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<1>
Accession Number
2040429424
Title
Prognostic impact of prior percutaneous coronary intervention on patients
undergoing coronary artery bypass grafting - A meta-analysis of
reconstructed time-to-event data.
Source
American Heart Journal Plus: Cardiology Research and Practice. 59 (no
pagination), 2025. Article Number: 100606. Date of Publication: 01 Nov
2025.
Author
Kirov H.; Caldonazo T.; Woehlecke H.; Fazini L.; Fischer J.; Costa V.;
Amorim P.; Runkel A.; Rodrigues E.; Mukharyamov M.; de Sa M.P.L.; Doenst
T.
Institution
(Kirov, Caldonazo, Woehlecke, Fischer, Runkel, Mukharyamov, Doenst)
Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena,
Germany
(Fazini) Department of Medical Sciences and Public Health, Clinical
Cardiology Unit, University of Cagliari, Cagliari, Italy
(Fazini) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
United States
(Costa, Amorim, Rodrigues, de Sa) Federal University of Rio de Janeiro,
Rio de Janeiro, Brazil
Publisher
Elsevier Inc.
Abstract
Background: There is controversy on the effect of percutaneous coronary
intervention (PCI) on outcomes of patients undergoing coronary artery
bypass grafting (CABG). We meta-analytically assessed the prognostic
impact of prior PCI in patients with coronary artery disease (CAD) who
underwent CABG. <br/>Method(s): We performed a systematic review and
meta-analysis of studies comparing patients who underwent CABG and had
prior PCI in the past with patients who underwent CABG as primary
treatment of CAD. Three databases were assessed. The primary endpoint was
perioperative mortality. The secondary outcomes were long-term survival,
perioperative myocardial infarction, neurological events, bleeding, acute
renal failure, and hospital length of stay. Reconstruction of
time-to-event data and pairwise meta-analysis were performed.
<br/>Result(s): Nineteen studies met the criteria for inclusion in the
final analysis. Risk of perioperative mortality in patients undergoing
CABG after a prior PCI was higher than in those undergoing primary CABG
(OR: 1.16, 95 % CI, 1.03-1.31, p = 0.02). However, the prior PCI group
presented higher survival rates when compared to the primary CABG group
over the entire follow-up (HR: 0.90, 95 % CI, 0.86-0.94, p < 0.01). There
was no significant difference between the groups regarding the other
secondary outcomes. <br/>Conclusion(s): When compared with patients who
underwent CABG as primary treatment of CAD, prior PCI is associated with
higher perioperative mortality for patients undergoing CABG. However, this
increase in perioperative risk does not correlate with a decrease in
long-term survival.<br/>Copyright &#xa9; 2025 The Authors

<2>
Accession Number
2036194985
Title
Smoking and Postoperative Pain: A Systematic Review and Meta-Analysis.
Source
Pain Practice. 25(8) (no pagination), 2025. Article Number: e70083. Date
of Publication: 01 Nov 2025.
Author
Chow R.; Lans Z.; Cohen S.P.; Lin H.-M.; Zhao J.; Rajput K.
Institution
(Chow, Lans, Lin, Zhao, Rajput) Department of Anesthesiology, Yale
University, New Haven, CT, United States
(Cohen) Department of Anesthesiology, Northwestern University, Evanston,
IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Smoking is known to increase the risk of numerous
postoperative complications, including increased rates of infection,
cardiovascular events, and pulmonary complications. In addition, there may
be an effect of smoking on pain in the perioperative period. Through this
meta-analysis, we sought to investigate what is known about the
relationship between smoking and acute postoperative pain. <br/>Method(s):
Articles published between January 2003 and December 2023 that compared
smokers to nonsmokers and utilized pain scores and/or measured
postoperative opioid consumption were selected for review. 95% confidence
intervals were utilized to determine statistical significance in
standardized mean differences for each outcome between smokers and
nonsmokers. <br/>Result(s): The meta-analysis included five studies that
assessed postoperative pain scores and opioid requirements in smokers and
nonsmokers. In the analysis of pain scores, smokers consistently had
higher pain scores overall on all postoperative days (POD) 0 (0.46 [95%
CI: 0.26-0.66]), POD1 (0.32 [0.17-0.46]), and POD2 (0.38 [0.24-0.52]).
Smokers also demonstrated higher opioid requirements compared to
nonsmokers on POD0 (0.62 [0.43-0.80]), POD1 (0.49 [0.36-0.62]), and POD2
(0.70 [0.56-0.84]). Four additional studies were included in our
systematic review, which further revealed an association between smoking
history and postoperative pain. <br/>Conclusion(s): Smokers demonstrate
increased postoperative pain, as assessed by pain scores and opioid
requirements. The ability to anticipate increased postoperative pain in
this population has the potential to improve postoperative outcomes for
patients with a smoking history.<br/>Copyright &#xa9; 2025 World Institute
of Pain.

<3>
Accession Number
2032846634
Title
Del Nido versus conventional blood cardioplegia in tetralogy of fallot
repair: A systematic review and meta-analysis of randomized controlled
trials.
Source
Perfusion (United Kingdom). 40(7) (pp 1535-1545), 2025. Date of
Publication: 01 Oct 2025.
Author
Consoli L.N.; Koziakas I.G.; Kanakis M.
Institution
(Consoli) Faculty of Medicine, Federal University of Bahia, Bahia, Brazil
(Koziakas) Department of Anesthesiology, Onassis Cardiac Surgery Center,
Athens, Greece
(Kanakis) Department of Pediatric and Congenital Heart Surgery, Onassis
Cardiac Surgery Center, Athens, Greece
Publisher
SAGE Publications Ltd
Abstract
Objectives: Compare outcomes of Del Nido (DN) versus conventional blood
cardioplegia (BC) in the surgical repair of Tetralogy of Fallot (ToF).
<br/>Method(s): Medical databases were searched to identify relevant
clinical trials. Meta-analysis was conducted for primary (cardiopulmonary
bypass [CPB] and aortic cross-clamp [ACC] times, hospital and intensive
care unit [ICU] length of stay [LOS], mechanical ventilation time) and
secondary (adverse events, lactate levels, volume of additional
cardioplegia) endpoints. Analysis was conducted for DN versus conventional
blood cardioplegia, and we performed sensitivity analysis with leave
one-out analysis for the primary outcome. <br/>Result(s): 4 randomized
controlled trials were included (n = 275). Mean differences (MD) with 95%
confidence intervals (CI) were calculated with a random-effects model.
Groups had similar CPB (MD -5.76 minutes; [-23.32 to 11.80]; p = 0.52) and
ACC (MD 3.06 minutes; [-13.64 to 7.52]; p = 0.57) times, ICU (MD -6.42
hours; [-25.62 to 12.78]; p = 0.51) LOS and additional cardioplegia volume
(MD -195.18 mL; [-434.19 to 43.82]; p = 0.11). The DN group had shorter
hospital LOS (MD -0.81 days; [-1.25 to -0.36]; p = 0.0003) and time under
mechanical ventilation (MD -4.57 hours; [-8.73 to -0.42]; p = 0.03). There
was no difference in mortality. <br/>Conclusion(s): DN cardioplegia has
similar clinical outcomes and operative times compared to conventional
blood cardioplegia in ToF surgery.<br/>Copyright &#xa9; The Author(s) 2025

<4>
Accession Number
2040433430
Title
Reappraisal of Evidentiary Support for Transcatheter Aortic Valve
Implantation for Low-Risk Aortic Stenosis: Insights From Midterm Results
of the PARTNER 3 and Evolut LR Trials.
Source
Journal of the American College of Cardiology. 86(13) (pp 1002-1005),
2025. Date of Publication: 30 Sep 2025.
Author
Kaul S.
Institution
(Kaul) Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
Publisher
Elsevier Inc.

<5>
Accession Number
2040629239
Title
Efficacy and Safety of Direct Oral Anticoagulants in Patients After Heart
Valve Replacement or Repair: A Systematic Review and Network
Meta-Analysis.
Source
Clinical Therapeutics. (no pagination), 2025. Date of Publication: 2025.
Author
Gao W.; Zhang Z.; Jia P.; Dong L.; Li R.; Xu J.; Zhang J.; Chen W.
Institution
(Gao, Zhang, Jia, Dong, Li, Xu, Zhang, Chen) Third Hospital of Shanxi
Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical
Sciences, Tongji Shanxi Hospital, Taiyuan, China
(Zhang, Jia, Dong, Chen) School of Pharmacy, Shanxi Medical University,
Taiyuan, China
Publisher
Elsevier Inc.
Abstract
Purpose: The optimal anticoagulation strategy following bioprosthetic
heart valve replacement or valve repair remains controversial. Therefore,
we conducted a meta-analysis to compare the efficacy and safety of direct
oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients
with heart valve disease. <br/>Method(s): We searched PubMed, Cochrane
Library, Embase, Web of Science, CNKI, and Wanfang for clinical studies
comparing DOACs and VKAs in patients following bioprosthetic heart valve
replacement or repair, up to November 1, 2023. The meta-analysis was
conducted using RevMan 5.3 and Stata 17.0. <br/>Finding(s): Thirty-three
studies involving 59,660 individuals were included in the meta-analysis.
Compared with VKAs, DOACs may reduce the risk of stroke or systemic
embolism (risk ratios [RR] = 0.83, 95% confidence interval [CI] 0.75-0.93,
P = 0.0007) and major bleeding (RR = 0.76, 95% CI 0.62-0.94, P = 0.009),
while the risks of all-cause death and intracranial bleeding were similar.
DOACs may increase the risk of gastrointestinal bleeding (RR = 1.42, 95%
CI 1.04-1.95, P = 0.03). Twelve studies (4,789 patients) were included in
a network meta-analysis. Indirect comparisons suggested rivaroxaban
appears most favorable in reducing stroke or systemic embolism and major
bleeding, though based on indirect evidence. Implications: In patients
following bioprosthetic heart valve replacement or repair, DOACs may
reduce the risk of stroke or systemic embolism and major bleeding, but may
increase gastrointestinal bleeding compared with VKAs. Among DOACs,
rivaroxaban appears to be the optimal choice. These findings should be
interpreted cautiously due to limited RCT evidence and incomplete
drug-specific reporting.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<6>
Accession Number
2040556106
Title
Impact of postoperative atrial fibrillation (POAF) on outcomes after
coronary artery bypass grafting: A meta-analysis of unique 247,270
patients from 50 studies.
Source
American Heart Journal Plus: Cardiology Research and Practice. 59 (no
pagination), 2025. Article Number: 100621. Date of Publication: 01 Nov
2025.
Author
Awad A.K.; Elbahloul M.A.; Al-omoush O.; Abdelnasser O.; Hajali M.;
Abdelnasser A.; Saleh O.; Altiti A.; Elgharably H.; El Diasty M.
Institution
(Awad, Abdelnasser) Faculty of Medicine, Ain-Shams University, Cairo,
Egypt
(Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr
El-Shaikh, Egypt
(Al-omoush) Internal Medicine and Family Medicine Department, The
Hashemite University, Zarqa, Jordan
(Hajali, Saleh, Altiti) Faculty of Medicine, The Hashemite University,
Zarqa, Jordan
(Abdelnasser) Faculty of Medicine, Helwan University, Cairo, Egypt
(Elgharably) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(El Diasty) Department of Biomedical and Molecular Sciences, Queen's
University, Kingston, Canada
(El Diasty) Division of Cardiac Surgery, University Hospitals Cleveland
Medical Centre, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) can occur in up to
53.1 % of patients undergoing cardiac surgery. This serious condition has
been associated with increased risk of morbidity and mortality during the
initial weeks after the procedure. In this updated meta-analysis, we aim
to study the impact of POAF on outcomes in patients undergoing CABG
surgery. <br/>Method(s): We searched PubMed, Scopus, Cochrane Library, and
WOS from inception till April 15, 2024. The pooled effect sizes were mean
difference (MD) for continuous outcomes and odds ratio (OR) for
dichotomous outcomes and a 95 % confidence interval (CI). <br/>Result(s):
A total of 247,270 patients from 50 studies were included. Mean age ranged
between 56.5 and 76 years and mean follow-up time duration ranged from six
months to 15 years. In-hospital, 30-days, and long-term mortality were
significantly higher in patients with POAF compared to patients without
POAF with (OR: 2.37; 95 % CI: 1.45-3.87; P = 0.0033), (OR: 2.33; 95 % CI:
1.74-3.13; P < 0.01), and (OR: 2.15; 95 % CI: 1.8-2.54; P <
0.01respectively. In terms of stroke, both short- and long-term strokes
were significantly higher in patients with POAF with (OR: 2.54; 95 % CI:
2.05-3.15; P < 0.01) and (OR: 1.92; 95 % CI: 1.37-2.68; P < 0.0007),
respectively. Although POAF has significant longer hospital and intensive
care unit stay and higher risk for post-operative renal failure and
myocardial infarction, there was no significant difference in
revascularization and reintubation rates in patients with POAF with (OR:
1.11; 95 % CI: 0.48-2.54; P = 0.656) and (OR: 2.72; 95 % CI: 0.86-8.67; P
= 0.0742), respectively. The need for intra-aortic balloon pump was higher
in POAF group with (OR: 1.84; 95 % CI: 1.42-2.37; P < 0.01) as well as the
risk of developing heart failure with OR: 1.8; 95 % CI: 1.43-2.26; P =
0.0012. <br/>Conclusion(s): Our findings suggest that POAF group may be
associated with higher short-term mortality, long-term mortality, and
length of hospital and ICU stay in patients undergoing CABG. Furthermore,
there was a higher association between POAF and some postoperative
complications such as stroke, acute renal failure, acute heart failure,
and pneumonia. However, POAF did not seem to significantly affect rates of
acute MI and reintubation.<br/>Copyright &#xa9; 2025

<7>
Accession Number
2040505913
Title
The relationship between death anxiety and fear of recurrence and
progression in chronic illness: A systematic review and meta-analysis.
Source
Journal of Psychosomatic Research. 198 (no pagination), 2025. Article
Number: 112373. Date of Publication: 01 Nov 2025.
Author
Menzies R.E.; Connery T.; Macdonald D.; Riotto G.D.
Institution
(Menzies) University of Sydney, NSW, Australia
(Connery) University College Cork, Cork, Ireland
(Macdonald, Riotto) Menzies Anxiety Centre, NSW, Australia
Publisher
Elsevier Inc.
Abstract
Objective: Recent research has identified fear of recurrence and fear of
progression (FORP) as common psychosocial issues among people with chronic
illnesses. Similarly, growing studies have identified death anxiety as
being a key transdiagnostic construct in mental health, particularly in
relation to anxiety. However, the relationship between these constructs
has received scarce attention. This systematic review and meta-analysis
examined the relationship between FORP and death anxiety across chronic
illnesses. <br/>Method(s): The current review was conducted in line with
PRISMA guidelines. We screened 2620 papers for the current systematic
review and meta-analysis. In total, 15 studies were included in the final
review (N<inf>total</inf> = 3506). <br/>Result(s): A meta-analysis
revealed a significant and large correlation (r = 0.592) between death
anxiety and overall FORP. The type of illness emerged as a significant
moderator of this effect, with significantly larger effect sizes found for
samples affected by cancer (r = 0.640) compared with other illnesses (r =
0.495). The relationship with death anxiety was equally strong between
studies which measured fear of progression versus fear of recurrence.
Overall, the studies were generally of high quality with low risk of
publication bias. <br/>Conclusion(s): The current findings support the
significant relationship between death anxiety and FORP across numerous
illness types. The clinical implications include the need to consider
death anxiety in the conceptualisation and management of FORP in chronic
illness.<br/>Copyright &#xa9; 2025

<8>
Accession Number
2034905616
Title
Comparison of the Ivor-Lewis vs McKeown Procedure in Esophageal Cancers:
An Updated Meta-Analysis and Systematic Review.
Source
American Surgeon. 91(11) (pp 1974-1982), 2025. Date of Publication: 01 Nov
2025.
Author
Tejada B.; Giannaris E.S.; Hashemi S.; Fountos D.M.; Ali M.M.; Mathew
J.A.; German D.E.
Institution
(Tejada, Giannaris, Hashemi, Fountos, Ali, Mathew, German) CUNY School of
Medicine, New York, NY, United States
Publisher
SAGE Publications Inc.
Abstract
Background: The Ivor Lewis and McKeown techniques are two established
approaches for esophagectomy in the treatment of esophageal cancer.
Despite their widespread use, limited direct comparisons exist to assess
the efficacy of these techniques across key intraoperative and
postoperative outcomes. We performed an updated pooled pairwise
meta-analysis to discern the relative benefits and risks associated with
each approach. <br/>Method(s): A systematic search of PubMed, Embase,
MEDLINE, and the Cochrane Library through September 2024 was conducted.
Eligible studies compared Ivor Lewis and McKeown techniques for
esophagectomy. Primary outcomes were 12-month mortality and anastomotic
complications; secondary outcomes were number of lymph nodes resected,
recurrent laryngeal nerve palsy, pulmonary complications, and chyle-leaked
complications. <br/>Result(s): A total of 9 studies comprising 15 341
patients were included. There were no significant differences in terms of
12-month mortality (OR .89, 95% CI .65 to 1.22, P = .48), the number of
lymph nodes resected (MD -1.18, 95% CI -4.51 to 2.16, P = .49), and
pulmonary complications (OR .87, 95% CI .61 to 1.24, P = .27). However,
Ivor Lewis significantly reduced the incidence of anastomotic leakage (OR
.42, 95% CI .18 to .98, P = .050), recurrent laryngeal nerve palsy (OR
.13, 95% CI .06 to .27, P &lt; .00001), and chyle-related complications
(OR .63, 95% CI .39 to 1.04, P = .05) compared to the McKeown technique.
<br/>Conclusion(s): This meta-analysis reveals certain significant
advantages in Ivor Lewis, while both maintain similarities in other
areas.<br/>Copyright &#xa9; The Author(s) 2025

<9>
Accession Number
2040345463
Title
Sustained Improvements After Intervention to Prevent Contrast-Associated
Acute Kidney Injury: A Randomized Controlled Trial.
Source
Journal of the American Heart Association. 14(10) (pp 1-10), 2025. Date of
Publication: 15 May 2025.
Author
Matheny M.E.; Carpenter-Song E.; Ricket I.M.; Solomon R.J.; Stabler M.E.;
Davis S.E.; Zubkoff L.; Westerman D.M.; Dorn C.; Cox K.C.; Minter F.F.;
Jneid H.; Currier J.W.; Athar S.A.; Girotra S.; Leung C.; Helton T.J.;
Agarwal A.; Vidovich M.I.; Plomondon M.E.; Waldo S.W.; Aschbrenner K.A.;
McKay V.; O'Malley A.J.; Brown J.R.
Institution
(Matheny, Davis, Westerman, Dorn, Minter) Department of Biomedical
Informatics, Vanderbilt University Medical Center, Nashville, TN, United
States
(Matheny) Geriatric Research Education and Clinical Care Center, Tennessee
Valley Healthcare System VA, Nashville, TN, United States
(Carpenter-Song, Cox, Aschbrenner) Department of Anthropology, Dartmouth
College, Hanover, NH, United States
(Ricket, Brown) Department of Epidemiology, Geisel School of Medicine at
Dartmouth, Hanover, NH, United States
(O'Malley) The Dartmouth Institute for Health Policy and Clinical
Practice, Lebanon, NH, United States
(Solomon) University of Vermont Larner College of Medicine, Burlington,
VT, United States
(Stabler) Department of Community and Family Medicine, Dartmouth-Hitchcock
Medical Center, Lebanon, NH, United States
(Zubkoff) University of Alabama at Birmingham and VA Birmingham Health
Care, Birmingham, AL, United States
(Jneid) Division of Cardiovascular Medicine, University of Texas Medical
Branch, Galveston, TX, United States
(Currier) Division of Cardiology, Department of Medicine, Veteran Affairs
Greater Los Angeles Healthcare System, Los Angeles, CA, United States
(Currier) Division of Cardiology, Department of Medicine, University of
California Los Angeles Healthcare System, Los Angeles, CA, United States
(Athar) Cardiology Section, Loma Linda VA Medical Center, Loma Linda, CA,
United States
(Athar) Department of Medicine, Division of Cardiology, Loma Linda
University School of Medicine, Loma Linda, CA, United States
(Girotra) Division of Cardiology, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, TX, United States
(Leung) Department of Medicine, Section of Cardiology, Orlando VA Medical
Center, Orlando, FL, United States
(Helton) East Tennessee State University, Johnson City, TN, United States
(Agarwal) Wright State University Dayton VA Medical Center, Dayton, OH,
United States
(Vidovich) Section of Cardiology, Jesse Brown VA Medical Center and
Department of Medicine, University of Illinois, Chicago, IL, United States
(Plomondon, Waldo) CART Program, VHA Office of Quality and Safety,
Washington, DC, United States
(Waldo) Department of Medicine, Cardiology Section, Rocky Mountain
Regional VA Medical Center, Aurora, CO, United States
(Waldo) Department of Medicine, Division of Cardiology, University of
Colorado School of Medicine, Aurora, CO, United States
(McKay) Washington University, St. Louis, MO, United States
(Brown) Dartmouth Center for Implementation Science, Biomedical Data
Science, Geisel School of Medicine at Dartmouth, Hanover, NH, United
States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In the IMPROVE AKI (A Cluster-Randomized Trial of Team-Based
Coaching Interventions to Improve Acute Kidney Injury) trial, a
combination of team-based coaching and data-driven surveillance dashboards
reduced the odds of AKI following cardiac catheterization by 46%. The
objective of this study was to determine if improvements in AKI outcomes
would be sustained after completion of the active intervention. METHODS
AND RESULTS: A 2x2 factorial cluster-randomized trial with an 18-month
active intervention phase (October 2019- March 2021) and an 18-month
sustainability phase (April 2021-September 2022) conducted among cardiac
catheterization laboratories in 20 Veterans Affairs sites. Interventions
included team-based coaching in a virtual learning collaborative or
technical assistance, with and without access to an automated surveillance
reporting dashboard. Data were collected on procedures involving adult
patients undergoing diagnostic coronary angiography or percutaneous
coronary interventions and not receiving chronic dialysis. The main
outcome was AKI within 7 days of cardiac catheterization among all
participants and those with preexisting chronic kidney disease. In
addition, survey and focused interview data were collected to understand
barriers and facilitators to sustaining AKI improvements. In this phase,
440 of 4160 patients experienced AKI, including 216 of 1260 patients with
chronic kidney disease. Compared with technical assistance alone, we
observed a reduction in AKI among virtual learning collaborative +
automated surveillance reporting sites (adjusted odds ratio, 0.60 [95% CI,
0.42-0.86]). Sites had implemented standardized orders (11), oral and
intravenous hydration standing orders (13), and contrast limiting
protocols (10). <br/>CONCLUSION(S): Team-based coaching coupled with
data-driven surveillance dashboards reduced AKI by 40% during the 18
months after active participation in the trial. Process improvement
education, care process standardization, and automated outcome feedback
may be effective and durable methods for reducing AKI.<br/>Copyright
&#xa9; 2025 The Author(s). Published on behalf of the American Heart
Association, Inc., by Wiley. This is an open access article under the
terms of the Creative Commons Attribution-NonCommercial-NoDerivs License,
which permits use and distribution in any medium, provided the original
work is properly cited, the use is non-commercial and no modifications or
adaptations are made.

<10>
Accession Number
2031349478
Title
Systematic review of clinical guidelines and consensus statements
concerning heparin and protamine dosing and monitoring of anticoagulation
levels for non-cardiac arterial procedures.
Source
Vascular. 33(5) (pp 1162-1172), 2025. Date of Publication: 01 Oct 2025.
Author
Roosendaal L.C.; Doganer O.; Wiersema A.M.; Blankensteijn J.D.; Jongkind
V.
Institution
(Roosendaal, Wiersema, Jongkind) Department of Vascular Surgery,
Dijklander Ziekenhuis, Hoorn, Netherlands
(Roosendaal, Doganer, Wiersema, Blankensteijn, Jongkind) Department of
Vascular Surgery, Amsterdam UMC, Amsterdam, Netherlands
(Roosendaal, Doganer, Wiersema, Blankensteijn, Jongkind) Amsterdam
Cardiovascular Sciences, Microcirculation, Amsterdam, Netherlands
Publisher
SAGE Publications Ltd
Abstract
Objectives: This systematic review was performed to examine all published
practice Guidelines and Consensus Statements (together: GCS) on heparin
dosing and monitoring during non-cardiac arterial procedures (NCAP). The
objective was to scrutinize the recommendations and advice outlined within
these GCS documents and to evaluate the supporting evidence for these
recommendations. Additionally, the use of the activated clotting time
(ACT) and target ACT values were explored. <br/>Method(s): This systematic
review was performed in accordance with the PRISMA Guidelines. Medline and
Embase databases were searched to identify all GCSs in the English
language on NCAP. The final literature search was performed in January
2023. This search was supplemented by searching websites of relevant
professional vascular surgical organizations for GCSs. Titles and
abstracts were assessed by two independent reviewers. <br/>Result(s): Of
9716 titles identified, 27 GCSs met the predefined inclusion criteria: six
GCSs regarding carotid intervention, seven regarding procedures for
aneurysmal disease of the abdominal aorta and iliac arteries, 12 regarding
interventions for acute and chronic peripheral arterial occlusive disease
and two regarding open and endovascular interventions of thoraco-abdominal
aortic aneurysms. Administration of heparin is advised for al NCAP. There
was high variability concerning heparin dose: both standard dose as weight
based dosing (30-150 IU/kg) was advised. Recommendations on repeated
doses, ACT monitoring and heparin reversal using protamine also varied
widely. In none of the GCSs, the type of the ACT measuring device or used
cartridges were specified. <br/>Conclusion(s): Large variability was found
between the included GCSs with regard to the recommendations on heparin
dose and target ACT values during NCAP. Advice and recommendations in GCSs
were based on low-quality studies or without providing any reference at
all. The described variability in recommendations emphasizes the need for
large prospective (randomized) studies or the incorporation of data on
heparin and the use of ACT monitoring into verified vascular surgery
registries, to develop evidence-based, practical and uniform applicable
recommendations.<br/>Copyright &#xa9; The Author(s) 2024

<11>
Accession Number
2040400219
Title
The Role of Angiotensin Receptor/Neprilysin Inhibitor in Moderate Ischemic
Mitral Regurgitation After Isolated Coronary Artery Bypass Grafting
(ARNI-MIMIC): Study Protocol for a Randomized Controlled Trial.
Source
American Journal of Cardiology. 256 (pp 102-106), 2025. Date of
Publication: 01 Dec 2025.
Author
Tiemuerniyazi X.; Chen L.; He L.; Yang Z.; Huang S.; Nan Y.; Song Y.; Yuan
X.; Hu Z.; Zhao D.; Zhao W.; Feng W.
Institution
(Tiemuerniyazi, Chen, He, Yang, Huang, Nan, Song, Yuan, Hu, Zhao, Zhao,
Feng) Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, National Clinical Research Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
Publisher
Elsevier Inc.
Abstract
Debates have been existed regarding the treatment of moderate ischemic
mitral regurgitation (IMR) in patients undergoing coronary artery bypass
grafting (CABG). While it might have priority on reducing the risk of
recurrent IMR, studies showed that concomitant mitral valve repair
increases the risk of adverse outcomes, such as neurological events, as
well as the in-hospital costs. In recent studies, angiotensin
receptor/neprilysin inhibitor (ARNI) was discovered to have potential
benefit in reducing the severity of IMR. The ARNI-MIMIC is a randomized
controlled clinical trial aiming to reduce the risk of recurrent IMR in
isolated CABG patients. A total of 220 eligible patients with moderate IMR
will be allocated into control (non-ARNI) and intervention (ARNI) groups
in a 1:1 pattern after isolated CABG. Patients in the intervention group
will be administered with continuous sacubitril/valsartan for 6 months
postoperatively, while patients in the control group will receive
guideline recommended therapy only. All of the patients will be invited to
complete 6-month follow-up. The primary endpoint is the change in the
effective regurgitant orifice area (EROA) of the mitral valve, which is
obtained by echocardiography and calculated by subtracting the follow-up
EROA from the preoperative EROA. This trial aims to investigate the
potential role of ARNI as compared to the control in moderate IMR patients
undergoing isolated CABG. If ARNI is proven to reduce the risk of moderate
IMR recurrence, patients will benefit from both improved life quality and
decreased medical costs. The This study was approved by the Institutional
Review Board of Fuwai Hospital on October 18th 2024, with an approval
number of 2024-2446. The results of this trail will be disseminated
through international academic conferences and publication in medical
journals regardless of the study outcomes. ClinicalTrials.gov ID
NCT06917664<br/>Copyright &#xa9; 2025 The Author(s)

<12>
Accession Number
2036103158
Title
A Review of Current Insights in Fungal Endocarditis.
Source
Journal of Clinical Medicine. 14(17) (no pagination), 2025. Article
Number: 6149. Date of Publication: 01 Sep 2025.
Author
Akritidou O.; Peristeri A.-M.; Lymperatou D.; Prokopidou A.; Christaki E.;
Nikopoulou A.
Institution
(Akritidou, Peristeri, Nikopoulou) Department of Internal Medicine, G.
Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
(Lymperatou, Prokopidou, Christaki) First Department of Internal Medicine
and Infectious Diseases Unit, University General Hospital of Ioannina,
Faculty of Medicine, University of Ioannina, Ioannina, Greece
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Fungal endocarditis (FE), is a rare yet
life-threatening disease, which predominantly affects immunocompromised
individuals, prosthetic valve recipients, and injection drug users. The
purpose of this review is to summarize the evolving epidemiological
trends, diagnostic challenges, and treatment strategies, by identifying
evidence that supports the optimal clinical approach. <br/>Method(s): A
literature search was performed, drawing from sources such as PubMed and
Google Scholar and included articles published between January 2015 and
March 2025. Clinical studies, case series, and meta-analyses reporting on
FE epidemiology, diagnostics, or treatment were included. <br/>Result(s):
The majority of FE cases is caused by Candida species, predominantly C.
albicans, while Aspergillus accounted for a lesser percentage of cases.
While blood cultures showed limited sensitivity, adjunctive diagnostic
tools such as serum biomarkers (beta-D-glucan, galactomannan) and advanced
imaging modalities (18F-FDG PET/CT) are increasingly used to guide the
diagnostic process. Early surgical intervention combined with antifungals
improved survival, particularly for Aspergillus, although comprehensive
data regarding this approach remains limited due to the rarity of the
disease. <br/>Conclusion(s): Fungal endocarditis requires an aggressive
treatment strategy, integrating early surgery, targeted antifungals, and
long-term suppression, especially for prosthetic valves. Despite advances,
the complexity of the condition and the variety of the pathogens involved,
continue to impede progress towards effective management of FE. Future
research must prioritize rapid diagnostics, standardized treatment
protocols, and novel antifungals to address this critical
condition.<br/>Copyright &#xa9; 2025 by the authors.

<13>
Accession Number
2040480467
Title
DAPAgliflozin for renal protection in heart transplant recipients.
Rationale and design of the randomized controlled DAPARHT trial.
Source
American Heart Journal. 291 (pp 128-135), 2026. Date of Publication: 01
Jan 2026.
Author
Holmen S.; Manintveld O.; Damman K.; Braun O.; Lofman I.H.; Szymanski M.;
Ravnestad H.; Gude E.; Bjorkelund E.; Andreassen A.K.; Gullestad L.; Broch
K.
Institution
(Holmen, Ravnestad, Gude, Bjorkelund, Andreassen, Gullestad, Broch)
Department of Cardiology, Oslo University Hospital, Oslo, Norway
(Holmen) Department of Medicine, Innlandet Hospital Trust, Hamar, Norway
(Holmen, Ravnestad, Gullestad, Broch) Institute of Clinical Medicine,
Faculty of Medicine, University of Oslo, Norway
(Manintveld) Department of Cardiology, Cardiovascular Institute, Erasmus
Medical Center, Rotterdam, Netherlands
(Manintveld) Erasmus MC Transplant Institute, Erasmus University Medical
Center Rotterdam, Rotterdam, Netherlands
(Damman) Department of Cardiology, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
(Braun) Skane University Hospital and Department of Clinical Sciences
Lund, Cardiology, Lund University, Lund, Sweden
(Lofman) Department of Medicine Solna, Karolinska Institutet, Department
of Cardiology, Karolinska University Hospital, Stockholm, Sweden
(Szymanski) University Medical Center Utrecht, Department of Cardiology,
Utrecht, Netherlands
Publisher
Elsevier Inc.
Abstract
Background and aims: Heart transplantation is the preferred treatment for
selected patients with end stage heart failure. Kidney function often
declines after heart transplantation. Sodium-glucose cotransporter 2
inhibitors (SGLT2i) slow the decline in eGFR in different populations.
However, the effect of SGLT2i on kidney function in heart transplant
recipients is unknown. <br/>Method(s): The Dapagliflozin for Renal
protection in Heart Transplant recipients (DAPARHT) trial is an
investigator initiated, double blind, randomized, placebo-controlled trial
designed to assess dapagliflozin's effect on kidney function in heart
transplant recipients. Adults heart transplanted at least one year prior
to randomization are eligible. Exclusion criteria include an estimated
glomerular filtration rate (eGFR) <25 mL/min/1.73 m², diabetes
type I, and contraindication to study medication. Four hundred and thirty
patients will be randomized 1:1 to receive 12 months blinded treatment
with dapagliflozin 10 mg o.d. or placebo, followed by 24-months open-label
treatment. The primary endpoint is the chronic slope of the eGFR from two
weeks to 12 months after starting randomized treatment. The open-label
phase evaluates dapagliflozin's long-term effects on kidney function,
clinical outcomes, safety, and tolerability. Enrolment began in June 2022.
As of December 18, 2024, 300 patients were enrolled. The mean baseline
creatinine was 104 +/- 28 micromol/L with corresponding eGFR of 66 +/- 22
mL/min/1.73 m². Estimated last patient visit is in September,
2028. <br/>Conclusion(s): The DAPARHT trial will test whether
dapagliflozin improves eGFR slope compared to placebo during one year of
follow-up, providing the first randomized evidence of the efficacy of
SGLT2i in heart transplant recipients. Trial Registration: Dapagliflozin
for Renal protection in Heart Transplant recipients (DAPARHT),
NCT05321706, clinicaltrials.gov.<br/>Copyright &#xa9; 2025 The Authors

<14>
Accession Number
2036161471
Title
Intraoperative Dexmedetomidine Enhances Postoperative Microcirculation and
Reduces Acute Kidney Injury in Cardiac Surgery: A Double-Blind Randomized
Trial.
Source
Drug Design, Development and Therapy. 19 (pp 8451-8462), 2025. Date of
Publication: 2025.
Author
Shih P.-Y.; Wu T.-T.; Chan K.-C.; Hsu R.-B.; Chang C.-T.; Chou W.-H.; Wu
C.-Y.
Institution
(Shih, Chan, Chou) Department of Anesthesiology, National Taiwan
University Hospital Hsinchu Br, No. 25, Lane 442, Sec.1, Jingguo Road,
Hsinchu, Taiwan (Republic of China)
(Wu, Chang, Wu) Department of Anesthesiology, National Taiwan University
Hospital Hsinchu Branch, Hsinchu, Taiwan (Republic of China)
(Hsu) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Dexmedetomidine, an alpha-2 adrenergic agonist, has shown
potential benefits in various surgical settings, but its impact on
microcirculation and renal function in cardiac surgery patients remains
unclear. <br/>Patients and Methods: This randomized, controlled,
double-blind clinical trial was conducted at a single university hospital.
Seventy patients undergoing non-emergency cardiac and aortic surgery
requiring cardiopulmonary bypass were enrolled, and 68 patients were
included in the final analysis. Patients were randomized to receive either
dexmedetomidine (0.5 mcg/kg loading dose, followed by 0.5 mcg/kg/h) or
saline. The infusion of dexmedetomidine or saline began at anesthesia
induction and continued until the end of surgery. Key microcirculatory
variables-total vessel density, proportion of perfused vessels, perfused
vessel density, De Backer's score, microvascular flow index, and
heterogeneity index-were measured at five time points: baseline, 1 hour
after cardiopulmonary bypass, 1 hour after arrival in the intensive care
unit, 24 hours after surgery, and 48 hours after surgery. Data were
analyzed using a mixed-effects model with Tukey's Honestly Significant
Difference correction. Intraoperative urine output, the incidence of
postoperative acute kidney injury, and other postoperative complications
were also compared. <br/>Result(s): Patients in the dexmedetomidine group
maintained higher postoperative proportion of perfused vessels and
perfused vessel density compared to the saline group, with a significant
interaction effect for perfused vessel density. Baseline perfused vessel
density was comparable between the two study groups (17.5 [15.9-18.6] vs
18.0 [16.1-19.8] mm/mm2, p = 0.540). At 48 hours postoperatively, patients
in the dexmedetomidine group had significantly higher PVD values than
those in the saline group (17.0 [15.0-19.0] vs 15.6 [13.7-16.9] mm/mm2; P
= 0.041). The dexmedetomidine group also had significantly higher
intraoperative urine output (950 vs 605 mL, p = 0.002). Additionally, the
incidence of postoperative acute kidney injury was significantly lower in
the dexmedetomidine group (11.8% vs 50%, p = 0.001). <br/>Conclusion(s):
Intraoperative dexmedetomidine infusion during cardiac surgery is
associated with higher postoperative microcirculatory state and a reduced
incidence of acute kidney injury.<br/>Copyright &#xa9; 2025 Shih et al.

<15>
Accession Number
2040556157
Title
Efficacy of intraoperative ketamine/esketamine in the prevention of
postoperative delirium: a systematic review and meta-analysis.
Source
Therapeutic Advances in Psychopharmacology. 15 (no pagination), 2025.
Article Number: 20451253251339378. Date of Publication: 01 Jan 2025.
Author
Chen C.; Zhou N.; Hou J.
Institution
(Chen) Department of Anesthesiology, The Affiliated Hospital of Southwest
Medical University, Sichuan Province, Luzhou, China
(Zhou) Department of Cardiology, The First Affiliated Hospital of Chengdu
Medical College, Sichuan Province, Chengdu, China
(Hou) Department of Cardiology, The First Affiliated Hospital of Chengdu
Medical College, No. 278, Baoguang Avenue, Xindu District, Chengdu, China
Publisher
SAGE Publications Ltd
Abstract
Background: Postoperative delirium (POD) is associated with higher risks
of postoperative complications and mortality (2- to 3-fold increase).
Studies investigating the effect of intraoperative ketamine on POD risk
have yielded conflicting results. This study aimed to assess the effects
of intraoperative ketamine and its more potent version, esketamine, on
POD. <br/>Design(s): Systematic review and meta-analysis.
<br/>Objective(s): To evaluate the effect of intraoperative
ketamine/esketamine on the incidence of POD. <br/>Method(s): We adhered to
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines, and searched the PubMed, Embase, Medline
(Ovid), Cochrane, Scopus, and Web of Science databases for the MeSH terms
"ketamine" and "emergence delirium" from database inception to July 10,
2024. The primary outcome was POD incidence following general anesthesia.
Data were analyzed using a common effects model, with between-study
heterogeneity tested using the I²statistic, and relative risk
(RR) with 95% confidence intervals (CIs) for dichotomous data was used as
the effect measure. <br/>Result(s): A total of 18 studies with a total of
1571 participants met eligibility criteria. A meta-analysis of all studies
suggests that the intraoperative use of ketamine/esketamine may reduce the
incidence of POD (RR = 0.71, 95% CI: 0.56, 0.90, p &lt; 0.01). In the drug
subgroup, esketamine demonstrated enhanced efficacy in preventing POD
compared to ketamine (RR = 0.59, 95% CI: 0.38, 0.90, p = 0.02). In
addition, subanesthetic doses of ketamine/esketamine (0.5 mg/kg)
contributed to POD prevention (RR = 0.52, 95% CI: 0.34, 0.79, p &lt;
0.01), whereas higher doses (&gt;0.5 mg/kg) showed no statistically
significant effect (RR = 0.89, 95% CI: 0.66, 1.21, p = 0.46). Further
analysis revealed additional benefits of ketamine/esketamine in reducing
POD incidence in cardiac surgery (RR = 0.46, 95% CI: 0.31, 0.68, p &lt;
0.01), in the elderly (RR = 0.68, 95% CI: 0.52, 0.91, p &lt; 0.01), and in
the first 24 h post-surgery (RR = 0.52, 95% CI: 0.29, 0.94, p = 0.03).
<br/>Conclusion(s): Our findings suggest that perioperative administration
of ketamine/esketamine had a protective effect against the incidence of
POD, with esketamine demonstrating superior efficacy compared to ketamine.
The treatment effect exhibited a dose-response relationship, with
subanesthetic doses showing greater efficacy. Furthermore,
ketamine/esketamine may offer additional benefits for patients with
specific risk factors.<br/>Copyright &#xa9; The Author(s), 2025. This
article is distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 License
(https://creativecommons.org/licenses/by-nc/4.0/) which permits
non-commercial use, reproduction and distribution of the work without
further permission provided the original work is attributed as specified
on the SAGE and Open Access pages
(https://us.sagepub.com/en-us/nam/open-access-at-sage).

<16>
Accession Number
2039066539
Title
Long-term secondary prevention with colchicine in patients with CAD: an
updated systematic review and meta-analysis.
Source
European Journal of Internal Medicine. 140 (no pagination), 2025. Article
Number: 106317. Date of Publication: 01 Oct 2025.
Author
Boracchi P.; Marano G.; Luconi E.; Cimminiello C.
Institution
(Boracchi, Marano) Medical Statistics Unit, Department of Biomedical and
Clinical Sciences, University of Studies of Milan, Milan, Italy
(Luconi) Department of Clinical and Community Sciences University of
Studies of Milan, Milan, Italy
(Cimminiello) Arianna Foundation on Anticoagulation, Via P. Fabbri 1/3,
Bologna, Italy
Publisher
Elsevier B.V.
Abstract
The CLEAR SYNERGY trial failed to demonstrate any benefit of colchicine in
patients with acute myocardial infarction (MI). In this meta-analysis of
the randomized clinical trials (RCTs) of colchicine in coronary artery
disease (CAD), we updated the estimates of effect on cardiovascular events
in patients with CAD. We searched for the largest RCTs of colchicine in
CAD patients. The effect was assessed in a pooled analysis of individual
events such as MI, urgent coronary revascularization (UR), stroke,
cardiovascular mortality, and total mortality, for each of these endpoints
using hazard ratios (HR) and their 95 % confidence intervals (CI),
estimated by the Cox model. Fixed-effects or random-effects models were
used. A similar approach was used for the composite of MI, UR, and
cardiovascular mortality (MACE 1) and stroke, MI, total mortality (MACE
2). Safety was also assessed. Five studies were selected with a total of
18,656 patients. Colchicine reduced the risk of MI by 21 %, HR 0.79 (95 %
CI: 0.68 - 0.92).Its effect was neutral on total and cardiovascular
mortality. The composite endpoints MACE 1 and MACE 2 were reduced by
colchicine, HR 0.81 (95 % CI: 0.68 - 0.98), and HR 0.88 (95 % CI: 0.79 -
0.98), respectively. There were no differences in non-cardiovascular
mortality, cancer, and serious gastrointestinal and infectious events. The
benefit of colchicine appears attenuated compared to past analyses, but is
still valuable in reducing the risk of MI and the composite of MI, UR, and
cardiovascular death. The safety appears reassuring in relation to all
serious adverse reactions.<br/>Copyright &#xa9; 2025 European Federation
of Internal Medicine

<17>
Accession Number
2039599672
Title
The mitral valve complex: A complex trap to be avoided by cardiac
electrophysiologists-A systematic review.
Source
Heart Rhythm. 22(10) (pp e1007-e1016), 2025. Date of Publication: 01 Oct
2025.
Author
Ali H.; Abdelrady Abdelsalam Farghaly A.; Anderson R.H.; Lupo P.; Foresti
S.; De Ambroggi G.; Bessi R.; Magnani S.; Cappato R.
Institution
(Ali, Lupo, Foresti, De Ambroggi, Bessi, Magnani, Cappato) Arrhythmia &
Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan,
Italy
(Abdelrady Abdelsalam Farghaly) Cardiovascular Department, Assiut
University, Assiut, Egypt
(Anderson) Biosciences Institute, Newcastle University, Newcastle Upon
Tyne, United Kingdom
Publisher
Elsevier B.V.
Abstract
Catheter entrapment within the mitral valve complex (MVC) is a rare but
serious complication during left heart catheterization. A systematic
review-the first on this topic-was conducted using PubMed and Embase
databases, following the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines, to identify cases of catheter entrapment
within the MVC during electrophysiological procedures. Forty-six patients
predominantly undergoing catheter ablation of atrial tachyarrhythmias
(71.7%) were included. Circular mapping catheters were the most frequently
entrapped materials (50%), followed by ablation and multispline catheters.
Ablation catheters were mostly entrapped when advanced retrogradely, while
multispline catheter entrapment was exclusively observed in patients with
mechanical valves. Percutaneous management was successful in 47.8% of
patients, one-third of whom required retrieval of embolized catheter
segments. Surgery was necessary in 52.2% of patients, including valve
surgery in 30.4%. Awareness of this potential complication and application
of preventive strategies are essential when mapping or ablating adjacent
to the MVC.<br/>Copyright &#xa9; 2025 Heart Rhythm Society

<18>
Accession Number
2036144045
Title
Predictors and Prognosis of Right Bundle Branch Block Following Heart
Transplantation: A Systematic Review and Meta-Analysis.
Source
Clinical Transplantation. 39(9) (no pagination), 2025. Article Number:
e70322. Date of Publication: 01 Sep 2025.
Author
Mostafa N.; Almaadawy O.; Elshahat A.; Dervis M.; Mohamed Hamed B.; Asad
A.; Zreigh S.; Soliman E.M.; Mostafa H.A.; Elbenawi H.; Ahmed M.
Institution
(Mostafa) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Almaadawy) Department of Internal Medicine, MedStar Health, Baltimore,
MD, United States
(Elshahat, Mohamed Hamed, Mostafa) Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Dervis, Asad, Zreigh) Faculty of Medicine, Ankara Yilidirim Beyazit
University, Ankara, Turkey
(Soliman) Faculty of Medicine, Zagazig University, Zagazig, Egypt
(Elbenawi) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Ahmed) Department of Cardiovascular Medicine, University of Florida,
Gainesville, FL, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Right bundle branch block (RBBB) has a high prevalence among
heart transplant recipients and could influence outcomes. Crucially, the
predictors of RBBB development after heart transplantation are not
well-established. Our study aims to evaluate the preoperative predictors
and outcomes of RBBB following heart transplantation. <br/>Method(s):
PubMed, Scopus, Web of Science, and Cochrane Library were searched up to
November 15, 2024, to identify studies comparing heart transplant
recipients with RBBB and without RBBB. Random-effects models were used to
estimate the pooled mean difference (MD) and risk ratios (RRs) with 95%
confidence intervals (95% CIs). <br/>Result(s): Nine studies incorporating
1507 patients were included. Patients who developed RBBB had higher graft
ischemia time [MD: 10.0; 95% CI: 2.00-17.91; p = 0.01] and pulmonary
vascular resistance (PVR) (MD: 0.44; 95% CI: 0.21-0.68; p < 0.001). There
was no significant difference between RBBB and non-RBBB patients in terms
of pulmonary artery pressure (MD: 1.83; 95% CI: -0.86-4.53; p = 0.18) or
donor age (MD: 1.51; 95% CI: -0.30- 3.31; p = 0.10). There was no
significant difference in the prognosis of RBBB patients in terms of acute
rejection (RR: 1.06; 95% CI: 0.70-1.61; p = 0.78), chronic rejection (RR:
0.92; 95% CI: 0.60-1.41; p = 0.70), or mortality (RR: 1.87; 95% CI:
0.81-4.31; p = 0.14). <br/>Conclusion(s): Despite the association of RBBB
with graft ischemia time and PVR, post-transplant RBBB had no significant
impact on mortality or graft rejection. Further research focusing on the
identification period and applied definition of RBBB is
recommended.<br/>Copyright &#xa9; 2025 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<19>
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.<br/>Copyright &#xa9; 2025 International Federation of
Gynecology and Obstetrics.

<20>
Accession Number
2040654371
Title
The Effect of Transport Manual and Mechanical Ventilation on Hemodynamics
Change: Randomized Clinical Trial.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. (no pagination),
2025. Article Number: 10892532251383583. Date of Publication: 2025.
Author
Morita Y.; Sakata T.; Nakamura Y.; Kikuchi Y.; Wang J.; Kaneyuki D.;
Kariya T.; Raphael J.
Institution
(Morita, Wang, Raphael) Department of Anesthesiology, Thomas Jefferson
University, Philadelphia, PA, United States
(Sakata, Nakamura, Kikuchi) Department of Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Kaneyuki) Department of Surgery, Independence Health System Westmoreland
Hospital, Greensburg, PA, United States
(Kariya) Department of Anesthesiology, University of Tokyo, Tokyo, Japan
Publisher
SAGE Publications Inc.
Abstract
Background: Ventilation methods during ICU transport after cardiac surgery
are critical. This study aimed to assess the effects of manual and
mechanical ventilation on post-transport hypotension in patients
undergoing cardiac surgery. <br/>Method(s): This prospective clinical
trial was conducted at a tertiary academic hospital. Adult patients who
underwent open heart surgery were randomized to either (1) manual
ventilation or (2) mechanical ventilation during transport. The primary
outcomes were the hemodynamic parameters change. The secondary outcomes
were the PaO2/FiO2 ratio and PaCO2 change. <br/>Result(s): A total of 78
patients were randomized into two groups: manual ventilation (n = 39) and
mechanical ventilation (n = 39). Significant hypotension (&gt;20% drop in
mean arterial pressure post-transport) was noted in nine patients in the
manual ventilation arm, but not in any patient in the mechanical
ventilation arm. In manually ventilated patients, receiver operating
characteristic curve analysis of systemic vascular resistance for
significant hypotension showed that the area under the curve was 0.962
(95% CI, 0.891-1). No mechanically ventilated patients had significant
hypotension. No significant difference was observed in % change in PaO2
and PaCO2 between the manual and mechanical ventilation arms.
<br/>Conclusion(s): This study demonstrated that significant
post-transport hypotension was more common in the manually ventilated arm
than in the mechanically ventilated arm. No significant differences in
oxygenation or ventilation were observed between the groups. The low
systemic vascular resistance showed excellent predictive value for
significant post-transport hypotension. Further research is warranted to
identify patient-specific risk factors to enhance transportation
safety.<br/>Copyright &#xa9; The Author(s) 2025

<21>
Accession Number
2040433425
Title
Low-Risk Patients, High-Impact Trials: Rapidly Evolving Evidence for
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 86(13) (pp 1006-1008),
2025. Date of Publication: 30 Sep 2025.
Author
Reddy R.K.; Windecker S.; Ahmad Y.
Institution
(Reddy) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Reddy) Nuffield Department of Population Health, University of Oxford,
Oxford, United Kingdom
(Windecker) Department of Cardiology, Bern University Hospital, University
of Bern, Bern, Switzerland
(Ahmad) Division of Cardiology, University of California, San Francisco,
San Francisco, CA, United States
Publisher
Elsevier Inc.

<22>
Accession Number
2032714351
Title
Comparative analysis of clinico-metabolic profiles between St Thomas and
del Nido cardioplegia solutions: A pilot study.
Source
Perfusion (United Kingdom). 40(7) (pp 1585-1591), 2025. Date of
Publication: 01 Oct 2025.
Author
Rastogi A.; Tewari P.; Pande S.; Trivedi R.; Agarwal S.K.; Dubey D.; Kumar
D.
Institution
(Rastogi, Tewari) Department of Anaesthesiology, Sanjay Gandhi
Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
(Pande, Agarwal) Department of Cardio Vascular and Thoracic Surgery,
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS),
Lucknow, India
(Trivedi, Dubey, Kumar) Department of Advanced Spectroscopy and Imaging,
Centre of Biomedical Research, Lucknow, India
(Trivedi, Dubey, Kumar) Academy of Scientific and Innovative Research
(AcSIR), Ghaziabad, India
Publisher
SAGE Publications Ltd
Abstract
Introduction: Cardioplegia (CP) is integral to myocardial protection
during cardiac surgery. Two standard cardioplegic solutions viz. Del Nido
solution (DNS) and St Thomas solution (STS) are widely used in cardiac
surgeries. The DNS is a single-dose CP that offers superior myocardial
protection in adults, and studies have claimed myocardial injury in STS
patients. The elevated circulatory level of citric acid cycle
intermediate, succinate is a metabolic hallmark of ischemia. Its rapid
oxidation after reperfusion causes ischemia-reperfusion (IR) injury
through mitochondrial reactive oxygen species production. Succinate has
been identified as an early marker of IR injury through blood
plasma/serum-based clinical metabolomics studies. The primary objective of
the study was metabolomic profiling of succinate from the coronary sinus
and venous blood. <br/>Method(s): Two blood samples each were obtained
from coronary sinus (CS) & venous reservoir from patients before the
application of aortic cross-clamp and after the release of aortic
cross-clamp from 22 patients divided into two groups. The blood-serum
metabolic profiles were measured by 800 MHz NMR spectrometer and compared
using univariate statistical analysis methods. The study also compared the
two groups' cardiopulmonary bypass variables and left ventricle functions.
<br/>Result(s): DNS leads to increased serum levels of succinate in the
coronary sinus blood after the reperfusion compared to STS. The results of
our study are consistent with a previous study that found DNS
administration (90 minutes) increases the inflammatory response in the
myocardium. <br/>Conclusion(s): NMR-based serum metabolomics revealed
significantly increased circulatory succinate in coronary sinus blood of
patients administered with DNS cardioplegia in comparison to STS
cardioplegia. URL-
https://ctri.nic.in/Clinicaltrials/login.php.<br/>Copyright &#xa9; The
Author(s) 2024

<23>
Accession Number
2040565427
Title
Antithrombotic strategies and outcomes in neonates and infants with
cardiac shunts: a systematic review and meta-analysis.
Source
Research and Practice in Thrombosis and Haemostasis. 9(6) (no pagination),
2025. Article Number: 103161. Date of Publication: 01 Aug 2025.
Author
Kiskaddon A.L.; Goldenberg N.A.; Branstetter J.W.; Ashour D.; Williams P.;
Stock A.C.; Giglia T.M.; Do N.L.; Bashir D.; Beg K.; Benvenuto V.;
Betensky M.; Bhat R.; Branstetter J.; Davies P.; Do N.; Garland K.; Giglia
T.; Goldenberg N.; Kiskaddon A.; Livingston J.; Male C.; Monagle P.;
Silvey M.; Stock A.; Teruya J.; Woods G.
Institution
(Kiskaddon) Divisions of Hematology and Cardiology, Department of
Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Kiskaddon, Goldenberg) Institute for Clinical and Translational Research,
Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
(Kiskaddon) Department of Pharmacy, Johns Hopkins All Children's Hospital,
St. Petersburg, FL, United States
(Kiskaddon, Stock) Heart Institute, Johns Hopkins All Children's Hospital,
St. Petersburg, FL, United States
(Goldenberg) Division of Hematology, Departments of Pediatrics and
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Goldenberg, Betensky) Cancer and Blood Disorders Institute, Johns Hopkins
All Children's Hospital, St. Petersburg, FL, United States
(Betensky) Division of Hematology, Departments of Pediatrics, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Branstetter) Department of Pharmacy, Children's Healthcare of Atlanta,
Atlanta, GA, United States
(Ashour) Institute for Clinical and Translational Research, Epidemiology
and Biostatistics Shared Resource, Johns Hopkins All Children's Hospital,
St. Petersburg, FL, United States
(Williams) Medical Library, Johns Hopkins All Children's Hospital, St.
Petersburg, FL, United States
(Stock) Division of Cardiac Critical Care, Johns Hopkins All Children's
Hospital, St. Petersburg, FL, United States
(Silvey) Division of Hematology/Oncology/Bone Marrow Transplant,
Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO,
United States
(Giglia) Division of Cardiology, Department of Pediatrics, The Children's
Hospital of Philadelphia, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, United States
(Do) Advocate Children's Heart Institute, Advocate Children's Hospital,
Chicago, IL, United States
(Do) Chicagoland Children's Health Alliance, Chicago, IL, United States
Publisher
Elsevier B.V.
Abstract
Background: Cardiac shunt thrombosis in neonates and infants remains a
concern for shunt failure and mortality. The optimal strategy for
thromboprophylaxis remains unknown. <br/>Objective(s): This systematic
review aims to characterize antithrombotic strategies and outcomes in
neonates and infants with a cardiac shunt. <br/>Method(s): MEDLINE,
Embase, and Cochrane CENTRAL were searched from inception through July
2024 for studies reporting shunt thrombosis prevalence among infants who
received a cardiac shunt. We estimated the pooled prevalence of shunt
thrombosis using random-effects meta-analysis. In the subgroup analysis,
we evaluated the effects of shunt type and antithrombotic strategies on
shunt thrombosis prevalence. <br/>Result(s): A total of 39 studies (29
retrospective, 10 prospective) were included, totaling 4735 patients. The
most common shunt type was the modified Blalock-Taussig (n = 2224, 47%).
Mortality related to shunt thrombosis occurred in 102 (26.2%) patients
with shunt thrombosis. The most common antithrombotic agents in the acute
postoperative setting were unfractionated heparin (UFH; n = 1452, 30.7%)
and aspirin (n = 1413, 29.3%). The pooled prevalence of shunt thrombosis
was 8.4% (95% CI, 6.5%-10.4%) and varied among antithrombotic agents:
aspirin 7.4% (95% CI, 4.0%-11.4%), UFH 3.8% (95% CI, 0%-12.3%), or UFH
followed by aspirin 6.3% (95% CI, 3.6%-9.4%). <br/>Conclusion(s): This
systematic review of nearly 5000 neonates and infants reveals a high rate
of mortality associated with shunt thrombosis. Collaborative prospective
studies are warranted to evaluate antithrombotic regimen-outcome
relationships and prognostic factors for shunt thrombosis and bleeding
outcomes in these children.<br/>Copyright &#xa9; 2025 The Author(s)

<24>
Accession Number
2036676526
Title
Midterm survival, clinical, and hemodynamic outcomes of a novel mechanical
mitral valve prosthesis.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(4) (pp 1060-1068.e3),
2025. Date of Publication: 01 Oct 2025.
Author
Ruel M.; Chu M.W.A.; Graeve A.; Gerdisch M.W.; Damiano R.J.; Smith R.L.;
Keeling W.B.; Wait M.A.; Hagberg R.C.; Quinn R.D.; Sethi G.K.; Floridia
R.; Barreiro C.J.; Pruitt A.L.; Accola K.D.; Dagenais F.; Markowitz A.H.;
Ye J.; Sekela M.E.; Tsuda R.Y.; Duncan D.A.; Swistel D.G.; Harville L.E.;
DeRose J.J.; Lehr E.J.; Alexander J.H.; Puskas J.D.
Institution
(Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Centre, Western
University, London, ON, Canada
(Graeve) Cardiothoracic Division, MultiCare Health System, Tacoma, Wash,
United States
(Gerdisch) Department of Cardiovascular and Thoracic Surgery, Franciscan
St Francis Health, Indianapolis, Ind, United States
(Damiano) Department of Surgery, Washington University SL, St. Louis, Mo,
United States
(Smith) Robotic Cardiac Surgery, The Heart Hospital Baylor Plano, Plano,
Tex, United States
(Keeling) Division of Cardiothoracic Surgery, Emory University Hospital
Midtown, Atlanta, GA, United States
(Wait) Department of Cardiovascular and Thoracic Surgery, UT Southwestern
Medical Center, Dallas, Tex, United States
(Hagberg) Department of Cardiac Surgery, Hartford Hospital, Hartford,
Conn, United States
(Quinn) Department of Cardiac Services, Maine Medical Center, Portland,
Maine, United States
(Sethi) Division of Cardiothoracic Surgery, University of Arizona, Tucson
Heart Center, Tucson, Ariz, United States
(Floridia) Department of Cardiovascular and Thoracic Surgery, Loma Linda
University Medical Center, Loma Linda, Calif, United States
(Barreiro) Sentara Health Research Center, Sentara Norfolk General
Hospital, Norfolk, Va, United States
(Pruitt) Cardiovascular and Thoracic Surgery, St Joseph Mercy Hospital,
Ann Arbor, Mich, United States
(Accola) Cardiovascular Surgery, Florida Hospital, Orlando, Fla, United
States
(Dagenais) Department of Cardiac Surgery, Institut universitaire de
cardiologie et de pneumologie de Quebec, Quebec City, QC, Canada
(Markowitz) Heart & Vascular Institute, University Hospitals-Cleveland,
Cleveland, Ohio, United States
(Ye) Division of Cardiovascular Surgery, St Paul's and Vancouver General
Hospital, Vancouver, BC, Canada
(Sekela) Division of Cardiothoracic Surgery, University of Kentucky,
Lexington, Ky, United States
(Tsuda) Department of Cardiology, Southern Arizona VA Medical Center,
Tucson, Ariz, United States
(Duncan) Cardiovascular and Thoracic Surgery, Novant Clinical Research
Institute, Winston-Salem, NC, United States
(Swistel) Department of Cardiac Surgery, NYU Langone Hospitals, New York,
NY, United States
(Harville) Department of Surgery, University of Oklahoma Health Sciences
Center, Oklahoma City, Okla, United States
(DeRose) Division of Cardiothoracic Surgery, Montefiore Medical Center,
Bronx, NY, United States
(Lehr) Cardiac Surgery, Swedish Medical Center, Seattle, Wash, United
States
(Alexander) Division of Cardiology, Duke Clinical Research Institute, Duke
University, Durham, NC, United States
(Puskas) Division of Cardiothoracic Surgery, Mount Sinai Saint Luke's, New
York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: To evaluate the midterm survival, clinical, and hemodynamic
outcomes of the On-X mechanical mitral valve, based on the 5-year results
of the Prospective Randomized On-X Anticoagulation Clinical Trial
(PROACT). <br/>Method(s): PROACT Mitral was a multicenter study evaluating
401 patients who underwent mitral valve replacement (MVR) with either
Standard or Conform-X On-X mitral valves, comparing low-dose and
standard-dose warfarin. Here we report prespecified secondary outcomes of
survival, New York Heart Association (NYHA) functional classification, and
valve hemodynamics as assessed by core lab-adjudicated echocardiography at
1, 3, and 5 years in the pooled population. <br/>Result(s): Actuarial
survival was 99.7% at 1 year, 95.1% at 3 years, and 92.4% at 5 years, with
no significant difference between the Standard and Conform-X cuffs.
Hemodynamic analysis revealed a mean transvalvular pressure gradient (MG)
of 4.6 +/- 2.0 mm Hg at 1 year, with no interaction between valve size and
patient body surface area. MG values were consistent over time. Quality of
life improved with 96.6% of patients in NYHA class I or II at the latest
available follow-up of 3 or 5 years. There were no significant differences
in survival, clinical, or hemodynamic outcomes between valve sizes.
<br/>Conclusion(s): The On-X mechanical mitral valve demonstrated
favorable survival, stable hemodynamics, and enhanced quality of life up
to 5 years postimplantation. Derived from high-quality, rigorous
randomized trial data, these findings can guide decision making in young
patients requiring MVR.<br/>Copyright &#xa9; 2024 The American Association
for Thoracic Surgery

<25>
Accession Number
2040368487
Title
beta blockers after myocardial infarction with mildly reduced ejection
fraction: an individual patient data meta-analysis of randomised
controlled trials.
Source
The Lancet. 406(10508) (pp 1128-1137), 2025. Date of Publication: 13 Sep
2025.
Author
Rossello X.; Prescott E.I.B.; Kristensen A.M.D.; Latini R.; Fuster V.;
Fagerland M.W.; Pocock S.J.; Halvorsen S.; Dominguez-Rodriguez A.;
Holmager T.L.F.; Sanchez P.L.; Bakken A.; Raposeiras-Roubin S.; Jensen
S.E.; Kimura T.; Ottani F.; Lambrechtsen J.; Anguita M.; Ozasa N.; Atar
D.; Ibanez B.; Munkhaugen J.
Institution
(Rossello, Fuster, Pocock, Raposeiras-Roubin, Ibanez) Centro Nacional de
Investigaciones Cardiovasculares Carlos III, Madrid, Spain
(Rossello) Cardiology Department, University Hospital Son Espases,
Instituto de Investigacion Sanitaria Islas Baleares and Universitat de les
Illes Balears, Palma de Mallorca, Spain
(Rossello, Dominguez-Rodriguez, Sanchez, Anguita, Ibanez) Centro de
Investigacion Biomedica en Red en Enfermedades Cardiovasculares, Madrid,
Spain
(Prescott, Kristensen, Holmager) Department of Cardiology, Copenhagen
University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
(Latini) Department of Acute Brain and Cardiovascular Injury, Istituto di
Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
(Fuster) Mount Sinai Fuster Heart Hospital, New York, NY, United States
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
(Pocock) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, London, United Kingdom
(Halvorsen, Bakken, Atar) Department of Cardiology, Oslo University
Hospital Ulleval, Oslo, Norway
(Halvorsen, Atar) Institute of Clinical Medicine, University of Oslo,
Oslo, Norway
(Dominguez-Rodriguez) Department of Internal Medicine, Universidad de La
Laguna, Department of Cardiology, Hospital Universitario de Canarias,
Instituto de Investigacion Sanitaria de Canarias, Tenerife, Spain
(Sanchez) Department of Cardiology, Hospital Universitario de Salamanca,
Biomedical Research Institute of Salamanca, Salamanca, Spain
(Raposeiras-Roubin) Cardiology Department, Hospital Universitario Alvaro
Cunqueiro, Vigo, Spain
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Kimura) Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
(Ottani) Cardiovascular Unit, "Infermi" Hospital, Rimini, Italy
(Lambrechtsen) Cardiovascular Research Unit, Odense University Hospital
Svendborg, Svendborg, Denmark
(Anguita) Department of Cardiology, Hospital Universitario Reina Sofia,
Instituto Maimonides de Investigacion Biomedica de Cordoba, University of
Cordoba, Cordoba, Spain
(Ozasa) Department of Primary Care and Emergency Medicine, Kyoto
University Graduate School of Medicine, Kyoto, Japan
(Ozasa) Department of Cardiology, Kansai Heart Center, Takanohara Central
Hospital, Nara, Japan
(Ibanez) Cardiology Department, University Hospital Fundacion Jimenez Diaz
and Instituto de Investigacion Sanitaria-Fundacion Jimenez Diaz,
Universidad Autonoma de Madrid, Madrid, Spain
(Munkhaugen) Department of Medicine, Drammen Hospital, Vestre Viken Trust,
Drammen, Norway
(Munkhaugen) Department of Behavioural Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
Publisher
Elsevier B.V.
Abstract
Background: The effects of beta-blocker therapy on clinical outcomes in
patients with myocardial infarction and mildly reduced (40-49%) left
ventricular ejection fraction (LVEF) are largely unknown. Four recently
conducted randomised trials tested the efficacy of beta blockers after a
recent myocardial infarction in patients without reduced LVEF (LVEF
>=40%). However, none were individually powered to assess these effects in
the subgroup of patients with mildly reduced LVEF. We aimed to assess the
efficacy of beta blockers in patients with myocardial infarction and
mildly reduced LVEF during the index hospitalisation. <br/>Method(s): We
conducted an individual patient-level meta-analysis of patients with
mildly reduced LVEF and no history or signs of heart failure from four
recent clinical trials. These studies were included because they were
randomised controlled trials testing long-term effects (median follow-up
>1 year) of oral beta-blocker therapy in patients who recently had a
myocardial infarction (randomisation within 14 days) and had mildly
reduced LVEF. No further studies were found in a systematic review (Jan 1,
2020 to June 26, 2025). A one-stage, fixed-effects, Cox proportional
hazards regression model was used to assess the treatment effect of beta
blockers on the predefined primary composite endpoint of all-cause death,
new myocardial infarction, or heart failure. All endpoints were
independently adjudicated. This meta-analysis was registered with PROSPERO
(CRD420251023480). <br/>Finding(s): 1885 patients with myocardial
infarction and mildly reduced LVEF were included in the meta-analysis: 979
from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK
trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were
assigned to beta blockers and 894 to control (no beta blockers). The
primary composite endpoint occurred in 106 patients (32.6 events per 1000
patient-years) in the beta-blocker group and 129 patients (43.0 per 1000
patient-years) in the no beta-blocker group (hazard ratio 0.75 [95% CI
0.58-0.97]; p=0.031). No heterogeneity between the trials
(trial-by-treatment p<inf>interaction</inf>=0.95) or between countries of
enrolment was observed (p<inf>interaction</inf>=0.98).
<br/>Interpretation(s): In patients with acute myocardial infarction with
mildly reduced LVEF without history or clinical signs of heart failure,
beta-blocker therapy was associated with a reduction in the composite of
all-cause death, new myocardial infarction, or heart failure. These
results extend the known benefits of these agents in patients with
myocardial infarction with reduced LVEF to the subgroup with mildly
reduced LVEF. <br/>Funding(s): Centro Nacional de Investigaciones
Cardiovasculares Carlos III (CNIC), Danish Heart Foundation, Novo Nordisk
Foundation, South-Eastern Norway Regional Health Authority, and Research
Council of Norway.<br/>Copyright &#xa9; 2025 Elsevier Ltd

<26>
Accession Number
648483258
Title
Application Effects of Single-Lumen Endotracheal Tube Intubation for
General Anesthesia in Totally Thoracoscopic Cardiac Surgery.
Source
Brazilian journal of cardiovascular surgery. 40(5) (no pagination), 2025.
Date of Publication: 01 Sep 2025.
Author
Yi X.; Wang L.
Institution
(Yi) First Hospital of Jilin University Second Operating Room Changchun
Jilin People's Republic of China Second Operating Room, First Hospital of
Jilin University, Changchun, Jilin, China
(Wang) First Hospital of Jilin University Department of Cardiac Surgery
Changchun Jilin People's Republic of China Department of Cardiac Surgery,
First Hospital of Jilin University, Changchun, Jilin, China
Abstract
INTRODUCTION: The rapid advancement of medical technology has enabled the
application of single-lumen endotracheal tube (SLET) incubation anesthesia
in thoracoscopic surgeries for thoracic diseases, demonstrating promising
results. This study aims to explore the application of extracorporeal
circulation (ECC) and combined intravenous-inhalation anesthesia (CIIA)
with SLET intubation in totally thoracoscopic cardiac surgery (TTCS).
<br/>METHOD(S): In this single-center, double-blind, randomized controlled
trial, we assessed primary outcomes, including intraoperative metrics and
postoperative conditions. Secondary outcomes included the number of
patients achieving spontaneous resuscitation and those requiring
extracorporeal defibrillation after opening the ascending aorta,
alertness/sedation scores five minutes post-extubation, and incidence of
postoperative complications. <br/>RESULT(S): The observation group showed
shorter durations in the anesthesia recovery room, intensive care unit
retention, extubation, eye-opening time, and postoperative hospital stay
compared to the control group (t = 5.913, 8.820, 7.792, 6.904, 11.140; all
P < 0.001) and had higher proportion of patients with an
alertness/sedation score of five (43/109, 39.45%) and rate of spontaneous
resuscitation after opening the ascending aorta (97/109, 88.99%) compared
to the control group ([8/109, 34%], [84/109, 77.06%]). In contrast, the
rate of external electrical defibrillation (12/109, 11.01%) and the
incidence of postoperative complications (2/109, 1.83%) were lower than in
the control group ([25/109, 22.94%], [10/109, 9.17%]) (chi = 31.350,
5.501, 5.644; all P < 0.05). <br/>CONCLUSION(S): Maintaining oxygen
saturation in thoracoscopic surgery requires effective cooperation of
anesthesia and ECC. The combined use of ECC and CIIA with SLET intubation
in TTCS is a safe, effective approach that warrants broader clinical
application.

<27>
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.
<br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2025
Elsevier Ltd

<28>
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<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2025.

<29>
Accession Number
2040584638
Title
TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and
Cognitive Outcomes.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Garg V.; Patel G.; Mandal B.; Kahlon S.; Puri G.D.; Kst S.; Rawat A.
Institution
(Garg, Patel, Mandal, Kahlon, Puri) Department of Anesthesia and Intensive
Care, Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh, India
(Kst) Department of Cardiovascular and Thoracic Surgery, Postgraduate
Institute of Medical Education and Research (PGIMER), Chandigarh, India
(Rawat) Pediatric Allergy and Immunology Unit, Postgraduate Institute of
Medical Education and Research (PGIMER), Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objectives: To compare the perioperative inflammatory response and early
neurocognitive outcomes in adult patients undergoing elective coronary
artery bypass grafting (CABG) under total intravenous anesthesia (TIVA)
versus volatile anesthesia. <br/>Design(s): Prospective, randomized
controlled trial. <br/>Setting(s): A tertiary care academic medical
center. <br/>Participant(s): Fifty adult patients aged 18 to 65 years
scheduled for elective on-pump CABG surgery. <br/>Intervention(s):
Patients were randomized to receive either propofol-based TIVA (Group P)
or sevoflurane-based volatile anesthesia (group S). Standardized surgical
and cardiopulmonary bypass protocols were followed in all patients.
<br/>Measurements and Main Results: Serum interleukin-6 (IL-6) levels were
measured preoperatively and at 24 and 48 hours postoperatively. Secondary
outcomes included Mini-Mental State Examination scores, ventilation
duration, vasoactive-inotropic score, renal function, and intensive care
unit stay. IL-6 levels had increased significantly at 24 hours and
decreased by 48 hours in both groups, with no significant intergroup
difference at any time point. Mini-Mental State Examination scores at 24
and 48 hours were significantly higher in the TIVA group. TIVA was also
associated with shorter mechanical ventilation duration. VIS, cardiac
function, renal parameters, and intensive care unit stay duration were
comparable between groups. <br/>Conclusion(s): TIVA and volatile
anesthesia resulted in similar perioperative IL-6 responses in patients
undergoing CABG. However, TIVA was associated with better early
postoperative cognitive function and faster emergence from mechanical
ventilation. These findings suggest a potential neurocognitive benefit of
TIVA in this surgical population.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<30>
Accession Number
2036211669
Title
Safety and effectiveness of oscillatory whole-body vibration training on
exercise capacity and physical performance in aortic valve stenosis
patients prior to transcatheter aortic valve implantation: a randomized
clinical trial.
Source
Clinical Research in Cardiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Klaus J.; Gerhardt F.; Nienaber S.; Mauri V.; Mollenhoff K.; Nies R.; Kuhn
E.; Gerfer S.; Djordjevic I.; Lee S.; Guthoff H.; Iliadis C.; Baldus S.;
Hohmann C.; Adam M.; Wienemann H.
Institution
(Klaus, Gerhardt, Nienaber, Mauri, Nies, Lee, Guthoff, Iliadis, Baldus,
Hohmann, Adam, Wienemann) Clinic III for Internal Medicine, University of
Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener
Str. 62, Cologne, Germany
(Mollenhoff) Institute of Medical Statistics and Computational Biology,
University of Cologne, Cologne, Germany
(Kuhn, Gerfer, Djordjevic) Department of Cardiac Surgery, University
Hospital Cologne, Cologne, Germany
(Gerhardt) Clinic for Cardiology and Pneumology, Internal Medicine and
Sports Medicine, St. Elisabeth-Hospital, Cologne, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Exercise training is generally discouraged in patients with
severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic
valve implantation (TAVI) due to safety concerns. However, whole-body
vibration (WBV) exercise could offer a novel approach to improve exercise
capacity and quality of life, though its effects remain unclear in this
population. <br/>Method(s): Thirty patients with AS scheduled for TAVI
were prospectively and randomly assigned to either the WBV group (12
sessions, 30 min each over 4 weeks) or a control group. Assessments of
cardiopulmonary exercise testing (CPET), 6-min walking distance (6MWD) and
health-related quality of life (HRQoL) questionnaires were conducted at
baseline (V1), one day before TAVI (V2) and at short-term follow-up (V3).
WBV was conducted between V1 and V2. <br/>Result(s): For the analysis at
V1 and V2 16 patients in the WBV group and 14 in the control group were
included. Mean age was 79.7 +/- 5.22 years, with a mean aortic valve area
of 0.75 +/- 0.21 cm². Peak V'O<inf>2</inf> increased by 0.3
mL*min^-1*kg^-1 in the WBV group versus a decrease of
- 1.4 mL*min^-1*kg^-1 in the control group
(difference, 1.7 mL*min^-1*kg^-1; 95% CI, [0.2 to
3.2], p = 0.03). Peak power improved by 5.1 W in the WBV group compared to
a decline of - 4.5 W in the control group (difference, 9.6 W; 95% CI, [2.1
to 17.1], p = 0.01). The WBV group also showed a non-significant
improvement in 6MWD (34 m vs. - 8 m in the control group; difference, 42
m; 95% CI, [-10 to 93], p = 0.11). No serious adverse events occurred in
the WBV group. <br/>Conclusion(s): This pilot study demonstrated that a
WBV exercise program is feasible, safe, and showed potential to preserve
exercise capacity as well as physical performance in AS patients scheduled
for TAVI.<br/>Copyright &#xa9; The Author(s) 2025.

<31>
Accession Number
2036653042
Title
Development of and recovery from acute kidney injury after cardiac
surgery: Randomized phase 2 trial of the hepatocyte growth factor mimetic
ANG-3777.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(4) (pp 1125-1132.e2),
2025. Date of Publication: 01 Oct 2025.
Author
Ayad S.S.; Beaver T.; Corteville D.; Swaminathan M.; Pearl R.G.; Aslam S.;
Csomor P.A.; Alperovich G.; Neylan J.
Institution
(Ayad) Outcomes Research Department, Anesthesiology Institute, Cleveland
Clinic, Cleveland, Ohio, United States
(Beaver) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, University of Florida, Gainesville, Fla, United States
(Corteville) Department of Cardiology, Sands-Constellation Heart
Institute, Rochester Regional Health, Rochester, NY, United States
(Swaminathan) Department of Anesthesiology, Atrium Health Wake Forest
Baptist, Wake Forest University School of Medicine, Winston-Salem, NC,
United States
(Pearl) Department of Anesthesiology, Perioperative, and Pain Medicine,
Stanford University School of Medicine, Stanford, Calif, United States
(Aslam, Neylan) Angion Biomedica, Uniondale, NY, United States
(Csomor) CSL Vifor, Glattbrugg, Switzerland
(Alperovich) CSL Vifor, Madrid, Spain
Publisher
Elsevier Inc.
Abstract
Objectives: To investigate the safety and efficacy of ANG-3777, a
hepatocyte growth factor mimetic, in mitigating the risk of acute kidney
injury (AKI) in patients undergoing cardiac surgery with cardiopulmonary
bypass. <br/>Method(s): In this double-blind placebo-controlled study
(Guard Against Renal Damage [GUARD]), patients were randomized to receive
intravenous ANG-3777 2 mg/kg or placebo once daily for 4 days. The primary
end point was severity of AKI, measured by mean area under the
concentration-time curve on percent increase in serum creatinine from days
2 to 6. Secondary end points included the proportions of patients who
developed major adverse kidney events by day 30 or 90 and the percentage
of patients diagnosed with AKI through day 5. <br/>Result(s): In total,
259 patients received study treatment (ANG-3777, n = 129; placebo, n =
130). Through day 6, there was no significant difference in least-squares
mean change in serum creatinine between ANG-3777 and placebo (1.1%; 95%
confidence interval, -6.2 to 8.4; P = .77), or in proportions of patients
who developed major adverse kidney events by day 30 (18.6% vs 16.2%; P =
.60) or day 90 (14.7% vs 21.5%; P = .16). Similar proportions of patients
were diagnosed with AKI through day 5 (ANG-3777, 47.3%; placebo, 48.5%);
however, exploratory analysis revealed more patients diagnosed with AKI
postoperatively showed signs of recovery after treatment with ANG-3777
than placebo. Overall, ANG-3777 was well tolerated, with similar
incidences of treatment-emergent adverse events between treatment arms.
<br/>Conclusion(s): Findings from this study do not support the efficacy
of ANG-3777 in preventing the development of AKI after cardiopulmonary
bypass.<br/>Copyright &#xa9; 2024 The Authors

<32>
Accession Number
2034972741
Title
Comparative outcomes of Myval versus contemporary transcatheter heart
valves: a systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 40(4) (pp 736-745), 2025.
Date of Publication: 01 Oct 2025.
Author
Ozbay M.B.; Degirmen S.; Gullu A.; Nriagu B.N.; Ozen Y.; Celebi O.O.;
Yayla C.
Institution
(Ozbay) Department of Medicine, Penn Medicine Princeton Medical Center,
Plainsboro, NJ, United States
(Degirmen, Nriagu) Department of Medicine, Metropolitan Hospital Center,
New York, NY, United States
(Gullu) Department of Medicine, North Alabama Medical Center, Florence,
AL, United States
(Ozen) Department of Cardiology, Faculty of Medicine, Selcuk University,
Konya, Turkey
(Celebi, Yayla) Department of Cardiology, Ankara City Hospital, University
of Health Sciences, Ankara, Turkey
Publisher
Springer
Abstract
Transcatheter aortic valve replacement is a key intervention for high-risk
patients with severe aortic stenosis. Myval, a newer transcatheter heart
valve (THV), shows promise, but a comprehensive comparison with other THVs
is lacking. This study evaluates the safety and efficacy of Myval compared
with contemporary THVs. A systematic review and meta-analysis of six
studies involving 2335 patients was performed. Primary outcomes included
all-cause mortality, cardiovascular mortality, new permanent pacemaker
implantation (PPI), device success, early safety, acute kidney injury,
stroke, vascular complications, and valve regurgitation. Myval was
associated with significantly lower rates of new PPI (RR, 0.62; 95% CI
0.45-0.86; P =.004), higher rates of device success (RR, 1.08; 95% CI
1.01-1.16; P =.02), and early safety (RR, 1.15; 95% CI 1.05-1.27; P =.003)
compared with contemporary THVs. No significant differences were observed
in all-cause mortality, cardiovascular mortality, acute kidney injury,
stroke, vascular complications, and valve regurgitation. Myval may offer
better short-term outcomes in terms of new PPI, device success, and early
safety compared with contemporary THVs. Larger, prospective studies with
longer follow-ups are needed to confirm these findings.<br/>Copyright
&#xa9; The Author(s) under exclusive licence to Japanese Association of
Cardiovascular Intervention and Therapeutics 2025.

<33>
Accession Number
648476800
Title
Impact of Right Atrial Appendage Ligation vs. Repair on Serum Atrial
Natriuretic Peptide, Brain Natriuretic Peptide, and Atrial Fibrillation
following Coronary Artery Bypass Grafting.
Source
Brazilian journal of cardiovascular surgery. 40(5) (no pagination), 2025.
Date of Publication: 01 Sep 2025.
Author
Can M.F.; Sicim H.; Selcuk I.; Selcuk UN.; Temizkan V.
Institution
(Can) Adana Cukurova State Hospital Department of Cardiovascular Surgery
Adana Turkiye Department of Cardiovascular Surgery, Adana Cukurova State
Hospital, Adana, Turkey
(Sicim) Kirklareli Training and Research Hospital Department of
Cardiovascular Surgery Kirklareli Turkiye Department of Cardiovascular
Surgery, Kirklareli Training and Research Hospital
(Selcuk, Temizkan) Sultan Abdulhamid Han Training and Research Hospital
Department of Cardiovascular Surgery Istanbul Turkiye Department of
Cardiovascular Surgery, Sultan Abdulhamid Han Training and Research
Hospital, Istanbul, Turkey
(Selcuk) Dr. Siyami Ersek Thoracic and Cardiovascular Training and
Research Hospital Department of Cardiovascular Surgery Istanbul Turkiye
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and
Cardiovascular Training and Research Hospital, Istanbul, Turkey
Abstract
OBJECTIVE: In this study, we aimed to compare the levels of serum atrial
natriuretic peptide (ANP) and brain natriuretic peptide (BNP) with
ligation and primary repair of right atrial appendage after venous
decannulation procedure in isolated coronary artery bypass grafting (CABG)
and their relationship with postoperative atrial fibrillation (POAF).
<br/>METHOD(S): In this prospective randomized study, 38 patients who
underwent isolated CABG in Haydarpasa Training Hospital between March 2015
and November 2015 were included. Patients were divided into two groups
whose atrial appendage were ligated (group A) or primary repaired (group
B) after right atrial appendage decannulation. Both groups were evaluated
in terms of perioperative serum ANP/BNP levels and POAF incidence. ANP/BNP
levels were measured by taking blood samples through the central venous
catheter on the preoperative day and postoperative days 1 and 3.
<br/>RESULT(S): While six POAF incidents were observed in group A, there
were none in group B. There was no statistical difference between the
groups (P > 0.05) in the evaluation of ANP/BNP levels. POAF rate in group
A was statistically significantly higher than in group B (P < 0.05).
<br/>CONCLUSION(S): No significant difference in perioperative ANP/BNP
levels was observed between the two groups. Also, no correlation between
ANP/BNP levels and POAF were detected. Development of POAF significantly
increased in group A. Therefore, we advocate that the prevalence of atrial
fibrillation might be reduced in patients who had undergone right atrial
repair with primary repair method.

<34>
Accession Number
2034609240
Title
Sex-specific predictive value of reticulated platelets in coronary artery
disease: A systematic review and meta-analysis.
Source
European Journal of Clinical Investigation. 55(10) (no pagination), 2025.
Article Number: e70078. Date of Publication: 01 Oct 2025.
Author
Elvinger S.; Kuehne S.G.; Patrignani A.; Tscharre M.; Freynhofer M.; Perl
L.; Kornowski R.; Cesari F.; Marcucci R.; Novelli L.; Bernlochner I.;
Raake P.W.; Chiarito M.; Bongiovanni D.
Institution
(Elvinger, Kuehne, Raake, Bongiovanni) Department of Internal Medicine I,
Cardiology, University Hospital Augsburg, University of Augsburg,
Augsburg, Germany
(Patrignani, Novelli, Chiarito) Department of Cardiovascular Medicine,
Humanitas Clinical and Research Center IRCCS and Humanitas University,
Milan, Rozzano, Italy
(Tscharre) Department of Internal Medicine with Cardiology, Nephrology and
Intensive Care Medicine, Universitatsklinikum Wiener Neustadt, Wiener
Neustadt, Austria
(Tscharre) Department of Medicine, Faculty of Medicine and Dentistry,
Danube Private University, Krems, Austria
(Freynhofer) 3rd Medical Department, Cardiology and Intensive Care
Medicine, Clinic Ottakring, Vienna, Austria
(Perl, Kornowski) The Cardiovascular Division, Beilinson Hospital, Rabin
Medical Center, Petach Tikva and the Faculty of Medical and Health
Sciences, Tel Aviv University, Tel Aviv, Israel
(Cesari, Marcucci) Department of Experimental and Clinical Medicine,
University of Florence, Florence, Italy
(Cesari, Marcucci) Atherothrombotic Diseases Centre, Careggi University
Hospital, Florence, Italy
(Bernlochner) Department of Internal Medicine I, School of Medicine,
University Hospital Rechts der Isar, Munich, Germany
Publisher
John Wiley and Sons Inc
Abstract
Background: Platelets play a crucial role in immune responses and
haemostasis. Among them, reticulated platelets (RPs) have gathered
attention for their association with prothrombotic states and as a
potential biomarker for cardiovascular events. However, the sex-specific
prognostic value of RPs remains underexplored. <br/>Objective(s): This
study aimed to systematically review and analyse sex-specific differences
in the prognostic role of RPs in cardiovascular disease. <br/>Method(s):
We conducted a comprehensive search on studies that reported patient
outcomes related to RPs. Study authors were contacted to provide
sex-specific patient-level data. Two studies were excluded due to data
unavailability. The primary endpoint was major adverse cardiovascular and
cerebrovascular events (MACCE). Secondary endpoints included
cardiovascular death, myocardial infarction, stroke, urgent
revascularization, and bleeding incidents. All outcomes were stratified by
sex. <br/>Result(s): The analysis included 5 studies, reporting outcomes
in 1835 patients (527 females and 1308 males). RPs are a significant
predictor of MACCE independently of sex males (OR 1.99 [95% CI 1.3, 3.05;
I² = 29%]), females (2.29 [95% CI 1.31, 3.99; I² =
10%]). For cardiovascular death RPs were predictive in females (OR 3.29
[95% CI 1.69, 6.40] I² =.83%) and showed a trend toward
significance in males (OR 2.19 95% CI [.98, 4.9] I² = 42.72%).
No sex-specific differences were observed in all other secondary
endpoints. <br/>Conclusion(s): RPs significantly predict MACCE in
cardiovascular disease independently from sex and may have a stronger
association with cardiovascular death in females. Further research is
needed to explore the sex-specific mechanisms of RPs' prognostic
value.<br/>Copyright &#xa9; 2025 The Author(s). European Journal of
Clinical Investigation published by John Wiley & Sons Ltd on behalf of
Stichting European Society for Clinical Investigation Journal Foundation.

<35>
Accession Number
2040487131
Title
Effect of evolocumab on saphenous vein graft patency after coronary artery
bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised,
double-blind, placebo-controlled trial.
Source
The Lancet. 406(10509) (pp 1223-1234), 2025. Date of Publication: 20 Sep
2025.
Author
Verma S.; Leiter L.A.; Teoh H.; Mancini G.B.J.; Quan A.; Elituv R.; Verma
M.; Misner E.; Szarek M.; Thorpe K.E.; Saha T.; Whitlock R.P.; Yanagawa
B.; Merkely B.; Juni P.; Koren M.J.; Nicholls S.J.; Bhatt D.L.; Mazer C.D.
Institution
(Verma, Teoh, Quan, Elituv, Misner, Yanagawa) Division of Cardiac Surgery,
St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada
(Leiter, Teoh) Division of Endocrinology and Metabolism, St Michael's
Hospital-Unity Health Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital-Unity Health
Toronto, Toronto, ON, Canada
(Verma, Yanagawa) Department of Surgery, University of Toronto, Toronto,
ON, Canada
(Verma, Yanagawa, Mazer) Department of Pharmacology and Toxicology,
University of Toronto, Toronto, ON, Canada
(Leiter) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Leiter) Department of Nutritional Sciences, University of Toronto,
Toronto, ON, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Mazer) Department of Physiology, University of Toronto, Toronto, ON,
Canada
(Mancini) Division of Cardiology, Centre for Cardiovascular Innovation,
Dilawri Cardiovascular Institute, University of British Columbia,
Vancouver, BC, Canada
(Verma, Elituv) North York Diagnostic and Cardiac Centre, Toronto, ON,
Canada
(Verma) Royal College of Surgeons in Ireland, Dublin, Ireland
(Szarek) Division of Cardiology, University of Colorado School of
Medicine, Aurora, CO, United States
(Szarek) CPC Clinical Research, University of Colorado School of Medicine,
Aurora, CO, United States
(Szarek, Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Saha) Department of Anesthesiology and Perioperative Medicine, Kingston
Health Sciences Centre, Kingston, ON, Canada
(Saha) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Whitlock) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Whitlock) Department of Health Research Methodology, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
(Whitlock) Perioperative and Surgery Research Program, Population Health
Research Institute, Hamilton, ON, Canada
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Juni) Clinical Trial Service Unit and Epidemiological Studies Unit,
Nuffield Department of Population Health, University of Oxford, Oxford,
United Kingdom
(Koren) Jacksonville Center for Clinical Research, Flourish Research
Group, Jacksonville, FL, United States
(Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC,
Australia
Publisher
Elsevier B.V.
Abstract
Background: Saphenous vein graft (SVG) failure remains a substantial
challenge after coronary artery bypass graft (CABG). LDL cholesterol
(LDL-C) is a causal risk factor for atherosclerosis, but its role in SVG
failure is not well established. We evaluated whether early initiation of
intensive LDL-C lowering with evolocumab could reduce SVG failure.
<br/>Method(s): NEWTON-CABG CardioLink-5 was a multicentre, double-blind,
randomised, placebo-controlled trial conducted at 23 sites in Canada, the
USA, Australia, and Hungary. Eligible participants were adults (age >=18
years) who underwent CABG with at least two SVGs and were being treated
with statin therapy of moderate or high intensity. Participants were
randomly allocated (1:1; variable block size) within 21 days of CABG to
subcutaneous evolocumab 140 mg or placebo every 2 weeks. The primary
endpoint was the 24-month vein graft disease rate (VGDR; the proportion of
SVGs with >=50% occlusion on coronary CT angiography or clinically
indicated invasive angiography) in the modified intention-to-treat
population. This trial is registered with ClinicalTrials.gov, NCT03900026,
and is completed. <br/>Finding(s): Between June 17, 2019, and Nov 10,
2022, 782 individuals were randomly assigned (389 to evolocumab and 393 to
placebo). At baseline, among the 554 participants with primary outcome
data available, the median age was 66 years (IQR 60-72), 471 (85%) of 554
participants were male and 83 (15%) were female, and the median LDL-C was
1.85 mmol/L (IQR 1.25-2.84) in the evolocumab group and 1.86 mmol/L
(1.20-2.76) in the placebo group. Evolocumab resulted in a mean 48.4%
placebo-adjusted reduction in LDL-C at 24 months (-52.4% vs -4.0%). The
24-month VGDR was 21.7% (149 of 686 grafts) in the evolocumab group and
19.7% (127 of 644 grafts) in the placebo group (difference 2.0% [95% CI
-3.1 to 7.1]; p=0.44). Treatment was well tolerated, with similar adverse
event profiles between the groups. <br/>Interpretation(s): Among patients
who underwent CABG, evolocumab did not reduce SVG disease at 24 months
following the index surgery despite substantial LDL-C lowering. Further
LDL-C lowering does not appear to meaningfully affect the
pathophysiological mechanisms responsible for early SVG failure.
<br/>Funding(s): Amgen Canada.<br/>Copyright &#xa9; 2025 Elsevier Ltd

<36>
Accession Number
2036014040
Title
Mortality Outcomes of Combined Heart and Liver Transplantation and
Isolated Heart Transplantation Following Fontan Procedures: A Systematic
Review and Meta-Analysis.
Source
Pediatric Transplantation. 29(7) (no pagination), 2025. Article Number:
e70174. Date of Publication: 01 Nov 2025.
Author
Holmvard O.; Povoa-Correa M.; Macintyre Innocenzi A.; Pacheco L.F.;
Parente D.B.; Luiz R.R.; de Lima Moreira J.P.; de Mello Perez R.;
Fernandes F.P.; Moll-Bernardes R.
Institution
(Holmvard, Povoa-Correa, Macintyre Innocenzi, Pacheco, Parente, Luiz, de
Lima Moreira, de Mello Perez, Fernandes, Moll-Bernardes) D'Or Institute
for Research and Education (IDOR), RJ, Rio de Janeiro, Brazil
(Povoa-Correa) Maternal and Child Health Department, Federal University of
Rio de Janeiro (UFRJ), RJ, Macae, Brazil
(Macintyre Innocenzi) Pediatric Cardiology Department, National Institute
of Cardiology (INC), RJ, Rio de Janeiro, Brazil
(Pacheco) Liver Transplant Surgery Department, Rede D'Or, RJ, Rio de
Janeiro, Brazil
(Parente) Radiology Department, Federal University of Rio de Janeiro
(UFRJ), RJ, Rio de Janeiro, Brazil
(Luiz) Institute for Studies in Public Health-IESC, Federal University of
Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
(de Lima Moreira) Fluminense Federal University, RJ, Niteroi, Brazil
(de Mello Perez) Internal Medicine Department, Federal University of Rio
de Janeiro (UFRJ), RJ, Rio de Janeiro, Brazil
(Fernandes) Pediatric Cardiac Transplantation, National Institute of
Cardiology (INC), RJ, Rio de Janeiro, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Background: Fontan-associated liver disease can progress to advanced
fibrosis, raising the potential need for combined heart-liver
transplantation (CHLT) in selected patients. However, the benefits of CHLT
over isolated orthotopic heart transplantation (HT), particularly in terms
of mortality, remain uncertain. In this systematic review, we compared
mortality outcomes following CHLT versus HT in patients with Fontan
circulation, with the aim of supporting clinical decision-making.
<br/>Method(s): This systematic review was conducted according to the 2020
PRISMA guidelines and registered in PROSPERO. PubMed, Scopus, and Embase
were searched. Studies examining HT or CHLT in patients with Fontan
circulation that provided information about total and/or 1-year mortality
were included. Bias risks were assessed using the Newcastle-Ottawa Scale.
We used random- and fixed-effect models, depending on heterogeneity, to
estimate pooled effects. <br/>Result(s): Sixteen studies were included in
this analysis. CHLT was associated with a lower mortality rate per
patient-year compared to HT (0.03 vs. 0.09; p < 0.01). However, after
excluding studies in which transplantations were performed before the year
2000, the difference between groups was no longer statistically
significant. One-year mortality rates were also not significantly
different between CHLT and HT (0.09 vs. 0.14; p = 0.28), with similar
results observed after excluding pre-2000 studies. <br/>Conclusion(s):
Overall, this systematic review suggests that CHLT may result in mortality
rates comparable to those of isolated HT. These findings support the
consideration of CHLT in patients with concomitant liver disease and
reinforce the importance of comprehensive liver evaluation in transplant
candidates.<br/>Copyright &#xa9; 2025 The Author(s). Pediatric
Transplantation published by Wiley Periodicals LLC.

<37>
Accession Number
2036055646
Title
Cost-effectiveness of CMR over MPS-SPECT: a systematic review of recent
trends for diagnosing CAD.
Source
Journal of Medical Economics. 28(1) (pp 1451-1466), 2025. Date of
Publication: 2025.
Author
Kluge B.; Harris J.; Sanchez-Collado I.; Perez-Roman I.; Paffett M.;
Christophel S.; Harz C.; Blankenburg M.; Greenwood J.P.
Institution
(Kluge, Christophel, Harz, Blankenburg) Bayer AG Pharmaceuticals, Berlin,
Germany
(Harris, Sanchez-Collado, Perez-Roman, Paffett) Wickenstones Ltd, Carlow,
Ireland
(Greenwood) Cardiology, University of Leeds, Leeds, United Kingdom
Publisher
Taylor and Francis Ltd.
Abstract
Aims: The health economic impacts of cardiovascular magnetic resonance
(CMR) imaging and myocardial perfusion scintigraphy by single photon
emission computed tomography (MPS-SPECT) as diagnostic modalities are not
well understood. This review is based on a wider systematic review and
aims to compare CMR and MPS-SPECT as first-line, non-invasive modalities
for the diagnosis of symptomatic individuals with a low-to-intermediate
pre-test probability (PTP) of coronary artery disease (CAD).
<br/>Material(s) and Method(s): We performed a systematic review of
MEDLINE and Embase, MEDLINE In-process, the Cochrane Database of
Systematic reviews and the Cochrane Central Register of Controlled Trials.
Studies from January 1992 to January 2023 were included, if they were
based in the UK, France, Germany, Italy, Japan, China, and/or the USA
(published in any language). Risk of bias was assessed using the Drummond
checklist. <br/>Result(s): Thirteen relevant reports were identified. In
the USA, CMR was consistently cost-effective compared with MPS-SPECT for
patients with a low-to-intermediate PTP of CAD; resource use and
associated costs, as well as total costs, were lower. For patients with a
low-to-intermediate PTP of CAD in Europe, CMR was cost-effective in
Germany, while in the UK increases in quality-adjusted life-years were
found but cost savings were mixed. This review found only 13 reports on
the economic benefits of CMR over MPS-SPECT, with just three providing
cost-effectiveness outcomes, highlighting the need for further research
across different settings and perspectives. <br/>Conclusion(s): Overall,
findings suggest that the cost savings from using CMR compared with
MPS-SPECT for patients with a low-to-intermediate PTP of CAD support
prioritized investment; however, confirmatory research is needed given the
limited number of cost-effectiveness analyses identified in this
review.<br/>Copyright &#xa9; 2025 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<38>
Accession Number
2039904457
Title
Efficacy of intravenous acetaminophen as adjunct analgesia in patients
undergoing cardiovascular surgery: a systematic review and meta-analysis.
Source
Korean Journal of Pain. 38(3) (pp 320-331), 2025. Date of Publication:
2025.
Author
Lee S.; Koo C.-H.; Bae Y.K.; Ryu J.-H.
Institution
(Lee, Koo, Bae, Ryu) Department of Anesthesiology and Pain Medicine, Seoul
National University Bundang Hospital, Seongnam, South Korea
(Lee, Koo, Ryu) Department of Anesthesiology and Pain Medicine, Seoul
National University College of Medicine, Seoul, South Korea
Publisher
Korean Pain Society
Abstract
Background: Although intravenous (IV) acetaminophen (AAP) may help reduce
severe postoperative pain and opioid use after cardiovascular surgery, its
effectiveness must be further validated. Therefore, the authors aimed to
evaluate the analgesic efficacy of perioperative IV AAP in patients
undergoing cardiovascular surgery by conducting this meta-analysis.
<br/>Method(s): A comprehensive literature search was conducted of PubMed,
Embase, CENTRAL, CINAHL, Scopus, and Web of Science databases for studies
published up to March 21, 2024. Six randomized controlled trials comparing
IV AAP with a placebo in cardiovascular surgery were included. The mean
difference (MD) was calculated to estimate pooled effect sizes. The
primary outcome was opioid consumption, measured in morphine equivalent
dose, and the secondary outcome was postoperative pain score.
<br/>Result(s): Postoperative opioid consumption was significantly reduced
with IV AAP than it was with a placebo (MD: -21.68, 95% confidence
interval [CI]: -38.41 to -4.95, P = 0.011). Significant reductions in
postoperative pain scores were observed at 6 hours (MD: -0.76, 95% CI:
-1.43 to -0.10, P = 0.025) and 24 hours (MD: -0.63, 95% CI: -1.02 to
-0.25, P = 0.001) after surgery. However, these reductions did not meet
clinically meaningful thresholds. No significant differences were observed
at 12, 18, and 48 hours postoperatively. <br/>Conclusion(s): IV AAP was
more effective than a placebo for postoperative adjunct analgesia in
patients who underwent cardiovascular surgery.<br/>Copyright &#xa9; The
Korean Pain Society. This is an Open Access article distributed under the
terms of the Creative Commons Attribution Non-Commercial License
(https://creativecommons.org/licenses/by-nc/4.0), which permits
unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

<39>
Accession Number
2034705396
Title
Comprehensive analysis of acute kidney injury incidence following
transcatheter versus surgical aortic valve replacement in aortic stenosis:
a systematic review and meta-analysis of 13,777 patients.
Source
Cardiovascular Intervention and Therapeutics. 40(4) (pp 932-942), 2025.
Date of Publication: 01 Oct 2025.
Author
Alazzam A.; Aldroubi Y.; Alhusban T.; said M.
Institution
(Alazzam) The Hashemite University, Zarqa, Jordan
(Aldroubi) Faculty of Medicine, University of Jordan, Amman, Jordan
(Alhusban) Jordanian Royal Medical Services, Prince Hashim Military
Hospital, Zarqa, Jordan
(said) Yarmouk University Faculty of Medicine - Irbid, Aydoun, Jordan
Publisher
Springer
Abstract
This systematic review and meta-analysis evaluate Acute Kidney Injury
(AKI) differences between surgical aortic valve replacement (SAVR) and
transcatheter aortic valve replacement (TAVR) and how surgical risk
stratification and diagnostic criteria influence outcomes. Following the
PRISMA guidelines, we included both non-randomized studies and randomized
clinical trials that reported AKI criteria and patients' surgical risk in
patients with aortic stenosis by searching PubMed, Scopus, and Web of
Science until late September. We executed a random-effects model in Review
Manager to pool effect estimates of AKI incidence or the need for dialysis
as an odds ratio (OR) and I² heterogeneity, and we utilized R
for meta-regression to address any heterogeneity with subgroup analysis
for surgical risk, AKI criteria, and study design. We used the Newcastle
Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool (RoB-1) for risk of
bias assessment and GRADE for certainty assessment. Involving 17 studies
and a total of 13,777 patients, we found that the AKI incidence was
significantly lower in TAVR compared to SAVR (OR = 0.36; 95% CI: [0.30,
0.44], I² = 55%, P = 0.003), along with the need for dialysis
(OR = 0.35; 95% CI: [0.19, 0.63], I² = 0%, P = 0.92). The study
also found that intermediate and low-risk patients had more favorable
outcomes. However, the retrospective study design and VARC-2 criteria were
associated with unfavorable outcomes. TAVR effectively reduced the risk of
AKI in all surgical risk categories and the need for dialysis compared to
SAVR in patients with AS.<br/>Copyright &#xa9; The Author(s) under
exclusive licence to Japanese Association of Cardiovascular Intervention
and Therapeutics 2025.

<40>
[Use Link to view the full text]
Accession Number
2039762965
Title
Randomized Controlled: Trial of New Oral Anticoagulants Versus Warfarin
for Postcardiac Surgery Atrial Fibrillation The NEW-AF Trial.
Source
Annals of Surgery. 282(4) (pp 630-638), 2025. Date of Publication: 01 Oct
2025.
Author
Moonsamy P.; Zhao Y.; Makarem A.; Paneitz D.C.; Wolfe S.; Turco I.; Colon
K.M.; Ethridge B.R.; Li S.S.; Leya G.; Verma S.; D'Alessandro D.A.; Jassar
A.S.; Langer N.B.; Tolis G.; Villavicencio M.A.; Melnitchouk S.I.; Bloom
J.P.; Michel E.; Kreso A.; Rabi S.A.; Akeju O.; Sundt T.M.; Osho A.A.
Institution
(Moonsamy, Zhao, Makarem, Paneitz, Wolfe, Turco, Colon, Ethridge, Li,
Leya, Verma, D'Alessandro, Jassar, Langer, Tolis, Villavicencio,
Melnitchouk, Bloom, Michel, Kreso, Rabi, Sundt, Osho) Division of Cardiac
Surgery, Department of Surgery, Massachusetts General Hospital, Boston,
MA, United States
(Akeju) Department of Anesthesia, Critical Care and Pain Medicine,
Massachusetts General Hospital, Boston, MA, United States
Publisher
Wolters Kluwer Health
Abstract
Objective: To determine whether anticoagulation for new onset atrial
fibrillation (AF) with rivaroxaban decreases length of stay compared with
warfarin. Summary of Background Data: Direct Oral Anticoagulants (DOACs)
have been shown to be noninferior to warfarin for stroke prevention in
nonsurgical patients with atrial fibrillation. There are no published
randomized trials comparing DOACs to warfarin in cardiac surgery patients,
and DOACs are yet to be widely adopted in this population. <br/>Method(s):
In a pragmatic, prospective, clinical trial, 100 patients with new-onset
AF after cardiac surgery were randomized to receive rivaroxaban (n = 50)
or warfarin (n = 50). Patients were followed for 30 days postdischarge,
with patient-reported outcomes assessed 2 weeks after discharge using the
Perception of Anticoagulant Treatment Questionnaire and the EuroQol-5D-3L
survey. <br/>Result(s): The primary endpoint, length of stay (LOS) from
day of surgery to discharge (days, IQR), was 7 (6-9) for rivaroxaban and 8
(6-9) for warfarin (P = 0.460). LOS from initiation of anticoagulation to
discharge was 2 (1-4) days for rivaroxaban and 2 (1-3) days for warfarin
(P = 0.738). The mean INR at discharge in the warfarin group was 1.68 (SD
0.5). No major bleeding events, strokes, or other arterial thromboembolism
events occurred in either group. Minor bleeding events were reported in
3/50 (6%) patients in the rivaroxaban group versus 1/50 (2%) in the
warfarin group (P = 0.617), none of which required blood transfusion. One
patient (2%) in the rivaroxaban group developed a pericardial effusion
requiring drainage, compared with none in the warfarin group (P = 1.000).
Patients taking rivaroxaban reported significantly higher scores for
convenience (P < 0.001) and better overall perception of their
anticoagulation experience (P = 0.006), though both groups reported
similar treatment satisfaction (P = 0.494). Mobility issues were reported
by 42.2% of patients taking rivaroxaban compared with 18.6% of those
taking warfarin (P = 0.021). All outcomes were consistent in both the
intention-to-treat and as-treated populations. <br/>Conclusion(s):
Treatment with rivaroxaban in new-onset atrial fibrillation after cardiac
surgery did not decrease length of stay compared with warfarin. However,
patients treated with rivaroxaban reported significantly better
convenience and a more favorable overall perception of their
anticoagulation experience compared with warfarin. Given similar safety
profiles, these findings support incorporating rivaroxaban as an option
for shared decision-making when selecting anticoagulation therapy for this
patient population.<br/>Copyright &#xa9; 2025 Wolters Kluwer Health, Inc.
All rights reserved.

<41>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; The Author(s) 2025

<42>
Accession Number
2040463125
Title
Impact of perioperative selenium supplementation on perioperative
hemodynamics in patients undergoing cardiac surgery: a post hoc analysis
of the Sustain CSX trial.
Source
Journal of Clinical Anesthesia. 107 (no pagination), 2025. Article Number:
112011. Date of Publication: 01 Nov 2025.
Author
Mohsen G.; Catena D.; Lee Z.-Y.; Notz Q.; Jiang X.; Velten M.; O'Brien B.;
Kleine-Brueggeney M.; Ott S.; Heyland D.K.; Duerr G.D.; Meybohm P.; Stoppe
C.
Institution
(Mohsen, Catena, Lee, O'Brien, Kleine-Brueggeney, Ott, Stoppe) Department
of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches
Herzzentrum der Charite, Augustenburgerplatz 1, Berlin, Germany
(Mohsen, Catena, Lee, O'Brien, Kleine-Brueggeney, Ott, Stoppe)
Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat
Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany
(Lee) Department of Anaesthesiology, Faculty of Medicine, University of
Malaysia, Jln Profesor Diraja Ungku Aziz, Seksyen 13, Kuala Lumpur,
Petaling Jaya, Malaysia
(Notz, Meybohm, Stoppe) Department of Anaesthesiology, Intensive Care,
Emergency and Pain Medicine, University Hospital, Wurzburg,
Josef-Schneider-Strasse 2, Wurzburg, Germany
(Jiang, Heyland) Clinical Evaluation Research Unit, Department of Critical
Care Medicine, Queen's University, 99 University Ave, Kingston, ON, Canada
(Velten) Department of Anesthesiology and Pain management, Division of
Cardiovascular thoracic Anesthesiology, University of Texas Southwestern
Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States
(O'Brien) St Bartholomew's Hospital and Barts Heart Centre, Department of
Perioperative Medicine, London, United Kingdom
(Ott) DZHK (German Centre for Cardiovascular Research), Partner Site
Berlin, Berlin, Germany
(Ott) Outcomes Research Consortium, Department of Anesthesiology,
Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, United States
(Duerr) Department of Cardiovascular Surgery, University Medical Center
Mainz (Johannes Gutenberg-University Mainz), Langenbeckstrasse 1, Mainz,
Germany
(Ott) Department of Cardiothoracic and Vascular Surgery, Deutsches
Herzzentrum der Charite, Berlin, Germany
Publisher
Elsevier Inc.

<43>
Accession Number
2040439443
Title
Harnessing the power of nature in surgery: A systematic scoping review of
nature prescribing and measures of benefit.
Source
Surgery (United States). 187 (no pagination), 2025. Article Number:
109657. Date of Publication: 01 Nov 2025.
Author
Nguyen M.; Liu E.; Karimuddin A.A.; Ghuman A.; Conklin A.I.
Institution
(Nguyen, Liu, Conklin) Faculty of Pharmaceutical Sciences, University of
British Columbia, Vancouver, Canada
(Karimuddin, Ghuman) Colorectal Surgery, St. Paul's Hospital, Providence
Health Care, and General Surgery Residency Training Program at the
University of British Columbia, Vancouver, Canada
(Karimuddin, Ghuman) Department of Surgery, Faculty of Medicine,
University of British Columbia, Vancouver, Canada
(Conklin) Centre for Advancing Health Outcomes, Providence Healthcare
Research Institute, Vancouver, Canada
(Conklin) Edwin S.H. Leong Centre for Healthy Aging, Faculty of Medicine,
University of British Columbia, Vancouver, Canada
Publisher
Elsevier Inc.
Abstract
Background: Natural environments can reduce stress and benefit overall
health and nature prescriptions may be a useful adjunct for postoperative
care in surgical patients. We sought to identify characteristics and
health measures of nature prescriptions in surgery. <br/>Method(s): We
undertook a scoping review of 5 bibliometric databases (to February 2024)
and citations of peer-reviewed original studies examining nature
prescription interventions in patients undergoing major surgical
procedures requiring anesthesia and hospital admission. Standardized data
extraction and narrative synthesis were performed. <br/>Result(s): The
search found 2,175 deduplicated eligible records and 20 full-texts for
screening. Ten studies were included and covered auditory (n = 3), visual
(n = 3), experiential (n = 3), or mixed interventions (n = 1), with small
sample sizes (median, 106; interquartile range, 252). About 50% focused on
cardiothoracic surgical patients. Interventions varied from viewing
plants/trees, listening to bird/water/forest sounds or being physically
immersed. Nearly all included studies reported patient-reported outcome
measures (eg, anxiety, pain or mood) that significantly improved across
all intervention types. Cardiovascular (eg, heart rate, blood pressure)
and respiratory (eg, respiratory rate, vital capacity) outcomes were
frequently measured, with greater improvements observed in the
nature-based intervention groups compared with controls. Few included
studies assess other clinical measures (eg, mortality, length of stay,
complications) and only 2 evaluated medications to show reductions in the
amount of analgesic consumption after being exposed to nature
interventions. <br/>Conclusion(s): Nature prescribing in surgery appears
diverse and shows promise for improving postoperative recovery and
well-being through reduced anxiety, pain, cardiorespiratory stress,
medication use, and improved mood. Medical and research attention to
include nature-based therapy in surgery seems warranted.<br/>Copyright
&#xa9; 2025 The Author(s)

<44>
Accession Number
2040588173
Title
Restrictive versus liberal oxygenation in patients undergoing
cardiopulmonary bypass-assisted heart surgery: a randomised controlled
trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Wiberg S.; Moller C.H.; Kjaergaard J.; Mikkelsen A.D.; Sorensen H.-M.;
Kunkel J.B.; Olsen P.S.; Hofsten D.E.; Ravn J.; Ravn H.; Boesgaard S.;
Hassager C.; Kober L.; Nilsson J.C.
Institution
(Wiberg, Sorensen, Nilsson) Department of Cardiothoracic Anesthesiology
and Intensive Care, Copenhagen University Hospital Rigshospitalet,
Copenhagen, Denmark
(Wiberg, Kjaergaard, Mikkelsen, Kunkel, Hofsten, Boesgaard, Hassager,
Kober) Department of Cardiology, Copenhagen University Hospital
Rigshospitalet, Copenhagen, Denmark
(Wiberg, Kjaergaard, Hassager) Department of Clinical Medicine, Faculty of
Health Sciences, University of Copenhagen, Copenhagen, Denmark
(Moller, Olsen, Ravn) Department of Cardiothoracic Surgery, Copenhagen
University Hospital Rigshospitalet, Copenhagen, Denmark
(Ravn) Department of Anesthesiology and Intensive Care, Odense University
Hospital, Odense, Denmark
Publisher
Elsevier Ltd
Abstract
Background: Maintaining adequate oxygen delivery during cardiopulmonary
bypass (CPB)-assisted cardiac surgery is crucial, but hyperoxia has been
suggested to cause organ injury. We compared the effects of restrictive vs
liberal oxygenation during CPB and weaning from CPB on clinical outcomes
in cardiac surgery. <br/>Method(s): We conducted a single-centre, patient-
and assessor-blinded randomised trial on adults undergoing CPB-assisted
coronary artery bypass grafting, aortic valve replacement, or both.
Participants were randomly assigned (1:1) to restrictive
(FIO<inf>2</inf>=50%) or liberal (FIO<inf>2</inf>=100%) oxygen therapy
during and for the first hour after weaning from CPB. The primary
composite outcome was the time to death, stroke, renal failure requiring
dialysis, or new-onset or worsening heart failure during follow-up.
<br/>Result(s): Among 1389 participants (mean age, 67 yr [range, 29-85
yr]; 17% female), randomisation to receive FIO<inf>2</inf> 50% resulted in
median PaO<inf>2</inf> levels of 19-23 kPa during CPB, compared with >60
kPa in participants receiving FIO<inf>2</inf> 100%. During a median
follow-up period of 5.9 yr (interquartile range, 2.5-8.3), 167/695 (24%)
participants in the restrictive oxygenation group and 168/694 (24%)
participants in the liberal oxygenation group met the primary endpoint
(hazard ratio, 1.01 [95% confidence interval, 0.8-1.3]; P=0.92). There was
no difference in adverse event rates between restrictive and liberal
oxygen therapy. <br/>Conclusion(s): Among patients undergoing elective or
urgent CPB-assisted coronary artery bypass grafting, aortic valve
replacement, or both, no significant differences were observed in
mortality, dialysis-dependent renal failure, stroke, or new-onset or
worsening heart failure between a restrictive oxygenation strategy
(FIO<inf>2</inf> 50%) and a liberal oxygenation strategy (FIO<inf>2</inf>
100%) during CPB and the subsequent weaning period. Clinical trial
registration: NCT02673931<br/>Copyright &#xa9; 2025 The Author(s)

<45>
Accession Number
2040496555
Title
Safety of general anesthesia in patients with unruptured intracranial
aneurysms undergoing non-aneurysm-related surgery: A systematic review.
Source
Journal of Clinical Neuroscience. 142 (no pagination), 2025. Article
Number: 111646. Date of Publication: 01 Dec 2025.
Author
Feng Q.J.; Tham K.J.; Tan C.L.
Institution
(Feng, Tan) Division of Neurosurgery, Department of General Surgery, Ng
Teng Fong General Hospital, Singapore
(Tham) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Tan) Division of Neurosurgery, Department of Surgery, National University
Hospital, Singapore
Publisher
Churchill Livingstone
Abstract
Objective: The increasing utilization of neuroimaging has led to a rising
number of incidental unruptured intracranial aneurysms (UIAs). Most UIAs
carry a low rupture risk, but concerns remain regarding the potential
impact of general anesthesia (GA) on perioperative aneurysm stability.
This systematic review aims to evaluate the incidence of perioperative
aneurysmal rupture in patients with UIAs undergoing GA for
non-aneurysm-related procedures. <br/>Method(s): A search of the PubMed
and EMBASE databases identified studies reporting adult patients with UIAs
undergoing GA for non-aneurysm-related surgeries, detailing aneurysm
characteristics and rupture incidence. The primary outcome was aneurysmal
rupture during or within 48 h of surgery, and the secondary outcome was
aneurysm-rupture-related mortality. Perioperative management strategies
were also reviewed. <br/>Result(s): A total of 21 studies involving 627
patients were included. The majority were case reports or small series,
alongside three larger cohort studies. Across all patients, only one case
of perioperative aneurysmal rupture (0.16 %) was identified, with no
rupture-related mortality. Most aneurysms were small (<7 mm) and located
in the anterior circulation. No specific surgical procedure or anesthetic
technique was associated with an increased rupture risk. Several studies
highlighted the importance of meticulous intraoperative hemodynamic
management, although no standardized protocols were reported.
<br/>Conclusion(s): This systematic review demonstrates that GA is
generally safe for patients with UIAs undergoing non-aneurysm-related
surgery, with an extremely low risk of perioperative rupture and no
associated mortality. Current evidence does not support prophylactic
aneurysm treatment. Individualized risk assessment and vigilant
perioperative blood pressure management are key to maintaining safety in
this population.<br/>Copyright &#xa9; 2025 Elsevier Ltd

<46>
Accession Number
2035927436
Title
Effect of Ciprofol on Postoperative Cognitive Function in Patients
Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective,
Randomized, Controlled Trial.
Source
Drug Design, Development and Therapy. 19 (pp 7541-7552), 2025. Date of
Publication: 2025.
Author
Lu J.; Shi Y.; Lan X.; Tang G.; Shao Y.; Chen C.; Xiong X.; Chen D.; Shi
J.
Institution
(Lu, Shi, Lan, Tang, Shao, Chen, Xiong, Shi) Department of Anesthesiology,
the Affiliated Hospital of Guizhou Medical University, Guiyang, China
(Chen) Department of Anesthesiology, West China second Hospital, Sichuan
University, Chengdu, China
(Chen) Key Laboratory of Birth Defects and Related Diseases of Women and
Children, Sichuan University, Chengdu, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: To investigate the effects of ciprofol on postoperative cognitive
function in patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). <br/>Patients and Methods: A total of 138 patients who
underwent cardiac surgery with cardiopulmonary bypass were included in
this prospective, randomized, controlled study. Patients were randomized
into two groups: the Ciprofol group (Group C) and the Propofol group
(Group P). During anesthesia induction and maintenance, the patients in
Group C received ciprofol, whereas those in Group P received propofol. The
primary outcome measure was the incidence of postoperative delirium (POD),
which was assessed twice daily for 7 days after surgery via either the
Confusion Assessment Method (CAM) or the Confusion Assessment Method for
the Intensive Care Unit (CAM-ICU). Statistical analyses included
chi-square tests for categorical outcomes and relative risk calculations
for POD. Additionally, delirium subtypes were recorded. The incidence of
postoperative cognitive dysfunction (POCD) was evaluated at 1 and 3 months
after surgery using the Telephone Montreal Cognitive Assessment (T-MoCA).
Furthermore, the occurrence of postinduction adverse events, including
hypotension, bradycardia, and tachycardia, as well as the incidence of
postoperative complications, were also documented. <br/>Result(s): POD
occurred in 19/64 (29.69%) patients in the Ciprofol group and 34/65
(52.31%) patients in the Propofol group (RR = 0.57; 95% confidence
interval = 0.37 to 0.88; p = 0.009). There was no significant difference
in the incidence of POCD at 1 month (22.03% vs 26.62%, p = 0.547) or 3
months (16.25% vs 16.00%; p = 0.771) after surgery between the two groups.
<br/>Conclusion(s): Ciprofol was found to decrease the incidence of POD in
patients who underwent cardiac surgery with cardiopulmonary bypass.
Nevertheless, no significant effect of this intervention on the incidence
of POCD was demonstrated at either 1 or 3 months after surgery. A
reduction in the incidence of delirium may be associated with improved
postoperative recovery, shortened hospital stays, and a decrease in
long-term cognitive impairments. Registration: The study had been
registered in the Chinese Clinical Trials Registry (www.chictr.org.cn;
Trial Identifier: ChiCTR2200061712).<br/>Copyright &#xa9; 2025 Lu et al.

<47>
Accession Number
2040468170
Title
Erector Spinae Plane Block Versus Retrolaminar Block for Perioperative
Analgesia in Pediatric Cardiac Surgery: A Randomized, Double-blinded,
Noninferiority Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Gopalakrishnan R.M.; Shinde N.; Meghalakshmi A.R.; Gutjahr G.;
Krishnakumar M.; Leeladharan S.P.; Thomas D.; Padmanabhan S.; Krishnakumar
R.
Institution
(Gopalakrishnan, Padmanabhan) Department of Pediatric Cardiac Anesthesia
and Intensive Care, Amrita Institute of Medical Sciences and Research
Centre, Kerala, Kochi, India
(Shinde, Meghalakshmi, Leeladharan, Thomas) Department of Cardiac
Anesthesia, Amrita Institute of Medical Sciences and Research Centre,
Kerala, Kochi, India
(Gutjahr, Krishnakumar) Department of Health Science Research, Amrita
Institute of Medical Sciences and Research Centre, Kerala, Kochi, India
(Krishnakumar) Department of Pediatric Cardiology, Amrita Institute of
Medical Sciences and Research Centre, Kerala, Kochi, India
Publisher
W.B. Saunders
Abstract
Objective: To compare the efficacy and safety of retrolaminar block (RLB)
with erector spinae plane block (ESPB) for perioperative analgesia in
pediatric cardiac surgery. <br/>Design(s): Prospective, randomized,
double-blinded, controlled, noninferiority trial. <br/>Setting(s): A
pediatric cardiac surgical unit at a tertiary care referral center in
South India. <br/>Participant(s): Children aged between 1 day and 18 years
who were scheduled for elective cardiac surgery (Risk adjustment for
congenital heart surgery categories 1-6) were enrolled in the study. A
total of 298 patients were randomly assigned to receive either an ESPB or
RLB, with 149 patients in each group. <br/>Intervention(s): Myofascial
blocks were performed by one of four anesthesiologists, each administering
either ESPB or RLB under ultrasound guidance according to the assigned
group. The treating anesthesiologist and intensive care unit (ICU)
intensivist were blinded to group allocation. <br/>Measurements and Main
Results: This study compared RLB, a safer and less commonly used posterior
myofascial block, with ESPB, a widely adopted technique with few reported
complications, to establish the noninferiority of RLB. The primary outcome
was hemodynamic response to surgical incision, defined as a greater than
10% rise in heart rate. Secondary outcomes included block administration
time; intraoperative inhalational anesthetic; dexmedetomidine and opioid
use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU
outcomes such as duration of mechanical ventilation, ICU length of stay,
reintubation rate, and cost of ventilator disposables and oxygen. The
groups were comparable in baseline characteristics. A rise in heart rate
of more than 10% was observed in 46% of patients in the ESPB group and 50%
in the RLB group (p = 0.3). Intraoperative drug consumption, pain and
sedation scores, as well as ICU outcomes, were similar between the groups.
<br/>Conclusion(s): RLB is noninferior to ESPB in pediatric cardiac
surgery, providing comparable analgesic efficacy, safety, and
postoperative recovery outcomes.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<48>
[Use Link to view the full text]
Accession Number
2039383459
Title
Comparison of analgesic efficacy and safety of caudal dexmedetomidine
versus intranasal dexmedetomidine in paediatric infraumbilical surgeries:
A randomised controlled trial.
Source
European Journal of Anaesthesiology. 42(10) (pp 899-906), 2025. Date of
Publication: 01 Oct 2025.
Author
Agarwal A.; Shah S.B.; Sinha R.; Prasad G.; Prakash K.; Goel P.
Institution
(Agarwal, Shah, Sinha, Prakash, Goel) Department of Anaesthesiology Pain
Medicine and Critical Care, All India Institute of Medical Sciences, New
Delhi, India
(Prasad) Department of Paediatric Surgery, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUNDThe established analgesic efficacy and safety of dexmedetomidine
in children has demonstrated a rise in its use and various administration
routes have been explored. However, clinical comparisons between caudal
and intranasal dexmedetomidine are lacking.OBJECTIVESWe aimed to compare
the analgesic efficacy, postanaesthesia recovery characteristics and side
effects associated with caudal versus intranasal dexmedetomidine as an
adjunct to a single-shot caudal block in paediatric infraumbilical
surgeries.DESIGNA noninferiority randomised controlled trial.SETTINGA
tertiary care hospital from November 2022 to May 2024.PATIENTSSixty-four
children aged 1 to 8years undergoing infraumbilical surgeries under
general anaesthesia supplemented with caudal
analgesia.INTERVENTIONSPatients were randomised to receive either caudal
dexmedetomidine (1mlkg^-1caudal 0.2% ropivacaine +
1mugkg^-1caudal dexmedetomidine) or intranasal dexmedetomidine
(1mlkg^-1caudal 0.2% ropivacaine + 1mugkg^-1intranasal
dexmedetomidine).MAIN OUTCOME MEASURESThe primary outcome was the duration
of postoperative analgesia. Other outcomes assessed included postoperative
pain scores, peri-operative analgesic consumption, peri-operative
haemodynamics, postoperative recovery profile and adverse events for 24h
postoperatively.RESULTSThe duration of postoperative analgesia in caudal
and intranasal group was 527+/-83 and 545+/-90min, respectively (P=0.422).
There was a comparable decrease in the intra-operative heart rate. The
greater number of episodes of intra-operative hypotension in the caudal
group (P=0.016) did not warrant vasopressors. Children in the caudal group
were more sedated until 2h postsurgery following which the sedation scores
in both the groups were equivalent. Postoperative pain scores,
peri-operative analgesic consumption and the incidence of emergence
delirium was comparable. No adverse events were reported in either
group.CONCLUSIONIntranasal dexmedetomidine can be considered a feasible
analgesic adjunct to a single-injection caudal block in children
undergoing infraumbilical surgeries associated with a smooth recovery
profile and no associated adverse effects.CLINICAL TRIAL
REGISTRATIONClinical Trial Registry of India (CTRI/2022/09/045492;
http://www.ctri.nic.in).<br/>Copyright &#xa9; 2025 Lippincott Williams and
Wilkins. All rights reserved.

<49>
Accession Number
2038497820
Title
Effect of PCSK9 inhibitor usage on coronary endothelial dysfunction in
patients with hypercholesterolemia after coronary stenting: The CuVIC-2
trial.
Source
Journal of Cardiology. 86(3) (pp 230-237), 2025. Date of Publication: 01
Sep 2025.
Author
Akiyama Y.; Katsuki S.; Koga Y.; Yamamoto M.; Hironaga K.; Suematsu N.;
Miyata K.; Mukai Y.; Inoue S.; Nishi J.-I.; Tashiro H.; Nakano Y.;
Funakoshi K.; Tagawa K.; Ichi I.; Tsutsui H.; Abe K.; Matoba T.
Institution
(Akiyama, Koga) Department of Cardiovascular Medicine, Oita Prefectural
Hospital, Oita, Japan
(Akiyama, Katsuki, Nakano, Abe, Matoba) Department of Cardiovascular
Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka,
Japan
(Yamamoto) Department of Cardiovascular Medicine, Harasanshin Hospital,
Fukuoka, Japan
(Hironaga) Department of Cardiovascular Medicine, Fukuoka City Hospital,
Fukuoka, Japan
(Suematsu) Department of Cardiovascular Medicine, Saiseikai Fukuoka
General Hospital, Fukuoka, Japan
(Miyata) Department of Cardiovascular Medicine, Japan Community Health
Care Organization, Kyushu Hospital, Fukuoka, Japan
(Mukai) Department of Cardiovascular Medicine, Japanese Red Cross Fukuoka
Hospital, Fukuoka, Japan
(Inoue) Department of Cardiovascular Medicine, National Hospital
Organization Kyushu Medical Centre, Fukuoka, Japan
(Nishi) Department of Cardiovascular Medicine, Iizuka Hospital, Fukuoka,
Japan
(Tashiro) Department of Cardiovascular Medicine, St. Mary's Hospital,
Fukuoka, Japan
(Funakoshi, Tagawa) Center for Clinical and Translational Research of
Kyushu University Hospital, Fukuoka, Japan
(Ichi) of Humanities and Science, Ochanomizu University, Tokyo, Japan
(Tsutsui) School of Medicine and Graduate School, International University
of Health and Welfare, Fukuoka, Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: The effects of evolocumab on coronary endothelial dysfunction
(CED), a hallmark of atherogenesis, are unknown. The aim of this study was
to investigate whether evolocumab, in combination with high-dose statins,
could ameliorate CED in patients who underwent coronary stenting.
<br/>Method(s): The CuVIC-2 trial was a multicenter randomized controlled
trial. CED was defined as intracoronary acetylcholine (ACh)-induced
contractile responses with signs of myocardial ischemia. We originally
intended to enroll 160 participants but altered the study design due to
the COVID-19 pandemic and then recruited 41 participants. The revised
primary endpoint was the coronary contraction rate in response to ACh
assessed in a core laboratory, ensuring a statistical power of over 80 %
using the mixed model for repeated measures. <br/>Result(s): The
evolocumab in combination with high-dose statins with or without ezetimibe
(EV + S) group included 19 males and 4 females aged 62 +/- 13 years. The
high-dose statins with or without ezetimibe (S) group included 13 males
and 5 females aged 64 +/- 11 years. Compared with the S group, the EV + S
group presented a significantly greater decrease in low-density
lipoprotein cholesterol at 28 weeks; 83 +/- 17 to 20 +/- 16 mg/dL (-76 %
from the baseline) in the EV + S group and 88 +/- 16 to 81 +/- 20 mg/dL
(-7 % from the baseline) in the S group (p < 0.0001). At 28 weeks, there
was no difference between the two groups in terms of the coronary artery
constriction rate across all doses [mean difference: 4.8 % (95 % CI: -13.6
to 23.2); p = 0.6]. <br/>Conclusion(s): Amelioration of CED by evolocumab
was not observed in this trial with several limitations.<br/>Copyright
&#xa9; 2025 The Authors

<50>
Accession Number
2039334474
Title
Time to rethink the prioritization of IABP patients in heart allocation
systems worldwide?.
Source
Journal of Heart and Lung Transplantation. 44(10) (pp 1674-1678), 2025.
Date of Publication: 01 Oct 2025.
Author
Delmas C.; Vandenbriele C.; Baudry G.
Institution
(Delmas) Intensive Cardiac Care Unit, University Hospital of Toulouse,
Toulouse, France
(Delmas) Universite Paul Sabatier - Toulouse III, Toulouse, France
(Delmas, Baudry) Recherche et Enseignement en Insuffisance Cardiaque
Avancee, Transplantation et Assistance (REICATRA), Institut Saint Jacques,
Toulouse, France
(Vandenbriele) Heart Center Aalst, Aalst, Belgium
(Vandenbriele) Adult Intensive Care, Royal Brompton and Harefield
Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United
Kingdom
(Vandenbriele) Department of Surgery and Cancer, Faculty of medicine,
Imperial College, London, United Kingdom
(Baudry) Universite de Lorraine, INSERM, Centre d'Investigation Clinique
Plurithematique 1433, Inserm U1116, CHRU de Nancy and F-CRIN, INI-CRCT,
Nancy, France
Publisher
Elsevier Inc.
Abstract
The intra-aortic balloon pump (IABP) remains widely used in clinical
practice despite increasing evidence questioning its efficacy and safety.
Designed as a simple temporary mechanical circulatory support device, IABP
might offer benefits such as afterload reduction, cardiac output
enhancement, and coronary perfusion improvement. However, large randomized
controlled trials such as IABP-SHOCK II and CRISP MI have failed to
demonstrate a survival benefit in acute myocardial infarction related
cardiogenic shock. The ALTSHOCK2 study recently failed to show a clinical
advantage of IABP-therapy in patients with heart failure-related
cardiogenic shock. The use of IABP as a bridge to transplantation is
particularly common in countries where national allocation systems
prioritize patients on IABP support. The results of the recent
ALTSHOCK2-trial question the justification for its continued inclusion in
prioritization models. Hence, we examine the physiological effects of
IABP, its application in shock states and low cardiac-output syndrome, and
its role in transplantation allocation policies worldwide. In line with
the present data, we call for a reevaluation of its role in clinical
practice and transplant allocation to align with strong clinical
evidence.<br/>Copyright &#xa9; 2025 International Society for the Heart
and Lung Transplantation

<51>
Accession Number
2035554933
Title
Incidence and Influencing Factors for Steam Pops in Cardiac Ablations: A
Systematic Review.
Source
PACE - Pacing and Clinical Electrophysiology. 48(9) (pp 941-952), 2025.
Date of Publication: 01 Sep 2025.
Author
Elenizi K.; Alharthi R.
Institution
(Elenizi) Department of Internal Medicine, Colleges of Medicine, Prince
Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
(Alharthi) Department of Cardiology, Dr. Sulaiman Al-Habib Hospital,
Riyadh, Saudi Arabia
Publisher
John Wiley and Sons Inc
Abstract
Background: Steam pops (SPs) during cardiac ablations have emerged as a
notable phenomenon with potential implications for procedural safety and
efficacy. This is the first review of SPs, which aims to explore the
current understanding of SPs. The review investigates their incidence,
associations, predictors, clinical significance, and management
strategies. Presently, the factors that give rise to SPs have not been
completely understood, and the root cause of SPs remains elusive. To
achieve this goal, the study conducted a comprehensive review of existing
research on SPs in cardiac ablation procedures to ascertain the prevalence
and predictors of SPs. <br/>Method(s): The research involved an extensive
search of databases from their inception until April 2024 to investigate
the prevalence of SPs during cardiac ablation procedures in humans. The
primary objective of this study was to gather patient demographics,
incidence rates, and potential risk factors and predictors that could
contribute to the occurrence of SPs and determine any significant
correlations between them. The data collected were thoroughly reviewed to
identify any significant associations between the various risk factors,
predictors, and the incidence of SPs. <br/>Result(s): A comprehensive
review of literature sourced from EMBASE and PubMed identified 25 relevant
studies focused on the incidence and clinical significance of steam pops
(SPs) during catheter ablation procedures. The studies reported varying
rates of SPs, ranging from 0% to 26%, with the highest incidence observed
in atrial fibrillation (AFib) and ventricular ablation cases. The
association between SPs and factors such as catheter type, irrigation
methods, and monitoring parameters was assessed. Notably, advanced
catheter technologies, such as the QDOT MICRO and THERMOCOOL SMARTTOUCH,
demonstrated a significant reduction in SP occurrences. Additionally, the
analysis highlighted the role of temperature control and contact force in
minimizing the risk of SPs, with temperature-controlled ablation (TCA)
generally leading to fewer SPs compared to power-controlled ablation
(PCA). Despite the low incidence of severe complications, the review
underscores the importance of careful monitoring of impedance and
real-time feedback during ablation to ensure patient safety.
<br/>Conclusion(s): SPs are not uncommon during ablation procedures with
irrigated catheters. Caution is required to avoid temperature feedback
issues. Advanced catheters are associated with a reduced incidence of
steam pops. The risks can be minimized by decreasing energy settings and
monitoring impedance changes.<br/>Copyright &#xa9; 2025 Wiley Periodicals
LLC.

<52>
Accession Number
2040337452
Title
A Randomized, Observer-Blinded, Active-Controlled, Phase IIIb Study to
Compare IV/Oral Delafloxacin Fixed-Dose Monotherapy With Best Available
Treatments in a Microbiologically Enriched Population With Surgical Site
Infections: The DRESS Study.
Source
Open Forum Infectious Diseases. 12(9) (no pagination), 2025. Article
Number: ofaf476. Date of Publication: 01 Sep 2025.
Author
Belev N.; Tein A.; Mangialardi G.; Nuti A.; Merlo G.M.; Scartoni S.;
Bertolotti M.; Lerro M.; Margaritora S.
Institution
(Belev) University Multiprofile Hospital for Active Treatment
"Eurohospital Plovdiv,", Plovdiv, Bulgaria
(Tein) Department of Surgery, Tartu University Hospital, Tartu, Estonia
(Mangialardi, Nuti, Merlo, Scartoni, Bertolotti, Lerro) Global Clinical
Sciences, Menarini Ricerche SpA, Florence, Italy
(Margaritora) Faculty of Medicine and Surgery, Catholic University of
Sacred Heart, Rome, Italy
(Margaritora) Thoracic Surgery Unit, University Hospital Foundation
Agostino Gemelli IRCCS, Rome, Italy
Publisher
Oxford University Press
Abstract
Background. Surgical site infections (SSIs) are the most common skin and
skin structure infections and are mostly polymicrobial, requiring
hospitalization and broad-spectrum antibiotics. This clinical trial
evaluated the noninferiority of delafloxacin vs best available therapy
(BAT) for the treatment of superficial or deep incisional SSI following a
cardiothoracic/related leg or abdominal surgical procedure. Methods. In
this randomized, observer-blinded, active-controlled, parallel-group,
multicenter, phase IIIb study, patients with SSI were randomized 1:1 to
receive delafloxacin 300 mg intravenous (IV)/450 mg oral (OS) or BAT IV/OS
(vancomycin or linezolid for cardiothoracic SSI, piperacillin/tazobactam
or tigecycline for abdominal SSI). The primary end point was clinical
success, defined as the clinical response (cure or improved) at test of
cure (TOC), performed 7-14 days after end of treatment (EOT) visit.
Secondary end points were clinical success at EOT, sustained clinical
response at last follow-up (LFU), microbiological response, and safety.
Results. Thi study enrolled 266 patients (delafloxacin = 134; BAT = 132)
with comparable baseline characteristics between the 2 treatment arms.
Delafloxacin clinical success was noninferior vs BAT at TOC visit (91.8%
vs 90.2%, respectively). Similar efficacy was confirmed at LFU (91.8%
delafloxacin; 87.9% BAT). Comparable microbiological response was obtained
with delafloxacin (89.5%) and BAT (79.4%). Delafloxacin and BAT
demonstrated comparable treatment adverse event rates (23.9% and 19.7%,
respectively), mostly mild-to-moderate gastrointestinal reactions.
Conclusions. This study provided new data on delafloxacin in SSIs,
covering the need for effective empiric treatment against the wide
spectrum of pathogens involved in these infections.<br/>Copyright &#xa9;
The Author(s) 2025.

<53>
Accession Number
648537203
Title
Outcomes of No-Touch Vs Conventionally Harvested Saphenous Veins for
Coronary Artery Bypass Surgery: A Meta-Analysis of Randomized Trials.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 67(9) (no pagination),
2025. Date of Publication: 02 Sep 2025.
Author
Sandner S.; Hirofuji A.; Mantaj P.; Di Franco A.; Rahouma M.; Gregg A.;
Krieger K.; Demetres M.; Gaudino M.
Institution
(Sandner, Hirofuji, Mantaj, Di Franco, Rahouma, Gregg, Krieger, Demetres,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY,
NY, United States
(Sandner, Mantaj) Department of Cardiac and Thoracic Aortic Surgery,
Medical University of Vienna, Vienna, Austria
Abstract
OBJECTIVES: The no-touch (NT) technique for saphenous vein (SV) harvesting
in coronary artery bypass surgery preserves perivascular tissue and has
been proposed to improve vein graft patency compared to conventional (CON)
harvesting. However, recent large randomized clinical trials (RCTs) have
reported conflicting results. We performed a meta-analysis of all
available RCTs comparing graft patency and clinical outcomes between NT-SV
and CON-SV harvesting techniques. <br/>METHOD(S): A systematic review was
conducted through May 9, 2025 to identify RCTs with systematic imaging
follow-up comparing the NT-SV and CON-SV. The primary outcome was graft
failure. Secondary outcomes included mortality, major adverse cardiac
events (MACE; composite of mortality, myocardial infarction, or repeat
revascularization), and leg wound complications. Outcomes were pooled
using inverse variance random and fixed effects models. <br/>RESULT(S):
Eight RCTs involving 4286 patients (NT-SV: 2155; CON-SV: 2131) were
analysed. NT-SV was associated with a significantly lower incidence of
graft failure than CON-SV (incidence rate ratio [IRR], 0.70; 95%
confidence interval [CI] 0.60-0.82; P < .001) at a weighted mean follow-up
of 3.7 years; this result was solid in multiple sensitivity analyses.
Mortality (IRR, 1.03; 95% CI, 0.72-1.47, P = .87) and MACE (IRR, 0.89; 95%
CI, 0.67-1.18; P = .42) were similar between groups. NT-SV was associated
with a higher incidence of leg wound complications (IRR, 1.73; 95% CI,
1.32-2.27; P < .001). <br/>CONCLUSION(S): The NT-SV harvesting technique
was associated with a significant reduction in graft failure and an
increased risk of wound complications compared to the CON-SV. Further
research is warranted to evaluate clinical NT-SV outcomes, and strategies
are needed to mitigate NT-SV harvest-site complications.<br/>Copyright
&#xa9; The Author(s) 2025. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery. 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 informat

<54>
[Use Link to view the full text]
Accession Number
2039516632
Title
Effects of Increased Cardiopulmonary Bypass Pump Flow on Renal Filtration,
Perfusion, Oxygenation, and Tubular Injury in Cardiac Surgical Patients: A
Randomized Controlled Trial.
Source
Anesthesiology. 143(4) (pp 906-916), 2025. Date of Publication: 01 Oct
2025.
Author
Wijk J.; Cordefeldt-Keiller A.; Bragadottir G.; Redfors B.; Ricksten
S.-E.; Lannemyr L.
Institution
(Wijk, Cordefeldt-Keiller, Bragadottir, Redfors, Ricksten, Lannemyr)
Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska
Academy, University of Gothenburg, Section of Cardiothoracic Anesthesia
and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac surgery with cardiopulmonary bypass (CPB) is
associated with impaired renal oxygenation and acute kidney injury. The
authors investigated whether an amount higher than their standard blood
flow during CPB could improve renal blood flow, the oxygen demand-supply
relationship, and function and attenuate tubular injury. <br/>Method(s):
After ethical approval and informed consent, 36 adult patients undergoing
cardiac surgery received either high flow (2.9 l . min^-1.
m^-2, n = 19) or standard flow (2.4 l . min^-1.
m^-2, n = 17) during CPB in this randomized, nonblinded,
parallell-arm study. Systemic hemodynamics and renal variables were
measured before and during CPB. Glomerular filtration rate was measured by
infusion clearance of iohexol and renal blood flow by infusion clearance
of para-aminohippuric acid, corrected for renal extraction of
para-aminohippuric acid, using a renal vein catheter. Renal oxygen
demand-supply relationship was estimated from renal oxygen extraction and
tubular injury assessed by urinary N-acetyl-beta-d-glucosaminidase.
<br/>Result(s): During CPB, high flow led to a larger increase in systemic
oxygen delivery (100 [95% CI, 60 to 141] vs. 31 [1.9 to 65] ml .
min^-1. m^-2]; between-group P < 0.001; effect size
Cohen's dz, 0.59) and target mean arterial pressure was maintained at a
lower norepinephrine dose (0.03 [-0.01 to 0.06] microg . kg^-1.
min^-1] vs. 0.10 [0.02 to 0.19] microg . kg^-1.
min^-1; P = 0.048; Cohen's dz, 0.62) compared with standard
flow. There were no differences in renal blood flow or oxygen extraction
between groups. Glomerular filtration rate increased during high-flow CPB
(6.4 [1.9 to 10.9] ml . min^-1. 1.73 m^-2), but not in
the standard-flow group (-2.3 [-10.9 to 6.2] ml . min^-1. 1.73
m^-2; between-group P = 0.044; Cohen's dz, 0.66). The peak
urinary excretion of N-acetyl-beta-d-glucosaminidase was 1.42 (0.87 to
3.6) versus 3.74 (1.5 to 7.7) units/micromol creatinine in the high-flow
and standard-flow groups, respectively (P = 0.049). No perfusion-related
adverse events were seen in either group. <br/>Conclusion(s): A 20%
higher-than-standard CPB flow during cardiac surgery improved renal
function, whereas no change in renal blood flow or oxygen demand-supply
relationship could be detected. Higher CPB flow was associated with a less
pronounced tubular injury marker release compared with standard
flow.<br/>Copyright &#xa9; 2025 Lippincott Williams and Wilkins. All
rights reserved.

<55>
Accession Number
2040508036
Title
Beating Heart Versus Arrested Heart for Isolated Tricuspid Valve Surgery:
A Kaplan-Meier-Derived Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2025. Article Number: 15569845251375959. Date
of Publication: 2025.
Author
Baudo M.; Sicouri S.; Yamashita Y.; Magouliotis D.; Cabrucci F.; Ramlawi
B.
Institution
(Baudo, Sicouri, Yamashita, Magouliotis, Cabrucci, Ramlawi) Department of
Cardiac Surgery Research, Lankenau Institute for Medical Research, Main
Line Health, Wynnewood, PA, United States
(Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The aim of the current study was to analyze the clinical and
surgical outcomes of patients undergoing isolated tricuspid valve surgery
(ITVS) from the available literature. It currently remains uncertain
whether arrested heart (AH) surgery has superior postoperative outcomes
over beating heart (BH) for ITVS. <br/>Method(s): A systematic review and
meta-analysis were conducted by searching PubMed, ScienceDirect, Scopus,
DOAJ, SciELO, and Cochrane databases from 2000 until November 2024. The
protocol was registered with the International Prospective Register of
Systematic Reviews under the PROSPERO registration number CRD42024622618.
<br/>Result(s): A total of 22 studies met the inclusion criteria. These
studies were published between 2012 and 2023 and included a combined total
of 1,627 patients, with 1,053 in the BH group and 574 in the AH group. The
present analysis showed that patients undergoing BH surgery were generally
more comorbid and more frequently underwent minimally invasive procedures
as compared with patients undergoing AH surgery. The BH and AH groups
reported no significant differences in postoperative outcomes. At
follow-up, BH was associated with higher recurrent &gt;2+ tricuspid
regurgitation rates (P = 0.048), but this did not affect late survival
(hazard ratio [HR] = 0.90, 95% confidence interval [CI]: 0.68 to 1.19, P =
0.457) or reintervention for TV (HR = 1.18, 95% CI: 0.61 to 2.29, P =
0.622) rates. <br/>Conclusion(s): A consensus between BH and AH for ITVS
is still lacking. However, BH ITVS procedures appear to be the preferred
surgeon choice for higher-risk patients. At follow-up, the BH group showed
higher rates of recurrent tricuspid regurgitation &gt;2+, without
affecting late survival or rates of TV reintervention.<br/>Copyright
&#xa9; The Author(s) 2025

<56>
Accession Number
2040416488
Title
The role of 3D printing and finite element-based computational simulations
in transcatheter pulmonary valve replacement.
Source
Progress in Biomedical Engineering. 7(4) (no pagination), 2025. Article
Number: 042007. Date of Publication: 01 Oct 2025.
Author
Perez-Cualtan C.E.; Castro-Paez C.; Guerrero-Chalela C.E.; Iaizzo P.A.;
Navarro-Rueda J.; Briceno J.C.
Institution
(Perez-Cualtan, Castro-Paez, Briceno) Department of Biomedical
Engineering, Universidad de los Andes, Bogota, Colombia
(Perez-Cualtan, Castro-Paez, Guerrero-Chalela, Navarro-Rueda, Briceno)
Center for 3D Modeling and Printing, Fundacion Cardioinfantil, Instituto
de Cardiologia, Bogota, Colombia
(Guerrero-Chalela) Adult Congenital Heart Disease Service, Fundacion
Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia
(Iaizzo, Navarro-Rueda) Visible Heart Laboratories, Institute for
Engineering in Medicine, Department of Surgery, University of Minnesota,
Minneapolis, MN, United States
(Navarro-Rueda) Department of Industrial Engineering, Pontificia
Universidad Javeriana, Bogota, Colombia
Publisher
Institute of Physics
Abstract
Background. Transcatheter pulmonary valve replacement (TPVR) has emerged
as a less invasive alternative to surgical pulmonary valve replacement for
patients with right ventricular outflow tract dysfunction, such is
especially important for those individuals whom had previous cardiac
surgical procedures. Recently, three-dimensional (3D) printing and finite
element (FE) computational simulation technologies have been employed to
enhance preoperative planning processes; however, their effectiveness and
clinical significance remain to be fully validated. This systematic review
aims to describe the applications and potential impacts of 3D printing and
FE simulation technologies for TPVR in clinical practice. Methods. A
systematic search of PubMed, Science Direct, Web of Science, and Google
Scholar was conducted to identify studies using patient-specific
3D-printed models and FE simulations for preoperative planning and device
performance testing. Results. From 289 identified articles, 28 met the
inclusion criteria for this review. The quality assessment of the articles
showed that the article selection process was adequate. The eligible
studies demonstrated that both 3D printing and FE-based simulations have
been primarily used to select the appropriate pulmonary valve size as well
as predict the optimal placement; i.e. to avoid potential complications
such as paravalvular leakage or pulmonary regurgitation. These
technologies are generally used in complex congenital and adult-congenital
cases. Additionally, these studies provide valuable insights into the
mechanical performances of the transcatheter valves using patient-specific
anatomies. Conclusion. 3D-printed models and FE simulations have both
demonstrated utilities in TPVR planning; by accurately reproducing a given
patient's anatomy and allowing evaluations of potential device-tissue
interactions. These tools thus allow for personalized treatments and also
contribute to device innovations and development. Yet, further research in
this field is required due to the noted limitations of current studies,
including small sample sizes, insufficient standardization, and/or
challenges in replicating the biomechanics of cardiac
tissue.<br/>Copyright &#xa9; 2025 The Author(s). Published by IOP
Publishing Ltd.

<57>
Accession Number
2040489627
Title
Efficacy and Safety of Pulmonary Vasodilator and Inodilator Drugs in
Congenital Heart Disease Surgery: A Systematic Review and Network
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Ollosu M.; Tripodi V.F.; Aresu C.; Ledda G.; Manai F.; Marini C.; Musu M.;
Ippolito M.; Cortegiani A.; Finco G.; Sardo S.
Institution
(Ollosu, Aresu, Ledda, Manai, Marini, Musu, Finco, Sardo) Department of
Medical Sciences and Public Health, University of Cagliari, Monserrato,
Italy
(Tripodi) Anesthesia and Intensive Care, Human Pathology Department,
"Gaetano Martino" University Hospital, Messina, Italy
(Ippolito, Cortegiani) Department of Anesthesia, Analgesia, Intensive Care
and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo,
Italy
(Ippolito, Cortegiani) Department of Precision Medicine in Medical,
Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Italy
Publisher
W.B. Saunders
Abstract
Background: Perioperative management of congenital heart disease (CHD)
surgery presents a unique challenge due to significant pathophysiological
alterations, with pulmonary hypertension contributing substantially to
morbidity and mortality. Although pulmonary vasodilators and inodilators
are commonly used, evidence of their efficacy and safety remains limited.
<br/>Objective(s): To evaluate the effectiveness and safety of
vasodilators and inodilators in pediatric patients undergoing CHD surgery.
<br/>Design(s): Systematic review with network meta-analysis. <br/>Data
Sources: PubMed, CENTRAL, and Embase. Eligibility Criteria: We included
single- or double-blind, parallel-group, randomized controlled trials
comparing the perioperative use of vasodilators and inodilators in
pediatric CHD surgery. We selected only English-language studies. We
excluded crossover, non randomized trials and trials comparing the same
drugs in all study arms. <br/>Result(s): We included 28 randomized
controlled trials involving 3118 patients. Intravenous levosimendan ranked
highest in decreasing postoperative mortality, although the effect was not
statistically significant. Intravenous sildenafil and inhaled nitric oxide
(NO) significantly reduced the duration of mechanical ventilation, and
inhaled NO also significantly shortened the length of intensive care unit
stay. Inhaled iloprost, NO, and enteral sildenafil reduced mean pulmonary
artery pressure. No intervention significantly affected the incidence of
acute kidney injury. <br/>Conclusion(s): Vasodilators and inodilators did
not significantly decrease perioperative mortality in pediatric CHD. Some
agents, such as intravenous sildenafil and inhaled NO, demonstrated modest
benefits of questionable clinical significance regarding duration of
mechanical ventilation, intensive care unit stay, and pulmonary pressure.
The results are limited by small sample sizes, study heterogeneity,
variability in standard care, and risk of bias, requiring cautious
interpretation. Registration: CRD42024552531.<br/>Copyright &#xa9; 2025
The Authors

<58>
[Use Link to view the full text]
Accession Number
2039587819
Title
Thresholds of Kidney Function Decline and Congestion Status and Their
Relation with Outcomes among Discharged Heart Failure Patients.
Source
Clinical Journal of the American Society of Nephrology. 20(9) (pp
1215-1225), 2025. Date of Publication: 01 Sep 2025.
Author
Oka T.; Tighiouart H.; McCallum W.; Tuttle M.; Isaka Y.; Konstam M.A.;
Udelson J.E.; Sarnak M.J.
Institution
(Oka, McCallum, Tuttle, Sarnak) Division of Nephrology, Tufts Medical
Center, Boston, MA, United States
(Oka, Isaka) Department of Nephrology, The University of Osaka Graduate
School of Medicine, Suita, Japan
(Tighiouart) Institute for Clinical Research and Health Policy Studies,
Tufts Medical Center, Boston, MA, United States
(Tighiouart) Tufts Clinical and Translational Science Institute, Tufts
University, Boston, MA, United States
(Konstam, Udelson) Division of Cardiology, The CardioVascular Center,
Tufts Medical Center, Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background Although both volume overload and reduced level of kidney
function are associated with higher mortality in heart failure,
decongestion can lead to kidney function decline. The optimal balance
between sustaining decongestion and preserving kidney function remains
uncertain among outpatients with heart failure. We compared associations
of postdischarge changes in kidney function and congestion status with
mortality in the Efficacy of Vasopressin Antagonism in Heart Failure
Outcome Study with Tolvaptan trial. Methods This post hoc analysis of a
randomized controlled trial included 3404 participants discharged from a
heart failure hospitalization. Compared with eGFR and clinical congestion
score at discharge, eight time-varying exposure groups were defined:
improved or worsened congestion, with varying degrees of eGFR decline (no
decline, 1%-20%, 21%-40%, and 41% or greater). The association of these
groups with all-cause mortality was assessed using marginal structural
models to account for time-dependent confounding. Results The mean (SD)
age and eGFR at discharge were 66 (12) years and 59.6 (22.3) ml/min per
1.73 m², respectively. Over a median (interquartile range)
follow-up of 44 (25-71) weeks, 740 patients died. Both higher degrees of
eGFR decline and worsened congestion were associated with higher mortality
risk. Compared with patients with worsened congestion and no eGFR decline,
those with improved congestion had lower mortality risk (hazard ratio
[HR], 0.51 [95% confidence interval (CI), 0.35 to 0.74] for no eGFR
decline; HR, 0.56 [95% CI, 0.38 to 0.85] for 1%-20% eGFR decline; and HR,
0.80 [95% CI, 0.46 to 1.39] for 21%-40% eGFR decline), whereas those with
improved congestion and 41% or greater eGFR decline had higher risk (HR,
2.23; 95% CI, 1.06 to 4.66). Conclusions Compared with worsened congestion
and no eGFR decline, improved congestion is generally associated with
lower mortality with eGFR declines, unless eGFR decline exceeds
40%.<br/>Copyright &#xa9; 2025 Lippincott Williams and Wilkins. All rights
reserved.

<59>
Accession Number
2034609744
Title
DIGitoxin to Improve ouTcomes in patients with advanced chronic Heart
Failure (DIGIT-HF): Baseline characteristics compared to recent randomized
controlled heart failure trials.
Source
European Journal of Heart Failure. 27(7) (pp 1224-1233), 2025. Date of
Publication: 01 Jul 2025.
Author
Thomas N.H.; Berliner D.; Liu X.; Maier L.S.; Schallhorn S.; Angelini E.;
Soltani S.; Rathje F.; Sandu M.-A.; Geller W.; Gaspar T.; Zdravkovic M.;
Kosevic D.; Scheiber D.; Becher P.M.; Lurz P.; Schroder C.; Neuhaus B.;
Seltmann A.; Schindler C.; Stichtenoth D.O.; Veltmann C.; Koch A.; von der
Leyen H.; Anker S.D.; Trampisch H.J.; Mohacsi P.; Polzl G.; Grosshennig
A.; von Karpowitz M.; Tebbe U.; Haass M.; von Haehling S.; Stohr R.; Marx
N.; Rieth A.; Mitrovic V.; Ritzel A.; Haas J.; Edelmann F.; Trippel T.;
Winkler S.; Seidel M.; Ernst M.; Hanefeld C.; Mugge A.; Becker K.;
Nickenig G.; Becher U.M.; Auer J.; Hambrecht R.; Wienbergen H.; Brachmann
J.; Schnupp S.; Oeckinghaus R.; Aschenbrenner T.; Piorkowski C.; Gaspar
T.P.; Meyer C.; Risse K.; Westenfeld R.; Kelm M.; Muhlen C.V.Z.; Grundmann
S.; Hellenkamp K.; Seidler T.; Fruhwald F.; Ablasser K.; Vogt A.; Nuding
S.; Nagele H.; Stierle D.; Westermann D.; Karakas M.; Bavendiek U.;
Bauersachs J.; Frankenstein L.; Tager T.; Bohm M.; Kindermann I.; Schulze
P.C.; Westphal J.G.; Pfister R.; Rosenkranz S.; Wachter R.; Metze M.;
Sandri M.; Thiele H.; Graf T.; Reil J.-C.; Braun-Dullaeus R.; Schmeisser
A.; Munzel T.; Gori T.; Schieffer B.; Grimm W.; Taggeselle J.; Stumpp A.;
Prondzinsky R.; Rode S.; Schon N.; Schon B.; Kaab S.; Brunner S.; Schwab
J.; Pauschinger M.; Gotte A.; Rickert V.; Gremmler U.; Krumm M.; Maier L.;
Unsold B.; Schwefer M.; Hettwer S.; Rausch S.; Rogacev K.; Philipp S.;
Lauf T.; Hulsmann M.; Stork S.; Kraus B.
Institution
(Bavendiek, Berliner, Schallhorn, Angelini, Soltani, Rathje, Sandu,
Geller, Veltmann, Bauersachs) Department of Cardiology and Angiology,
Hannover Medical School, Hannover, Germany
(Thomas, Liu, von Karpowitz, Koch, Groshennig) Institute for
Biostatistics, Hannover Medical School, Hannover, Germany
(Schwab) Department of Cardiology, Paracelsus Medical University,
Nuremberg, Germany
(Schwab) MVZ Kardiologie, Klinikum Neumarkt, Neumarkt, Germany
(Rieth) Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
(Maier) Department for Internal Medicine II, University Hospital
Regensburg, Regensburg, Germany
(Gaspar) Department of Internal and Cardiovascular Medicine, Herzzentrum
Dresden, University Clinic, Dresden, Technische Universitat Dresden,
Dresden, Germany
(Hambrecht) Department of Internal Medicine II, Cardiology, Angiology and
Intensive Care Medicine, Klinikum Links der Weser, Bremen, Germany
(Zdravkovic) Clinic for Internal Medicine, University Clinical Hospital
Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade,
Belgrade, Serbia
(Philipp) Department of Internal Medicine, Cardiology and Intensive Care
Medicine, Elbeklinikum Stade, Stade, Germany
(Kosevic) Department of Cardiology, Institute for Cardiovascular Diseases
Dedinje, Belgrade, Serbia
(Nickenig) Department of Medicine-Cardiology, University Hospital Bonn,
Bonn, Germany
(Scheiber) Division of Cardiology, Pulmonology and Vascular Medicine,
University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf,
Medical Faculty, Duesseldorf, Germany
(Winkler) Department of Internal Medicine, BG Klinikum Unfallkrankenhaus
Berlin, Berlin, Germany
(Becher) Department of Cardiology, University Heart and Vascular Center
Hamburg, Hamburg, Germany
(Becher) German Center of Cardiovascular Research (DZHK), Partner Site
Hamburg/Kiel/Lubeck, Hamburg, Germany
(Lurz) University Medical Center Mainz, Center of Cardiology, Johannes
Gutenberg University, Mainz, Germany
(Hulsmann) Universitatsklinik fur Innere Medizin II, Abteilung
Kardiologie, Medizinische Universitat Wien, Wien, Austria
(Schroder) Institute of Clinical Pharmacology, Hannover Medical School,
Hannover, Germany
(Neuhaus, Seltmann) Center for Clinical Trials, Hannover Medical School,
Hannover, Germany
(von der Leyen) Orgenesis, Inc, Germantown, MD, United States
(von der Leyen) Hannover Medical School, Hannover, Germany
(Veltmann) Center for Electrophysiology Bremen, Bremen, Germany
(Stork) Department Clinical Research & Epidemiology, Comprehensive Heart
Failure Center Wurzburg, and Department Internal Medicine I, University
Hospital Wurzburg, Wurzburg, Germany
(Bohm) Klinik fur Innere Medizin III, HOMICAREM (HOMburg Institute for
CArdioREnalMetabolic Medicine), Universitatsklinikum des Saarlandes,
Saarland University, Homburg, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Aims: This report presents the baseline characteristics of patients
enrolled in the DIGIT-HF trial and compares them with participants from
recent trials with improved outcomes in patients with heart failure (HF)
and a reduced ejection fraction (HFrEF). <br/>Methods and Results:
DIGIT-HF, a randomized, double-blind, placebo-controlled, multicentre
trial enrolling patients with symptomatic HFrEF (New York Heart
Association [NYHA] functional class II and left ventricular ejection
fraction [LVEF] <=30%, or NYHA class III-IV and LVEF <=40%), compares the
efficacy and safety of digitoxin versus placebo in addition to standard
treatment. Most baseline characteristics of the intention-to-treat
population (1212 patients, mean age 66 +/- 11 years, 20% women, mean LVEF
29 +/- 7%) were similar to those in recent HFrEF trials. The distribution
of NYHA class II, III, and IV was 30%, 66% and 4%, respectively, and
indicates that the patients were sicker than in comparator HFrEF trials.
Less patients had atrial fibrillation (27%) than those in recent HFrEF
trials, but prescription rates of background therapy with beta-blockers
(96%), angiotensin-converting enzyme inhibitors/angiotensin receptor
blockers/angiotensin receptor-neprilysin inhibitors (95%),
mineralocorticoid receptor antagonists (76%), and diuretics (87%) were
high and similar. Overall, 40% of patients were on angiotensin
receptor-neprilysin inhibitors, 19% on sodium-glucose cotransporter 2
inhibitors, and 9% on ivabradine. Rates of implantable
cardioverter-defibrillator (ICD, 64%) and cardiac resynchronization
therapy (CRT, 25%) devices were much higher than in recent HFrEF trials.
<br/>Conclusion(s): Patients included in DIGIT-HF display a more severe HF
symptom burden and higher rates of ICD/CRT implants compared to
participants in recent HFrEF trials, while pharmacotherapy was largely
similar. Clinical Trial Registration: EudraCT
(2013-005326-38).<br/>Copyright &#xa9; 2025 The Author(s). European
Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of
European Society of Cardiology.

<60>
Accession Number
2040490254
Title
Bentall Versus David Procedure for Aortic Root Replacement in Patients
With Bicuspid Aortic Valve: Systematic Review and Meta-Analysis Using
Reconstructed Time-to-Event Data.
Source
Heart Lung and Circulation. (no pagination), 2025. Date of Publication:
2025.
Author
Zoupas I.; Sarantopoulos A.; Schizas N.; Boultadakis E.; Koukis I.; Manna
I.; Iliopoulos D.C.
Institution
(Zoupas, Sarantopoulos, Schizas, Boultadakis, Koukis, Manna, Iliopoulos)
4^th Department of Cardiac Surgery, Hygeia Hospital, Athens,
Greece
(Sarantopoulos) Medical School, European University Cyprus, Nicosia,
Cyprus
(Iliopoulos) Department of Cardiac Surgery, Faculty of Medicine, National
and Kapodistrian University of Athens, Athens, Greece
(Iliopoulos) Department of Cardiothoracic and Vascular Surgery, UTHealth
Houston, Houston, TX, United States
Publisher
Elsevier Ltd
Abstract
Background: There is little evidence comparing the effectiveness of
valve-sparing aortic root replacement with the David procedure and
replacement with a composite graft (Bentall procedure) for patients with
bicuspid aortic valves (BAV). This systematic review and meta-analysis
compared the overall survival and the freedom from re-intervention in BAV
patients who underwent root replacement with either the David or Bentall
procedure. <br/>Method(s): Two databases were searched for studies
including BAV patients who underwent either the David or Bentall
operation. This review was performed in accordance with the
recommendations of the PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-analyses) statement. One-stage and two-stage
meta-analyses were conducted with Kaplan-Meier-derived individual patient
data and a random-effects model. <br/>Result(s): Thirteen studies were
included, providing data about 1,264 BAV patients who underwent a Bentall
procedure and 602 patients who underwent a David procedure. During a
follow-up period of 8 years, overall survival rates were significantly
improved in the David group compared with the Bentall group (hazard ratio
[HR] 0.19, 95% confidence interval [CI] 0.08-0.42; p<0.001). This was
confirmed by the two-stage meta-analysis (HR 0.22, 95% CI 0.09-0.55;
p=0.00, I²=0.00%). Regarding freedom from re-intervention,
splitting timepoint analysis revealed that no arm offered a statistically
significant advantage (HR 1.24, 95% CI 0.58-2.63; p=0.575). Finally, the
David operation was associated with fewer postoperative complications.
<br/>Conclusion(s): The David operation is associated with improved
survival and lower complication rates than the Bentall procedure for
patients with BAV. However, freedom from re-operation rates were
comparable between the two procedures.<br/>Copyright &#xa9; 2025
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<61>
Accession Number
2035380535
Title
Impact of aortic angulation on outcomes in transcatheter aortic valve
replacement with balloon-expandable and self-expanding valves: a
systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 40(4) (pp 746-766), 2025.
Date of Publication: 01 Oct 2025.
Author
Khalefa B.B.; Gonnah A.R.; Yassin M.N.A.; Fayed H.; Arnaout M.; Elkholy
M.K.A.; Ramadan M.; Elettreby A.M.; Dway A.; Eldeeb H.; Abujabal A.S.;
Roberts D.H.
Institution
(Khalefa, Abujabal) Faculty of Medicine, Ain Shams University, Cairo,
Egypt
(Gonnah) Department of Medicine, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Yassin) Faculty of Medicine, Cairo University, Cairo, Egypt
(Fayed, Eldeeb) Faculty of Medicine, Al-Azhar University, Cairo, Egypt
(Arnaout) Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab
Republic
(Elkholy) Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
(Ramadan) Faculty of Medicine, Suez University, Suez, Egypt
(Elettreby) Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Dway) Faculty of Medicine, Al-Andalus University for Medical Sciences,
Tartus, Syrian Arab Republic
(Roberts) Lancashire Cardiac Centre, Blackpool, United Kingdom
(Roberts) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Publisher
Springer
Abstract
High aortic angulation (AA) can pose significant challenges during TAVR.
This meta-analysis determines the impact of a horizontal aorta on TAVR
outcomes with balloon-expandable (BEV) and self-expanding valves (SEVs). A
comprehensive search was conducted from inception to June 2024. Thirteen
observational studies assessing the impact of aortic angulation in
patients undergoing TAVR replacement were included. The pooled results
indicated that short-term mortality was significantly lower in patients
with a non-horizontal aorta (RR = 0.76; 95% CI 0.62-0.95, P = 0.01).
Subgroup analysis displayed that BEVs had a lower short-term mortality
with a horizontal aorta than SEVs. The incidence of stroke was not
significantly affected by aortic angulation with either valve type.
However, the overall risk of permanent pacemaker implantation was lower in
patients with a non-horizontal aorta for both valve types. Paravalvular
regurgitation was also reduced in the non-horizontal aorta group, with no
difference between aortic angulations in patients with BEVs. In contrast,
SEVs favored a non-horizontal aorta in reducing paravalvular leak (RR =
0.66; 95% CI 0.46-0.94, P = 0.02). Both BEVs and SEVs show better results
in patients with lower aortic root angulation. The increased incidence of
conduction abnormalities and PPI rates with both valve types in patients
with horizontal aorta is a concern. BEVs could be potentially used
preferentially to SEVs in patients with a horizontal aorta as there was no
difference between horizontal and non-horizontal aorta groups regarding
short-term mortality, moderate-to-severe paravalvular leak, and need for a
second valve.<br/>Copyright &#xa9; The Author(s) 2025.

<62>
Accession Number
2036118878
Title
Early Aortic Valve Replacement vs. Conservative Therapy in Asymptomatic
Severe Aortic Stenosis Patients: A Meta-Analysis.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
7981651. Date of Publication: 2025.
Author
Alayidh M.; Ibrahim A.A.; Alharthi N.M.; Emara A.G.; Alamri J.A.; Almazyad
Y.F.; Alshammari T.G.; Alharbi A.M.; Mustafa E.H.; Alzaher R.Z.; Turkmani
M.; Shadoul E.
Institution
(Alayidh) Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
(Ibrahim) Faculty of Medicine, Menoufia University, Menoufia, Egypt
(Alharthi) Faculty of Medicine, Taif University, Taif, Saudi Arabia
(Emara) Department of Cardiology, Menoufia University, Menoufia, Egypt
(Alamri) Faculty of Medicine, King Faisal University, Al-Ahsa, Saudi
Arabia
(Almazyad) Faculty of Medicine, Qassim University, Buraidah, Saudi Arabia
(Alshammari, Alharbi) Faculty of Medicine, Princess Nourah Bint
Abdulrahman University, Riyadh, Saudi Arabia
(Mustafa) Faculty of Medicine, Omdurman Islamic University, Khartoum,
Sudan
(Alzaher) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Turkmani) Faculty of Medicine, Michigan State University, East Lansing,
MI, United States
(Turkmani) Division of Pulmonary and Critical Care, University of Toledo,
Toledo, OH, United States
(Shadoul) Department of Cardiology, King Salman Hospital, Riyadh, Saudi
Arabia
Publisher
John Wiley and Sons Inc
Abstract
Background: Aortic stenosis (AS) is frequently seen in elderly
individuals. However, the preferred strategy for asymptomatic severe AS
remains unclear. We compared early aortic valve replacement (eAVR) with
conservative care. <br/>Method(s): We conducted a systematic review and
meta-analysis of RCTs from major databases until December 20, 2024. Risk
ratios (RRs) and mean differences (MDs) were pooled with 95% confidence
intervals (CIs) using R version 4.3. <br/>Result(s): Four RCTs (1427
patients) showed no substantial difference in all-cause mortality between
the early intervention and conservative care (RR: 0.69 [95% CI:
0.42-1.11]; p = 0.13). However, early intervention was markedly associated
with a lower incidence of cardiovascular mortality (RR: 0.65 [95% CI:
0.44-0.96]; p = 0.03), hospitalization for heart failure (RR: 0.27 [95%
CI: 0.13-0.54]; p < 0.01), and stroke (RR: 0.62 [95% CI: 0.40-0.95]; p =
0.03) compared to that of conservative care. Moreover, there was no
significant difference between the two groups in myocardial infarction
(RR: 0.22 [95% CI: 0.04-1.24]; p = 0.09), repeated aortic-valve surgery
(RR: 0.74 [95% CI: 0.12-4.78]; p = 0.75), and thromboembolic complications
(RR: 0.72 [95% CI: 0.23-2.21]; p = 0.56). <br/>Conclusion(s): In
asymptomatic severe AS, early AVR did not mitigate overall mortality but
substantially lowered cardiovascular mortality, heart failure
hospitalizations, and stroke risks compared to conservative management.
Perioperative complications were similar in both groups.<br/>Copyright
&#xa9; 2025 Mazen Alayidh et al. Journal of Cardiac Surgery published by
John Wiley & Sons Ltd.

<63>
Accession Number
2040368464
Title
Clopidogrel versus aspirin for secondary prevention of coronary artery
disease: a systematic review and individual patient data meta-analysis.
Source
The Lancet. 406(10508) (pp 1091-1102), 2025. Date of Publication: 13 Sep
2025.
Author
Valgimigli M.; Choi K.H.; Giacoppo D.; Gragnano F.; Kimura T.; Watanabe
H.; Kim H.-S.; Kang J.; Park K.W.; Pettersen A.-A.; Woodward M.; Bhatt
D.L.; Calabro P.; Angiolillo D.J.; Mehran R.; Song Y.B.; Hahn J.-Y.
Institution
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
University of Italian Switzerland, Lugano, Switzerland
(Valgimigli) Department of Cardiology, Bern University Hospital,
University of Bern, Bern, Switzerland
(Choi, Song, Hahn) Heart Vascular Stroke Institute, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Giacoppo) Department of General Surgery and Medical-Surgical Specialties,
University of Catania, Catania, Italy
(Giacoppo) Cardiovascular Research Institute Dublin, Royal College of
Surgeons in Ireland, Dublin, Ireland
(Giacoppo) ISAResearch Zentrum, German Heart Center, Munich, Germany
(Gragnano, Calabro) Department of Translational Medical Sciences,
University of Campania Luigi Vanvitelli, Caserta, Italy
(Kimura, Watanabe) Department of Cardiovascular Medicine, of Medicine,
Kyoto University, Kyoto, Japan
(Kim, Kang, Park) Cardiovascular Center, Department of Internal Medicine,
Seoul National University Hospital, Seoul, South Korea
(Pettersen) Department of Cardiology, Ringerike Hospital, Vestre Viken HF,
Drammen, Norway
(Woodward) The George Institute for Global Health, School of Public
Health, Imperial College London, London, United Kingdom
(Woodward) The George Institute for Global Health, University of New South
Wales, Sydney, NSW, Australia
(Bhatt, Mehran) Mount Sinai Fuster Heart Hospital, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
Publisher
Elsevier B.V.
Abstract
Background: Aspirin monotherapy is recommended indefinitely for patients
with established coronary artery disease (CAD). The aim of this individual
patient level meta-analysis was to provide a comprehensive evaluation of
the comparative efficacy and safety of clopidogrel versus aspirin
monotherapy in patients with established CAD, most of whom had undergone
percutaneous coronary intervention or had acute coronary syndrome.
<br/>Method(s): We conducted a systematic search in PubMed, Scopus, Web of
Science, and Embase to identify randomised trials published from database
inception to April 12, 2025, comparing clopidogrel monotherapy with
aspirin monotherapy in patients with established CAD who had discontinued
or never started dual antiplatelet therapy. Randomised trials featuring an
initial phase of dual antiplatelet therapy were eligible for inclusion in
this individual patient data meta-analysis. In the main analysis, we used
semi-parametric shared log-normal frailty models (one-stage analysis),
including a random intercept to account for differences in the baseline
hazard across trials, and a random slope to account for between-trial
differences in treatment effects. The primary efficacy endpoint was a
composite of cardiovascular death, myocardial infarction, or stroke (major
adverse cardiovascular or cerebrovascular events [MACCE]); the primary
safety endpoint was major bleeding. This study is registered with PROSPERO
(CRD42025645594). <br/>Finding(s): Seven randomised trials including 28
982 patients (14 507 assigned to clopidogrel; 14 475 assigned to aspirin)
with a median follow-up of 2.3 years (IQR 1.1-4.0) were eligible and
included. At 5.5 years, MACCE was less common in patients assigned to
clopidogrel than in patients assigned to aspirin (929 events [2.61 per 100
patient-years] vs 1062 events [2.99 per 100 patient-years]; hazard ratio
0.86 [95% CI 0.77-0.96]; p=0.0082). Mortality and major bleeding (256
events [0.71 per 100 patient-years] with clopidogrel vs 279 events [0.77
per 100 patient-years] with aspirin; 0.94 [0.74-1.21]; p=0.64) did not
differ. <br/>Interpretation(s): These findings add to the evidence that
clopidogrel monotherapy is superior to aspirin monotherapy for MACCE
prevention with no increase in the risk of bleeding, and support the
preferential use of clopidogrel over aspirin for secondary prevention in
patients with established CAD. <br/>Funding(s): Cardiocentro Ticino
Institute, Ente Ospedaliero Cantonale, Switzerland.<br/>Copyright &#xa9;
2025 Elsevier Ltd

<64>
Accession Number
648437838
Title
Surgery Versus Surveillance: A Quality-of-Life Analysis of Patients With
Moderately Dilated Aortic Root or Ascending Aorta.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 67(9) (no pagination),
2025. Date of Publication: 02 Sep 2025.
Author
Guo M.H.; Appoo J.J.; Demers P.; Es H.; Jassar A.; Patel H.J.; Brinkman
W.; Ouzounian M.; Atoui R.; Grau J.B.; Bozinovski J.; Chu M.W.A.; Desai
N.; Dagenais F.; Hughes G.C.; Lachapelle K.; Pozeg Z.; Tseng E.E.; Kachroo
P.; Whitlock R.; El-Hamamsy I.; Baeza C.R.; Estrera A.L.; Herget E.; Wells
G.A.; Boodhwani M.
Institution
(Guo, Es, Boodhwani) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(Appoo) University of Calgary, Calgary, AB, Canada
(Demers) Division of Cardiac Surgery, University of Montreal, Montreal,
QC, Canada
(Jassar) Division of Cardiac Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Patel) Division of Cardiac Surgery, University of Michigan Health, Ann
Arbor, MI, United States
(Brinkman) Division of Cardiac Surgery, Baylor Scott & White Health,
Plano, TX, United States
(Ouzounian) Division of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Atoui) Division of Cardiac Surgery, Health Sciences North, ON, Canada
(Grau) Division of Cardiac Surgery, Valley Health System, Ridgewood, NJ,
United States
(Bozinovski) Division of Cardiac Surgery, Ohio State University Wexner
Medical Center, Columbus, OH, United States
(Chu) Division of Cardiac Surgery, Western University, London Health
Sciences Centre, London, ON, Canada
(Desai) Division of Cardiac Surgery, University of Pennsylvania,
Philadelphia, PA, United States
(Dagenais) Division of Cardiac Surgery, Laval University, Quebec City, QC,
Canada
(Hughes) Division of Cardiac Surgery, Duke University, Durham, NC, United
States
(Lachapelle) Division of Cardiac Surgery, McGill University, Montreal, QC,
Canada
(Pozeg) Division of Cardiac Surgery, New Brunswick Heart Centre, Saint
John, Canada
(Tseng) Division of Cardiothoracic Surgery, San Francisco Medical Center,
San Francisco, CA, United States
(Kachroo) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St Louis, MO, United States
(Whitlock) Division of Cardiac Surgery, McMaster University, Hamilton, ON,
L8S 4L8, Canada
(El-Hamamsy) Division of Cardiac Surgery, Mount Sinai Hospital, New York
City, NY, United States
(Baeza) Division of Cardiac Surgery, University Hospitals Cleveland
Medical Center, Cleveland, OH, United States
(Estrera) Department of Cardiothoracic Surgery, McGovern Medical School at
UTHealth Houston, Houston, TX, United States
(Herget) Department of Radiology, University of Calgary, Calgary, AB,
Canada
(Wells) Cardiovascular Research Method Centre, University of Ottawa Heart
Institute, Ottawa, ON, Canada
Abstract
OBJECTIVES: The impact of diagnosis and management of ascending thoracic
aortic aneurysm (ATAA) on patients' quality of life (QoL) is not well
characterized. This study aims to compare QoL with surgery versus
surveillance in patients with moderate ATAAs. <br/>METHOD(S): Treatment In
Thoracic Aortic aNeurysm: Surgery versus Surveillance is a multicentre
randomized trial for patients with ATAA between 5.0 and 5.4 cm and
includes a registry of patients who underwent either surgery or
surveillance. From May 2019 to December 2022, 157 patients from 15 centres
were enrolled in the surveillance (n = 105) or surgery (n = 52) registry
and completed baseline and follow-up 36-item short form survey (SF-36) for
QoL assessment. The primary outcomes were changes in physical component
summary and mental component summary (MCS) scores. Propensity matching was
performed to adjust for baseline differences. <br/>RESULT(S): Patients in
the surveillance arm were older and had higher prevalence of hypertension,
dyslipidaemia, and atrial fibrillation (all P < 0.05). The overall mean
duration between baseline and follow-up SF-36 questionnaire was 13.2 +/-
3.6 months. After propensity match, compared to scores at baseline,
patients in the surgery arm experienced significantly greater improvement
in scores in MCS (4.1 +/- 10.9 vs 0.1 +/- 7.7; P = 0.04), general health
(7.2 +/- 17.6 vs -0.7 +/- 14.5; P = 0.02), and mental health (9.5 +/- 17.5
vs 1.4 +/- 13.4; P = 0.01). <br/>CONCLUSION(S): In a multicentre,
prospective, non-randomized comparison of patients with moderate ATAAs,
surgical treatment was associated with improvement in mental components of
QoL at 1 year compared to surveillance.<br/>Copyright &#xa9; The Author(s)
2025. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<65>
Accession Number
2040337660
Title
Nurse-led cardiac rehabilitation programme on physical capacity and mental
health for heart valve patients: study protocol of a quasi-experimental
study.
Source
BMJ Open. 15(9) (no pagination), 2025. Article Number: e096823. Date of
Publication: 02 Sep 2025.
Author
Zhou J.; Zhou Y.; Huang Y.; Wang P.
Institution
(Zhou, Zhou, Huang, Wang) Southeast University Zhongda Hospital,
Department of cardiac surgery, Jiangsu, Nanjing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Evidence-based early rehabilitation intervention after heart
valve surgery has been proven to have many benefits, but the experience of
implementing nurse-led early rehabilitation combining exercise and
psychology is still lacking. It is urgent to find a more acceptable and
cost-effective method to provide exercise intervention and psychological
support. The aim of this study is to design a nurse-led cardiac
rehabilitation programme to increase the physical capacity and mental
health for heart valve patient based on broaden-and-build theory. Methods
and analysis A non-blinded randomised controlled trial will be conducted.
A total of 86 adults diagnosed with heart valve disease will be recruited
and randomly assigned to the control group and intervention group. The
recovery for valvular heart disease intervention, based on the
broaden-and-build theory, will be guided one-on-one by a multidisciplinary
team and will consist of two main components: physical intervention and
psychological intervention. The baseline assessment will be conducted 1 to
2 days after admission, and sequent evaluations will be implemented at
post-intervention, 3 months after intervention and 6 months after
intervention. The primary outcome is the finding of six-min walk test and
mental state. Other outcomes include quality of life, 36-item short-form
health survey, Short Physical Performance Battery, stress, coping modes
and social support. Ethics and dissemination This study was conducted
following the Helsinki Declaration and was approved by the ethics
committee of the Zhong Da Hospital, Southeast University
(2024ZDSYLL098-P01). The results of this study are scheduled to be
published in relevant peer-reviewed journals.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<66>
Accession Number
2034792574
Title
Anaesthesia support for transcatheter heart valve interventions: a
narrative review.
Source
Anaesthesia. 80(10) (pp 1254-1268), 2025. Date of Publication: 01 Oct
2025.
Author
Charlesworth M.; Hayes T.; Buch M.H.; Davies E.A.
Institution
(Charlesworth, Hayes, Davies) Department of Cardiothoracic Anaesthesia,
Critical Care and ECMO, Wythenshawe Hospital, Manchester, United Kingdom
(Buch) Department of Interventional Cardiology, Wythenshawe Hospital,
Manchester, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Introduction: There have been few other areas of medical practice in the
last two decades that have evolved at the same pace as transcatheter heart
valve interventions. As well as providing peri-operative care,
anaesthetists are core members of 'Heart Teams', who plan the care of and
manage patients with valvular heart disease. This review aims to summarise
core information on these procedures for anaesthetists. <br/>Method(s): We
conducted a literature review to identify highly cited or high Altmetric
scoring articles published in the last five years on the peri-operative
management of patients undergoing transcatheter aortic, mitral, pulmonary
and tricuspid valve interventions. <br/>Result(s): There was little
contemporary published evidence comparing or recommending anaesthetic
techniques and describing their effect on peri-operative outcomes.
Instead, there is a wealth of evidence on outcomes in specific patient
risk groups undergoing transcatheter procedures. However, these trials
focussed mainly on mortality and complications, received substantial
industry funding and pooled adverse outcomes as a composite using
frequentist non-inferiority methods. Most real-world patients would likely
be excluded from these trials and clinicians therefore should apply
evidence, expertise and local experience to make risk/benefit judgements
for individual patients referred to the Heart Team. Knowledge of the
issues around diagnosis, patient selection, procedural steps and device
design characteristics are arguably of more importance to the anaesthetist
than the specifics of techniques for local anaesthesia infiltration,
conscious sedation and general anaesthesia, which are transferrable skills
for all adult anaesthetists. <br/>Discussion(s): There is a need for new
peri-operative research with a focus on patient-centred metrics, rather
than complication composites and mortality outcomes. Clinically, there is
increasing focus on patient-centred treatment, timing of interventions and
a team-based approach with greater emphasis placed on comorbidities and
their aggressive management.<br/>Copyright &#xa9; 2025 Association of
Anaesthetists.

<67>
Accession Number
2040694363
Title
Outcomes of Scar-Related Ventricular Tachycardia Ablation With
Percutaneous Left Ventricular Assist Device Support.
Source
JACC: Clinical Electrophysiology. (no pagination), 2025. Date of
Publication: 2025.
Author
Kawamura I.; Koruth J.S.; Kusa S.; Iwasawa J.; Lam J.; Ellsworth B.;
Watanabe K.; Nies M.; Lampert J.; Maan A.; Musikantow D.R.; Turagam M.K.;
Moss N.; Whang W.; Miller M.A.; Reddy V.Y.; Dukkipati S.
Institution
(Kawamura, Koruth, Kusa, Iwasawa, Lam, Ellsworth, Watanabe, Nies, Lampert,
Maan, Musikantow, Turagam, Whang, Miller, Reddy, Dukkipati) Helmsley
Electrophysiology Center, Department of Cardiology, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Kawamura) Department of Cardiovascular Medicine, Institute of Science
Tokyo, Tokyo, Japan
(Kusa) Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan
(Iwasawa) Department of Cardiology, Heart Rhythm Center, International
University of Health and Welfare Mita Hospital, Tokyo, Japan
(Moss) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Percutaneous left ventricular assist devices (pLVADs) are
often used in critically ill patients undergoing scar-related ventricular
tachycardia (VT) ablation. However, there are no randomized controlled
trials evaluating their benefits. <br/>Objective(s): The goal of this
study was to compare outcomes between pLVAD- and non-pLVAD-supported VT
ablation using a propensity score matching analysis. <br/>Method(s): This
retrospective analysis comprised 481 scar-related VT patients who
underwent catheter ablation (175 pLVAD and 306 non-pLVAD). A 1:1
propensity score matching was conducted to balance baseline
characteristics for comparison of procedural and long-term outcomes.
<br/>Result(s): A propensity score analysis generated 115 matched pairs in
each group. Baseline characteristics of the matched cohorts were
comparable (mean left ventricular ejection fraction 27%, 40% NYHA
functional class >=III, and 36% electrical storm). Compared with the
non-pLVAD, more patients in the pLVAD group had at least 1 VT termination
during ablation. Despite including a higher use of advanced ablation
strategies and a longer procedure time, the pLVAD group had a
postprocedural VT inducibility similar to that of the non-pLVAD group. The
incidence of periprocedural major complications was higher among pLVAD
patients (29.6% vs 13.9%; P = 0.004), largely driven by vascular
complications requiring intervention and periprocedural heart failure.
During a median follow-up of 326 days, Kaplan-Meier curves showed no
statistically significant differences in composite outcome
(hospitalization for VT or worsening heart failure requiring
hospitalization, LVAD implantation, orthotopic heart transplantation, and
all-cause mortality), and VT recurrence. <br/>Conclusion(s): The use of
pLVADs during VT ablation is associated with longer procedures and higher
procedural complications without any benefit in acute or long-term
outcomes.<br/>Copyright &#xa9; 2025 American College of Cardiology
Foundation

<68>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2025 The Author(s).
Catheterization and Cardiovascular Interventions published by Wiley
Periodicals LLC.

<69>
Accession Number
2040599962
Title
Revascularisation strategies for non-acute myocardial ischaemic syndromes.
Source
Heart. (no pagination), 2025. Article Number: heartjnl-2025-326101. Date
of Publication: 2025.
Author
Kawczynski M.J.; Barili F.; Brophy J.M.; Zoccai G.B.; Anselmi A.; Boden
W.E.; Albuquerque A.; Almeida R.; Beurtheret S.; Biondi-Zoccai G.; Boden
W.; Borger M.; Brophy J.; Buttiglione G.; Dayan V.; De Caterina R.; de la
Cuesta M.; Firstenberg M.; Garcia-Villareal O.; Gomes W.; Heuts S.; Kaul
S.; Kawczynski M.; Mandrola J.; Cuartas M.M.; Misfield M.; Musumeci F.;
Parolari A.; Quintana E.; Redberg R.; Riad R.; Rodriguez-Roda Stuart J.;
Ronco D.; Uva M.S.; Tomasi J.; Verhoye J.-P.; Zenati M.; Dib N.
Institution
(Kawczynski, Heuts) Department of Cardiothoracic Surgery, Maastricht
University Medical Center, Maastricht, Netherlands
(Kawczynski, Heuts) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht University, Maastricht, Netherlands
(Barili, Parolari) Universita Degli Studi Di Milano, Milan, Italy
(Barili) IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
(Barili) Harvard T.H. Chan School of Public Health, Boston, MA, United
States
(Brophy) McGill University, Montreal, QC, Canada
(De Caterina) Cardiology Division, Pisa University Hospital, Pisa, Italy
(Zoccai) Department of Medical Surgical Sciences and Biotechnologies,
Sapienza University of Rome, Rome, Italy
(Zoccai) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
(Anselmi) Department of Thoracic and Cardiovascular Surgery, University
Hospital Centre Rennes, Rennes, France
(Boden) VA Boston Healthcare System, Boston University School of Medicine,
Boston, MA, United States
Publisher
BMJ Publishing Group
Abstract
Background Contemporary guidelines by the European Society for Cardiology
and American College of Cardiology/American Heart Association for the
treatment of non-acute myocardial ischaemic syndromes dispute the value of
revascularisation and differ in their recommendation to perform
revascularisation. A Bayesian network meta-analysis was performed,
evaluating the strength of evidence for the comparative incremental
effectiveness of coronary artery bypass grafting (CABG) versus
percutaneous coronary intervention (PCI) over medical therapy on long-term
outcomes. Methods A hierarchical Bayesian network meta-analysis was
designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised
controlled trials (RCTs) published between 2005 and 10 June 2025, which
consisted of three initial treatment modalities: optimal medical therapy
(OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality
at maximum follow-up; secondary outcomes were trates of the rates of
myocardial infarction, stroke and re-revascularisation at maximum
follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied
by surface under the cumulative ranking curve (SUCRA) scores. Results 10
RCTs, comprising 10 742 patients, were included. For all-cause mortality,
the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI
0.68-1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79-1.16); and the HR
of CABG+OMT versus PCI+OMT was 0.91 (0.71-1.13). The SUCRAs of a CABG+OMT
strategy ranking as the optimal revascularisation treatment regarding
mortality, myocardial infarction, stroke and re-revascularisation were
88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent
across sensitivity analyses, including in the node-splitting models.
Conclusions This Bayesian network meta-analysis found that an initial CABG
(+OMT) revascularisation strategy was associated with higher probabilities
of optimal outcomes, with the exception of stroke, compared with an
initial PCI (+OMT) revascularisation strategy, although CrIs overlapped,
suggesting that some uncertainty remains.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2025.

<70>
Accession Number
2040694216
Title
Outcomes of Left Atrial Appendage Patency After Device Closure Detected by
Cardiac CT: A Meta-Analysis.
Source
JACC: Cardiovascular Imaging. (no pagination), 2025. Date of Publication:
2025.
Author
Jacquemyn X.; Sa M.P.; Korsholm K.; Nielsen-Kudsk J.E.; Iriart X.; Saw J.;
Alkhouli M.; Jain S.; Bittencourt M.S.; Sultan I.
Institution
(Jacquemyn, Sultan) Department of Cardiothoracic Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(Jacquemyn, Jain, Sultan) UPMC Heart and Vascular Institute, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Sa) Cleveland Clinic Florida, Weston, FL, United States
(Korsholm, Nielsen-Kudsk) Department of Cardiology, Aarhus University
Hospital, Skejby, Denmark
(Iriart) Department of Pediatric and Adult Congenital Cardiology, Hopital
Cardiologique du Haut-Leveque, CHU de Bordeaux, Bordeaux-Pessac, France
(Saw) Division of Interventional Cardiology, Vancouver General Hospital
and the University of British Columbia, Vancouver, BC, Canada
(Alkhouli) Department of Cardiology, Mayo Clinic School of Medicine
Rochester, MN, United States
(Bittencourt) Department of Medicine and Radiology University of
Pittsburgh, Pittsburgh, United States
Publisher
Elsevier Inc.
Abstract
Background: Residual leaks are common after left atrial appendage
occlusion (LAAO). <br/>Objective(s): The authors aimed to systematically
evaluate the prognostic implications of residual left atrial appendage
(LAA) patency and peridevice leaks (PDLs) detected by cardiac computed
tomography (CT) following LAAO. <br/>Method(s): The authors used
traditional meta-analytical methods and a Bayesian framework to assess the
probability of increased risks associated with these residual leaks.
<br/>Result(s): Seventeen studies encompassing 2,036 patients met the
inclusion criteria. During follow-up, the presence of any LAA patency was
significantly associated with an almost 2-fold increased OR of
thromboembolism (pooled OR: 1.87, 95% CI: 1.08-3.24), corresponding to 28
(95% CI: 3-68) additional events per 1,000 patients. Although PDL showed a
similar trend, it was not significantly associated with increased
thromboembolism risk (pooled OR: 1.50, 95% CI: 0.85-2.65). For
thromboembolism with LAA patency, under a noninformative prior, the mean
logOR was 0.59 (95% credible interval [Crl]: 0.06-1.15), and translated
median OR of 1.87 (95% CrI: 1.06-3.14) and a mean absolute risk difference
(ARD) of 2.8% (95% CrI: 0.2%-6.8%). The posterior probability of ARD >0%
was 98.5%. For any PDL, the mean logOR was 0.38 (95% CrI: -0.22 to 0.95),
with a median OR of 1.53 (95% CrI: 0.80-2.59) and mean ARD of 1.9% (95%
CrI: -0.7% to 5.4%). The posterior probability of ARD >0% was 89.8%.
<br/>Conclusion(s): LAA patency and PDL identified by CT may be associated
with an increased risk of thromboembolism. These findings indicate that
residual leaks detected by CT may be clinically significant and should not
be regarded as benign.<br/>Copyright &#xa9; 2025 The Authors

<71>
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). <br/>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.
<br/>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).
<br/>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.<br/>Copyright
&#xa9; 2025 The Author(s). Published by IMR Press.

<72>
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.<br/>Copyright &#xa9; The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<73>
Accession Number
2037158684
Title
Transcoronary Sinus Therapy for Coronary Microvascular Dysfunction.
Source
Reviews in Cardiovascular Medicine. 26(8) (no pagination), 2025. Article
Number: 38565. Date of Publication: 01 Aug 2025.
Author
Rao J.; Wang Y.; Tan L.; Hu L.; Zeng X.
Institution
(Rao, Wang, Tan, Hu, Zeng) Department of Cardiology, The First Affiliated
Hospital of Guangxi Medical University, Guangxi, Nanning, China
(Zeng) Guangxi Key Laboratory Base of Precision Medicine in
Cardiocerebrovascular Diseases Control and Prevention & Guangxi Clinical
Research Center for Cardio-Cerebrovascular Diseases, Guangxi, Nanning,
China
(Zeng) School of Basic Medical Sciences, Guangxi Medical University,
Guangxi, Nanning, China
Publisher
IMR Press Limited
Abstract
Coronary microvascular disease has been found to increase the incidence of
the composite endpoint for cardiovascular events and affect coronary
revascularization. Coronary microvascular disease is often accompanied by
epicardial disease, and despite successful revascularization and optimal
medications, coronary microvascular disease may lead to reduced exercise
tolerance and worsening clinical symptoms. Moreover, despite advances in
percutaneous coronary intervention for coronary revascularization, the
management of microvascular obstruction in reperfused myocardial tissue
remains challenging and is a high-risk procedure. Previous studies have
identified the coronary venous system as a new avenue for treating
coronary microvascular obstructions associated with revascularization.
Current data suggest that coronary sinus interventions, which primarily
include coronary sinus reducer and pressure-controlled intermittent
coronary sinus occlusion interventions, can provide significant clinical
aid in 70-80% of patients with refractory angina pectoris and acute
myocardial infarction who suffer from microvascular disease with no
possibility of revascularization by modulating coronary venous pressures.
However, a recent randomized trial demonstrated no difference in infarct
size reduction between the pressure-controlled intermittent coronary sinus
occlusion-assisted and conventional primary percutaneous coronary
intervention groups. This article reviews recent advancements in coronary
sinus-based therapeutic approaches for coronary microvascular
disease.<br/>Copyright &#xa9; 2025 The Author(s).

<74>
Accession Number
2036217680
Title
Valve-sparing aortic root reimplantation versus aortic root replacement in
bicuspid aortic valve with aortic root aneurysm: a systematic review and
meta-analysis.
Source
Cardiothoracic Surgeon. 33(1) (no pagination), 2025. Article Number: 29.
Date of Publication: 01 Dec 2025.
Author
Santos K.; Bartolozzi H.; Obi O.S.; Habiyambere G.I.; Maris M.I.; Plonek
T.
Institution
(Santos, Plonek) Medisch Spectrum Twente, Enschede, Netherlands
(Santos) New Vision University School of Medicine, Tbilisi, Georgia
(Bartolozzi) Trakia University, Stara Zagora, Bulgaria
(Obi) New York Institute of Technology College of Osteopathic Medicine,
NY, United States
(Habiyambere) University of Global health Equity, Butaro campus, Burera,
Rwanda
(Maris) University of Medicine and Pharmacy Victor Babes Timisoara,
Timisoara, Romania
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Patients with bicuspid aortic valve (BAV) often develop aortic
root aneurysms. While aortic root replacement (Bentall procedure) has been
the standard treatment for combined valvular and root pathology,
valve-sparing root reimplantation (David procedure) has gained popularity
for its potential to preserve the native valve and avoidance of prosthesis
related complications. However, comparative data specific to patients with
BAV and root aneurysm remain limited. Thus, we aimed to systematically
compare the outcomes of the David and Bentall procedures in this
anatomically and clinically distinct population. <br/>Method(s): A
literature search was conducted in PubMed, Scopus, and Cochrane Library
for studies comparing David and Bentall in patients with regurgitant BAV
and aortic root aneurysm. Pooled odds ratios (OR) and mean differences
(MD) with 95% confidence intervals (CI) were calculated using RevMan
8.11.0. <br/>Result(s): Four observational studies comprising 679 patients
were included, of whom 252 (37.1%) underwent the David procedure. The
David procedure was associated with significantly longer cardiopulmonary
bypass (CPB) [MD 42.2 min; 95% CI 16.7 to 67.6; p = 0.001] and aortic
cross-clamp (ACC) time [MD 50.8 min; 95% CI 22.8 to 78.8; p < 0.001].
However, due to extreme heterogeneity caution is warranted in interpreting
these findings. The David procedure also demonstrated a statistically
significant but clinically uncertain reduction in hospital length of stay
[MD -1.4 days; 95% CI -2.7 to -0.1; p = 0.03] and re-explorations for
bleeding [OR 0.4, 95% CI 0.1 to 0.9; p = 0.04]. Other postoperative
outcomes, including stroke, arrhythmias, 30-day mortality, and ICU length
of stay, were comparable between the two approaches. <br/>Conclusion(s):
The David procedure may be a viable option in selected BAV patients with
root aneurysm. Despite longer CPB and ACC time, it is associated with
shorter hospital stays and fewer re-explorations for bleeding, with
similar rates of other postoperative outcomes. However, our findings
should be interpreted with caution due to the retrospective design of the
included studies, strong selection bias, and variability in patient
characteristics and surgical techniques. Prospective, multicentre studies
with extended follow-ups are needed to validate our results and better
define the optimal surgical strategy in this population.<br/>Copyright
&#xa9; The Author(s) 2025.

<75>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<76>
Accession Number
2036225177
Title
"Intracoronary levosimendan in neonatal cardiac surgery: a retrospective
study on hemodynamic effects and catecholamine-sparing outcomes".
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1577847. Date of Publication: 2025.
Author
Ibraev T.; Zhauarova G.; Kerimkulov A.; Rakhimova K.; Sungkarbekov E.
Institution
(Ibraev, Zhauarova, Kerimkulov, Rakhimova, Sungkarbekov) UMC "National
Research Cardiac Surgery Center" (Heart Center), Corporate Fund
"University Medical Center", Astana, Kazakhstan
Publisher
Frontiers Media SA
Abstract
Background: Levosimendan is a calcium-sensitizing inotrope with
vasodilatory properties, shown to improve cardiac output and reduce
mortality in adults with advanced heart failure. However, data on its
safety and efficacy in neonatal cardiac surgery are limited.
<br/>Objective(s): To evaluate the intraoperative use of levosimendan in
neonates with complex congenital heart defects (CHDs) undergoing
open-heart surgery. <br/>Method(s): We conducted a retrospective
observational study of 59 neonates aged 2-30 days who underwent surgical
correction of complex CHDs with cardiopulmonary bypass. Levosimendan was
administered intracoronarily as part of the blood cardioplegia protocol in
doses of 25-45 mcg/kg. <br/>Result(s): Compared to historical controls,
the levosimendan group demonstrated a significant reduction in
postoperative catecholamine requirements, including adrenaline and
norepinephrine. In 12% of cases, surgery was completed without the use of
any catecholamines. No rhythm disturbances were observed. The positive
inotropic effect lasted up to 72 h without systemic hypotension. Median
adrenaline doses were significantly lower (p < 0.05), and norepinephrine
use was reduced from 12% to 5%. <br/>Conclusion(s): Intracoronary
administration of levosimendan during neonatal cardiac surgery appears to
reduce catecholamine dependence and support myocardial recovery without
causing rhythm disturbances or hypotension. Further randomized controlled
trials are needed to validate these findings.<br/>Copyright 2025 Ibraev,
Zhauarova, Kerimkulov, Rakhimova and Sungkarbekov.

<77>
Accession Number
648633156
Title
Balloon vs. self-expanding valves for transcatheter aortic valve
implantation in bicuspid aortic stenosis: a meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 26(9) (pp 477-486),
2025. Date of Publication: 01 Sep 2025.
Author
Attachaipanich T.; Attachaipanich S.; Kaewboot K.
Institution
(Attachaipanich) Department of Internal Medicine, Faculty of Medicine,
Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Attachaipanich) Graduate School of Science, Osaka University, Osaka,
Japan
(Kaewboot) Division of Rheumatology, Department of Internal Medicine,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Abstract
AIMS: Bicuspid aortic valve (BAV) is a common congenital heart disease.
However, pivotal randomized trials of transcatheter aortic valve
replacement (TAVR) have excluded this population. There remains a lack of
consensus on the optimal choice between balloon-expandible valves (BEVs)
and self-expanding valves (SEVs) in this setting. This study aimed to
compare the efficacy and safety of BEVs vs. SEVs in patients with BAV
stenosis. <br/>METHOD(S): A systematic search using four databases,
including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was
conducted from inception to 26 November, 2024. Studies comparing the
outcome of BEVs and SEVs in patients with BAV stenosis were included.
<br/>RESULT(S): Nineteen studies comprising 3794 participants were
included in this meta-analysis. Procedural mortality did not differ
significantly between BEVs and SEVs [odds ratio (OR), 1.06; 95% confidence
interval (95% CI) 0.42-2.69, P = 0.91]. Similarly, no differences were
observed in all-cause mortality at 1 year or 3 years. BEVs were associated
with a lower risk of permanent pacemaker implantation (OR, 0.60; 95% CI
0.48-0.76, P < 0.01) and moderate to severe paravalvular leakage (OR,
0.44; 95% CI 0.23-0.85, P = 0.01) compared with SEVs. However, BEVs were
associated with a higher risk of annular rupture (OR, 2.80; 95% CI
1.05-7.49, P = 0.04). <br/>CONCLUSION(S): BEVs and SEVs demonstrate
similar survival outcomes from the procedural period up to 3 years of
follow-up. However, the risk profiles for specific complications differ
between the valve types. Valve selection for TAVR in patients with BAV
stenosis should be considered based on individual anatomical
characteristics and the associated risk of specific
complications.<br/>Copyright &#xa9; Written work prepared by employees of
the Federal Government as part of their official duties is, under the U.S.
Copyright Act, a "work of the United States Government" for which
copyright protection under Title 17 of the United States Code is not
available. As such, copyright does not extend to the contributions of
employees of the Federal Government.

<78>
Accession Number
2040585919
Title
Practice changing updates in perioperative medicine literature 2024. A
systematic review.
Source
American Journal of Medicine. (no pagination), 2025. Date of Publication:
2025.
Author
Khambaty M.; Silbert R.E.; Stephenson C.R.; Bartlett M.A.; Regan D.W.;
Sanchez J.J.; Sundsted K.K.; Mauck K.F.
Institution
(Silbert, Stephenson, Bartlett, Mauck) Division of General Internal
Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of
Medicine, Rochester, MN, United States
(Khambaty, Regan, Sanchez, Sundsted) Division of Hospital Internal
Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of
Medicine, Rochester, MN, United States
Publisher
Elsevier Inc.
Abstract
Every year, new publications advance our understanding of perioperative
medicine. These publications are spread over a variety of journals that
require dedicated effort to identify. To aid this task, we have undertaken
a multi-database literature search from January to December of 2024. We
included original research articles, systematic reviews, meta-analyses,
and guidelines. We excluded abstracts, case reports, letters, or
literature pertaining to cardiovascular surgery, pediatrics, and
obstetrics. Two authors reviewed each reference using the Distiller SR
systematic review software (Evidence Partners Inc., Ottawa, Ontario,
Canada). A modified Delphi technique was used to narrow down to seven of
the most impactful publications and another seven tabular summaries. The
purpose of this review is to understand the strength and limitations of
the new literature in order to improve perioperative outcomes for
patients.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<79>
Accession Number
2036180195
Title
Intraoperative Ventilatory Strategies in Patients Undergoing
Video-Assisted Thoracic Surgery: A Narrative Review.
Source
Advances in Therapy. (no pagination), 2025. Date of Publication: 2025.
Author
Coppola S.; Pastene B.; Fratti I.; Senturk M.; Emre Demirel E.; Leone M.;
Chiumello D.A.
Institution
(Coppola, Chiumello) Department of Anesthesia and Intensive Care, ASST
Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9,
Milan, Italy
(Pastene, Leone) Department of Anesthesiology and Intensive Care Unit,
Hospital Nord, Aix Marseille University, Assistance Publique Hopitaux
Universitaires de Marseille, Marseille, France
(Coppola, Fratti, Chiumello) Department of Health Sciences, University of
Milan, Milan, Italy
(Senturk) School of Medicine, Department of Anesthesiology and Intensive
Care, Acibadem University, Istanbul, Turkey
(Emre Demirel) Istanbul Medical Faculty, Department of Anesthesiology and
Reanimation, Istanbul University, Istanbul, Turkey
(Chiumello) Coordinated Research Center on Respiratory Failure, University
of Milan, Milan, Italy
Publisher
Adis
Abstract
Video-assisted thoracic surgery (VATS) and robotic-assisted thoracic
surgery (RATS) are commonly used in thoracic surgery, yet postoperative
complications still occur in up to 10% of the patients. The aim of our
narrative review was to summarize the best available evidence on
mechanical ventilation settings, particularly with regard positive
end-expiratory pressure (PEEP) selection, tidal volume (VT) and
ventilation mode, as well as the feasibility of two-lung ventilation in
patients undergoing thoracic surgery using VATS or RATS techniques. We
searched the MEDLINE/PubMed database using the terms "VATS" or "RATS" and
"ventilation" between 1 January 2007 and 1 February 2025. Publications
were screened by title or abstract. We discussed studies according to
their methodological quality, ventilation mode, as well as the feasibility
of two-lung ventilation in patients undergoing thoracic surgery using VATS
or RATS techniques. In patients receiving one-lung ventilation (OLV), the
application of a protective lung ventilation using an intermediate VT
ranged between 5 and 8 ml (mL) of predicted body weight (PBW) and a PEEP
of 5-8 cmH<inf>2</inf>O was not found to be associated with a lower
incidence of postoperative pulmonary complications and improved hospital
outcomes. Titrating PEEP based on mechanical properties appears to enhance
perioperative oxygenation and ventilatory mechanics and to reduce
postoperative pneumonia. However, no conclusions can be drawn regarding
ventilation modes, because only few studies have compared the same low VT
using different pressure versus volume control modes. The feasibility of
two-lung ventilation during specific thoracic surgery procedures has
recently been positively evaluated, with no differences in postoperative
complications found. The level of evidence for the ventilatory settings in
patients undergoing VATS or RATS remains low. In conclusion, large
randomized controlled trials (RCTs) are needed to determine whether
certain intraoperative ventilatory strategies can reduce postoperative
pulmonary complications (PPCs) in patients.<br/>Copyright &#xa9; The
Author(s) 2025.

<80>
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.<br/>Copyright &#xa9; 2025 Wiley Periodicals LLC.

<81>
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.<br/>Copyright &#xa9; 2025 The
Author(s). Physiological Reports published by Wiley Periodicals LLC on
behalf of The Physiological Society and the American Physiological
Society.

<82>
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. <br/>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).
<br/>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. <br/>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. <br/>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).<br/>Copyright &#xa9; 2025 American College of Cardiology
Foundation

<83>
Accession Number
2040584992
Title
Defining the Learning Curve in Minimally Invasive Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2025. Date of Publication:
2025.
Author
Elsebaie A.; Boutros C.S.; Awad A.K.; Sanad M.; Pelletier M.; Abu-Omar Y.;
El-Diasty M.
Institution
(Elsebaie) Faculty of Health Sciences, Department of Medicine, Queen's
University, Kingston, ON, Canada
(Boutros, Awad, Pelletier, Abu-Omar, El-Diasty) Cardiac Surgery
Department, Harrington Heart and Vascular Institute, University Hospitals
Cleveland Medical Center, Cleveland, Ohio, United States
(Awad) Faculty of Medicine, Ain-Shams University, Cairo, Egypt
(Sanad) Cardiothoracic Surgery Department, Mansoura University, Mansoura,
Egypt
(El-Diasty) Department of Biomedical and Molecular Sciences, Queen's
University, Kingston, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Minimally invasive cardiac surgery (MICS) has become a popular
approach due to its potential benefits, such as improved cosmesis, faster
recovery, shorter hospital stays, and cost-effectiveness, compared with
traditional median sternotomy. However, there have been some concerns
regarding procedural efficiency and surgical outcomes, especially in the
early phase of the learning curve of these procedures. <br/>Method(s): In
March 2025, a systematic review was conducted using MEDLINE, Embase, the
Cochrane Library and Google Scholar databases to identify potential
studies that quantitively assessed the learning curve in MICS using
predefined metrics based on surgical times and/or clinical outcomes.
<br/>Result(s): There were 28 studies involving 13,257 patients that met
the inclusion criteria, most of which were retrospective, focusing on 3
types of MICS: minimally invasive mitral valve surgery, aortic valve
replacement, and coronary artery bypass grafting. The learning curve was
assessed using arbitrary (split-group) and nonarbitrary (cumulative sum)
methods. Common perioperative metrics included operative, cardiopulmonary
bypass, aortic cross-clamp times, and postoperative complications. The
reported number of cases needed to overcome the learning curve varied
widely, ranging from 23 to 125 cases (mean, 39 cases [for repair] and 78
[for replacement]) for minimally invasive valve surgery, 40 to 138 cases
(mean, 93 cases) for minimally invasive aortic valve replacement, and 16
to 100 cases (mean, 40 cases) for minimally invasive coronary artery
bypass grafting. <br/>Conclusion(s): Differences in surgical process and
postoperative outcomes suggest a learning curve in MICS, although stable
morbidity and mortality rates indicate the safe adoption of these
procedures with appropriate training. Nonetheless, significant
heterogeneity across studies prevents precise learning curve
characterization, highlighting the need for standardized, multivariable
assessment frameworks.<br/>Copyright &#xa9; 2025 The Authors

<84>
Accession Number
648628548
Title
Use of the win ratio approach to assess outcomes in the DapaTAVI trial.
Source
Revista espanola de cardiologia (English ed.). (no pagination), 2025.
Date of Publication: 19 Sep 2025.
Author
Rossello X.; Gonzalez-Manzanares R.; Amat-Santos I.; Disdier V.P.; Roca
L.N.; Otero D.L.; Franco L.N.; Gheorge L.; Sanz-Sanchez J.; Herrero J.G.;
Ferreiro R.G.; Garcia A.J.M.; Vilalta V.; Ojeda S.; Fernandez G.V.;
Soriano J.G.C.; Regueiro A.; Rollan M.S.; Rios X.F.; Uribarri A.; Reyes
R.M.; Romaguera R.; Avanzas P.; Blas S.G.; Franco-Pelaez J.A.; Moreiras
J.M.; Ramon Gonzalez Juanatey J.; Tirado G.; Calle G.; Luis Diez J.;
Santos-Martinez S.; Viu M.M.; Suarez X.C.; Sanmartin X.; Gonzalo N.;
Barrios A.G.; Bermudez I.G.; Real C.; Fuster V.; Ibanez B.;
Raposeiras-Roubin S.
Institution
(Rossello, Disdier, Roca) Unidad de Cardiologia, Institut d'Investigacio
Sanitaria Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma
de Mallorca, Baleares, Spain; Facultad de Medicina, Universitat de les
Illes Balears (UIB), Palma de Mallorca, Baleares, Spain; Departamento de
Investigacion Clinica, Centro Nacional de Investigaciones Cardiovasculares
(CNIC), Madrid, Spain
(Gonzalez-Manzanares) Unidad de Cardiologia, Hospital Universitario Reina
Sofia, Cordoba, Spain; Instituto Maimonides de Investigacion Biomedica de
Cordoba (IMIBIC), Cordoba, Spain; Centro de Investigacion Biomedica en Red
de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III,
Madrid, Spain
(Amat-Santos, Herrero, Santos-Martinez) Centro de Investigacion Biomedica
en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud
Carlos III, Madrid, Spain; Unidad de Cardiologia, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Otero) Unidad de Cardiologia, Hospital Universitario Montecelo,
Pontevedra, Spain; Unidad de Cardiologia, Hospital Clinico Universitario
de Santiago, Santiago de Compostela, A Coruna, Spain; Instituto de
Investigacion Sanitaria Galicia Sur, Vigo, Pontevedra, Spain
(Franco, Tirado, Gonzalo) Unidad de Cardiologia, Hospital Clinico
Universitario San Carlos, Madrid, Spain
(Gheorge, Calle, Barrios) Unidad de Cardiologia, Hospital Puerta del Mar,
Cadiz, Spain
(Sanz-Sanchez, Luis Diez) Unidad de Cardiologia, Hospital Universitario La
Fe, Valencia, Spain
(Ferreiro, Viu, Bermudez) Instituto de Investigacion Sanitaria Galicia
Sur, Vigo, Pontevedra, Spain; Unidad de Cardiologia, Hospital
Universitario Alvaro Cunqueiro, Vigo, Pontevedra, Spain
(Garcia) Unidad de Cardiologia, Hospital Universitario Virgen de la
Victoria, Malaga, Spain
(Vilalta, Suarez) Unidad de Cardiologia, Hospital Universitario German
Trias i Pujol, Badalona, Barcelona, Spain
(Ojeda) Unidad de Cardiologia, Hospital Universitario Reina Sofia,
Cordoba, Spain; Instituto Maimonides de Investigacion Biomedica de Cordoba
(IMIBIC), Cordoba, Spain; Departamento de Ciencias Medicas y Quirurgicas.
Universidad de Cordoba, Cordoba, Spain
(Fernandez) Unidad de Cardiologia, Hospital Universitario Marques de
Valdecilla, Santander, Spain; Instituto de Investigacion Valdecilla
(IDIVAL), Santander, Spain
(Soriano) Unidad de Cardiologia, Hospital Universitario de Albacete,
Albacete, Spain
(Regueiro) Unidad de Cardiologia, Hospital Clinic, Barcelona, Spain
(Rollan) Unidad de Cardiologia, Hospital General Universitario de
Alicante, Alicante, Spain
(Rios) Unidad de Cardiologia, Hospital Universitario Juan Canalejo, A
Coruna, Spain
(Uribarri) Unidad de Cardiologia, Hospital Universitario Vall D'Hebron,
Barcelona, Spain
(Reyes) Unidad de Cardiologia, Hospital Universitario QuironSalud La Luz,
Madrid, Spain
(Romaguera) Unidad de Cardiologia, Hospital Universitario de Bellvitge,
L'Hospitalet de Llobregat, Barcelona, Spain
(Avanzas) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;
Unidad de Cardiologia, Hospital Universitario Central de Asturias, Oviedo,
Spain; Instituto de Investigacion Sanitaria del Principado de Asturias
(ISPA), Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo,
Oviedo, Spain
(Blas) Centro de Investigacion Biomedica en Red de Enfermedades
Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain;
Servicio de Cardiologia, Hospital Clinico Universitario de Valencia,
Valencia, Spain; Instituto de Investigacion Sanitaria INCLIVA, Valencia,
Spain
(Franco-Pelaez) Unidad de Cardiologia, Hospital Universitario Fundacion
Jimenez Diaz, Madrid, Spain
(Moreiras) Unidad de Cardiologia, Hospital Clinico Universitario de
Salamanca, Salamanca, Spain
(Ramon Gonzalez Juanatey) Centro de Investigacion Biomedica en Red de
Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III,
Madrid, Spain; Unidad de Cardiologia, Hospital Clinico Universitario de
Santiago, Santiago de Compostela, A Coruna, Spain; Instituto de
Investigacion Sanitaria de Santiago (IDIS), Santiago de Compostela, A
Coruna, Spain; Facultad de Medicina, Universidad de Santiago de
Compostela, Santiago de Compostela, A Coruna, Spain
(Sanmartin) Unidad de Cardiologia, Hospital Universitario Montecelo,
Pontevedra, Spain; Unidad de Cardiologia, Hospital Clinico Universitario
de Santiago, Santiago de Compostela, A Coruna, Spain; Unidad de
Cardiologia, Hospital Universitario Marques de Valdecilla, Santander,
Spain
(Real) Departamento de Investigacion Clinica, Centro Nacional de
Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Unidad de
Cardiologia, Hospital Clinico Universitario San Carlos, Madrid, Spain
(Fuster) Departamento de Investigacion Clinica, Centro Nacional de
Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiovascular
Institute, Icahn School de Medicine at Mount Sinai, New York, United
States
(Ibanez) Departamento de Investigacion Clinica, Centro Nacional de
Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de
Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV),
Instituto de Salud Carlos III, Madrid, Spain; Unidad de Cardiologia,
Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
(Raposeiras-Roubin) Departamento de Investigacion Clinica, Centro Nacional
de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de
Investigacion Sanitaria Galicia Sur, Vigo, Pontevedra, Spain; Unidad de
Cardiologia, Hospital Universitario Alvaro Cunqueiro, Vigo, Pontevedra,
Spain; Facultad de Medicina, Universidad de Santiago de Compostela,
Santiago de Compostela, A Coruna, Spain. Electronic address:
raposeiras26@hotmail.com
Abstract
INTRODUCTION AND OBJECTIVES: The win ratio (WR) approach is used to assess
composite endpoints in a hierarchical fashion. This novel method offers an
excellent opportunity to assess the robustness of the findings yielded by
landmark trials, such as the DapaTAVI trial. <br/>METHOD(S): We applied
the WR method to evaluate the treatment effect of dapagliflozin in
hierarchically ordered clinical outcomes. Several combinations of outcomes
were tested, including time-to-event, binary, and continuous endpoints.
<br/>RESULT(S): The WR of the original primary endpoint was 1.36 (95%CI,
1.03-1.78; P = .028), comparable to the reciprocal of the original hazard
ratio (1/HR, 1.38; 95%CI, 1.06-1.81). The win difference was 4.84% (95%CI,
0.55-9.12), confirming consistent findings in terms of absolute effect.
Alternative combinations of the primary outcome with different
prioritization of its components yielded similar treatment effects and
statistical significance. Ignoring a time-to-event approach and including
recurrent events did not substantially affect treatment efficacy and its
statistical significance. In contrast, the inclusion of the total length
of stay for heart failure hospitalizations in the hierarchy shifted the
point estimate toward the null. Including New York Heart Association
functional class improved the precision of the estimate (WR = 1.31; 95%CI,
1.09-1.56; P = .003). Conversely, including quality of life through Kansas
City Cardiomyopathy Questionnaire comparisons shifted the overall estimate
toward the null (WR = 1.10; 95%CI, 0.94-1.30; P = .236).
<br/>CONCLUSION(S): The WR approach is a solid method to assess treatment
efficacy. We observed consistent findings using this approach in the
DapaTAVI trial.<br/>Copyright &#xa9; 2025 Sociedad Espanola de
Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

<85>
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. <br/>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. <br/>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).<br/>Copyright &#xa9; The Author(s) 2025.

<86>
Accession Number
2040584798
Title
A randomised clinical trial of regional cerebral perfusion versus deep
hypothermic circulatory arrest: five-year and ten-year follow-up for
neurodevelopmental outcomes in children with functional single ventricle.
Source
Cardiology in the Young. (no pagination), 2025. Date of Publication:
2025.
Author
Wolschendorf R.M.; Smith-Parrish M.; Peterson A.; Yu S.; Ohye R.G.; Bove
E.; Best M.; Goldberg C.S.
Institution
(Wolschendorf, Yu, Goldberg) Division of Pediatric Cardiology, Department
of Pediatrics, University of Michigan Medical School, Ann Arbor, MI,
United States
(Smith-Parrish) Division of Pediatric Cardiology, Department of
Pediatrics, Vanderbilt University, Nashville, TN, United States
(Ohye, Bove) Section of Pediatric Cardiovascular Surgery, Department of
Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI,
United States
(Peterson) Department of Neurology, Vanderbilt University, Nashville, TN,
United States
(Best) Pediatric Neuropsychology Clinic, Yale University, New Haven, CT,
United States
Publisher
Cambridge University Press
Abstract
Objective: This study aimed to evaluate school-age neurodevelopmental
outcomes among children with single ventricle heart disease who underwent
neonatal Norwood operation with regional cerebral perfusion compared to
deep hypothermic circulatory arrest. Additionally, we aimed to identify
predictors of school-age development, including early developmental
measures. Study design: Patients enrolled in a prospective randomised
trial of infants with single ventricle heart disease undergoing the
Norwood operation with either regional cerebral perfusion or deep
hypothermic circulatory arrest were included. For the same cohort of
patients, this study performed neurodevelopmental testing at 5 years and
10 years of age. At 5 years, a comprehensive neuropsychological evaluation
was performed. At 10 years, parent report instruments were used to measure
participants' behaviour and executive function. <br/>Result(s): Forty-one
patients at 5 years of age and 33 patients at 10 years of age completed
neurodevelopmental evaluation. There were no significant differences in
neurodevelopmental scores between the regional cerebral perfusion and deep
hypothermic circulatory arrest groups at either 5 or 10 years. At 5 years
of age, the average full scale intelligence quotient (IQ) was 93.4 +/-
SD18.8. The Bayley Scale of Infant Development Psychomotor Developmental
Index (r = 0.68, p <.0001) and mental developmental index (r = 0.64, p
<.0001) at 1 year positively correlated with the full scale IQ at 5 years.
<br/>Conclusion(s): Neurodevelopment is delayed in patients with single
ventricle heart disease. Neurodevelopmental outcomes at school age did not
differ based on the perfusion strategy for the Norwood operation. Mental
and psychomotor developmental indices at 1 year are predictive of early
school-age measures.<br/>Copyright &#xa9; The Author(s), 2025. Published
by Cambridge University Press.

<87>
Accession Number
648638393
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: 21 Sep 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
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. <br/>METHOD(S): 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. <br/>RESULT(S): 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. <br/>CONCLUSION(S):
Adding bilateral RSB to bilateral PIFB did not improve pain control or
other outcomes for patients undergoing cardiac surgery.<br/>Copyright
&#xa9; American Society of Regional Anesthesia & Pain Medicine 2025. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<88>
Accession Number
2040575358
Title
Vasoactive support in cardiogenic shock: a systematic review of randomised
controlled trials.
Source
British Journal of Anaesthesia. Conference: RAUK Annual Scientific
Meeting. Leeds United Kingdom. 135(4) (pp 1133), 2025. Date of
Publication: 01 Oct 2025.
Author
McGuigan P.; McNamee E.R.; Wardman C.; Boyle A.; Warren A.; Proudfoot A.;
Blackwood B.; McAuley D.
Institution
(McGuigan, Wardman, Boyle) Belfast Health and Social Care Trust, Belfast,
United Kingdom
(McNamee, Blackwood, McAuley) Wellcome-Wolfson Institute for Experimental
Medicine, Queen's University Belfast, Belfast, United Kingdom
(Warren, Proudfoot) Barts Health NHS Trust, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Cardiogenic shock is a multifactorial heterogeneous syndrome in which
disorders of the cardiovascular system impair cardiac output leading to
inability to sustain end-organ perfusion.^1,2 It is complex and
carries a high mortality rate. The purpose of this systematic review was
to evaluate whether use of vasoactive agents vs placebo or usual care in
adults with cardiogenic shock improves the outcomes of mortality,
escalation to mechanical circulatory support, heart transplant, or
neurological outcomes. We searched MEDLINE and Embase using the OVID
platform. CENTRAL was used to search CT.Gov, ICTRP, and CINAHL registers
using MeSH terms relating to cardiogenic shock and vasoactive drugs
(PROSPERO registration number CRD42024614065). No date or language
restrictions were set. Inclusion criteria were RCTs of adult patients with
cardiogenic shock as defined in each trial. Exclusion criteria were case
series, case-control studies, observational studies, post hoc analysis of
previously conducted randomised controlled trials, studies which present
duplicate data, studies not reporting mortality, studies that deliver
vasoactive drugs for fixed durations assessing physiological response,
trials of paediatric populations, and post-cardiac surgical populations.
Risk of bias was assessed by two reviewers independently using the
Cochrane Risk of Bias tool for randomised trials. Nineteen studies met
inclusion criteria. Primary outcome measure was mortality (up to 30 days
or hospital discharge); intervention was any vasoactive drug with the aim
of increasing blood pressure or cardiac output; and comparator was placebo
or usual care. Where norepinephrine was one of two drugs studied, it was
considered usual care. For all classes of drugs studied, there was no
evidence of an effect on 30-day mortality-catecholamines: n=62, relative
risk (RR), 1.20 (confidence interval [CI], 0.44-3.29), I²=16%;
phosphodiesterase-3 inhibitors: n=85, RR, 0.60 (CI, 0.22-1.63),
I²=40%, majority of events from a single study; levosimendan:
n=61, RR, 0.75 (CI, 0.43-1.31), I²=40%, high risk of bias in
two studies; nitric oxide synthase inhibitors: n=274, RR, 0.92 (CI,
0.26-3.31), I²=56%, high risk of bias in one study; and
adrenomedullin antibody: n=60, RR, 1.01 (CI, 0.68-1.50), data from a
single study. There was low certainty of evidence for all interventions.
There are no existing core outcome sets for trials of vasoactive agents in
cardiogenic shock. Of the 4221 studies screened, a comparatively small
number of studies (with a small number of participants) were included in
the review, with a number of these including a patient population in a low
cardiac output state. Further research is required into the use of
vasoactive drugs in the setting of cardiogenic shock in order to draw
conclusions of benefit and apply to apply these results to clinical
practice. Funding Belfast Health and Social Care Trust, Research
Charitable Funds. References 1. Sinha SS, Morrow DA, Kapur NK, et al. J Am
Col Cardiol 2025; 85: 1618-41 2. Waksman, R Pahuja M, van Diepen S, et al.
Circulation 2023; 148: 1113-26<br/>Copyright &#xa9; 2025

<89>
Accession Number
2040627050
Title
Thoracoscopic blood patch instillation for persistent air leak in
pneumothorax: a case series and systematic review.
Source
Monaldi Archives for Chest Disease. 95(2) (no pagination), 2025. Article
Number: 2994. Date of Publication: 2025.
Author
Kedia Y.; Madan M.; Kaushik R.; Kumar R.; Mahendran A.; Ish P.; Talukdar
T.; Gupta N.
Institution
(Kedia) Department of Pulmonary and Critical Care Medicine, VMMC and
Safdarjung Hospital, New Delhi, India
(Madan, Kaushik, Mahendran, Ish, Gupta, Talukdar, Gupta) Department of
Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi,
India
(Kumar) Department of Pulmonary Medicine, VMMC and Safdarjung Hospital,
New Delhi, India
Publisher
Page Press Publications
Abstract
Persistent air leaks in patients with pneumothorax can lead to significant
morbidity. If a patient with a persistent air leak is medically unfit for
thoracic surgery, either medical pleurodesis via chest tube or
thoracoscopy is an option. Thoracoscopy offers the advantage of
visualizing the site of the air leak and enabling direct instillation of
the pleurodesis agent or glue at that location. Autologous blood patch
instillation via chest tube has been reported to be a cheap and very
effective technique for the management of persistent air leaks. However,
thoracoscopic blood patch instillation has not been reported in the
literature. We report two cases of secondary spontaneous pneumothorax in
which patients had persistent air leaks for more than 7 days and were
subjected to thoracoscopy to locate the site of the leak. In the same
sitting, 50 mL of autologous blood patch was instilled directly at the
leak site. Post-procedure, the air leak subsided in both patients, and the
chest tube was removed with complete lung expansion. We also conducted a
systematic review of the use of medical thoracoscopic interventions for
treating persistent air leaks.<br/>Copyright &#xa9;the Author(s), 2024.

<90>
Accession Number
648631942
Title
Efficacy and safety of colchicine on adverse cardiovascular outcomes in
patients with myocardial infarction: A systematic review.
Source
Pharmacy Education. Conference: 83rd FIP World Congress of Pharmacy and
Pharmaceutical Sciences. Copenhagen Denmark. 25(4) (pp 69-70), 2025. Date
of Publication: 01 Sep 2025.
Author
Yang H.; Wang T.; Wang M.
Institution
(Yang, Wang, Wang) Far Eastern Memorial Hospital, New Taipei city, Taiwan
(Republic of China)
Publisher
International Pharmaceutical Federation
Abstract
Inflammation may play an important role in acute coronary syndrome and
stable coronary artery disease that contributes to post-Myocardial
infarction (MI) prognosis. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline
provided a class 2b recommendation for the use of colchicine, an
anti-inflammatory agent, in patients after acute coronary syndrome.
However, a recently published clinical trial revealed that colchicine did
not reduce adverse cardiovascular events. This study aims to assess the
efficacy and safety of colchicine in secondary prevention for patients
with established myocardial infarction. A comprehensive electronic search
was conducted across PubMed and Cochrane Library for randomized controlled
trials (RCTs) assessing the efficacy of colchicine on major adverse
cardiovascular (MACEs) in myocardial infarction patients from inception
until February 2025, using the following keywords: Colchicine and
myocardial infarction. Studies reported the incidence of recurrent MI,
MACEs and mortality rate in patients with MI were included. The primary
outcome was recurrent MI, after colchicine administration. The secondary
outcomes were incidence of MACEs, included cardiovascular death, all-cause
death, resuscitated cardiac arrest, recurrent MI, stroke, ischemia-driven
coronary revascularization, heart failure. Risk ratio (RR) and 95 %
confidence intervals (CI) were extracted or calculated from each study.
Statistical analysis was performed using Review Manager (RevMan) version
5.4. A total of 6 RCTs with 18,091 patients (9,038 patients in the
colchicine group and 9,053 patients in the control group) were included.
The length of follow-up varied from 6 months to 36 months. Colchicine had
a trend to reduce recurrent MI (RR: 0.75, 95% CI 0.55-1.02, P =0.06,
I2=64%) and MACEs (RR: 0.81, 95% CI 0.66-1.00, P =0.05, I2=73%) but was
not statistically significant. Moreover, there was no significant
difference in all-cause death (RR: 1.03, 95% CI 0.85-1.23, P =0.78, I2=0%)
and cardiovascular death (RR: 0.94, 95% CI 0.79-1.22, P =0.99, I2=0%). The
incidence of adverse events, included any adverse effects (RR: 1.03, 95%
CI 0.88-1.19, P =0.72, I2=62%), serious gastrointestinal side effects (RR:
1.13, 95% CI 0.88-1.44, P =0.34, I2=0%) and serious infection (RR: 0.99,
95% CI 0.80-1.22, P =0.90, I2=36%) are similar across the two groups. This
meta-analysis concludes that colchicine did not impact the incidence of
recurrent MI, MACEs and mortality in secondary prevention for patients
with established myocardial infarction. Although gastrointestinal events
were historically reported at a higher rate in patients on colchicine,
this meta-analysis did not observe such findings.

<91>
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.
<br/>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.<br/>Copyright &#xa9; 2025 EDIZIONI MINERVA MEDICA.

<92>
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. <br/>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.
<br/>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). <br/>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. <br/>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.<br/>Copyright
&#xa9; The Author(s) 2025.

<93>
Accession Number
2040342206
Title
Efficacy and safety of prothrombin complex concentrate versus frozen
plasma in cardiac surgery: a systematic review and meta-analysis with
trial sequential analysis.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Shalabi L.; Ibrahim A.; Zreigh S.; Tawfik A.M.; Shalabi S.; Rifai M.;
Legrand M.
Institution
(Shalabi) Faculty of Medicine, Gharyan University, Gharyan, Libyan Arab
Jamahiriya
(Ibrahim, Tawfik) Faculty of Medicine, Alexandria University, Alexandria,
Egypt
(Zreigh) Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara,
Turkey
(Shalabi) College of Pharmacy, Gharyan University, Gharyan, Libyan Arab
Jamahiriya
(Rifai) Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
(Legrand) Department of Anesthesia and Perioperative Care, University of
California, San Francisco, CA, United States
Publisher
Elsevier Ltd

<94>
Accession Number
648619426
Title
ESP BLOCK WITH DEXAMETHASONE MITIGATES PAIN CHRONIFICATION AFTER CARDIAC
SURGERY: A 90-DAY RANDOMIZED STUDY WITH FUNCTIONAL IMPACT.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A14), 2025. Date of Publication: 01 Sep 2025.
Author
Linares L.A.R.; Martinez R.C.R.; Galas F.R.B.G.
Institution
(Linares, Galas) INCOR, FMUSP, Sao Paulo, Brazil
(Martinez) FMUSP, FMUSP - Faculdade Sirio Libanes, Sao Paulo, Brazil
Publisher
BMJ Publishing Group
Abstract
Background and Aims Persistent post-sternotomy pain is a disabling outcome
of cardiac surgery, often under-recognized. While ESP blocks are
increasingly used perioperatively, their role in preventing chronic
pain-especially when combined with dexamethasone-has never been rigorously
tested. <br/>Objective(s): To determine whether perineural dexamethasone
with ESP block reduces long-term pain and functional impairment after
CABG, using a structured 90-day follow-up. Methods Adult patients
undergoing CABG were randomized to receive ESP blocks with ropivacaine +/-
dexamethasone (8 mg total). Pain intensity and interference were evaluated
via the Brief Pain Inventory (BPI) at 30, 60, and 90 days. Evaluations
included rest and movement conditions to capture the full pain spectrum.
Results The dexamethasone group (n=22) demonstrated significantly lower
pain scores at day 30 (worst pain: 1.77 vs. 2.24; p = 0.002) and less
interference in key functions like sleep, activity, and enjoyment of life
(global interference: 0.47 vs. 1.26; p = 0.023). These differences, most
pronounced during movement, faded by day 90, when both groups reported
minimal pain. No adverse events related to dexamethasone were observed.
Conclusions This is the first randomized study to show that
dexamethasone-enhanced ESP block reduces chronic post-sternotomy pain and
its impact on daily life. By integrating movement- sensitive metrics and
longitudinal follow-up, our findings underscore a novel, actionable
strategy to prevent pain chronification in cardiac surgical patients.
Future multicenter trials should build on this pioneering evidence.

<95>
Accession Number
648619221
Title
OPTIMAL DOSE OF DEXAMETHASONE TO PROLONG A BLOCK.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A415), 2025. Date of Publication: 01 Sep 2025.
Author
Laconi G.
Institution
(Laconi) Department of Anesthesia,Intensive Care,and Pain Management,
University Hospital of Ferrara Italy, Ferrara, Italy
Publisher
BMJ Publishing Group
Abstract
Dexamethasone (DXM) is frequently administered as an adjuvant of
postoperative analgesia with widely varying dosing regimens. Based on the
assumption that the optimal dosage of a drug should correspond to the
amount needed to produce the desired effect with minimal adverse effects,
when talking about the dosage of dexamethasone we should also refer to the
route of administration, which for dexamethasone historically has been
perineural and intravenous.1 Recently a meta-analysis published by
Albrecht et colleagues2 comparing the intravenous versus perineural route
of administration found low quality evidence that perineural
administration of DXM increases duration of analgesia by an average of 2
hours compared with intravenous injection for interscalene brachial plexus
block. This increase in the duration of analgesic block, from a clinical
point of view was considered to be of little significance, even in the
face of an administration, that of perineural, which remains off label,
and which in any case should be considered only in cases where
preservative free formulations are available, because of the otherwise
known neurotoxic effects.3 These data also appear to be confirmed by a
metanalysis by Sehmbi et colleagues4 which showed that intravenous
dexamethasone given at the time of regional anesthesia increases the
duration of sensory block by 76 minutes, compared to local anesthetic
alone, also recording a better performance respect to perineural route. In
this regard, the authors of the paper pointed out that in addition to the
route of administration of dexamethasone, reference must also be made to
the type of locoregional blockade performed; peripheral blocks of the
upper limb in fact, with greater vascularization than the lower limb, can
certainly result in different systemic absorption, even with regard to
perineural administration, creating a bias in the results of the studies.
In addition, intravenous dexamethasone administration might present better
efficacy in reducing the incidence of rebound pain.5 A metaanalysis
published in 2011 by De Oliveira et al.6 that considered the
administration of DXM at low doses (less than 0.1 mg/kg), intermediate
doses (0.11-0.2 mg/kg) and high doses (major or equal to 0.21 mg/kg)
claimed that analgesic effects appeared at intermediate doses of DXM, and
adverse effects typically related to the administration of DXM such as
hyperglycemia, increased surgical wound healing times, surgical site
infections remained negligible at these dosages. Recently, a study by
Corcoran and colleagues7 analyzing 8,880 adult patients undergoing
non-urgent, non-cardiac surgery that received 8 mg of intravenous
dexamethasone in comparison to placebo did not find a significant increase
in surgical site infections within 30 days after surgery. A study by
Porter and colleagues8 investigated the impact of DXM on glycemic control
and outcomes in patients with type 2 diabetes mellitus undergoing elective
primary total joint arthroplasty showed an increased risk of elevated mean
glucose on postoperative day (POD) 0-2 and hyperglycemia on POD 0, but
this was not associated with an increase in total insulin dose
administered or the occurrence of surgical site infections, hospital
readmission, or mortality within 30 days after surgery. A metanalysis by
Laconi and collegues9 about high doses of glucocorticoids (DXM major or
equal to 0.2 mg/kg or major or equal to 15 mg intravenously) administered
preoperatively 1 hours before surgery found an opioid-sparing effect at 24
hours after surgery of approximately 10 mg Oral Morphine Equivalents
(OME), however, there are still inconsistent data on the adverse effects
that high doses of DXM may cause. Another study by Van Der Weegen and
colleagues,10 a matched cohort study, found no difference in the
proportion of patients needing rescue analgesics during hospitalization
between the group of patients who received 20 mg of DXM preoperatively and
the group of patients who received 8 mg. Robust scientific evidence on the
optimal dosage of DXM as adjunct to postoperative analgesia, especially
with regard to the administration of high doses, has yet to be
established. Administration of DXM should also take into account the type
of peripheral nerve block that will need to be performed (sites with high
or low vascularization). The most consistent data in the literature
currently available concern intermediate doses (< 10 mg of DXM), which
demonstrate an adequate safety profile, possibly even in high-risk
populations such as diabetics. There are still no consistent data on high
doses of DXM, particularly with regard to the possible assessment of
adverse effects.

<96>
Accession Number
648619341
Title
FINDING THE SWEET SPOT: OPTIMISING PARASTERNAL BLOCK VOLUME AT 0.125%
BUPIVACAINE FOR ENHANCED POST CARDIAC SURGERY ANALGESIA.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A41), 2025. Date of Publication: 01 Sep 2025.
Author
Prozorovskis E.; Polins D.; Strike E.; Miscuks A.
Institution
(Prozorovskis, Polins, Strike) Department of Cardio-Anaesthesiology and
Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
(Miscuks) University of Latvia, Riga, Latvia
Publisher
BMJ Publishing Group
Abstract
Background and Aims Intense post sternotomy pain delays mobilisation and
increases peri operative opioid exposure. Ultrasound guided bilateral
parasternal block provides targeted anterior chest wall analgesia;
however, the dose-volume relationship of local anaesthetic for this block
remains undefined. After establishing that 0.125% bupivacaine is
clinically effective, we conducted a randomised controlled trial to
evaluate whether varying injectate volumes at this fixed concentration
modulate analgesic efficacy and opioid consumption. Methods This
prospective, randomised, single-blind trial enrolled 44 adults for
elective median sternotomy. After ethics approval (Pauls Stradins Clinical
University Hospital, 281123- 11L), patients received a bilateral
parasternal block with 0.125% bupivacaine: 20 ml (n = 12), 40 ml (n = 20)
or 60 ml (n = 12). Pain intensity (Numerical Rating Scale, NRS 0-10) was
measured at 0, 4, 8, 12, 20 and 24 h. Secondary endpoints were 24-h opioid
use and time-to-rescue analgesia. Results Median NRS at 12 hours
postoperatively was 1 (IQR 0-3) after 20 ml, 1 (IQR 0-3) after 40 ml and 1
(IQR 0-2) after 60 ml (p = 0.801); pain scores did not differ
significantly at any measured time point (p >0.05). Time to rescue was
markedly shorter with 20 ml - median 120 min (IQR 120-300)-versus 40 ml -
995 min (IQR 440-1275) and 60 ml - 420 min (IQR 218-450); Repeated rescue
opioid was needed in 25% of patients who received 20 ml, whereas none
required it after 40 ml or 60 ml (p = 0.012). Conclusions Injectate volume
was decisive: >= 40 ml abolished rescue-opioid use; 40 ml produced the
longest opioid-free period with no safety issues, whereas 60 ml offered no
added benefit. Thus, a 40 ml bilateral parasternal block with 0.125%
bupivacaine is the volume-efficacy sweet spot for post-sternotomy
analgesia. Larger multicentre trials should validate these findings and
refine practice.

<97>
Accession Number
648619310
Title
THORACIC EPIDURALS STILL ROCK: A CRITICAL COMPONENT IN MODERN ANESTHETIC
PRACTICE.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A423-A425), 2025. Date of Publication: 01 Sep 2025.
Author
Hoogma D.F.; Van Loon P.
Institution
(Hoogma, Van Loon) University Hospitals Leuven, Department of
Anesthesiology, UZ Leuven, Herestraat 49, Leuven, Belgium
(Hoogma) University of Leuven, Biomedical Sciences Group, Department of
Cardiovascular Sciences, Belgium
Publisher
BMJ Publishing Group
Abstract
Thoracic epidural analgesia (TEA) has been a cornerstone in perioperative
pain management for many decades, particularly for thoracic and abdominal
surgeries. With the evolving surgical practices and emergence of
alternative analgesic techniques, including fascial plane blocks and, TEA
has been considered by many as obsolete. This manuscript explores the
current evidence supporting TEA's efficacy, addresses common criticisms,
and delineates its role in contemporary anesthetic practice. In summary,
TEA remains a valuable tool in the anesthesiologist's arsenal in selected
patients. Introduction The field of anesthesiology has witnessed
remarkable changes over the past two decades, with the rise of enhanced
recovery after surgery (ERAS) protocols, minimally invasive surgical
techniques, and non-neuraxial regional anesthetic techniques such as
fascial plane blocks.1 2 In this dynamic environment, thoracic epidural
analgesia (TEA), once considered the gold standard for perioperative pain
management in major thoracic and abdominal surgeries, has faced scrutiny.
Critics have questioned its continued relevance, citing concerns about its
invasiveness, potential complications, and the perceived equivalence of
newer ultrasound guided techniques. 3-5 However, these assertions often
lack context and fail to account the specific context in which TEA
continues to offer unparalleled benefits. Rather than viewing TEA as a
relic of the past, it is more appropriate to consider it a specialized and
highly effective tool, one that, when used judiciously, can significantly
enhance perioperative outcomes. TEA offers robust segmental analgesia by
blocking afferent nociceptive input and efferent sympathetic fibers at the
thoracoabdominal level.6 Especially the visceral component is unique and
cannot be achieved by any of the proposed modern regional analgesic
techniques.6 As surgical invasiveness decreases, visceral pain often
becomes the dominant source of postoperative discomfort, making TEA's
comprehensive analgesic profile even more valuable. Consequently, its
efficacy in open abdominal or thoracic surgeries such as lobectomies,
esophagectomies, and open aortic repairs is well-documented. Beyond
excellent pain control, TEA has also been associated with improved
pulmonary function and a reduced incidence of postoperative pulmonary
complications (PPCs).7 Recent meta-analyses continue to support these
findings, demonstrating that TEA significantly reduces PPCs and improves
pain scores compared to systemic opioids, particularly following
esophagectomy.8 This translated into relevant clinical benefits: reduced
opioid requirements, enhanced patient satisfaction and earlier
mobilization. This manuscript aims to critically reexamine TEA's relevance
by presenting current evidence, dispelling common myths, and highlighting
clinical scenarios where TEA remains not only relevant but demonstrably
superior to popular alternative techniques. Benefits from TEA Opioids
remain a cornerstone in perioperative anesthesia and analgesia.9
Nevertheless, its liberal use is accompanied by multiple side effects,
including postoperative nausea and vomiting, ileus, sedation,
hyperalgesia, and respiratory depression. Strategies to mitigate these
side-effects by reducing the amount of opioids are therefore essential to
enhance recovery.9 TEA produces an unparalleled potent opioid-sparing
effect in patients undergoing major thoracic and abdominal surgeries. A
meta-analysis concluded that TEA was associated with lower postoperative
opioid use and superior pain control after open colorectal and upper GI
surgeries. 10 This translates into fewer opioid-related adverse effects
such as nausea, vomiting, ileus, and respiratory depression. 11 12
Moreover, TEA contributes to earlier return of gastrointestinal function,
improved pulmonary function and shorter hospital stays in major
thoraco-abdominal surgeries.10- 12 Role of TEA in ERAS Protocols ERAS
protocols aim to reduce surgical stress, maintain physiological function,
and promote early mobilization using an evidence-based approach.1 A
central tenet of ERAS is the minimization of opioid use, as excessive
reliance on opioids is a known contributor to ERAS failure doe to the
aforementioned side effects. Benefits of TEA aligns closely with these
objectives.11 13 14 By providing superior segmental analgesia, covering
both somatic and visceral components, in addition to reducing to opioid
consumption and mitigating opioid related side-effects, TEA also blunts
the neuroendocrine stress response and facilitates early ambulation and
recovery.13 15 However, recent ERAS protocols increasingly emphasize
incorporating non-neuraxial regional techniques, such as fascial plane
blocks, as part of opioid-sparing strategies.1-3 For many patients
undergoing minimally invasive procedures, such as uniportal video-assisted
thoracoscopic surgery or laparoscopic pancreaticoduodenectomy surgery,
these alternative offer adequate analgesia. Nevertheless, in patients at
high-risk of severe pain or pulmonary complications or in those undergoing
major thoracoabdominal surgery, TEA remains the most effective technique.
In this context, TEA has been associated with lower pain scores, reduced
pulmonary complications, enhancing recovery and quality of life, and
shorter length of intensive care and hospital stay.16-19 Dispelling Common
Myths TEA causes persistent hypotension: One of the most frequently cited
drawbacks of TEA is the risk for persistent hypotension due, primarily due
to sympathetic blockade.15 This effect is particularly pronounced with
thoracic epidurals, leading to vasodilation and reduced vascular
resistance. While this is a legitimate concern, it is important to
contextualize it within modern perioperative management strategies.
Moreover, this controlled sympathetic blockade created by TEA is not
purely detrimental, as TEA has been shown to improve splanchnic perfusion,
reduce myocardial oxygen demand, and reduce surgical stress hormone
responses.20 Contemporary strategies, including goal-directed fluid
therapy, vasopressor titration and enhanced hemodynamic monitoring, have
improved the ability to prevent and manage TEA-associated hypotension
safely and effectively.21 TEA is technically difficult and unreliable: A
common argument against the use of TEA is its perceived technical
difficulty and variability in success. However, as with any advanced
technique, such variability should not justify its dismissal. Instead,
institutions should prioritize structured training programs that include
anatomical and simulation- based training, and the use of adjunctive or
confirmatory technologies such as ultrasound, epidural wave form analysis
or electrical epidural stimulation.22 These efforts should be supported by
continuous quality improvement initiatives to ensure procedural competence
and consistency across providers. 21 23 Large cohort studies and expert
consensus have consistently demonstrated that when performed by
experienced practitioners within a well-supported system, TEA achieves
high success rates with a low incidence of complications. Therefore,
rather than abandoning TEA, it should be embraced as a valuable technique
that can be safely and effectively be implemented in selected cases.21 22
Fascial plane blocks are equally effective: Recent popular fascial plane
blocks, including transversus abdominis plane (TAP), paravertebral block
(PVB), erector spinae plane (ESP) and serratus anterior plane (SAP) block.
These techniques offer analgesia that is, in many cases, comparable to TEA
for selected endpoints. In addition, they are generally considered
technically easier to perform and are associated with more favorable
safety profile. Among these, the PVB has reemerged as a preferred
alternative in thoracic surgery. It provides effective unilateral
analgesia with significantly fewer side effects compared to TEA. However,
a meta-analysis comparing PVB and TEA in thoracotomy patients found that
while both techniques were effective, TEA provided more consistent pain
control and improved preservation of pulmonary function.24 The ESP and SAP
block are often favored in by clinicians patients due to their superficial
locations and perceived safety.3 15 However, their efficacy can be
variable, even more in bilateral or extensive surgical fields.25
Additionally, these blocks require higher volumes of local anesthetics,
which may increase the risk of systemic toxicity.26 In summary, while
fascial plane blocks appear attractive for low-risk patients undergoing
minimally invasive procedures in, their role in high-risk surgeries and
patients remains less well defined. TEA continues to be the most reliable
technique in these settings, supported by robust evidence demonstrating
superiority in enhancing recovery.15 Therefore, TEA remains the primary
choice for open thoraco-abdominal surgeries.27 28 Conclusion The assertion
that thoracic epidurals are obsolete fails to account for the robust body
of evidence supporting their continued use in carefully selected patient
populations. TEA remains the gold standard for thoracic and abdominal
procedures, particularly in high-risk patients and open surgeries. Its
role in reducing postoperative complications, enhancing recovery, and
minimizing opioid exposure cannot be overstated. Rather than abandoning
TEA, the focus should shift toward optimizing its use, through thoughtful
patient selection, institutional support, and ongoing training. As
anesthetic practice continues to evolve, TEA stands not as a relic, but as
a precision instrument, highly effective when applied judiciously within
the right clinical context.

<98>
Accession Number
648619245
Title
INTRATHECAL MORPHINE IN MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY:
A RANDOMIZED, PLACEBO-CONTROLLED, MULTICENTER TRIAL.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A4-A5), 2025. Date of Publication: 01 Sep 2025.
Author
Vanderheeren M.-C.; Van Den Eynde R.; Oosterlinck W.; Embrecht B.; Rex S.;
Hoogma D.F.
Institution
(Vanderheeren, Van Den Eynde, Rex, Hoogma) Anaesthesiology, University
Hospitals Leuven, Leuven, Belgium
(Van Den Eynde, Oosterlinck, Rex, Hoogma) Cardiovascular Sciences,
University Hospitals Leuven, Leuven, Belgium
(Oosterlinck) Cardiac Surgery, University Hospitals Leuven, Leuven,
Belgium
(Embrecht) Anaesthesiology, Imeldaziekenhuis, Bonheiden, Belgium
Publisher
BMJ Publishing Group
Abstract
Background and Aims Minimally invasive cardiac surgery (MICS) is
increasingly performed to reduce surgical trauma and enhance recovery, yet
optimal strategies for postoperative pain control and patient-centered
outcomes remain unclear. We hypothesized that intrathecal morphine (ITM),
when added to a multimodal analgesic protocol, improves quality of
recovery (QoR) following robotically-assisted minimally invasive direct
coronary artery bypass (RAMIDCAB) surgery. Methods In this multicentre,
double-blind, randomized, placebo- controlled trial, approved by the
ethical committee (EudraCT 2022-003684-14), patients undergoing RAMIDCAB
were randomized 1:1 to receive either ITM (5 mug/kg) with intravenous (IV)
saline, or intrathecal saline with IV morphine (0.1 mg/kg) (control). All
patients followed a standardized Enhanced Recovery Program (ERP). The
primary endpoint was QoR-40 score at 24 hours post-extubation. Secondary
endpoints included pain scores, opioid consumption, rescue analgesia, and
adverse events. Results Sixty-four patients were randomized. Compared to
control, ITM did not result in a minimally clinically important
improvement in the QoR-40 score at 24 or 48 hours (figure 1). However, ITM
provided significantly better postoperative analgesia in the early
postoperative period (figure 2). Cumulative opioid consumption over 24
hours was significantly lower in the ITM group (-11.9 mg morphine
equivalents, p = 0.0004) (figure 3) and fewer patients required rescue
analgesia (ARR -22.2%, p = 0.02). There were no statistically significant
differences in adverse events between groups. Conclusions Although ITM did
not improve overall QoR-40 scores, it significantly enhanced early
postoperative analgesia and reduced opioid requirements. These findings
support the integration of ITM into ERP protocols for MICS.

<99>
Accession Number
648619182
Title
NEW STUFF ON THE SCENE. ROLE OF NONPHARMACOLOGICAL TREATMENTS.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A410-A412), 2025. Date of Publication: 01 Sep 2025.
Author
Lavand'hommep P.
Institution
(Lavand'hommep) Cliniques Universitaires St Luc, UCL, Brussels, Belgium
Publisher
BMJ Publishing Group
Abstract
A recent analysis of a large registry data (10415 patients from 10
countries)1 reported that, despite considerable efforts to improvement
during the last decades, postoperative pain is still a common experience
for many patients. According to the findings, 50% of the patients endured
severe pain (NRS > 7/ 10) and 25% spent more than 50% of their time in
pain during the first 24 h. More, severe pain negatively interfered with
functional and emotional recovery in at least 30% of the patients.1 How to
explain these findings. On one hand, current guidelines for postoperative
pain management as well as those promoting enhanced recovery after surgery
remain poorly applied. Even multimodal analgesia is not systematically
administered to all the patients.1 On the other hand, by definition, pain
is an individual, complex,multifaceted experience, that is shaped by a
lifetime of learning processes and influenced by sensory, affective,
cognitive and sociocultural factors. 2 That may explain the considerable
variability of patients to experience pain and to respond to analgesic
treatments. Thereby, it is not surprising that currently recommended
postoperative pain management may not fit all the patients. Today, acute
pain management, including postoperative pain, mostly relies on the
administration of pharmacological treatments. As previously discussed,
their effectiveness suffers limitations, particularly in some patients. In
contrast, the use of non-pharmacological interventions remains unfrequent
(average 28% utilization), distraction-based interventions proposed to 25%
of the patients and physical modality i.e. cold pack proposed to 8% of the
previously mentioned cohort of patients.1 The failures of classical
perioperative analgesic treatments and the opioid health-related crisis
have underscored the importance to optimize various approached to pain
management and to further question the role and benefits of intergrating
complementary medicine in perioperative pain management.3 Complementary
Medicine and Integrative Health Complementary medicine (CM) is a term used
to describe non-pharmacological approaches to health, healing and
rehabilitation. 3 CM interventions may be categorized in 5 subgroups:
alternative medicines (e.g. homeopathy), natural product based therapy
(e.g. dietary supplements), energy therapies (e.g. acupuncture),
body-based interventions (e.g. massages) and mindbody interventions (e.g.
hypnotherapy). Integrative Health is the practice of incorporating both
traditional and CM into a comprehensive treatment plan.3 Practice of
Integrative Health, also called holistic medicine, considers all the
aspects of the patient when choosing the most appropriate treatment.3
Despite the patient's preferences and their growing desire for a more
integrated approach in their cares, several barriers to a regular use of
CM in perioperative pain management are still present (see table 1). The
lack of rigorous scientific evidence supporting the use of CM still stands
as a major barrier for health care providers. However, as stated in an
editorial4 'a little better is still better' and the marginal gains
provided by non-pharmacological interventions could be used to improve
postoperative recovery as a global human experience, even without much
impact on pain intensity or opioids consumption. Utilization of CM
treatments may help to reduce excessive anxiety and may improve sleep
quality, two factors which greatly affect the pain severity, the need of
rescue analgesics and the speed of postoperative recovery. Evidence of CM
usefulness in perioperative cares Some CM therapies have gained more
popularity in the recent years, by examples acupuncture and psychological
interventions. Acupuncture could be considered as the 'most invasive' of
all CM therapies. Perioperative acupuncture may reduce the incidence of
postoperative nausea and decrease the frequency of anti-emetic drugs use.3
It may also modulate the body stress response to the surgical injury.
Decrease of stress biomarkers like troponin levels after open cardiac
surgery or S100b levels after craniotomy has been observed.5 6 Always in
relation with the modulation of the stress response, perioperative
acupuncture has been associated with decreased vasopressor requirements
and improved glucose control. Transcutaneous electrical acupoint
stimulation (TEAS) is an emerging therapeutic approach that combines the
effects of TENS (transcutaneous electrical nerve stimulation) with
acupuncture points stimulation.7 TEAS is a non-invasive technique by
contrast with traditional acupuncture and needlebased electrostimulation.
Despite multiple applications, the mechanisms of TEAS still remain poorly
understood and a large heterogeneity exists among published studies in
relation with stimulation frequencies and stimulation points used.8 Two
systematic reviews seem to conclude to some benefit of TEAS on the control
of perioperative nausea-vomiting and pain, allowing to reduce some
hospitalization costs.7 8 Psychological interventions include an umbrella
of different types of interventions and techniques, from psycho-education,
relaxation and behavioral modification therapies.9 Because emotions and
cognition are strongly associated with the development of acute and
chronic pain, psychological interventions are defined as strategie
targeted towards reducing stress, anxiety, negative emotions and
depression. By these mechanisms, these interventions help to reduce
postoperative opioids use and pain scores in some patients. Whether these
interventions have demonstrated their efficacy in chronic pain management
e.g. in cancer patients,10 there is a clear need to show the perioperative
benefits and more specifically to determine the optimal technique, the
optimal timing of administration and the optimal patient9 Two recent
systematic reviews and metaanalysis have questioned the role of
perioperative psychological interventions on postsurgical pain, disability
and psychologic well-being.11 12 Psychological approaches considered
included cognitive-behavioral therapy (CBT), acceptance and commitment
therapy (ACT) and mindfulness-based interventions (MBIs). The last
meta-analysis12 which extended the review published by Nadinda et al,11
included 27 RCTs (around 3000 patients). Compared with usual care or
control treatment, moderate quality evidence exists that psychological
interventions reduced pain intensity and anxiety after surgery12 but did
not influence pain catastrophizing or depression. According to the
results, CBT seemed the most beneficial for surgical patients.12 Both
reviews underlined the fact that psychological interventions delivered by
a psychologist were more effective than those delivered by other
professionals (i.e. anesthesiologists, surgeons, nurses). It is worth
noting the limitations of these systematic reviews, related to the quality
and heterogeneity of the RCTs results. Among relaxation techniques,
hypnosis and virtual reality (VR) are now very popular and widely used in
perioperative setting. While hypnosis requires a specific formation, the
utilization of VR only necessitates a specific equipment.13 It is worth
noting that virtual reality includes a huge variety in the type of applied
VR, from augmented reality to mixed reality, even including hypnotic
suggestions. Clinical studies suggest that therapeutic effects of VR in
reducing acute pain may be most evident when VR is administered at the
same time of the painful stimulus.13 Some authors consider that VR and
analgesia achieved from hypnosis are similar in that the patient is
detached from reality. However, for hypnosis, patient susceptibility to
hypnotic suggestion is an important consideration. Low quality evidence
suggests that VR alone can reduce pain independent of hypnotizability.
Further, the effectiveness of combining VR and hypnosis remains unclear.13
14 A study comparing perioperative hypnosis versus enhanced standard of
care after total knee arthroplasty15 pointed out the fact that hypnosis
lessened postoperative pain intensity (35%) and opioid use (54%) only in
the subgroup of patients who were taking opioids before surgery. Well-
known difficult perioperative management of this patients population makes
the results particularly interesting and deserving further confirmation.
Actual benefits of psychological interventions in operative setting have
been measured in populations where patients suffering chronic pain
conditions, presenting with psychiatric illness or chronic opioids intake
have been excluded.9 Finally, among available psychological interventions,
patient's education plays an important role although its real benefits in
terms of postoperative pain and analgesics use are far from evident.9 A
recent study in patients presenting with a significant preoperative
anxiety level has found that a brief short-term individualized information
and empathic conversation, paired with an educational video significantly
reduced preoperative anxiety compared to a standard preanesthetic
consultation.16 Further studies should assess the postoperative benefit of
such intervention on global recovery. In conclusion, patient's
participation to their perioperative cares has a major impact on the
overall benefit of the surgical procedure. The failures of classical
analgesic treatments and the opioid health-related crisis point out the
importance to optimize current perioperative management by promoting
different approaches. Today, growing evidences support the utilization of
CM as adjuvants to standard perioperative treatments, particularly to
improve postoperative recovery as a global human experience. Future
research should question the role, the indications and the benefits of
integrating complementary medicine in perioperative pain management.
Rigorous research protocols are mandatory and need to consider the
patient's global recovery experience, beyond postoperative pain scores and
opioid consumption.

<100>
Accession Number
648619232
Title
DEXAMETHASONE-ENHANCED ESP BLOCK ACCELERATES EXTUBATION AFTER CABG: A
RANDOMIZED TRIAL WITH DYNAMIC PAIN ASSESSMENT.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A69), 2025. Date of Publication: 01 Sep 2025.
Author
Linares L.A.R.; Galas F.R.B.G.; Martinez R.C.R.
Institution
(Linares, Galas) Incor, Fmusp, Sao Paulo, Brazil
(Martinez) Fmusp, Fmusp - Faculdade Sirio Libanes, Sao Paulo, Brazil
Publisher
BMJ Publishing Group
Abstract
Background and Aims Enhancing recovery after cardiac surgery is a major
goal of regional anesthesia. The erector spinae plane (ESP) block is
gaining traction in this field, but the impact of perineural
dexamethasone-particularly when combined with serial pain assessments at
rest and movement- remains unexplored. <br/>Objective(s): To evaluate
whether dexamethasone as an adjuvant to ESP block improves early recovery
markers, including mechanical ventilation duration and dynamic pain
scores, in patients undergoing coronary artery bypass grafting (CABG).
Methods In this double-blind, randomized controlled trial, patients
received bilateral ESP block with 0.2% ropivacaine +/- 8 mg perineural
dexamethasone. Pain was rigorously assessed at rest and during movement
over 48 hours using NRS/VAS scales. Other endpoints included opioid use
and extubation time. Results Among 43 patients (21 control, 22
dexamethasone), static and dynamic pain scores were low and comparable.
However, the dexamethasone group exhibited a significantly shorter time to
extubation (751 +/- 333 vs. 848 +/- 236 min, p = 0.041). This earlier
ventilatory liberation occurred despite similar opioid requirements,
suggesting improved pain tolerance during active respiratory effort. No
block-related complications were reported. Conclusions This is the first
study to integrate perineural dexamethasone with dynamic pain assessments
following ESP block in cardiac surgery. Although acute pain scores were
similar, dexamethasone significantly accelerated extubation- highlighting
its role in enhancing recovery. These findings advocate for its inclusion
in ERACS pathways and warrant multicenter validation.

<101>
Accession Number
648619369
Title
ADHERENCE TO PRACTICE GUIDELINES FOR POSTOPERATIVE EPIDURAL ANALGESIA: A
RETROSPECTIVE CLINICAL AUDIT.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A76-A77), 2025. Date of Publication: 01 Sep 2025.
Author
Rehman S.U.; Malik M.
Institution
(Rehman) Anaesthesia Trainee, Hospital and Medical Centre, Lahore,
Pakistan
(Malik) Department of Anesthesia, Doctors Hospital and Medical Centre,
Lahore, Pakistan
Publisher
BMJ Publishing Group
Abstract
Background and Aims Postoperative pain control following any surgical
procedure is very crucial, and it is associated with increased patient
satisfaction and improved pulmonary function. Parenteral opioids not only
decrease the colonic motility and increases chances of postoperative ileus
[9]. Multimodal analgesia is the fundamental component of enhanced
recovery after surgery. A randomized controlled trial was done that shows
reduced perioperative morbidity and mortality with neuraxial techniques,
when compared with other analgesic techniques Methods Non-probability
consecutive sampling technique was used to collect the data. After the
Approval to conduct this audit was obtained from ethical committee of the
hospital (can be presented on request), data was collected from Surgical
Epidural Registers of Anaesthesia department. All the calculations were
done manually and then put in Microsoft Word Document. Results A total of
308 surgical epidurals were inserted over the period of three years in our
institute. Orthopaedic procedures constitute 125 (40.6%), 41 (13.31%) for
thoracic surgery procedures, 36 (11.7%) for general surgery procedures, 25
(8.11%) for hepatobiliary procedures and 14 (4.54%) for urology procedures
and 12 (3.89%) for Gynaecological procedures. Level of insertion is as per
recommended guidelines in 200 patient out of 308. Bupivacaine is the most
commonly used drug, while 0.1% concentration is generally preferred in our
setup. Among the adjuvants, fentanyl, dexmedetomidine and tramadol were
used. Overall complications rate is 40 (12.98%), with motor blockade being
the most common, followed by nausea/vomiting, hypotension, dural tap and
blood tap. Conclusions This audit will help us in rectifying the loop
holes in the surgical epidural analgesia services provided by our
department, but also other epidural analgesia services providers to make
changes in their practices for better outcomes in future.

<102>
Accession Number
648619577
Title
HYGIENIC STANDARDS AND ENVIRONMENTAL CONCERNS.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A370-A372), 2025. Date of Publication: 01 Sep 2025.
Author
Ip V.
Institution
(Ip) University of Calgary, Calgary, Canada
Publisher
BMJ Publishing Group
Abstract
Hygienic standards and environmental concerns Vivian H. Y. Ip MBChB FRCA
Clinical Professor, Department of Anesthesia, Perioperative, and Pain
Medicine University of Calgary Calgary Alberta Canada Email:
hip@ualberta.ca Conflict of Interests: Dr. Vivian Ip is the Chair of the
Environmental Sustainability Section, the Chair of the Regional Anesthesia
Section at the Canadian Anesthesiologists' Society, and the Advisor of the
Green Anesthesia Special Interests Group at the American Society of
Regional Anesthesia and Pain Medicine. Word count = 1333 References = 22
Introduction Regional anesthesia has been practiced for over a decade, the
infection complications have reduced significantly with the evolution of
infection control and prevention practices. 1 Institutional protocols as
well as vigilant surveillance and audits ensure infection control and
prevention practice standards are upheld. Nowadays, the infectious
complications of regional anesthesia in acute pain medicine in terms of
neuraxial or peripheral nerve blocks are very rare.1 Nonetheless, there is
always a dual challenge in healthcare with infection prevention and
environmental impact. While infection prevention practice can be resource
intensive, especially without consideration on the environmental
sustainability and promote responsible use of resource. High-income
countries often possess an abundance of resources, which can lead
practitioners to overlook the critical need for responsible resource use.
These resources are, in fact, costly and finite, as well as the potential
to generate a substantial waste and carbon footprint. With the healthcare
industry contributing a significant amount of net global carbon dioxide
emission, and if healthcare were a country, it would rank the 5th largest
emission of carbon dioxide in the world, there should be an evaluation of
how this can be improved. Ironically, the environmental impact affects the
health of humanity, considerations of responsible use of resource, while
balancing patient safety is paramount. This expert opinion discussion aims
to outline the strategies in clinical practice to be 'clean and green' in
regional anesthesia. The scale of the problem: Infection rate in regional
anesthesia versus the environmental impact of healthcare A recent review
investigated the pooled estimate of overall infectious complications
following all central neuraxial block was 9/100000 (95% CI: 5, 13/100000),
central neuraxial infections following all central neuraxial block was
estimated to be 2/100000 (95% CI: 1,3/100000), and even rarer following
spinal anesthesia at 1/100000 (95% CI: 1,2/100000). Even rarer is the
infection rate reported in the obstetric population with an overall
infection rate of 1/100000 (95% CI: 1,3/100000) and central neuraxial
injections at 4/1000000) (95% CI: 0.3, 1/100000) following all central
neuraxial blocks.1 For peripheral nerve blocks, the reported rate of
infections complications was slightly higher at 1.8%. (95% CI 1.2,
2.5/100) (Selvamani) A 10-year cohort study review of ultrasound-guided
nerve block using non-sterile gel, sterile transparent film barrier and
disinfect ultrasound transducer in between uses fount no infection rate in
7476 patients.2 Another study found no significant infection in 211
femoral nerve catheters.3 A large retrospective review of 9649 patients
reported zero infections in the lumbar plexus catheters.4 Regarding
environmental sustainability, healthcare industry contributes 4.6% of the
global net carbon emissions.5 Recently, the 'United Nations Environment
Program' issued a stern statement urging immediate action to curb carbon
emissions to prevent catastrophic temperature spikes and mitigate the
worst impacts of climate change. To stay on track for limiting global
temperature rise to 1.5degreeC (34.7degreeF), carbon emissions must
decrease by 42% by 2030 and by 57% by 2035.6 Failure to act could lead to
a temperature rise of 2.6-3.1degreeC (36.7-37.6degreeF). In 2023, annual
global temperatures reached a record high of 1.45degreeC, and if current
policies persist, the world is on track for a 2.7degreeC increase by
2100.6 Sadly, anthropogenic emissions continue to increase globally and a
reverse course to maintain, minimise greenhouse gas emissions seems
impossible. Hygienic Standards in RA Recently, ASRA Pain Medicine produced
an excellent guideline on infection control in both acute and chronic pain
practice.7 The article contains several procedural recommendations with
the associated level of evidence. The only Grade A evidence is that
preoperative antibiotic prophylaxis given 1 hour prior to surgical
incision for invasive procedures, as there is strong certainty suggesting
preoperative antibiotic prophylaxis reduces risk of surgical site
infection. Although these types of invasive procedures tend to refer to
chronic pain. For acute pain procedural recommendations, most are of grade
B evidence, with the more robust and consistent evidence to prevent
infection being hand hygiene, the use of chlorhexidine in alcohol, and the
aseptic non-touch techniques (ANTT).7 8 In the ASRA Pain Medicine
infection consensus guideline, it states that all procedural staff should
perform hand hygiene prior to the first case of the day, before and after
glove use, before and after patient contact, and any time hands are
visibly soiled. Hand hygiene with skin antisepsis is a key component, and
the single most important basic preventative measure that significantly
reduce hospital-acquired infections with high certainty.7 9 Another area
with great certainty is the use of chlorhexidine in alcohol for
preparation of the procedural site. A Cochrane meta-analysis in 2015
showed that preoperative skin preparation with chlorhexidine in alcohol
was associated with lower infection rates after clean surgeries. 10
Furthermore, the ANTT clinical procedure guideline has been incorporated
into many institutional protocols globally. It is a specific type of
aseptic technique with a unique theory and practice framework to improve
and standardize aseptic technique for all clinical procedures. This
technique ensures that only uncontaminated equipment and fluids come into
contact with susceptible body sites and is also endorsed by NICE in the
UK.8 11Upon examination of the outbreak investigations with bacterial
meningitis amongst patients undergoing spinal procedures where healthcare
providers did not wear a face mask, the organism causing the infection was
traced back to the respiratory flora of the unmasked provider. This
provides strong epidemiological evidence to advocate for all personnel in
the immediate area as well as the person performing the neuraxial blocks,
when catheter or injection of drug into the spinal canal or subdural
space, should wear a surgical face mask to minimise the risk of droplet
transmission. 12 13 Environmental considerations in regional anesthesia in
the context of infection prevention The main concern is overuse of
resources in practices that are considered to reduce infection rate but
not supported by robust evidence. Without responsible use of resource to
minimize waste generation, energy used to process reusable attires and
equipment, as well as medication waste, it leaves a significant carbon
footprint without meaningful clinical impact. There is also a myth that
disposable equipment reduces infection risks compared to reusable
supplies. Reusable supplies and equipment do not increase risk of
infection when adequate sterilization is the key. A recent systematic
review included 9 studies including more than 45,000 cases demonstrated no
significant difference in surgical site infection rates between the
reusable and disposable groups. At the same time, reusable surgical
headwear significantly lowers the carbon footprint than disposable
alternatives.14 Studies have shown that there is no difference between
reusable or disposable supplies to reduce the risk of surgical site
infection in orthopedic and spinal surgery,15 coronary artery surgery,16
intensive care unit.17 However, reusable supplies generate much less
carbon emission.18-20 Another strategy to reduce waste and emissions is
creative thinking of 'doing more with less'. One example is using
alcohol-based hand rub between patients. This approach is advocated by the
hand hygiene liaison group, limits the use of resources, saves water,
towels and energy used compared to handwashing.21 22 Fine balance While
clinical guidelines are essential to provide valuable guidance on clinical
practice, some recommendations lack robust evidence. Yet, once published
as a guideline, they may be followed rigidly without assessment or
consideration of the level of evidence. Though guidelines are meant to
inform rather than replace clinical judgement, this concept might be
overlooked. Furthermore, there will be a point where diminishing returns
are reached whereby adding more resources and intervention while holding
other factors constant will not result in reduction in infection rates.
The financial and social cost can then become disproportionally high
compared to clinical benefits. It is important to realize that resource is
finite and a greater harm and significant negative impact on society, such
as more frequent and intense weather events, may be caused by trying to
achieve a relatively small gain. Furthermore, better financial and
resource allocation to other parts of healthcare may yield greater
clinical benefits, for example, allocate funding on climate resiliency.
Conclusion Therefore, looking ahead, there needs to be a raise in
awareness and education, while drafting policy that balances infection
prevention taking account of responsible use of resources without
compromising patient safety.

<103>
Accession Number
648619385
Title
DEXMEDETOMIDINE IN PARAVERTEBRAL BLOCK FOR ATYPICAL LOBECTOMY: A
COMPARATIVE STUDY.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A77), 2025. Date of Publication: 01 Sep 2025.
Author
Masoodi A.; Anna Y.; Rumiantseva O.; Oleksandr Z.; Dziuba D.
Institution
(Masoodi, Anna, Oleksandr, Dziuba) Kyiv Clinical Regional Hospital,
Anesthesiology, ICU and ED, Kyiv, United Kingdom
(Masoodi, Dziuba) Shupyk National Healthcare University of Ukraine,
Department of Anesthesiology and Intensive Care, Kyiv, United Kingdom
(Rumiantseva) Clinic, 'Opora', Kyiv, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background and Aims This study aimed to evaluate the analgesic
effectiveness and perioperative outcomes of paravertebral block (PVB)
using 0.25% bupivacaine alone versus 0.25% bupivacaine combined with
dexmedetomidine in patients undergoing atypical lobectomy. Methods Thirty
patients undergoing atypical lobectomy were randomly assigned to two equal
groups. Group A received a single-shot US-guided paravertebral block with
0.25% bupivacaine (20 ml), while Group B received the same concentration
and volume of bupivacaine combined with 50 mg of dexmedetomidine. All
patients underwent general anesthesia.Parameters assessed included
demographic and intraoperative data, fentanyl consumption, postoperative
pain using the visual analog scale (VAS) at 1 and 3 hours, duration of
analgesia, and type of surgical procedure. Statistical comparisons were
made using appropriate tests, with a significance level of p < 0.05.
Results The mean age in Group A was 56.9 +/- 8.47 years, and in Group B it
was 54.7 +/- 8.70 years (p = 0.489). The male-to-female ratio was 9:10 in
Group A and 7:10 in Group B. ASA physical status II- III. The mean
duration of surgery was 135.0 +/- 49.93 minutes in Group A and 137.0 +/-
50.21 minutes in Group B (p = 0.914).None of these differences were
statistically significant.Pain scores at 3 hours postoperatively were
significantly lower in Group B (1.9 +/- 1.13) compared to Group A (5.5 +/-
1.55), p = 0.000. The duration of analgesia was significantly longer in
Group B (9.3 +/- 1.01 hours vs. 4.8 +/- 1.10 hours, p = 0.001). No
significant differences were found in VAS at 1 hour, intraoperative
fentanyl use. Conclusions The addition of dexmedetomidine to bupivacaine
in paravertebral block significantly enhances the quality and duration of
postoperative analgesia in patients undergoing atypical lobectomy. This
combination is a safe and effective strategy to optimize pain management
in thoracic surgery.

<104>
Accession Number
648619434
Title
METHADONE FOR PERIOPERATIVE PAIN MANAGEMENT IN PAEDIATRIC PATIENTS.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd European Society
of Regional Anaesthesia and Pain Therapy, ESRA. Oslo Norway. 50(Supplement
1) (pp A352-A354), 2025. Date of Publication: 01 Sep 2025.
Author
De Negri P.; De Negri C.
Institution
(De Negri, De Negri) Intensive Care and Pain Medicine, AORN S.Anna e S.
Sebastiano - Caserta, Caserta, Italy
Publisher
BMJ Publishing Group
Abstract
Background Perioperative pain management in paediatric patients presents
unique challenges due to differences in physiology, pain perception, and
pharmacokinetics compared to adults. Inadequate pain control can have both
immediate and long-term consequences, including delayed recovery,
increased risk of chronic pain, and psychological distress. Traditional
opioid analgesics, while effective, are associated with significant side
effects and risks, such as respiratory depression, opioid-induced
hyperalgesia, and the potential for tolerance and dependence. Methadone, a
synthetic opioid with a distinctive pharmacological profile, offers a
promising alternative or adjunct in this context. Its use in paediatric
perioperative settings has been limited but is gaining traction as new
evidence emerges. Pharmacological properties of methadone: Methadone
mechanism of action. As a potent m-opioid receptor agonist, it provides
robust analgesia. Simultaneously, its antagonism of the NMDA receptor
contributes to reduced central sensitization, inhibition of opioid-induced
hyperalgesia, and potential prevention of chronic post-surgical pain.
Methadone's long and variable half-life (ranging from 8 to 59 hours in
children, depending on age and individual metabolism) supports sustained
analgesic effects, which can be particularly beneficial for procedures
associated with significant or prolonged pain. Pharmacokinetically,
methadone is highly lipophilic, resulting in extensive tissue distribution
and a large volume of distribution. It is metabolized in the liver,
primarily by CYP3A4, CYP2B6, and CYP2D6 enzymes, with considerable
inter-individual variability. This variability underpins the need for
individualized dosing and careful monitoring, especially in paediatric
populations, where developmental differences further complicate
pharmacokinetics. Rationale for perioperative use in children: The
rationale for methadone use in paediatric perioperative care is grounded
in its ability to provide prolonged analgesia from a single intraoperative
dose, potentially reducing the need for repeated opioid administration and
minimizing fluctuations in pain control. Methadone's NMDA antagonism may
also decrease the risk of developing opioid tolerance and opioid-induced
hyperalgesia, both of which are significant concerns in children
undergoing repeated or extensive surgical interventions. Moreover, the
efficacy of methadone in treating neuropathic pain makes it a valuable
option for surgeries involving nerve injury or where neuropathic pain
components are anticipated, such as spinal fusion, major orthopaedic
procedures, or thoracotomies. Clinical evidence: Although the paediatric
literature on perioperative methadone is not as extensive as in adults, a
growing body of studies supports its utility. Several prospective
randomized controlled trials and retrospective cohort studies have
evaluated the efficacy and safety of intraoperative methadone in children:
- In spinal fusion surgery, single intraoperative doses of methadone
(0.2-0.3 mg/kg) have been associated with lower postoperative pain scores,
reduced opioid consumption, and decreased need for rescue analgesia
compared to morphine or fentanyl. - Studies in paediatric cardiac and
abdominal surgery have reported similar findings, with methadone providing
prolonged analgesia and improved patient comfort, often with no increase
in adverse events when appropriately monitored. - Case series and smaller
trials suggest that methadone's benefits extend to patients with opioid
tolerance, where it can help overcome tolerance-related challenges and
provide effective pain control Despite these positive findings, the
evidence base remains limited by small sample sizes, heterogeneous dosing
regimens, and variability in outcome measures. Larger, multicentre trials
are needed to confirm these results and develop standardized protocols.
Safety profile and risk mitigation: The main safety concerns with
methadone in paediatric perioperative care are: - Respiratory depression:
the long half-life of methadone increases the risk of delayed respiratory
depression, necessitating extended monitoring postoperatively, especially
in children with risk factors such as obesity, sleep-disordered breathing,
or concurrent sedative use. - QT Interval prolongation: methadone can
prolong the QT interval, predisposing to torsades de pointes and other
arrhythmias. Baseline and postoperative ECG monitoring are recommended in
children with known cardiac disease, electrolyte imbalances, or those on
other QT-prolonging drugs. Drug accumulation and interactions: Owing to
its hepatic metabolism, the clearance of methadone may be affected by drug
interactions (e.g., CYP inhibitors/inducers) and liver dysfunction.
Individualized dosing and awareness of potential interactions are
critical. Other side effects: Nausea, vomiting, constipation, and pruritus
are common to all opioids, including methadone. These are generally
managed with standard supportive measures. Overall, when administered by
experienced clinicians in a monitored setting, the safety profile of
methadone 22is comparable to other opioids, with the added benefit of less
frequent dosing. Practical application and dosing strategies: methadone is
typically administered as a single intravenous dose at induction of
anaesthesia, with suggested doses ranging from 0.1 to 0.3 mg/ kg (maximum
doses vary by protocol and institutional practice). Lower doses are
advisable in younger children or those with risk factors for adverse
effects. The timing of administration is usually at induction or early in
the procedure to allow for titration and observation of initial effects.
Postoperative pain management should continue to incorporate multimodal
strategies, including acetaminophen, NSAIDs, and regional anaesthesia
where appropriate. The prolonged action of methadone may reduce or
eliminate the need for patient-controlled analgesia (PCA) or frequent
nurse-administered opioid boluses, streamlining postoperative care and
potentially facilitating earlier mobilization and discharge. Patient
selection and monitoring: Not all paediatric patients are ideal candidates
for perioperative methadone. Careful preoperative assessment is essential,
with particular attention to: - Cardiac history and baseline ECG -
Respiratory comorbidities (e.g., sleep apnea) - Hepatic and renal function
- Concomitant medications (especially those affecting QT interval or
methadone metabolism) - Continuous cardiorespiratory monitoring is
recommended for at least 24 hours postoperatively in patients receiving
methadone, with prompt recognition and management of any adverse effects.
Current guidelines and expert consensus: There are currently no
universally accepted guidelines for perioperative methadone use in
paediatric patients. However, expert panels and institutional protocols
increasingly recognize its value in selected cases, particularly for: -
Major surgeries with expected severe or prolonged pain - Patients with
opioid tolerance or chronic pain syndromes - Cases where conventional
opioids have failed or produced unacceptable side effects - Education of
the entire perioperative team-including anaesthesiologists, surgeons,
nurses, and pharmacists-is vital to ensure safe and effective use. Future
directions and research needs: Key areas for future research include: -
Large, multicentre randomized controlled trials to establish optimal
dosing, efficacy, and safety across diverse paediatric populations and
surgical procedures - Pharmacogenomic studies to identify predictors of
methadone metabolism and response, enabling personalized medicine
approaches - Long-term outcome studies to assess the impact of
perioperative methadone on chronic pain development, opioid use patterns,
and quality of life - Comparative effectiveness research evaluating
methadone against other long-acting opioids and multimodal analgesic
strategies Additionally, the development of standardized protocols and
consensus guidelines will facilitate broader and safer adoption of
methadone in paediatric perioperative care. Conclusions methadone is an
underutilized but promising option for perioperative pain management in
paediatric patients. Its unique pharmacological profile-combining potent
opioid analgesia with NMDA antagonism-offers several potential advantages
over conventional opioids, including prolonged pain relief, reduced opioid
requirements, and mitigation of opioid-induced hyperalgesia and tolerance.
While safety concerns exist, particularly regarding respiratory depression
and QT prolongation, these can be managed with careful patient selection,
individualized dosing, and vigilant postoperative monitoring. As evidence
continues to accumulate, methadone may assume a more prominent role in
paediatric anaesthesia, particularly for children undergoing major
surgery, those with opioid tolerance, or in cases refractory to standard
analgesic regimens. Ongoing research and the development of clear
guidelines will be essential to maximize the benefits and minimize the
risks associated with its use.

<105>
Accession Number
648618135
Title
Beyond biomarkers: the relevance of supporting evidence in the diagnosis
of periprocedural myocardial infarction.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2025. Date of Publication: 15 Sep 2025.
Author
Swinnen B.; Gollman-Tepekoylu C.; Heuts S.
Institution
(Swinnen, Heuts) Department of Cardiothoracic Surgery, Maastricht
University Medical Centre, Maastricht, Netherlands
(Swinnen, Heuts) Cardiovascular Research Institute Maastricht, Maastricht
University, Maastricht, Netherlands
(Swinnen) Department of Radiology and Nuclear Medicine, Maastricht
University Medical Centre, Maastricht, Netherlands
(Gollman-Tepekoylu) Department of Cardiac Surgery, Innsbruck Medical
University, Innsbruck, Austria

<106>
Accession Number
648608656
Title
A SYSTEMATIC REVIEW AND META-ANALYSIS OF MICRORNA AS PREDICTIVE BIOMARKERS
OF ACUTE KIDNEY INJURY.
Source
Heart. Conference: British Cardiovascular Society Annual Conference, BCS
2025. Manchester United Kingdom. 111(Supplement 3) (pp A244-A246), 2025.
Date of Publication: 01 Sep 2025.
Author
Brown N.; Roman M.; Miller D.; Murphy G.; Wozniak M.J.
Institution
(Brown, Roman, Miller, Murphy, Wozniak) University of Leicester,
Leicester, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Acute kidney injury (AKI) affects up to 15% of hospitalised patients and
commonly arises following severe infections, major surgeries, or exposure
to nephrotoxic agents. AKI diagnosis based on changes in serum creatinine
levels lacks specificity and may delay diagnosis. MicroRNAs (miRNAs) are
short, non-coding RNA oligonucleotides secreted by all cell types. This
systematic review evaluated studies investigating miRNAs in AKI to assess
their potential as diagnostic markers. Data were included from patients
diagnosed with AKI related to sepsis, cardiopulmonary bypass surgery,
nephrotoxins, ischemia, radiocontrast exposure, shock, and trauma.
Seventy-one studies were included in the review, with the majority focused
on sepsis-induced AKI, followed by AKI due to cardiac surgery, ICU
admission, and exposure to nephrotoxic agents or ischemic conditions.
Studies that employed untargeted assays identified 856 differentially
expressed miRNAs, although none were validated across more than one study.
Additionally, 68 studies used a targeted approach, measuring miRNAs by
qRT-PCR, and reported downregulation of miR-495-3p and miR-370-3p in
sepsisinduced AKI after diagnosis. Upregulation of miR-21 at the time of
AKI diagnosis was reported in three studies, with a significant pooled
effect size of 0.56. Whilst miR-21 levels were also measured 19-24 hours
post-cardiac surgery in three studies, the pooled effect was not
significant. Despite extensive research into miRNAs in AKI, a significant
knowledge gap remains regarding their applicability as diagnostic
biomarkers in human AKI.

<107>
Accession Number
2040470480
Title
Prospective clinical trial evaluating the impact on mobilization after
major robotic urologic surgery: The move trial.
Source
European Urology Open Science. Conference: 22nd Meeting of the EAU Robotic
Urology Section. London United Kingdom. 79(Supplement) (pp S46), 2025.
Date of Publication: 01 Sep 2025.
Author
Goms L.; Schiereck T.; Gallardo L.; Degener S.; Karthaus C.; Holz L.;
Hensen M.-T.; Muller L.; Jacobsen M.; Von Rundstedt F.-C.
Institution
(Goms, Schiereck, Gallardo, Degener, Karthaus, Holz, Hensen, Von
Rundstedt) Helios University Hospital Wuppertal, University of
Witten-Herdecke, Dept. of Urology, Wuppertal, Germany
(Muller) Medical Faculty Heinrich Heine University Dusseldorf, Dept. of
Biology, Dusseldorf, Germany
(Jacobsen) University Hospital RWTH Aachen, Dept. of Internal Medicine,
Aachen, Germany
Publisher
Elsevier B.V.
Abstract
Introduction & Objectives: Ambulation after major surgery is essential for
the length of stay after major surgery. At the same time mobilizing
patients has the potential to reduce respiratory, gastrointestinal and
thrombo-embolic complications. We have evaluated the impact of digitally
based instruction videos on the mobility of patients in the postoperative
setting and their impact on postoperative complications and the ength of
stay. <br/>Material(s) and Method(s): We randomly assigned, in a 1:1
ratio, patients after major robotic surgery to digitally based instruction
videos for mobilization using tablet computers versus standard of care
(encouragement to ambulate by surgeons and nursing staff). A total of 340
patients were randomized. Baseline activity was measured by PASE scores.
Patient activity and vital signs were monitored with CE activity trackers.
Physical activity was comprehensively measured through an activity score
which was continously recorded and analyzed with a median value per hour.
Clinical Data and Complications were recorded for the 30-day postoperative
period. The primary outcome was physical activity. Secondary endpoints
were length of stay, postoperative complications correlated with changes
in vital signs. <br/>Result(s): 340 eligible patients where randomly
assigned to digital instruction videos (168) versus simple encouragement
to ambulate (172). Median age of patients was 66 years. Median Length of
Stay was 5 days. The preoperative PASE score was 122 and 136 in the
control group. Patient in the interventional group showed initially higher
activity scores on postoperative day 1 and 2 but there was no significant
difference in overall physical activity between the two groups over the
course of the hospital stay. By assessment of the activity trackers the
heart rate and respiratory rate decreased continuously over the course of
the hospital stay (HR: -3.5 [-4.9; -2.2], p<0.001; RR: -1.3 [-1.7; -0.8],
p<0.0019). Heart rate variability as a sign of physical recovery was
increased respectively. (HRV: +3.5 [1.1; 6.0], p=0.004). This gradual
change of HR and HRV was not detected in patients with surgical or
genitourinary complications. <br/>Conclusion(s): As compared to the
standard ambulation protocol, the use of instruction videos for
postoperative mobilization did not lead to a measureable improvement in
physical activity or a reduction of postoperative complications. The
length of stay was significantly reduced in patients undergoing robotic
kidney surgery. Changes in Heart rate and heart rate variability were less
pronounced in patients with postoperative complications. In patients with
an eventful recovery the change of heart rate and heart rate variability
reflected a common pattern of normalization over the course of the
hospital stay.<br/>Copyright &#xa9; 2025 European Association of Urology.
Published by Elsevier B.V.

<108>
Accession Number
648600569
Title
Everolimus and Low-Dose Tacrolimus After Heart Transplant in Children: A
Randomized Clinical Trial.
Source
JAMA. (no pagination), 2025. Date of Publication: 17 Sep 2025.
Author
Almond C.S.; Daly K.P.; Albers E.L.; Alejos J.C.; Ameduri R.; Auerbach
S.R.; Barkoff L.; Barnes A.P.; Bock M.J.; Butto A.; Carlo W.F.;
Castleberry C.D.; Chrisant M.R.; Deshpande S.R.; Dreyer W.J.; Everitt
M.D.; Feingold B.; Gonzales S.; Hollander S.A.; Kindel S.J.; Klein G.L.;
Lal A.K.; Lamour J.M.; Lee J.; Lu M.; Lytrivi I.D.; Miyamoto S.D.; Pahl
E.; Peng D.M.; Ryan T.D.; Singh T.P.; Su J.A.; Sutcliffe D.L.; Ybarra
A.M.; Zangwill S.; Rossano J.W.; Sleeper L.A.
Institution
(Almond, Barkoff, Gonzales, Hollander, Lee) Department of Pediatrics
(Cardiology), Stanford University School of Medicine, Palo Alto, CA,
United States
(Daly, Klein, Lu, Singh, Sleeper) Department of Cardiology, Boston
Children's Hospital, Department of Pediatrics, Harvard Medical School,
Boston, MA, United States
(Albers) Seattle Children's Hospital, Seattle, WA, United States
(Alejos) University of California Los Angeles Mattel Children's Hospital,
Los Angeles, Mexico
(Ameduri) Mayo Clinic, Rochester, MN, United States
(Auerbach, Everitt, Miyamoto) University of Colorado, Children's Hospital
Colorado Heart Institute, Anschutz Medical Campus, Aurora, United States
(Barnes) Department of Pediatrics, Children's Mercy Hospital, University
of Missouri Kansas City, Kansas City, MO, United States
(Bock) Division of Pediatric Cardiology, Loma Linda University Children's
Hospital, Loma Linda University School of Medicine, Loma Linda, CA, United
States
(Butto) Children's Healthcare of Atlanta, Atlanta, Georgia
(Carlo) University of Alabama at Birmingham, Birmingham, United Kingdom
(Castleberry, Ybarra) Departments of Pediatrics, St Louis Children's
Hospital, Washington University in Saint Louis, St Louis, MO, United
States
(Chrisant) Joe DiMaggio Children's Hospital, Hollywood, FL, Puerto Rico
(Deshpande) Children's National Health System, WA, United States
(Dreyer) Texas Children's Hospital, Baylor College of Medicine, Houston,
United States
(Feingold) UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United
States
(Kindel) Medical College of Wisconsin, Milwaukee, United States
(Lal) Department of Pediatrics Primary Children's Hospital, University of
Utah School of Medicine, Salt Lake City, United States
(Lamour) Children's Hospital at Montefiore, Bronx, NY, United States
(Lytrivi) Columbia University Medical Center, NY, United States
(Pahl) Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital
of Chicago, Northwestern School of Medicine, Chicago, IL, United States
(Peng) Department of Pediatrics (Cardiology), University of Michigan
Medical School, Ann Arbor, United States
(Ryan) Heart Institute, University of Cincinnati College of Medicine,
Cincinnati Children's Hospital and Medical Center and Department of
Pediatrics, Cincinnati, OH, United States
(Su) Children's Hospital of Los Angeles, Los Angeles, CA, United States
(Sutcliffe) Children's Medical Center of Dallas, University of Texas
Southwestern, Dallas, United States
(Zangwill) Phoenix Children's Hospital, Phoenix, AZ, United States
(Rossano) Children's Hospital of Philadelphia, University of Pennsylvania
School of Medicine, Philadelphia, United States
Abstract
Importance: Studies suggest that everolimus may reduce the risk of
rejection, cardiac allograft vasculopathy (CAV), chronic kidney disease
(CKD), and cytomegalovirus (CMV) after heart transplant. Everolimus use is
controversial because of data demonstrating higher infection deaths when
everolimus is introduced de novo after transplant. It is unclear whether
everolimus is safe and effective when initiated at 6 months posttransplant
in children, a population in which median graft survival is limited to 15
years and randomized clinical trials are lacking. <br/>Objective(s): To
evaluate the safety and efficacy of everolimus combined with low-dose
tacrolimus to prevent major adverse transplant events (MATEs) in children
after heart transplant. <br/>Design, Setting, and Participant(s):
Multicenter, randomized, open-label, clinical trial enrolling 211 patients
who were alive 6 months after pediatric heart transplant at 25 US sites
from February 2018 to August 2020. The last date of follow-up was April
17, 2023. <br/>Intervention(s): Participants were randomized to receive
everolimus and low-dose tacrolimus (n = 107) or standard-dose tacrolimus
and mycophenolate mofetil (n = 104) for 30 months. <br/>Main Outcomes and
Measures: The primary efficacy end point was the MATE-3 score at 30
months, a validated composite ordinal end point including acute cellular
rejection, CAV, and CKD. The primary safety end point was the MATE-6
score, encompassing the MATE-3 score plus antibody-mediated rejection,
infection, and posttransplant lymphoproliferative disorder.
<br/>Result(s): Among 211 children randomized, the mean age was 8.2 (SD,
6.3) years, 97 (46%) underwent transplant for congenital heart disease,
and 49 (23%) were treated for rejection before 6 months. At 30 months, the
mean MATE-3 score did not differ between the 2 treatment groups (mean
difference, -0.32; 95% CI, -0.90 to 0.20; P = .16). The mean MATE-6 score
was no higher in the everolimus group than in the mycophenolate group
(baseline-adjusted mean difference, -0.40; 95% CI, -1.81 to 0.93), meeting
the success criterion for safety (noninferiority margin <3). There were no
differences in graft survival, MATE-free survival, or freedom from any
individual MATE. Everolimus was associated with greater improvement in
estimated glomerular filtration rate at 12 months (mean difference, 10.5
mL/min/1.73 m2; 95% CI, 1.09-19.91 mL/min/1.73 m2) and a lower incidence
of CMV infection (hazard ratio, 0.50; 95% CI, 0.26-0.93). <br/>Conclusions
and Relevance: Among 6-month pediatric heart transplant survivors,
everolimus and low-dose tacrolimus did not differ from tacrolimus and
mycophenolate in preventing the composite of cellular rejection, CAV, and
CKD at 30 months. However, everolimus and low-dose tacrolimus appear to be
safe based on the total burden of 6 MATEs and may be associated with
improved kidney function and less CMV infection. Trial Registration:
ClinicalTrials.gov Identifier: NCT03386539.

<109>
Accession Number
648604720
Title
Less Is More for Bleeding Management Algorithms in Cardiac Surgery: A
Network Meta-Analysis and Meta-Regression of Randomized Studies.
Source
Anesthesia and analgesia. (no pagination), 2025. Date of Publication: 17
Sep 2025.
Author
Barbaria A.; Baryshnikova E.; Anguissola M.; Landi G.; Aloisio T.;
Casalino S.; Ranucci M.
Institution
(Barbaria, Baryshnikova, Anguissola, Aloisio, Casalino, Ranucci) From the
Department of Cardiovascular Anesthesia and Intensive Care, I.R.C.C.S.
Policlinico San Donato, Milan, Italy
(Landi) Department of Cardiothoracic Surgery, Heart and Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
Abstract
BACKGROUND: Major bleeding after cardiac surgery is still a relatively
common complication, requiring red blood cell (RBC) transfusions and use
of procoagulants. The existing guidelines recommend a bleeding management
based on viscoelastic tests and bleeding management algorithms (BMA).
However, there are different BMAs with different trigger values prompting
the use of different procoagulants; consequently, based on these trigger
values, a BMA can be more or less liberal in the use of drugs and blood
derivates aimed to control bleeding. At present, no studies have
investigated the effectiveness of liberal versus restrictive BMAs in
limiting the risk of RBC transfusion. <br/>METHOD(S): In this study, we
performed 2 network meta-analyses and a meta-regression of randomized and
nonrandomized (before and after) studies where a BMA was applied. Based on
the trigger values prompting the use of procoagulants (fresh frozen
plasma, platelet concentrate, fibrinogen concentrate, prothrombin complex
concentrate, recombinant activated factors), we have adjudicated the
various BMAs to a restrictive or liberal group, and we compared the
effectiveness of restrictive versus liberal BMAs in limiting RBC
transfusions. Additionally, the consumption of procoagulants was compared
between the 2 groups. <br/>RESULT(S): Both restrictive and liberal BMAs
were superior to conventional strategies in limiting RBC transfusions
(rate and units). Restrictive BMAs were more effective than liberal BMAs
in terms of RBC units transfused (mean difference -0.43 units, 95%
confidence interval [CI], -0.80 to -0.07, P = .020). The RBC transfusion
rate was tested after correction for potential confounders (complexity of
surgery and hematocrit trigger for RBC transfusion) with a meta-regression
RBC transfusion rate was significantly lower in restrictive versus liberal
BMAs (odds ratio 0.728, 95% CI 0.569-0.932, P = .012). The use of any kind
of procoagulants was significantly (P = .001) lower in restrictive versus
liberal BMAs. <br/>CONCLUSION(S): Overall, viscoelastic test-based BMAs
are superior to conventional strategies in limiting RBC transfusions in
the presence of major bleeding; however, a restrictive strategy of
procoagulant administration is superior to a liberal strategy in terms of
RBC transfusion containment. Liberal BMAs are associated with a
significantly higher use of procoagulants without any benefit in terms of
RBC transfusions; therefore, in terms of cost/benefit ratio, restrictive
BMAs should be preferred.<br/>Copyright &#xa9; 2025 International
Anesthesia Research Society.

<110>
Accession Number
648617675
Title
Efficacy and Safety of Semaglutide on Cardiovascular Outcomes in Patients
with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized
Controlled Trials.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 19 Sep
2025.
Author
Bacha Z.; Javed J.; Sheraz M.; Sikandar M.; Zakir M.; Ali M.A.; Khan M.;
Iqbal A.; Rehman A.; Alam U.; Ahmed R.
Institution
(Bacha, Sikandar, Zakir, Ali, Khan, Rehman, Alam) From the Department of
Medicine, Khyber Medical College, Peshawar, Pakistan
(Javed) Department of Medicine, Jinnah Sindh Medical University, Karachi,
Pakistan
(Sheraz) Department of Medicine, Continental Medical College, Lahore,
Pakistan
(Iqbal) Department of Medicine, Bacha Khan Medical College, Mardan,
Pakistan
(Ahmed) Department of Cardiology, National Institute of Heart and Lung,
Imperial College, London, United Kingdom
Abstract
Cardiovascular complications remain the leading cause of morbidity and
mortality in patients with type 2 diabetes mellitus (T2DM), despite
substantial advances in pharmacologic management. Semaglutide, a
glucagon-like peptide-1 receptor agonist, has shown potential in reducing
cardiovascular events through its multifaceted metabolic and
anti-inflammatory effects. This systematic review and meta-analysis aimed
to assess the efficacy and safety of semaglutide in improving
cardiovascular outcomes among patients with T2DM. A comprehensive
literature search was conducted across multiple databases up to March 30,
2025. Randomized controlled trials comparing semaglutide with placebo in
adults with T2DM were included. Five randomized controlled trials with a
total of 19,717 participants were included. Semaglutide was associated
with a significant reduction in major adverse cardiovascular events [risk
ratios (RR), 0.82; P < 0.00001], cardiovascular death (RR, 0.81; P =
0.05), and need for coronary revascularization (RR, 0.74; P < 0.0001). A
significant reduction in cardiac disorder-related adverse events was also
observed (RR = 0.80; P = 0.03). No significant difference was noted in
all-cause mortality (RR = 0.83; P = 0.16), hospitalization for heart
failure (RR = 0.86; P = 0.10) or unstable angina (RR = 0.94; P = 0.63),
nonfatal myocardial infarction (RR = 0.82; P = 0.10) or stroke (RR = 0.83;
P = 0.06), and vascular disorders (RR = 1.03; P = 0.73). These findings
highlight semaglutide's role as a cardioprotective agent, supporting its
integration into standard care for high-risk T2DM patients.<br/>Copyright
&#xa9; 2025 Wolters Kluwer Health, Inc. All rights reserved.

<111>
Accession Number
2036076342
Title
Minimally invasive surgical approaches for pneumothorax: evolution and
current perspectives.
Source
Expert Review of Respiratory Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
Mizobuchi T.; Ito Y.; Sobue A.; Tada Y.; Nagato K.; Yamamoto T.
Institution
(Mizobuchi, Ito, Sobue, Tada, Nagato, Yamamoto) Department of General
Thoracic Surgery, Social Welfare Organization Saiseikai Imperial Gift
Foundation, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: PubMed was used for a literature search (1990-2025) on the
minimally invasive surgical approaches for pneumothorax, which have
evolved markedly, with video-assisted thoracic surgery (VATS) emerging as
a preferred procedure. Systematic reviews of randomized control trials
indicate that VATS is less invasive than traditional thoracotomy.
Furthermore, uniportal VATS provides less postoperative pain and better
cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems
preferred as the minimally invasive surgical approach for pneumothorax.
New devices such as small-diameter thoracoscopes and forceps, which are
used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted
thoracic surgery, may contribute to reducing the postoperative incidence
of intercostal neuralgia and enhancing satisfaction with the cosmetic
results. Areas covered: The ideal surgical approaches for pneumothorax,
referencing guidelines, and studies from various countries. Expert
opinion: This review explores various aspects of minimally invasive
surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via
the intercostal approach is commonly performed worldwide and ensures high
surgical quality. This review discusses what should be performed within
the thoracic cavity to reduce the postoperative recurrence rate of
pneumothorax, problems associated with thoracic adhesions that may be
disadvantageous for pneumothorax patients in the future, and the latest
surgical approaches that may become mainstream.<br/>Copyright &#xa9; 2025
Informa UK Limited, trading as Taylor & Francis Group.

<112>
Accession Number
648617323
Title
Left Main Revascularization in Patients with Chronic Kidney Disease: A
Systematic Review and Meta-Analysis.
Source
Current cardiology reviews. (no pagination), 2025. Date of Publication:
17 Sep 2025.
Author
Gialamas I.; Kalogeras K.; Pantelidis P.; Zakynthinos G.E.; Lysandrou A.;
Katsianos E.; Goliopoulou A.; Gounaridi M.I.; Vythoulkas-Biotis N.;
Katsarou O.; Oikonomou E.; Siasos G.; Vavuranakis M.
Institution
(Gialamas, Kalogeras, Pantelidis, Zakynthinos, Lysandrou, Katsianos,
Goliopoulou, Gounaridi, Vythoulkas-Biotis, Katsarou, Oikonomou, Siasos,
Vavuranakis) 3rd Department of Cardiology, Sotiria Chest Disease Hospital,
Medical School, National and Kapodistrian University of Athens, Athens,
Greece
Abstract
INTRODUCTION/OBJECTIVE: This systematic review and meta-analysis compares
percutaneous coronary intervention (PCI) with coronary artery bypass
grafting (CABG) as revascularization strategies for patients with left
main coronary artery disease (LMCAD) and chronic kidney disease (CKD).
<br/>METHOD(S): A comprehensive search of PubMed, Embase, and CENTRAL was
conducted, with a pre-registered study protocol registered on PROSPERO
(ID: CRD42024496529). The primary endpoint was major adverse cardiac and
cerebrovascular events (MACCE), a composite of allcause mortality,
myocardial infarction (MI), stroke, or ischemia-driven revascularization.
Secondary endpoints included each component of MACCE and 30-day all-cause
mortality. <br/>RESULT(S): Seven studies were analyzed, including five
cohort studies and two subanalyses of randomized clinical trials,
encompassing 3,475 patients. PCI was associated with a higher incidence of
MACCE (hazard ratio [HR]: 1.50; 95% confidence interval [CI] 1.26-1.79),
driven by allcause mortality (HR: 1.38; 95% CI 1.07-1.78), MI (HR: 1.75;
95% CI 1.17-2.62), and ischemiadriven revascularization (HR: 3.22; 95% CI
2.10-4.93). There were no differences in stroke rates (HR: 0.70; 95% CI
0.40-1.22) or 30-day all-cause mortality (odds ratio [OR]: 0.92; 95% CI
0.35-2.41). <br/>DISCUSSION(S): While previous studies have reported
conflicting evidence regarding the noninferiority of PCI to CABG in
patients with LMCAD, our pooled analysis demonstrates an increased
incidence of MACCE in the PCI group, primarily driven by higher rates of
all-cause mortality, myocardial infarction, and ischemia-driven
revascularization. The findings suggest that CKD may play a role in
clinical outcomes comparable to diabetes in multivessel disease and should
be a key factor in revascularization decisions. <br/>CONCLUSION(S): CABG
is associated with superior long-term outcomes compared to PCI in patients
with LMCAD and CKD. However, dedicated randomized controlled trials
stratified by CKD stage are essential to guide optimal treatment
strategies in this high-risk population.<br/>Copyright&#xa9; Bentham
Science Publishers; For any queries, please email at
epub@benthamscience.net.

<113>
Accession Number
648615056
Title
Comparative Efficacy and Safety of Transcatheter Aortic Valve Replacement
Versus Surgical Aortic Valve Replacement in Patients With End-Stage Renal
Disease: A Systematic Review and Meta-Analysis.
Source
Cardiology in review. (no pagination), 2025. Date of Publication: 19 Sep
2025.
Author
Bacha Z.; Javed J.; Khattak F.; Shah I.M.; Ali M.A.; Sheraz M.; Wali E.;
Shahid I.; Farooq A.; Obaid Ullah Z.; Khan Z.; Al-Badri S.G.; Sajjad F.;
Henna F.; Irfan S.
Institution
(Bacha, Khattak, Shah, Ali, Wali, Farooq, Khan, Sajjad) From the
Department of Medicine, Khyber Medical College, Peshawar, Pakistan
(Javed) Department of Medicine, Jinnah Sindh Medical University, Karachi,
Pakistan
(Sheraz) Department of Medicine, Continental Medical College, Lahore,
Pakistan
(Shahid) Department of Medicine, King Edward Medical University, Lahore,
Pakistan
(Obaid Ullah) Department of Medicine, Fatima Jinnah Medical University,
Lahore, Pakistan
(Al-Badri) Department of Medicine, College of Medicine, University of
Warith Al-Anbiyaa, Karbala, Iraq
(Henna) Department of Medicine, Dubai Medical College for Girls, Dubai,
United Arab Emirates
(Irfan) Department of Medicine, Department of Preventive medicine,
Ministry of Health, Kuwait
Abstract
End-stage renal disease (ESRD) severely elevates the risks of aortic
stenosis interventions. While surgical aortic valve replacement (SAVR) has
traditionally been the gold standard treatment, transcatheter aortic valve
replacement (TAVR) has been introduced as a minimally invasive
alternative. This systematic review and meta-analysis aimed to evaluate
the safety and efficacy of TAVR compared with SAVR in patients with ESRD.
Adhering to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines, a comprehensive literature search of databases
PubMed, Embase, and Web of Science up to March 2025 found 7 cohort studies
comprising 15,462 patients. Primary outcomes consisted of 30-day and
in-hospital mortality, while secondary outcomes evaluated pacemaker
implantation, complications, length of stay, costs, and discharge report.
TAVR was related to considerably lower in-hospital mortality (risk ratio,
0.52) and a pattern toward decreased 30-day mortality. It also decreased
the risks of cardiac tamponade, respiratory issues, blood transfusions,
and transfers to other facilities. No TAVR was associated with increased
rates of pacemaker implantation and vascular complications. It notably
shortened hospital stay and enhanced home discharge rates, while
healthcare costs were lower compared with SAVR. Sensitivity analyses
validated the reliability of most findings. Regardless of high
heterogeneity and limitations consisting of geographic restriction to the
United States and limited long-term outcomes, this study contributes to
evidence that TAVR may offer superior short-term outcomes for patients
with ESRD, especially those at high surgical risk. Clinical decisions
should be personalized, weighing procedural risks against impactful
benefits.<br/>Copyright &#xa9; 2025 Wolters Kluwer Health, Inc. All rights
reserved.

<114>
Accession Number
648615241
Title
Rationale and Design of the EPISODE Trial: A Randomized Controlled Trial
on the Effect of PCSK9 Inhibitors in Calcific Aortic Valve Stenosis.
Source
Journal of the American Heart Association. (pp e042112), 2025. Date of
Publication: 19 Sep 2025.
Author
Zheng Y.; Li Q.; Yang Y.; Yang J.; Liu Z.; Ma X.; Wang Z.
Institution
(Zheng, Li, Yang, Yang, Liu, Ma, Wang) Department of Cardiology, Beijing
Anzhen Hospital Capital Medical University Beijing China, China
(Ma, Wang) Beijing Institute of Heart Lung and Blood Vessel Disease,
Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic
Disease, Clinical Center for Coronary Heart Disease Capital Medical
University Beijing China, China
Abstract
BACKGROUND: Calcific aortic valve stenosis (CAVS) can lead to cardiac
adverse outcomes; however, currently, no effective pharmacological
interventions are available to prevent or delay disease progression.
Emerging evidence has identified significant associations between CAVS and
key biomarkers, including Lp(a) (lipoprotein [a]), low-density lipoprotein
cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9).
However, robust evidence from randomized controlled trials is still
lacking to substantiate these associations. <br/>METHOD(S): The EPISODE
(Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a
prospective, evaluator-blinded, randomized controlled trial designed to
assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS.
A total of 160 patients with mild-to-moderate or asymptomatic severe CAVS
will be randomly assigned to receive either statin monotherapy or a
combination of statins and PCSK9 inhibitors. Participants will undergo
follow-up assessments at 3-month intervals for 24 months, including
transthoracic ultrasonic cardiogram, computed tomography, and
quality-of-life evaluations using the EuroQol-5 Dimension-3 Level
questionnaire. The primary end point is the annualized change in peak
aortic jet velocity, whereas secondary end points encompass changes in
aortic valve area, calcification score, incidence of heart valve surgery,
and quality of life. Safety end points include all-cause mortality and
cardiovascular events. <br/>CONCLUSION(S): The trial aims to evaluate the
efficacy of PCSK9 inhibitors in modulating disease progression, reducing
adverse cardiovascular events, and improving clinical outcomes in patients
with CAVS. The anticipated findings are expected to provide critical
insights for developing novel therapeutic strategies for early
intervention in CAVS. REGISTRATION: URL: https://www.clinicaltrials.gov;
Unique Identifier: NCT04968509.

<115>
Accession Number
648621203
Title
Major Clinical Outcomes in Patients with Carotid Artery Stenosis
Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-analysis.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 17 Sep 2025.
Author
Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Ktenopoulos N.;
Koliastasis L.; Synetos A.; Drakopoulou M.; Tsalamandris S.; Latsios G.;
Tsioufis K.; Toutouzas K.
Institution
(Theodoropoulou, Ktenopoulos, Koliastasis, Synetos, Drakopoulou,
Tsalamandris, Latsios, Tsioufis) Unit for Structural Heart Diseases and
Valvulopathies, First Department of Cardiology, Athens School of Medicine,
Hippokration Hospital, Athens, Greece
(Vythoulkas-Biotis) Third Departmnent of Cardiology, Athens School of
Medicine, Sotiria Thoracic Diseases Hospital of Athens, Greece
(Apostolos) Department of Cardiology, Harefield Hospital, Royal Brompton
and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust,
London, United Kingdom; Unit for Structural Heart Diseases and
Valvulopathies, First Department of Cardiology, Athens School of Medicine,
Hippokration Hospital, Athens, Greece
(Toutouzas) Unit for Structural Heart Diseases and Valvulopathies, First
Department of Cardiology, Athens School of Medicine, Hippokration
Hospital, Athens, Greece
Abstract
Data on carotid artery stenosis (CAS) prevalence in patients undergoing
transcatheter aortic valve replacement (TAVR) are limited. It remains
unclear whether CAS serves as a predictor of worse outcomes following
TAVR. This meta-analysis aims to assess the impact of CAS on major
clinical outcomes in this population. A comprehensive literature search
was conducted across three databases to identify relevant studies. The
primary endpoint was the 30-day incidence of Stroke or Transient Ischemic
Attack (TIA) in patients with CAS>=50% and CAS>=70%, respectively.
Secondary endpoints included in-hospital Stroke/TIA, in-hospital
mortality, 30-day mortality, bleeding events, myocardial infarction (MI),
acute kidney injury (AKI), periprocedural vascular complications, and
permanent pacemaker implantation (PPM) up to 30 days. A total of 15
studies, involving 129,155 patients, were included in the meta-analysis.
CAS was associated with higher rates of 30-day Stroke/TIA: 1) CAS >=50%
(Risk Ratio (RR): 1.38, 95% Confidence Intervals (CI): 1.19, 1.59), 2) CAS
>=70% (RR: 1.61, 95% CI: 1.10, 2.36). CAS comorbidity was also linked to
increased risk for in-hospital stroke/TIA (RR: 1.73, 95% CI: 1.28, 2.33),
30-day mortality (RR: 1.29, 95% CI: 1.13, 1.47), and 30-day bleeding
events (RR: 1.15, 95% CI: 1.08, 1.23). No differences were observed in the
rest secondary endpoints. In conclusion, CAS was associated with a higher
risk of 30-day and in-hospital cerebrovascular events following TAVR.
Patients with CAS are at an increased risk of 30-day all-cause mortality
without any impact on in-hospital mortality. Further studies are required
to validate our results.<br/>Crown Copyright &#xa9; 2025. Published by
Elsevier Inc. All rights reserved.

<116>
Accession Number
648608407
Title
SHIFTING TRENDS IN ANTITHROMBOTIC THERAPY: A RETROSPECTIVE SINGLE-CENTRE
ANALYSIS OF WARFARIN VS. DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH LEFT
VENTRICULAR THROMBUS.
Source
Heart. Conference: British Cardiovascular Society Annual Conference, BCS
2025. Manchester United Kingdom. 111(Supplement 3) (pp A167-A169), 2025.
Date of Publication: 01 Sep 2025.
Author
Oo M.M.; Cerquetani E.; Onuwaje O.; Patel A.; Chakrabarti G.; Garg S.
Institution
(Oo, Cerquetani, Onuwaje, Patel, Chakrabarti, Garg) Royal Blackburn
Hospital, Blackburn, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Current guidelines recommend warfarin as the first-line
treatment for left ventricular (LV) thrombus due to its well-established
efficacy. However, emerging evidence indicates that direct oral
anticoagulants (DOACs) may serve as potential alternatives. Aim To analyse
trends in the utilization of warfarin and DOACs for the management of LV
thrombus and evaluate their associated clinical outcomes. Methods Between
January 2019 and December 2024, 85,800 echocardiograms were performed at a
single-site, non-surgical cardiac centre in the UK. Reports were
retrospectively reviewed to identify newly diagnosed LV thrombus, with
patients stratified by clinician-selected anticoagulation (warfarin or
DOACs). Results The study cohort of 189 patients were predominantly male,
with a mean (+/-standard deviation) age of 66 +/- 14 years. The mean LV
ejection fraction (LVEF) at baseline was 35 +/- 11%. The average thrombus
diameter was 18 +/- 10 mm. Anticoagulant therapy was given in 170 patients
with 94 (49.7%) treated with warfarin, 70 (37%) with DOACs, and 6 (3.2%)
low molecular weight heparin; 19 (10.1%) patients received no treatment.
Among those receiving DOACs, Apixaban was most frequently prescribed
(37.1%), followed by equal usage of Rivaroxaban and Edoxaban (30% in each
group), and Dabigatran (2.9%). A switch from warfarin to DOACs was
recorded in 30 patients (18.3%) which was primarily in those needing long
term anticoagulant therapy. The use of DOACs to treat LV thrombus rose
steadily from 2020, and in 2024, they were used more frequently than
warfarin. (Figure 1) Follow-up imaging demonstrated thrombus resolution in
79 patients (48.2%); with similar rates amongst those receiving warfarin
(46/94, 48%) and DOACs (33/70, 47%), mean duration of 8 +/- 7 months after
the initiation of anticoagulation, with 62.5% of these patients continuing
long-term anticoagulant therapy. Similar demographic characteristics and
comorbidity profiles was noted between warfarin and DOAC groups. Thrombus
size did not differ significantly between groups; however, the mean LVEF
was lower in the warfarin versus DOAC group (33 +/- 10% versus 37 +/- 9%,
p = 0.014). Patients treated with DOAC had shorter time to thrombus
resolution on follow up scan. (Table 1) Over a mean follow-up period of 29
+/- 20 months, 55 patients (33.5%) experienced the composite primary
outcome- which encompassed 17 cerebrovascular events, 1 other
thromboembolic event, 1 major bleeding, 36 all-cause deaths of which 6
were cardiovascular-related. More clinical events were noted in the
warfarin group (40.4% vs 24.3%, p=.044). (Figure 2) Demographic
characteristics, comorbidities, LVEF, thrombus size, and treatment
modality did not have a significant impact on clinical outcomes in
patients with LV thrombus. Of note, patients treated with warfarin
exhibited a 2.4 times increased risk of experiencing a primary outcome
event (HR 2.4, CI 1.097-5.298, p=.029) (table 2) Conclusion Our study
indicates a shifting trend towards the use of DOACs for LV thrombus
management, with comparable efficacy and safety to warfarin. Furthermore,
our findings suggest more favourable clinical outcomes in patients treated
with DOACs. However, given the retrospective nature of our analysis,
randomized controlled trials are needed to definitively establish the role
of DOACs in this clinical setting.

<117>
Accession Number
648615691
Title
Clinical Outcomes Following Invasive Cardiovascular Interventions in Frail
Populations: A Systematic Review and Meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2025. Date of Publication: 12 Sep 2025.
Author
Jiang H.; Wong J.J.; Li L.-J.; Gao F.; Wykrzykowska J.J.; Ho K.W.;
Takahashi S.; Lee K.S.; Kong W.K.F.; Poh K.K.; Tan R.-S.; Koh A.S.
Institution
(Jiang, Wong, Gao, Ho, Tan, Koh) National Heart Centre Singapore,
Singapore
(Li) Global Centre for Asian Women's Health (GloW), Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
(Li) Department of O&G, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
(Li) Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE),
Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Li) Institute for Human Development & Potential (iHDP), Agency for
Science, Technology & Research (A*STAR), Singapore
(Gao, Ho, Tan, Koh) Duke-National University of Singapore Medical School,
Singapore
(Wykrzykowska) Cardiology Department, University Medical Center Groningen,
Groningen, Netherlands
(Takahashi) Department of Cardiology, Shonan Oiso Hospital, Oiso Japan,
Japan
(Lee) Department of Cardiology, Mayo Clinic Arizona, United States
(Kong, Poh) Department of Medicine, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Kong, Poh) Department of Cardiology, National University Heart Centre
Singapore, Singapore
Abstract
BACKGROUND: Frailty is highly prevalent in cardiovascular disease and
associates with poor clinical outcomes. Several cardiovascular conditions
benefit from invasive interventions, but the impact of these procedures in
frail patients remains unclear. <br/>OBJECTIVE(S): We performed a
systematic review and meta-analysis to summarize evidence and quantify the
pooled effect of clinical outcomes of invasive cardiovascular
interventions among frail vs non-frail patients. <br/>METHOD(S):
Systematic search of 2 electronic databases from January 2015 to April
2025 was performed. All randomized controlled trials (RCTs) and
prospective cohort studies examining outcomes of invasive cardiovascular
interventions stratified by frailty were included. Outcomes included
all-cause mortality, hospitalizations, and other adverse outcomes. Risk
ratios (RRs) and their 95% confidence intervals (CI) were assessed using
random-effects models. <br/>RESULT(S): Thirty-one studies (10 RCTs, 21
prospective, 3 retrospective studies) with a total of 27,534 participants
were included. Compared with non-frail patients, frail patients after
cardiovascular procedures were at higher risks of all-cause mortality (RR
3.14, 95% CI 2.29-4.30), and hospitalizations (RR 1.88, 95% CI 1.29-2.73).
Frail patients undergoing transcatheter aortic-valve implantation and
percutaneous mitral-valve interventions did not have significant increased
mortality risks compared to non-frail patients (p>0.05). Pre-frailty
predicted lower mortality risks amongst patients undergoing transcatheter
vs surgical aortic valve replacement (HR 0.78, 95% CI 0.67-0.92). Frail
patients with non-ST elevation myocardial infarction derived similar
mortality benefits from an invasive vs conservative approach (HR 1.13, 95%
CI 0.64-2.01). <br/>CONCLUSION(S): Frailty prognosticates adverse outcomes
following invasive cardiovascular interventions and influences treatment
efficacy, highlighting its significance in treatment
selection.<br/>Copyright &#xa9; 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

<118>
Accession Number
2040566307
Title
Bleomycin for Malignant Pericardial Effusion: A Systematic Review of
Efficacy and Adverse Events.
Source
Journal of Cardiovascular Pharmacology. (no pagination), 2025. Date of
Publication: 2025.
Author
Siahaan P.P.; Kurniawan R.B.; Saputra P.B.T.; Arnindita J.N.; Savitri
C.G.; Andira L.H.; Meitavany E.N.; Putranto J.N.E.; Alkaff F.F.
Institution
(Siahaan, Kurniawan) Faculty of Medicine, Universitas Airlangga, Surabaya,
Indonesia
(Saputra, Arnindita, Savitri, Andira, Putranto) Department of Cardiology
and Vascular Medicine, Faculty of Medicine, Universitas Airlangga,
Indonesia
(Saputra, Arnindita, Savitri, Andira, Putranto) Department of Cardiology
and Vascular Medicine, Dr. Soetomo General Academic Hospital, Surabaya,
Indonesia
(Meitavany) School of Biomedical Engineering and Imaging Sciences (BMEIS),
King's College London, London, United Kingdom
(Alkaff) Division of Nephrology, Department of Internal Medicine,
University Medical Center Groningen, University of Groningen, Netherlands
(Alkaff) Division of Pharmacology and Therapy, Department of Anatomy,
Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga,
Surabaya, Indonesia
(Putranto) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Jl.
Mayjen Prof. Dr. Moestopo No 47, East Java, Surabaya, Indonesia
Publisher
Lippincott Williams and Wilkins
Abstract
Malignant pericardial effusion (MPE) is a progressive fluid accumulation
in the pericardial space that can lead to pericardial tamponade. Despite
the high recurrence rate associated with pericardiocentesis, it remains
the mainstay therapy. Bleomycin has emerged as an intrapericardial
sclerosing therapy that may reduce recurrence and improve patients'
quality of life. This systematic review aimed to assess the efficacy and
safety profile of Bleomycin instillation in patients with MPE. An
exhaustive search was conducted in PubMed, Web of Science, Scopus,
ProQuest, EBSCO, and ClinicalTrials.gov databases. Eligible studies
included MPE patients as participants who were treated with
intrapericardial Bleomycin, reporting the patients' outcomes and using
English in the full text. Individual studies were assessed for quality
using the Newcastle-Ottawa Scales for cohort studies and the Jadad Scale
for trial studies. Eight studies were included in this systematic review
involving 242 MPE patients treated with Bleomycin. Bleomycin demonstrated
lower recurrence rates than other sclerosing agents, with only <=5% of
patients requiring repeated drainage due to recurrence. Bleomycin
treatment resulted in 3.5 days less hospitalisation compared to
doxycycline. Bleomycin is also safe to use, with reported less severe pain
compared to other treatment agents for MPE, such as doxycycline and
pericardiocentesis. Bleomycin may benefit patients by reducing recurrence
rates and improving patients' quality of life. Moreover, it is safe and
has low rates of adverse events following the instillation.<br/>Copyright
&#xa9; 2025 The Author(s).

<119>
Accession Number
648622462
Title
INFLUENZA VACCINATION FOR PREVENTION OF DEATH AND MAJOR CARDIOVASCULAR
EVENTS IN PATIENTS WITH A HISTORY OF STROKE: A SUBANALYSIS OF THE VIP-ACS
TRIAL.
Source
International journal of stroke : official journal of the International
Stroke Society. (pp 17474930251383626), 2025. Date of Publication: 19 Sep
2025.
Author
Fonseca H.A.; Sampaio Silva G.; Monfardini F.; Nicolau J.C.; Rizzo L.V.;
Berwanger O.
Institution
(Fonseca, Sampaio Silva, Monfardini, Rizzo, Berwanger) Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Sampaio Silva) Departament of Neurology and Neurosurgery, Universidade
Federal de Sao Paulo (UNIFESP), Brazil
(Nicolau) Hospital das Clinicas, Faculdade de Medicina, Universidade de
Sao Paulo, 3Instituto do Coracao (InCor), Sao Paulo, Brazil
(Berwanger) George Institute for Global Health UK at Imperial College
London, London, United Kingdom
Abstract
BACKGROUND: An in-hospital double-dose influenza vaccination strategy's
effect on preventing major cardiovascular events (MACE) in patients with
previous stroke is still uncertain. This study is a prespecified analysis
of the vaccine against influenza to avoid cardiovascular events after the
Acute Coronary Syndrome (VIP-ACS) trial. <br/>METHOD(S): The VIP-ACS trial
was a randomized, pragmatic, multicenter, open-label trial with
blinded-adjudication endpoints. Adult patients with acute coronary
syndrome (ACS) <= seven days of hospitalization were randomized to an
in-hospital double-dose quadrivalent inactivated influenza vaccine or a
standard-dose vaccine at 30 days post-randomization. The primary endpoint
was a hierarchical composite of all-cause death, myocardial infarction
(MI), stroke, unstable angina, hospitalization for heart failure, urgent
coronary revascularization, and hospitalization for respiratory causes,
analyzed by the win ratio (WR) method. The secondary endpoint was a
hierarchical composite consisting of CV death, MI and stroke (MACE).
Patients were followed for 12 months each influenza season.
<br/>RESULT(S): The trial enrolled 1,801 patients (31% female). A total of
67 patients had a history of stroke. There were no significant differences
between groups on the primary hierarchical endpoint: 11.4% wins in the
double-dose vaccine group vs 12.1% wins in the standard-dose vaccination
group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke.
However, in-hospital double-dose vaccination favored individuals with
previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8%
wins). Results were consistent for hierarchical MACE (WR:3.01;
95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital
double-dose vaccination. <br/>CONCLUSION(S): After an ACS, in-hospital
double-dose influenza vaccination prevents hospitalizations and death
compared with standard-dose vaccination at 12 months in individuals with
previous strokes.