrombosis occurred in 3.3% (95% CI 1.9-5.6; I2 = 0%), and mortality
occurred in 4.9% (95% CI 2.0-11.5; I2 = 37%). Meta-regression demonstrated
a significant inverse association between time to AC resumption and risk
of recurrent ICH (regression coefficient -0.039; 95% CI -0.093 to 0.015; p
= 0.13), corresponding to an approximate 50% relative reduction in risk at
11 days after ICH. No significant time-dependent association was observed
for ischemic stroke (coefficient -0.013; 95% CI -0.065 to 0.039; p =
0.61). DISCUSSION(S): In patients with MHVs who experienced an ICH,
this meta-analysis found that resumption of AC was associated with a
recurrent ICH rate of 11.4% and an ischemic stroke rate of 6.1% during AC
suspension. Meta-regression suggested a lower risk of recurrent ICH with
later AC resumption, with a potential risk reduction at approximately 11
days after ICH. No time-dependent increase in ischemic stroke was
observed. Limitations include the retrospective design of most studies and
heterogeneous AC timing across cohorts.

<79>
Accession Number
2040694485
Title
Systematic review on radiation-induced DNA damage and cancer risk in
endovascular operators.
Source
Journal of Vascular Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Maris E.-L.; Klaassen J.; Hazenberg C.E.V.B.; Petri B.-J.; Trimarchi S.;
van Herwaarden J.A.
Institution
(Maris, Klaassen, Hazenberg, Petri, van Herwaarden) Department of Vascular
Surgery, Utrecht Medical Centre Utrecht, Utrecht, Netherlands
(Trimarchi) Section of Vascular Surgery, Cardiac Thoracic Vascular
Department, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico,
Milan, Italy
(Trimarchi) Department of Clinical and Community Sciences, University of
Milan, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Objective: Endovascular interventions have increasingly replaced open
surgery owing to their minimally invasive nature and benefits such as
faster recovery and fewer wound complications. This shift has led to
greater reliance on fluoroscopy, raising concerns about occupational
radiation exposure. Ionizing radiation, although essential for guiding
procedures, can damage living tissue and potentially induce long-term
health effects. Recent guidelines from the European Society for Vascular
Surgery and the Cardiovascular and Interventional Radiological Society of
Europe emphasize growing radiation risks and advocate for dose
optimization and protective strategies. Endovascular specialists-vascular
surgeons, interventional cardiologists, and radiologists-are among the
most exposed hospital staff. Yet, limited studies have specifically
examined the effects of fluoroscopy-induced DNA damage and carcinogenesis
in these professionals. The aim of this systematic review was to evaluate
the extent to which occupational radiation exposure contributes to DNA
damage and cancer risk in endovascular operators. Method(s): A
systematic search of the literature from 2000 to April 2025 of PubMed and
EMBASE was conducted following the PRISMA guidelines. All experimental
studies, observational studies, and case reports that examined DNA damage
or cancer occurrence in operators performing endovascular procedures owing
to occupational radiation exposure were included in this review. Studies
were categorized into two primary outcomes: cancer and DNA damage. A risk
of bias assessment was performed according to Cochrane guidelines.
 Result(s): Twenty-five studies were identified. The findings from
these studies suggest that occupational radiation exposure in endovascular
operators may lead to early-stage DNA damage shortly after exposure.
Additionally, the studies observed chronic DNA damage, including
double-strand DNA breaks and chromosomal aberrations, which are
hypothesized to be a contributing factor to genomic instability and
carcinogenesis. Furthermore, the studies researching carcinogenesis
suggest an increased risk of cancer development in endovascular operators,
with particular emphasis on cancer localizations that are more susceptible
to radiation, such as leukemia and thyroid cancer, and in unprotected body
areas, such as the skin and the brain. Conclusion(s): This systematic
review suggests that endovascular operators involved in fluoroscopy-guided
interventional procedures may face an increased risk of stochastic health
effects, with a particular emphasis on chronic DNA damage and
carcinogenesis in locations more vulnerable to radiation. This review
highlights the critical need for enhanced radiation safety measures,
awareness, and preventative strategies. Copyright © 2025 The
Author(s)

<80>
Accession Number
648667449
Title
Sternal complications after clamshell surgery for (heart-)lung
transplantation-A systematic literature review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 23 Sep 2025.
Author
Klei D.S.; Sabaoglu R.; Mokhles M.M.; de Heer L.M.; van Wessem K.J.P.
Institution
(Klei, van Wessem) Department of Trauma Surgery, University Medical Centre
Utrecht, Utrecht, Netherlands
(Sabaoglu, Mokhles, de Heer) Department of Cardiothoracic Surgery,
University Medical Centre Utrecht, Utrecht, Netherlands
Abstract
OBJECTIVES: Bilateral transverse thoracosternotomy ('clamshell') is widely
used for (heart-)lung transplantations but postoperative sternal
complications are a significant challenge. The primary objective of this
systematic review was to evaluate the prevalence of sternal complications
after clamshell surgery in (heart-)lung transplantation patients.
 METHOD(S): A systematic literature review was conducted. On April 4,
2025, PubMed and Embase databases were searched. Original studies
reporting sternal complications after clamshell surgery in adults for
bilateral lung or heart-lung transplantation were included. Studies
including <10 patients were excluded. Study quality was assessed using the
National Institutes of Health assessment tool. The total and range of
sternal complication prevalence was provided. Meta-analysis of sternal
complication prevalence was not performed due to significant heterogeneity
across studies. RESULT(S): The database searches yielded 945 eligible
articles. 18 studies were included, including 828 patients who underwent a
total of 830 bilateral lung or heart-lung transplantations through
clamshell surgery. All included studies were cohort studies with poor (n =
15), fair (n = 1), or good (n = 2) quality. In total, 286 sternal
complications were reported (0.34 event per clamshell surgery; range 0.02
to 1.35 in individual studies) and 90 sternal reoperations were conducted
(0.14 reoperation per clamshell surgery; range 0.02 to 0.29 in individual
studies). CONCLUSION(S): Despite limitations in study quality and
heterogeneity, this review highlights the high prevalence and relevance of
sternal complications following clamshell surgery for (heart-)lung
transplantation. Future studies should focus on patient selection, risk
stratification, development of modified sternal closure techniques, and
implementation of alternative surgical approaches to (heart-)lung
transplantation. Copyright © The Author(s) 2025. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<81>
[Use Link to view the full text]
Accession Number
648666449
Title
Prevention of postoperative acute kidney injury: insights from recent
clinical trials.
Source
Current opinion in nephrology and hypertension. (no pagination), 2025.
Date of Publication: 25 Sep 2025.
Author
Benyahia R.; Klein J.; Faguer S.
Institution
(Benyahia, Faguer) Department of Nephrology and Organ Transplantation,
Referral Centre for Rare Kidney Diseases, French Intensive Care Renal
Network, University Hospital of Toulouse, France
(Benyahia, Klein, Faguer) National Institute of Health and Medical
Research (INSERM), Institute of Metabolic and Cardiovascular Diseases
(I2MC), Renal Fibrosis Lab
(Benyahia, Klein, Faguer) Faculty of Health, University of Toulouse,
Toulouse, France
Abstract
PURPOSE OF REVIEW: Postoperative acute kidney injury (PO-AKI) is a common
complication associated with increased morbidity and mortality. Despite
its frequency, guidelines for the prevention of PO-AKI are relatively
recent and still based on weak or contradictory evidence. This review aims
to summarize large recent studies published in the past 2 years that have
attempted to address these gaps. RECENT FINDINGS: While the POST-CABGDM
and Stop-or-Not trials have provided additional evidence on the
preoperative prescription of RAAS and SGLT2 inhibitors in selected
surgical settings, future research must integrate preoperative risk
profiling to personalize therapy. Likewise, although the POISE-3 trial
seems to suggest that maintaining a mean arterial pressure of at least 60
mmHg is crucial in noncardiac surgery, it does not explore how targets
might be personalized. In cardiac surgery, both the SIRAKI02 trial (i.e.,
extracorporeal blood purification membrane connected to the
cardiopulmonary bypass) and the PROTECTION trial (i.e., intraoperative
amino-acid infusion) demonstrated benefit only for mild AKI, raising
questions about their mechanistic basis and clinical significance.
SUMMARY: "Prevention is better than cure," a principle that holds
particularly true for PO-AKI, a common complication that still lacks
effective curative treatments. Although the recent abovementioned trials
have yielded important findings, they concurrently underscore the
significant obstacles in conducting clinical trials on PO-AKI and in
formulating robust recommendations based on their outcomes. Copyright
© 2025 Wolters Kluwer Health, Inc. All rights reserved.

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