EPICORE Embase Updates: November 2025

Total documents retrieved: 118

Results Generated From:
Embase <1980 to 2025 Week 44>
Embase Weekly Updates (updates since 2025-10-24)

<1>
Accession Number
2039496873
Title
Role of Blended Learning in Enhancing Self-Efficacy and Medication
Adherence in Cardiac Rehabilitation for Individuals Undergoing Coronary
Artery Bypass Surgery: A Randomized Control Trial.
Source
Archives of Physical Medicine and Rehabilitation. 106(11) (pp 1645-1653),
2025. Date of Publication: 01 Nov 2025.
Author
Veisi G.; Pakrad F.; Gobbens R.; Mohammadi Y.; Majidi L.
Institution
(Veisi) Student Research Committee, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Pakrad) Chronic Diseases (Home Care) Research Center, Institute of
Cancer, Avicenna Health Research Institute, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Gobbens) Faculty of Health, Sport and Social Work, Inholland University
of Applied Sciences, Netherlands
(Gobbens) Zonnehuisgroep Amstelland, Amstelveen, Netherlands
(Gobbens) Department of Family Medicine and Population Health, Faculty of
Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
(Gobbens) Department of Tranzo Academic Centre Transformation in Care and
Welfare, Faculty of Behavioural and Social Sciences, Tilburg University,
Tilburg, Netherlands
(Mohammadi) Modeling of Noncommunicable Diseases Research Center,
Institute of Health Sciences and Technologies, Avicenna Health Research
Institute, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Mohammadi) Department of Epidemiology, School of Public Health, Hamadan,
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Majidi) Department of Physical Medicine and Rehabilitation, Faculty of
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
Publisher
W.B. Saunders
Abstract
Objective: This study aimed to evaluate the effectiveness of a traditional
cardiac rehabilitation (CR) program compared with an augmented program
that integrates traditional CR with face-to-face training sessions and
remote assistance facilitated through an application based on the
knowledge, attitudes, and practices model for individuals undergoing
coronary artery bypass graft (CABG) surgery. Design(s): A randomized
controlled trial with a blinded outcome assessment was used
(IRCT20230902059333N1). Setting(s): A major heart center in a
middle-income country. Participant(s): Of the 80 patients referred to
the CR program during the study, 70 patients (N=70) were successfully
enrolled, reaching the target sample size. Participants were randomly
assigned in a 1:1 ratio, resulting in 35 patients per group.
 Intervention(s): In addition to traditional CR, patients participated
in 4 in-person training sessions throughout the rehabilitation process and
received 3 months of follow-up support via the app after completing the
program. Main Outcome Measure(s): Medication adherence and
self-efficacy were assessed before the initiation of CR, immediately after
its completion, and 3 months postcompletion. Result(s): There were no
significant demographic differences between the intervention and control
groups. However, throughout the study, significant differences emerged in
favor of the 3 groups concerning medication adherence and self-efficacy
(P<.001). The intervention group showed substantial and continuous
improvements in medication adherence and self-efficacy scores, which were
evident from the 1st month and persisted over time. Conclusion(s):
Implementing a blended learning approach in CR has demonstrated benefits
in medication adherence and self-efficacy, highlighting the necessity for
further research and clinical application. Copyright © 2025
American Congress of Rehabilitation Medicine

<2>
Accession Number
2041059777
Title
A study protocol of the rehabilitative efficacy of cardiovascular
ultrasound therapy after percutaneous coronary intervention in patients
with coronary artery disease: A multicenter, parallel-group, randomized
controlled study.
Source
PLOS ONE. 20(10 October) (no pagination), 2025. Article Number: e0327557.
Date of Publication: 01 Oct 2025.
Author
He C.; Peng J.; Liu H.; Zhong L.; Wei Y.; Qiu H.; Liu C.; Lv N.; Liu L.;
Qi X.; Zhang F.; You B.; Song Q.; Shen L.
Institution
(He, Peng, Shen) Department of Geriatric Medicine, Laboratory of
Gerontology and Anti-Aging Research, Qilu Hospital, Shandong University,
Shandong, Jinan, China
(Liu) Qingdao Municipal Hospital, Shandong, Qingdao, China
(Zhong) Yantai Yuhuanding Hospital, Shandong, Yantai, China
(Wei) Linyi People's Hospital, Shandong, Linyi, China
(Qiu) Tengzhou Central People's Hospital, Shandong, Tengzhou, China
(Liu) Weifang People's Hospital, Shandong, Weifang, China
(Lv) Jining No. 1 People's Hospital, Shandong, Jining, China
(Liu) Weihai Central Hospital, Shandong, Weihai, China
(Qi) Liaocheng People's Hospital, Shandong, Liaocheng, China
(Zhang) Dongying People's Hospital, Shandong, Dongying, China
(You) Qilu Hospital of Shandong University, Shandong, Qingdao, China
(Song) Department of Emergency Medicine, Qilu Hospital of Shandong
University, Shandong, Jinan, China
Publisher
Public Library of Science
Abstract
Background Coronary artery disease (CAD) is a leading cause of mortality
and disability, placing heavy burdens on healthcare systems. Although
cardiovascular ultrasound therapy has demonstrated effectiveness and
safety in improving refractory angina, relevant clinical studies are rare
and clinical evidence is lacking. Methods and design This is a
prospective, parallel-group, randomized controlled trial. We enrolled 200
patients with coronary artery disease who had undergone percutaneous
coronary intervention (PCI) and randomized them into two groups. The
intervention group will be given usual-practice plus cardiovascular
ultrasound therapy intervention and the control group will be given only
usual-practice intervention. After 20 treatments with cardiovascular
ultrasound therapy, high-sensitivity C-reactive protein in serum will be
used as the primary outcome measures. The following will be used in
determining secondary outcomes: indicators of serum myocardial injury,
blood lipid levels, markers of endothelial function, inflammatory factors,
hemodynamic indicators, echocardiography, ultrasound examination for
carotid plaques, 6-minute walk test, short-term variability in heart rate,
and mental health assessment. The researchers plan to test the outcome
indicators at multiple time points. Statistical analyses will be performed
using SPSS version 26 statistical software (IBM, Armonk, NY). Discussion
This is the first clinical study of the rehabilitative efficacy of
cardiovascular ultrasound therapy in the treatment of CAD after PCI.
Clinical recovery currently depends mainly on modalities such as
medication, exercise, and nutritional therapy; therefore, cardiovascular
ultrasound therapy, as a new mode of therapy, might become a major advance
in the treatment of CAD after PCI. Copyright © 2025 He et al.
This is an open access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source
are credited.

<3>
Accession Number
2034707049
Title
Current status and challenges of DCD heart transplantation in the
Asia-Pacific region.
Source
Journal of Artificial Organs. 28(4) (pp 522-526), 2025. Date of
Publication: 01 Dec 2025.
Author
Matsumoto Y.
Institution
(Matsumoto) Department of Cardiovascular Surgery, Keio University School
of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, Japan
Publisher
Springer
Abstract
Heart transplantation remains the definitive treatment for end-stage heart
failure, but donor shortages persist globally. This review aims to
evaluate the current status, enabling technologies, ethical
considerations, and future prospects of donation after circulatory death
(DCD) heart transplantation in the Asia-Pacific region. A comprehensive
narrative review was conducted using published literature and
country-specific reports to assess global and regional trends in DCD heart
transplantation. Particular focus was given to enabling technologies
(e.g., thoracoabdominal normothermic regional perfusion [taNRP] and ex
situ machine perfusion), legal and ethical frameworks, and implementation
barriers across countries in the Asia-Pacific. While countries such as the
UK, US, and Australia have achieved comparable survival outcomes between
DCD and donation after brain death (DBD) heart transplantation, most
Asia-Pacific countries remain in early stages. Australia leads the region
with over 70 successful DCD heart transplants using the Organ Care System.
Japan lacks legal clarity and clinical protocols for withdrawal of
life-sustaining therapy, restricting DCD to kidney transplants. China
employs a hybrid DBCD model but faces logistical and ethical constraints.
In South Korea, India, and others, DCD heart programs are not yet
established. High cost and limited availability of enabling technologies,
alongside ethical controversy surrounding taNRP, are key barriers. Broader
adoption of DCD heart transplantation in Asia-Pacific countries requires
legal reform, ethical consensus, cost-effective perfusion strategies, and
public engagement. Coordinated efforts across technological, societal, and
regulatory domains are essential to expand access to this life-saving
modality. Copyright © The Author(s), under exclusive licence to
the Japanese Society for Artificial Organs 2025.

<4>
Accession Number
2041029549
Title
Glucagon-Like Peptide-1 Receptor Agonists for People With Chronic Kidney
Disease and Diabetes.
Source
American Family Physician. 112(4) (pp 369-370), 2025. Date of Publication:
01 Oct 2025.
Author
Elliott J.; Frasca D.J.
Institution
(Elliott, Frasca) Virginia Commonwealth University, Riverside Family
Medicine Residency, Newport News, United States
Publisher
American Academy of Family Physicians

<5>
Accession Number
2041123282
Title
Systematic review and meta-analysis: Is surgical cardiac denervation
effective against postoperative atrial fibrillation?.
Source
World Journal of Cardiology. 17(9) (no pagination), 2025. Date of
Publication: 26 Sep 2025.
Author
Bakht D.; Amir M.; Saleem F.; Asif A.; Mubashir M.M.; Farooq A.S.; Malik
M.Z.; Hassan A.; Bakht K.; Arham M.; Bokhari S.F.H.; Awais M.N.; Ali
M.K.B.; Dad A.; Akram M.R.
Institution
(Bakht, Amir, Saleem, Asif, Mubashir, Farooq, Malik, Hassan, Bakht, Arham,
Bokhari, Awais, Ali, Dad, Akram) Department of Medicine, King Edward
Medical University, Punjab, Lahore, Pakistan
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a complication
after cardiac surgeries associated with increased morbidity and hospital
stay. Surgical cardiac denervation, which reduces autonomic input to the
heart, has been proposed as a good preventive against POAF. However,
evidence on its effectiveness remains inconsistent. AIM To evaluate the
impact of surgical cardiac denervation on the incidence of POAF and
related clinical outcomes. METHODS This meta-analysis adhered to Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A
literature search was conducted across PubMed, Cochrane, ScienceDirect,
and EMBASE up to April 2025 using a preformed search strategy using
Medical Subject Headings terms and free-text keywords. Risk of bias
assessment was done via Risk of Bias 2.0 and Risk Of Bias In
Non-randomized Studies - of Interventions tools. Study analysis was
performed using Review Manager version 5.4, with heterogeneity assessed
via I 2 values and appropriate fixed- or randomeffects models applied.
RESULTS Five studies (N = 1266) were included, with 627 patients
undergoing cardiac denervation and 639 serving as controls. Denervation
did not significantly reduce overall POAF [odds ratio = 0.71; 95%
confidence interval (CI): 0.32-1.58; P = 0.40; I 2 = 83%], but was
associated with a significant reduction in persistent atrial fibrillation
(odds ratio = 0.19; 95%CI: 0.10-0.36; P < 0.00001; I 2 = 0%). Among
secondary outcomes, only postoperative serum magnesium levels
significantly reduced the denervation group (mean difference: -0.07
mmol/L; 95%CI: -0.08 to -0.06; P < 0.00001). Other outcomes, such as
reoperation for bleeding, stroke/transient ischemic attack, length of
hospital stay, 30-day mortality, and postoperative drainage, did not show
any significant difference. CONCLUSION Surgical cardiac denervation does
not significantly reduce overall POAF but does lower the incidence of
persistent atrial fibrillation. It is also shown to decrease serum
magnesium levels. Other outcomes, such as stroke, reoperation, and
hospital stay, showed no significant differences. Copyright ©
(2025), (Baishideng Publishing Group Inc). All rights reserved.

<6>
Accession Number
51488581
Title
Short-term results of a randomized trial examining timing of carotid
endarterectomy in patients with severe asymptomatic unilateral carotid
stenosis undergoing coronary artery bypass grafting.
Source
Journal of Vascular Surgery. 54(4) (pp 993-999), 2011. Date of
Publication: 01 Oct 2011.
Author
Illuminati G.; Ricco J.-B.; Cali F.; Pacile M.A.; Miraldi F.; Frati G.;
MacRina F.; Toscano M.
Institution
(Illuminati, Cali, Pacile) 'Francesco Durante' Department of Surgery,
University of Rome 'La Sapienza', Rome, Italy
(Ricco) Department of Vascular Surgery, University of Poitiers, Poitiers,
France
(Miraldi, Frati, MacRina, Toscano) Department of Cardiovascular Surgery,
University of Rome 'La Sapienza', Rome, Italy
Publisher
Mosby Inc.
Abstract
Objective: This study evaluated the timing of carotid endarterectomy (CEA)
in the prevention of stroke in patients with asymptomatic carotid stenosis
>70% receiving a coronary artery bypass graft (CABG). Method(s): From
January 2004 to December 2009, 185 patients with unilateral asymptomatic
carotid artery stenosis >70%, candidates for CABG, were randomized into
two groups. In group A, 94 patients received a CABG with previous or
simultaneous CEA. In group B, 91 patients underwent CABG, followed by CEA.
All patients underwent preoperative helical computed tomography scans,
excluding significant atheroma of the ascending aorta or aortic arch.
Baseline characteristics of the patients, type of coronary artery lesion,
and preoperative myocardial function were comparable in the two groups. In
group A, all patients underwent CEA under general anesthesia with the
systematic use of a carotid shunt, and 79 patients had a combined
procedure and 15 underwent CEA a few days before CABG. In group B, all
patients underwent CEA, 1 to 3 months after CABG, also under general
anesthesia and with systematic carotid shunting. Result(s): Two
patients (one in each group) died of cardiac failure in the postoperative
period. Operative mortality was 1.0% in group A and 1.1% in group B (P
=.98). No strokes occurred in group A vs seven ipsilateral ischemic
strokes in group B, including three immediate postoperative strokes and
four late strokes, at 39, 50, 58, and 66 days, after CABG. These late
strokes occurred in patients for whom CEA was further delayed due to an
incomplete sternal wound healing or because of completion of a cardiac
rehabilitation program. The 90-day stroke and death rate was 1.0% (one of
94) in group A and 8.8% (eight of 91) in group B (odds ratio [OR], 0.11;
95% confidence interval [CI], 0.01-0.91; P =.02). Logistic regression
analysis showed that only delayed CEA (OR, 14.2; 95% CI, 1.32-152.0; P
=.03) and duration of cardiopulmonary bypass (OR, 1.06; 95% CI, 1.02-1.11;
P =.004) reliably predicted stroke or death at 90 days.
 Conclusion(s): This study suggests that previous or simultaneous CEA
in patients with unilateral severe asymptomatic carotid stenosis
undergoing CABG could prevent stroke better than delayed CEA, without
increasing the overall surgical risk. © 2011 Society for Vascular
Surgery.

<7>
Accession Number
2032567203
Title
Perspectives on why DanGer Shock is the first positive trial on mechanical
circulatory support in cardiogenic shock.
Source
Heart Failure Reviews. 30(2) (pp 381-385), 2025. Date of Publication: 01
Jun 2025.
Author
Mondellini G.M.; van den Enden A.J.M.; Van Mieghem N.M.
Institution
(Mondellini, van den Enden, Van Mieghem) Department of Interventional
Cardiology, Cardiovascular Institute, Erasmus University Medical Center
Rotterdam, Thoraxcenter, Office Nt-645, Dr. Molewaterplein 40, Rotterdam,
Netherlands
Publisher
Springer
Abstract
Cardiogenic shock related to acute myocardial infarction (AMI-CS) remains
a severe condition associated with a high risk of mortality despite
increased availability of primary percutaneous coronary intervention and
improvements in pharmacologic and device-based therapy. The results of the
DanGer Shock trial stand out compared with the outcomes of the previous
trials and mark the first mechanical circulatory support (MCS) strategy to
show a benefit in patients with AMI-CS, a population that has always been
challenging to study. Notably, negative findings from previous trials may
mask positive treatment effects in specific subgroups and patient
category. We systematically reviewed the design of all contemporary
randomized controlled AMI-CS trials and identified four distinct features,
which likely provide reasons why DanGer Shock became the first positive
randomized controlled trial to support MCS in AMI-CS. DanGer Shock was the
first RCT that established MCS in the context of AMI-CS. Key features were
(1) patient phenotype that 1) includes STEMI and 2) excludes severe RV
failure and persistent comatose state after out-of-hospital cardiac
arrest; (3) optimal timing of MCS deployment, as soon as possible (lower
SCAI stage) and before revascularization efforts; and (4) rigorous
intensive care management protocols on hemodynamic and MCS
monitoring. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2024.

<8>
Accession Number
2041123062
Title
Fractional flow reserve guided percutaneous coronary intervention vs
coronary artery bypass grafting for multivessel coronary artery disease: A
meta-analysis.
Source
World Journal of Cardiology. 17(9) (no pagination), 2025. Date of
Publication: 26 Sep 2025.
Author
Kataveni S.; Ellahi E.; Zafar F.; Veettil I.N.K.; Iqbal A.; Dhir B.;
Sabarish S.; Erambalur S.; Yathindra M.R.; Kvn M.; Nawaz S.; Dudekula
S.K.; Haq U.U.; Hussain A.; Khawar M.M.
Institution
(Kataveni, Ellahi, Zafar, Veettil, Iqbal, Dhir, Sabarish, Erambalur,
Yathindra, Kvn, Nawaz, Dudekula, Haq, Hussain, Khawar) Department of
Cardiology, Gandhi Medical College, Telangana, Hyderabad, India
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) are well-established treatments for
multivessel coronary artery disease (CAD), a condition where multiple
heart arteries are narrowed. A newer approach, fractional flow reserve
(FFR)-guided PCI, uses a specialized measurement to select which artery
blockages to treat, aiming to enhance patient outcomes. Despite its
adoption, the comparative effectiveness of FFRguided PCI vs CABG remains
unclear, particularly regarding key health outcomes such as survival,
heart-related complications, and the need for further procedures. AIM To
evaluate the safety and effectiveness of FFR -guided PCI compared to CABG
in patients with multivessel CAD. METHODS This meta-analysis followed
standard reporting guidelines and included randomized controlled trials
(RCTs) comparing FFR-guided PCI with CABG in patients with multivessel
CAD. We searched medical databases, including PubMed, EMBASE,
ScienceDirect, and ClinicalTrials.gov, from their start to May 2025. We
calculated combined risk ratios (RRs) with 95% confidence intervals
(95%CIs) to analyze the data. RESULTS Three RCTs were analyzed. There was
no notable difference in all-cause mortality between FFR-guided PCI and
CABG (RR = 1.01, 95%CI: 0.78-1.31, P = 0.93). However, FFR-guided PCI
showed higher rates of major adverse cardiac events (MACEs; RR = 1.30,
95%CI: 1.11-1.52, P = 0.001), myocardial infarction (RR = 1.49, 95%CI:
1.11-2.01, P = 0.009), and repeat revascularization (RR = 2.25, 95%CI:
1.78-2.85, P < 0.00001). Stroke rates were comparable between the two
treatments (RR = 0.80, 95%CI: 0.54-1.20, P = 0.28). CONCLUSION FFR-guided
PCI and CABG have similar rates of all-cause mortality and stroke in
patients with multivessel CAD. However, CABG results in fewer MACEs,
myocardial infarctions, and repeat procedures. Copyright ©
(2025), (Baishideng Publishing Group Inc). All rights reserved.

<9>
Accession Number
2040679272
Title
Peri-operative rehabilitation in patients undergoing elective cardiac
valve surgery: a randomised controlled trial.
Source
Anaesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Liu F.; Xu M.; Zhou H.; Wang H.; Liu Y.; He X.; Huang H.; Sun T.; Jian X.;
Wu M.; Sun Y.; Cao P.; Chen J.; Guo L.; Ma H.
Institution
(Liu, Liu, Xu, Zhou, Wang, Liu, He, Chen, Guo, Ma) Department of
Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial
People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical
University, Guangdong, Guangzhou, China
(Huang, Sun, Jian, Chen, Wu) Department of Cardiac Surgery, Guangdong
Cardiovascular Institute, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, Guangdong, Guangzhou, China
(Huang, Sun, Jian, Chen, Wu) Guangdong Provincial Key Laboratory of South
China Structural Heart Disease, Guangdong Provincial People's Hospital,
Guangdong Academy of Medical Sciences, Guangdong, Guangzhou, China
(Sun, Cao) Clinical Research Center, Zhujiang Hospital, Southern Medical
University, Guangdong, Guangzhou, China
(Sun, Cao) Department of Biostatistics, School of Public Health, Southern
Medical University, Guangdong, Guangzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Patients with valvular heart disease are at high risk of
postoperative pulmonary complications, which contribute to morbidity and
mortality. However, few studies have focused specifically on
peri-operative rehabilitation in this patient population. We aimed to
evaluate whether peri-operative rehabilitation benefits patients
undergoing elective cardiac valve surgery by reducing the incidence of
postoperative pulmonary complications, the duration of postoperative
hospitalisation and mortality. Method(s): This single-centre,
randomised controlled trial compared usual care (usual care group) with a
peri-operative rehabilitation bundle (rehabilitation group) comprising
four components: education; inspiratory muscle training; active cycle of
breathing techniques; and early mobilisation. The primary outcome was a
composite measure of the occurrence of postoperative pulmonary
complications within the first 7 days; incidence of prolonged
postoperative hospitalisation > 7 days; and in-hospital all-cause
mortality. Secondary outcomes included each component of primary outcome
measure; duration of stay in the ICU; total duration of postoperative
hospitalisation; and 3-month all-cause mortality. Result(s): On an
intention-to-treat basis, data from 818 patients were analysed (419
allocated to the usual care group and 399 to the rehabilitation group).
The primary composite outcome did not differ between groups, occurring in
224/419 (53.5%) patients allocated to the usual care group and 206/399
(51.6%) patients allocated to the rehabilitation group (odds ratio 0.88,
95%CI 0.66-1.17, p = 0.376). Postoperative pulmonary complications were
present in 197 (47.1%) patients allocated to the usual care group and 161
(40.4%) patients allocated to the rehabilitation group (odds ratio 0.720,
95%CI 0.541-0.956, p = 0.023). There was no significant difference between
the groups in terms of duration of postoperative hospital stay of > 7 days
or in-hospital mortality. Discussion(s): Peri-operative
rehabilitation reduced the incidence of postoperative pulmonary
complications in patients having surgery for valvular heart disease. We
recommend incorporating comprehensive peri-operative rehabilitation into
the clinical management of these patients. Copyright © 2025 The
Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of
Association of Anaesthetists.

<10>
Accession Number
2041040337
Title
Glucose Variability IN Diabetic Patients Receiving DEXmedetomidine During
Off-Pump Coronary Artery Bypass Grafting: GV-IN-DEX, A Randomised
Controlled Trial.
Source
Annals of Cardiac Anaesthesia. 28(4) (pp 432-438), 2025. Date of
Publication: 01 Oct 2025.
Author
Goel K.; Kohli J.K.; Shri I.; Kalaiselvan J.; Sharma L.K.; Avinash R.
Institution
(Goel, Kohli, Kalaiselvan, Avinash) Department of Cardiac Anesthesia, Atal
Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New
Delhi, India
(Shri) Department of Anesthesia, Atal Bihari Vajpayee Institute of Medical
Sciences and Dr. RML Hospital, New Delhi, India
(Sharma) Department of Biochemistry, Atal Bihari Vajpayee Institute of
Medical Sciences and Dr. RML Hospital, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Diabetes mellitus (DM) is a complex carbohydrate metabolic
disorder with increased levels of inflammation. Stress response to cardiac
surgery manifests as a major neuroendocrine and cytokine response leading
to increased levels of inflammation and subsequent hyperglycemia,
contributing to significant cardiovascular morbidity and mortality. To
mitigate these effects in patients undergoing off-pump coronary artery
bypass grafting (OPCABG), our study focused on using dexmedetomidine
infusion hypothesizing decreased stress response and thereby improved
glucose variability (GV). Method(s): Patients were randomized into
two groups: group D (dexmedetomidine) was administered the drug at 0.5
microg/kg/h, and group C (control) was administered an equivalent amount
of saline. Preinduction C-reactive protein (CRP) and interleukin-6 (IL-6)
levels were sent, and perioperative GV and mean insulin requirement were
recorded in 24 h. Postoperatively, samples were sent and recorded for IL-6
and CRP levels at 12 and 24 h. The primary objective of our study was to
assess the effect of injection dexmedetomidine on blood GV with secondary
objectives being the assessment of the level of IL-6 and CRP at
preinduction (0 h) and at 12 and 24 h postoperatively and comparison of
mean insulin requirement between the groups. Result(s): Eighty-nine
diabetic patients were enrolled in this study, among which 21 were
excluded. Sixty-eight patients, with 34 patients in each group, were
selected for analysis. There was a significant difference between the two
groups in terms of GV (P = 0.042) (16.44 +/- 4.63 vs. 14.38 +/- 3.45),
mean insulin requirements (U/h) (P = 0.001) (1.38 +/- 0.63 vs. 0.88 +/-
0.59), CRP (mg/dL) (12 h) (P = 0.012) (2.6 +/- 2.83 vs. 1.51 +/- 1.13, and
CRP (mg/dL) (24 h) (P = <0.001) (16.71 +/- 6.45 vs. 10.19 +/- 4.56). IL-6
was comparable in both groups at all points. Conclusion(s): Patients
receiving intraoperative dexmedetomidine infusion during OPCABG
demonstrated improved GV leading to a reduction in insulin requirements
and reduced CRP levels at 12 and 24 h postoperatively. We may incorporate
dexmedetomidine in our routine clinical practice to ameliorate stress
response in these patients. Copyright © 2025 Annals of Cardiac
Anaesthesia.

<11>
Accession Number
2040595662
Title
High-Flow Nasal Oxygen Therapy in Preventing Post-Extubation Hypoxaemia
and Postoperative Pulmonary Complications: A Systematic Review and
Meta-Analysis +.
Source
Diagnostics. 15(19) (no pagination), 2025. Article Number: 2449. Date of
Publication: 01 Oct 2025.
Author
Tan J.W.Y.; Izaham A.; Abd Rahman R.; Teo R.; Masri S.N.N.S.; Md Ralib A.;
Chin K.-Y.
Institution
(Tan, Izaham, Abd Rahman, Teo) Department of Anaesthesiology and Intensive
Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob
Latif, Bandar Tun Razak, Kuala Lumpur, Cheras, Malaysia
(Izaham, Abd Rahman, Teo, Masri) Department of Anaesthesiology and
Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan
Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Cheras,
Malaysia
(Md Ralib) Department of Anaesthesiology and Intensive Care, Kulliyyah of
Medicine International, Islamic University of Malaysia, Bandar Indera
Mahkota, Kuantan, Malaysia
(Chin) Department of Pharmacology, Faculty of Medicine, Universiti
Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala
Lumpur, Malaysia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Post-extubation hypoxaemia and postoperative pulmonary
complications (PPCs) are common in surgical patients and contribute
significantly to morbidity and prolonged recovery. High-flow nasal oxygen
therapy (HFNOT) has been proposed as an alternative to conventional oxygen
therapy (COT) in improving oxygenation and reducing PPCs postoperatively.
 Objective(s): To evaluate the effectiveness of HFNOT compared to COT
in reducing post-extubation hypoxaemia and PPCs in adult surgical
patients, and to assess its impact on other clinical outcomes including
ICU and hospital length of stay, mortality, and the need for escalation of
respiratory support. Method(s): A systematic review and meta-analysis
of randomized controlled trials was conducted following PRISMA guidelines.
Studies were identified from five databases including PubMed, Scopus,
EBSCOHost, ProQuest, Ovid MEDLINE and Web of Science. Adult postoperative
patients who received HFNOT after extubation were compared to those
receiving COT. Primary outcomes included PaO<inf>2</inf>/FiO<inf>2</inf>
(PF) ratio and incidence of PPCs. Secondary outcomes were hospital and ICU
length of stay, mortality, and need for escalation of therapy.
 Result(s): Seventeen trials comprising 1830 patients were included.
HFNOT significantly improved PF ratio post-extubation and reduced the
incidence of hypoxaemia and PPCs compared to COT. For secondary outcomes,
HFNOT was associated with a reduced hospital length of stay and lower
postoperative mortality, while no significant difference was found for ICU
stay. Escalation of respiratory support was more frequent in the COT
group. Subgroup analyses indicated greater improvements in oxygenation
with HFNOT of shorter duration (<24 h) and in non-cardiothoracic patients.
 Conclusion(s): HFNOT is associated with improved postoperative
oxygenation and a reduction in respiratory complications following
extubation in surgical patients. The most pronounced benefits were
observed in non-cardiothoracic populations and with short-duration
applications. While the beneficial effects of HFNOT appear consistent
across the included randomized controlled trials, further large-scale
studies with standardized intervention durations, surgical populations,
and clearly defined criteria for escalation of therapy are needed to
strengthen and confirm these findings. Copyright © 2025 by the
authors.

<12>
Accession Number
2040592502
Title
Effect of Transcatheter Aortic Valve Implantation on Non-Invasive
Myocardial Work Parameters: A Systematic Review and Meta-Analysis.
Source
Journal of Clinical Medicine. 14(19) (no pagination), 2025. Article
Number: 6997. Date of Publication: 01 Oct 2025.
Author
Leo I.; Sicilia F.; Sabatino J.; Cersosimo A.; Carabetta N.; Strangio A.;
Panuccio G.; Canino G.; Ielapi J.; Salerno N.; Sorrentino S.; Torella D.;
De Rosa S.
Institution
(Leo, Sicilia, Sabatino, Cersosimo, Strangio, Panuccio, Canino, Ielapi,
Salerno, Torella) Department of Experimental and Clinical Medicine, Magna
Graecia University, Catanzaro, Italy
(Leo, Salerno, Sorrentino, Torella, De Rosa) Research Center for
Cardiovascular Science, Magna Graecia University, Catanzaro, Italy
(Sabatino) Pediatric Research Institute (IRP) 'Citta della Speranza',
Padua, Italy
(Sabatino) Department of Women's and Children's Health, University
Hospital Padua, Padua, Italy
(Carabetta, Sorrentino) Department of Medical and Surgical Sciences, Magna
Graecia University, Catanzaro, Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Aortic stenosis (AS) leads to progressive left
ventricular (LV) pressure overload, adverse myocardial remodeling, and
eventual functional decline. While traditional parameters such as left
ventricular ejection fraction (LVEF) may remain preserved until advanced
stages, they are insufficiently sensitive to early dysfunction. Global
longitudinal strain (GLS) offers improved detection but remains
load-dependent. In contrast, non-invasive myocardial work (MW)-derived
from pressure-strain loops-offers a more load-independent assessment of
myocardial function. This systematic review and meta-analysis aimed to
evaluate the effects of transcatheter aortic valve implantation (TAVI) on
MW indices in patients with severe AS. Method(s): We performed a
systematic review and meta-analysis of studies reporting non-invasive
myocardial work parameters before and after TAVI (PROSPERO ID:
CRD420250517138). Databases were searched through 31 March 2025. Pooled
mean differences in global work index (GWI), global constructive work
(GCW), global wasted work (GWW), and global work efficiency (GWE) were
calculated using random-effects models. Sensitivity analyses and
meta-regression were conducted to explore heterogeneity and the influence
of baseline characteristics. Result(s): Eleven studies encompassing
1493 patients were included. TAVI was associated with a significant
reduction in GWI (-236.67 mmHg% [95% CI: -373.82 to -99.52]; I2
= 97.0%; p = 0.002) and GCW (-243.71 mmHg% [95% CI: -407.38 to -80.03];
I2 = 97.4%; p = 0.006). No significant changes were observed in
GWW or GWE. Meta-regression showed age and baseline LVEF significantly
influenced GWE changes, but not other parameters. Conclusion(s): TAVI
leads to a significant reduction in GWI and GCW, reflecting decreased
myocardial workload and afterload relief. These findings support the
utility of MW indices as valuable tools for assessing myocardial
adaptation post-TAVI and potentially guiding clinical
decision-making. Copyright © 2025 by the authors.

<13>
Accession Number
2034498768
Title
Invasive and conservative management of elderly patients presenting with
acute coronary syndrome: A meta-analysis of randomized controlled trials
and adjusted observational studies.
Source
International Journal of Cardiology. 417 (no pagination), 2024. Article
Number: 132523. Date of Publication: 15 Dec 2024.
Author
Improta R.; Di Pietro G.; Piccialuti A.; De Filippo O.; Birtolo I.;
Severino P.; Tocci M.; Saade W.; Cammertoni F.; Vizza D.; Sardella G.;
D'Ascenzo F.; Stefanini G.; Mancone M.
Institution
(Improta, Di Pietro, Piccialuti, Birtolo, Severino, Tocci, Saade, Vizza,
Sardella, Mancone) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome,
Italy
(De Filippo, D'Ascenzo, Mancone) Department of Medical Sciences,
University of Turin, Division of Cardiology, Cardiovascular and Thoracic
Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy
(Cammertoni) Department of Cardiovascular Sciences, Cardiac Surgery Unit,
Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
(Stefanini) Operative Unit of Clinical and Interventional Cardiology and
Intensive Coronary Care Unit, Humanitas Research Hospital, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Elderly patients are often under-represented in studies about
coronary revascularization in acute coronary syndromes (ACS) and
undertreated in clinical practice. We sought to evaluate differences in
outcomes between an initial invasive or conservative strategy in this
subset of patients, Methods: The analysis was performed following PRISMA
guidelines. Randomized controlled trials (RCTs) and adjusted observational
studies comparing an invasive and conservative strategy in old patients
with ACS were systematically identified. Random or fixed effect model was
used accordingly to heterogeneity testing results. Short-term mortality
was the primary outcome. 30-day and longer-term re-infarction, MACE and
all-cause mortality were secondary endpoints. Sensitivity analysis
including RCTs only were performed for the primary endpoint and 1 year
mortality and another analysis, stratifying NSTEMI and STEMI studies, was
performed for short-term mortality. Result(s): Invasive management
was associated with lower short and long-term mortality (30 days OR 0.64,
95 % CI 0.54-0.76, p < 0.001; 1 year HR 0.60, 95 % CI 0.52-0.78, p <
0.001; Long-term HR 0.62, 95 % CI 0.55-0.71, p < 0.001) compared to a
conservative strategy. In the short-term follow-up, the benefit was
preserved when differentiating for NSTEMI or STEMI studies but not when
considering only RCTs. Major bleedings were more frequent in the invasive
group (30 days OR 1.61, 95 % CI 1.39-1.87, p < 0.001). The mean difference
in length of stay was not significantly different between the two
strategies (mean difference in days 0.14, 95 % CI -0.79 to 1.06, p =
0.77). Conclusion(s): An initial invasive strategy might lead to
reduced short and long-term mortality in elderly patients presenting with
acute coronary syndrome but it is associated with increased bleeding
events rate. No difference in hospital stay length was observed. Results
were mainly driven by non-randomized studies. Copyright © 2024
The Authors

<14>
Accession Number
2040628242
Title
Computed Tomography Angiography or Standard Care After Left Main PCI?.
Source
Journal of the American College of Cardiology. 86(19) (pp 1724-1734),
2025. Date of Publication: 11 Nov 2025.
Author
D'Ascenzo F.; Cerrato E.; De Filippo O.; Gaido L.; Franze A.; Iannaccone
M.; Wanha W.; Santarelli A.; Guiducci V.; Barbero U.; Fernandez Pereira
C.; Gatti M.; Tebaldi M.; Giammaria M.; Boccuzzi G.; Wojakowski W.; di
Pietro G.; Placido R.; Gili S.; Depaoli A.; Biondi Zoccai G.; Tomassini
F.; Bruno F.; Zugna D.; Faletti R.; Biscaglia S.; Caglioni S.; Varbella
F.; de Ferrari G.M.; Campo G.
Institution
(D'Ascenzo, De Filippo, Bruno, de Ferrari) Division of Cardiology,
Cardiovascular and Thoracic Department, "Citta della Salute e della
Scienza" Hospital, Turin, Italy
(D'Ascenzo, de Ferrari) Department of Medical Sciences, University of
Turin, Turin, Italy
(Cerrato, Franze, Varbella) Interventional Unit, San Luigi Gonzaga
University Hospital, Orbassano (Turin), Italy
(Cerrato, Franze, Tomassini, Varbella) Interventional Cardiology Unit,
Rivoli Infermi Hospital, ASLTO3 Rivoli, Turin, Italy
(Gaido, Giammaria) Ospedale Maria Vittoria, Turin, Italy
(Iannaccone, Boccuzzi) S.C. Cardiologia, Ospedale S.G. Bosco, ASL Citta di
Torino, Turin, Italy
(Wanha, Wojakowski) Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, Katowice, Poland
(Santarelli) Cardiology Unit, Bufalini Hospital, Cesena, Italy
(Guiducci) Cardiology Unit Azienda USL-IRCCS Reggio Emilia, Reggio Emilia,
Italy
(Barbero) Santissima Annunziata Hospital, Savigliano, Italy
(Fernandez Pereira) Department of Interventional Cardiology, Sanatorio
Otamendi, Buenos Aires, Argentina
(Gatti, Faletti) Department of Surgical Sciences, Radiology Unit,
University of Turin, Turin, Italy
(Tebaldi) Cardiology Unit, Ospedale degli Infermi, ASL Romagna, Faenza
(RA), Italy
(di Pietro) Department of Clinical Internal, Anesthesiology and
Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
(Placido) Division of Radiology, Hospital Maria Vittoria, Turin, Italy
(Gili) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Depaoli) Radiology Unit, Hospital of Ivrea, Ivrea, Italy
(Biondi Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi Zoccai) Maria Cecilia Hospital, GVM Care and Research, Cotignola,
Italy
(Zugna) Cancer Epidemiology Unit, Department of Medical Sciences,
University of Turin, Turin, Italy
(Biscaglia, Caglioni, Campo) Cardiology Unit, Azienda Ospedaliero
Universitaria di Ferrara, Cona (FE), Italy
Publisher
Elsevier Inc.
Abstract
Background: The clinical benefit of routine coronary computed tomography
angiography (CCTA) after percutaneous coronary intervention (PCI) for
unprotected left main (LM) disease is uncertain. Objective(s): The
authors evaluated whether CCTA-guided follow-up improves clinical outcomes
vs symptoms- or ischemia-driven care after LM PCI. Method(s): PULSE
was a prospective, multicenter, open-label randomized trial. A total of
606 patients treated with second-generation drug-eluting stents were
enrolled (October 2019 to September 2024) and randomized 1:1 to CCTA at 6
months (experimental) or standard care (control). The primary endpoint was
a composite of all-cause death, spontaneous myocardial infarction (MI),
unstable angina, or definite or probable stent thrombosis at 18 months.
Secondary endpoints included target-lesion revascularization (TLR) and
each primary endpoint component. Result(s): CCTA was completed in
272/303 experimental patients (89.8%) after a median of 200 days (IQR:
181-270 days). The primary endpoint occurred in 36/303 experimental
patients vs 38/303 control patients (11.9% vs 12.5%; HR: 0.97; 95% CI:
0.76-1.23; P = 0.80). Compared with the control arm, the CCTA arm showed a
reduced risk of spontaneous MI (0.9% vs 4.9%; HR: 0.26; 95% CI: 0.07-0.91;
P = 0.004) and an increased risk of imaging-triggered TLR (4.9% vs 0.3%;
HR: 7.7; 95% CI: 1.70-33.7; P = 0.001), whereas clinically driven TLR
rates were similar (5.3% vs 7.2%; HR: 0.74; 95% CI: 0.38-1.41; P = 0.32).
 Conclusion(s): Routine CCTA after LM PCI did not reduce the composite
primary endpoint, but was associated with fewer spontaneous MIs and more
imaging-triggered revascularizations. Future trials to clarify its value
in complex anatomic subsets appear to be warranted. (Angiographic Control
vs Ischemia-Driven Management of Patients Treated With PCI on Left Main
With Drug-Eluting Stents [PULSE; NCT04144881]) Copyright © 2025
American College of Cardiology Foundation

<15>
Accession Number
2039490866
Title
Intercostal cryoanalgesia for acute pain after video-assisted thoracic
surgery lung resection: A randomized controlled preliminary trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(5) (pp 1242-1251.e1),
2025. Date of Publication: 01 Nov 2025.
Author
Koliakos E.; Overbeek C.; Guay J.; Zaouter C.; Jamous J.A.; Nasir B.;
Liberman M.; Abdulnour E.; Ghosn P.; Frigault E.; Glorion M.; Williams S.;
Ferraro P.; Moore A.
Institution
(Koliakos, Nasir, Liberman, Abdulnour, Ghosn, Frigault, Ferraro) Division
of Thoracic Surgery, Centre Hospitalier de l'Universite de Montreal,
Montreal, Quebec, Canada
(Overbeek, Guay, Zaouter, Jamous, Williams, Moore) Department of
Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Montreal,
Quebec, Canada
(Glorion) Department of Thoracic Surgery and Lung Transplantation, Foch
Hospital, Suresnes, France
Publisher
Elsevier Inc.
Abstract
Objective: Video-assisted thoracoscopic surgery (VATS) is associated with
significant postoperative pain. Multimodal analgesia, including
single-shot paravertebral blocks, is widely used but provides limited
analgesic duration. Intercostal cryoanalgesia, which offers prolonged pain
relief, presents a promising adjunctive option. This study aimed to assess
the analgesic benefit of intercostal cryoanalgesia in VATS lung cancer
surgery. The primary outcome was thoracic pain during cough 24 hours
postsurgery, measured via a verbal numerical rating scale. Method(s):
In a randomized, double-blind, controlled trial, 80 patients undergoing
VATS lobectomy for lung cancer were assigned to either a control group
receiving standard multimodal analgesia with single-shot paravertebral
blocks or a cryoanalgesia group receiving additional transpleural
intercostal cryoanalgesia (Cryoprobe; Erbe). Thoracic pain at rest and
during cough was evaluated at multiple time points up to 6 months
postoperatively. Secondary outcomes included quality of recovery, oral
morphine equivalents consumption, side effects, thoracic sensory loss (Von
Frey filament), and neuropathic pain (Douleur neuropathique 4 score).
 Result(s): Thoracic verbal numerical rating scale during cough at 24
hours showed no significant difference between groups (4.7 +/- 2.7 vs 4.8
+/- 2.9; P = .78). Pain scores, quality of recovery, opioid consumption,
side effects, Douleur neuropathique 4 scores, and sensory loss incidence
were comparable over 7 days. Pain scores during cough were significantly
higher 1 month after surgery (4.7 +/- 2.4 vs 3.4 +/- 2.0; P = .036) but
not at 3-month and 6-month follow-up. Conclusion(s): In this
double-blind trial, measurable cryoanalgesia was not observed in the
treatment group during cough at 24 hours post-VATS, nor was measurable
thoracic sensory loss or improved acute or chronic recovery
outcomes. Copyright © 2025 The American Association for Thoracic
Surgery

<16>
Accession Number
2041040097
Title
Dexmedetomidine Improves Inflammatory Stress and Hemodynamic in Patients
Undergoing Open Heart Surgery via Interleukin-13: A Randomized,
Double-Blind, Controlled, Clinical Trial.
Source
Annals of Cardiac Anaesthesia. 28(4) (pp 401-409), 2025. Date of
Publication: 01 Oct 2025.
Author
Hatemi B.M.J.; Enayati A.; Ghorbani S.; Tahmasebi F.; Aljadayel H.A.;
Jabbari A.; Movafegh A.
Institution
(Hatemi) Ischemic Disorders Research Center, International Campus,
Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Hatemi) Anesthesia Techniques Department, College of Health and Medical
Techniques, Al-Mustaqbal University, Babylon, Hillah, Iraq
(Enayati, Tahmasebi, Aljadayel, Jabbari) Ischemic Disorders Research
Center, Jorjani Clinical Sciences Research Institute, Golestan, Iran,
Islamic Republic of
(Ghorbani) Cancer Research Center, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Jabbari) Department of Anesthesiology and Critical Care Medicine,
Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Movafegh) Department of Anesthesiology, Tehran University of Medical
Sciences, School of Medicine faculty, Tehran, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Few studies have explored the anti-inflammatory effects of
drugs in cardiac surgery. Dexmedetomidine (Dex), a centrally acting
alpha-agonist, is believed to possess anti-inflammatory properties. We
conducted a randomized, double-blind, controlled trial to assess the
anti-inflammatory effects of Dex in patients undergoing open-heart surgery
with cardiopulmonary bypass. Method(s): Adult eligible patients
undergoing cardiac surgery with cardiopulmonary bypass were randomly
assigned to receive either standard anesthetics or De x 0.5 mug/kg/h in
addition to anesthetics in a single-center, randomized, double-blinded
study. The primary outcome was the change in inflammatory mediators () in
plasma 24 hours postsurgery compared with baseline, measured by ELISA.
Secondary outcomes are defined as changes in hemodynamic and biological
markers, recovery time, and Dex's safety. Result(s): In total, 80
patients were included in the control and Dex groups. The Dex group
increased IL-13 levels as anti-inflammatory cytokines, while it was
decreased in the control group. Dex reduced the levels of interleukin
(IL)-6 (P = 0.777) and IL-18 (P = 0.895) at the 24 hours postsurgery, with
no statically significant difference against the control group. Both
groups did not increase the levels of IL-1beta and TNF-alpha regards to
baseline (P = 0.812 and P = 0.420, respectively); however, this increase
was lower in the Dex group for TNF-alpha and slightly higher for IL-1beta.
Dex provided better hemodynamic and repository stability. In addition, the
incidence of common events including hypotension, bradycardia, and
tachycardia was higher in the control group than in Dex.
 Conclusion(s): We found that administering Dex at the onset of
anesthesia and during cardiopulmonary bypass reduces inflammatory factors,
promotes hemodynamic stability, and enhances patient safety. It may offer
significant benefits for those undergoing open heart
surgery. Copyright © 2025 Annals of Cardiac Anaesthesia.

<17>
Accession Number
2041040157
Title
Modified Del Nido Versus Custodiol Cardioplegia for Myocardial Protection
in Adult Patients Undergoing Cardiac Surgery; A Prospective Randomized
Double-Blinded Clinical Trial.
Source
Annals of Cardiac Anaesthesia. 28(4) (pp 451-458), 2025. Date of
Publication: 01 Oct 2025.
Author
Abdelhady M.A.; Goda A.S.; Sayed Gomaa M.S.; Hamed M.A.; Hassan A.A.S.M.
Institution
(Abdelhady, Goda, Hamed, Hassan) Departments of Anesthesiology, Fayoum
University, Fayoum, Egypt
(Sayed Gomaa) Department of Internal and Acute Medicine, Faculty of
Medicine, Fayoum University, Fayoum, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Cardioplegia is essential for myocardial protection. Modified
Del Nido and Custodiol cardioplegia have been successfully used; however,
a limited number of clinical trials compared both solutions. Our objective
was to evaluate the effectiveness of Modified Del Nido cardioplegia
against Custodiol in protecting the myocardium in adult patients having
open heart surgery. Method(s): In this prospective randomized
double-blinded clinical trial, fifty-eight adult patients registered for
elective open heart surgery at Fayoum University hospitals, Fayoum, Egypt,
between February 2022 and November 2023, have enrolled. Patients were
randomized to receive either a Modified Del Nido cardioplegia solution
(MDN group) (n = 29) or Custodiol cardioplegia (C group) (n = 29). The
primary outcome was Troponin I (microg/L) measured 24 h after surgery.
 Result(s): Both groups had comparable demographics. Troponin I was
much lower in the MDN group (median = 2.9, IQR = 2.7-3.2) than in the C
group (median = 3.6, IQR = 3.1-4.1) 24 h after surgery. Similarly, there
were substantial differences in CK-MB between the two groups 24 h
postoperatively. The MDN group had better results in terms of time taken
for cardiac arrest, the incidence of ventricular fibrillation upon
cross-removal, and the percentage of patients requiring inotropes. The MDN
group shows notably reduced hospital length of stay (LOS), intensive care
unit length of stay (ICU LOS), and weaning from mechanical ventilation
times. Conclusion(s): Adult cardiac surgery may be performed safely
and successfully using Modified Del Nido cardioplegia in comparison to
Custodiol cardioplegia. Copyright © 2025 Annals of Cardiac
Anaesthesia.

<18>
Accession Number
2041040178
Title
Intravenous Versus Inhaled Milrinone in Patients with Known Pulmonary
Hypertension Undergoing Cardiac Surgery: A Systematic Review and
Meta-analysis.
Source
Annals of Cardiac Anaesthesia. 28(4) (pp 364-378), 2025. Date of
Publication: 01 Oct 2025.
Author
Kavanagh T.; Kilpatrick T.; Hardy B.; Lee S.; Seavill M.; Lau C.-W.M.;
Bullard S.; Green S.; Cadd M.
Institution
(Kavanagh, Kilpatrick, Lee, Lau, Bullard, Green, Cadd) Anaesthetic
Department, Royal Sussex County Hospital, University Hospitals Sussex,
United Kingdom
(Hardy) Department of Cardiothoracic Anesthesia, Cardiovascular Intensive
Care Unit, Auckland City Hospital, Auckland, New Zealand
(Seavill) Anaesthetic Department, Conquest Hospital, East Sussex
Healthcare Trust, United Kingdom
Publisher
Wolters Kluwer Medknow Publications
Abstract
To summarize the evidence on the hemodynamic effects and vasopressor
requirements of adult patients with known pulmonary hypertension (PH)
undergoing cardiac surgery treated with intravenous and inhaled milrinone.
A total of 400 patients in 5 prospective (4 RCT) studies were included for
pooled analysis. There was no significant difference in the primary
outcome; mean pulmonary artery pressure (MPAP) between groups (MD: -4.80,
95% CI -10.57 to 0.98). Inhaled milrinone was associated with a greater
systemic vascular resistance index (SVRI) (MD: 259.21, 95% CI 168.70 to
349.72) and reduction in pulmonary capillary wedge pressure (MD: -4.64,
95% CI -5.47 to -3.81). There were no observable differences in mean
arterial pressure, pulmonary vascular resistance, cardiac index, or
central venous pressure. All studies included were assessed to be
moderate/some concern risk of bias. Inhaled milrinone has not been shown
to have a significant beneficial effect on MPAP and SVR when compared to
intravenous milrinone in patients with known PH undergoing cardiac
surgery. However, it has shown some benefits in maintaining MAP and
improving oxygenation in this patient cohort. The study is limited by the
bias of the included studies and the variability of inhaled drug dosage
and administration timing, further well-powered randomized controlled
trials are required. Copyright © 2025 Annals of Cardiac
Anaesthesia.

<19>
Accession Number
358858061
Title
Volume Replacement With a Balanced Hydroxyethyl Starch (HES) Preparation
in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 24(3) (pp 399-407),
2010. Date of Publication: 2010.
Author
Boldt J.; Mayer J.; Brosch C.; Lehmann A.; Mengistu A.
Institution
(Boldt, Mayer, Brosch, Lehmann, Mengistu) Department of Anesthesiology and
Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen,
Germany
Publisher
W.B. Saunders
Abstract
Objective: Balanced fluids appear to be have advantages over unbalanced
fluids for correcting hypovolemia. The effects of a new balanced
hydroxyethyl starch (HES) were studied in cardiac surgery patients.
 Design(s): Prospective, randomized, unblinded study. Setting(s):
Clinical study in a single cardiac surgery institution.
 Participant(s): Sixty patients undergoing elective cardiac surgery
with cardiopulmonary bypass. Intervention(s): Patients received
either a balanced 6% HES 130/0.4 plus a balanced crystalloid (n = 30) or
an unbalanced HES-in-saline plus saline (n = 30) to keep cardiac index
>2.5 L/min/m2. Measurements and Main Results: Base excess
(BE), kidney function, inflammatory response (interleukins-6, -10),
endothelial activation (intercellular adhesion molecule-1 [ICAM]), and
coagulation (thromboelastometry, whole blood aggregation) were measured
after induction of anesthesia, after surgery and 5 hours later, and at the
1st and 2nd postoperative days; 2,950 +/- 530 mL of balanced and 3,050 +/-
560 mL of unbalanced HES were given. BE was reduced significantly in the
unbalanced group (from 1.11 +/- 0.71 mmol/L to -5.11 +/- 0.48 mmol/L after
surgery) and remained unchanged in the balanced group. Balanced volume
replacement resulted in significantly lower IL-6, IL-10, and ICAM plasma
concentrations and lower urine concentrations of kidney-specific proteins
than in the unbalanced group. After surgery, thromboelastometry data and
platelet function were changed significantly in both groups; 5 hours
thereafter they were significantly changed only in the unbalanced group.
 Conclusion(s): A plasma-adapted HES preparation in addition to a
balanced crystalloid resulted in significantly less decline in BE, less
increase in concentrations of kidney-specific proteins, less inflammatory
response and endothelial damage, and fewer changes in hemostasis compared
with an unbalanced fluid strategy. © 2010 Elsevier Inc. All rights
reserved.

<20>
Accession Number
2040561636
Title
Meta-analysis of scar formation and depression and anxiety symptoms in
patients after cardiac surgery.
Source
Frontiers in Psychiatry. 16 (no pagination), 2025. Article Number:
1628394. Date of Publication: 2025.
Author
Wang Y.; Liu W.; Lin L.
Institution
(Wang) Department of Dermatology and Cosmetology Surgery, Yuhuangding
Hospital, Yantai, China
(Liu) Department of Cardiovascular Surgery, Yantai Yuhuangding Hospital,
Yantai, China
(Lin) Department of Burn and Plastic Surgery, Yantai Yuhuangding Hospital,
Yantai, China
Publisher
Frontiers Media SA
Abstract
Background: The vertical median skin scar associated with median
sternotomy, a standard approach for most cardiac surgeries, can cause
psychological distress in patients, particularly depression and anxiety.
The impact of scarring after cardiac surgery on depression and anxiety
symptoms in patients is not well understood. Aim(s): The purpose of
this meta-analysis was to investigate the effect of scarring on depressive
and anxiety symptoms in patients after cardiac surgery. Method(s): To
investigate the relationship between scar formation and depression and
anxiety symptoms in patients after cardiac surgery. We searched databases
such as Web of Science, Cochrane Library, PubMed, and Embase for studies
published before August 2024 on scar descriptions and psychological states
after cardiac surgery. After data extraction and quality assessment, we
used RevMan5.4 to analyze the depression and anxiety symptoms of patients
after scar formation. Two authors independently performed the focused
analyses and reached a final consensus on the included studies, which were
subsequently quality checked and risk of bias assessed by a third author.
 Result(s): Four studies were included in the meta-analysis. All 4
studies used Patient and Observer Scar Assessment Scale (POSAS) to assess
scar, and one study also combined Vancouver Scar Scale (VSS) for scar
assessment. Meta-analysis results show that Full sternotomy has a smaller
scar score than Limited sternotomy (OR = 0.94 [95% confidence interval
(CI) 0.28-1.61]; P = 0.005), and there is no significant heterogeneity
between the two groups (I2 = 0%). And the postoperative
depression score in the Full sternotomy group was higher than that in the
Limited sternotomy group (OR = 1.61 [95%CI 0.63-2.60]; P = 0.001), and
there was no significant heterogeneity between the two groups
(I2 = 0%). However, there was no statistical difference in
postoperative anxiety scores between the two groups (OR = 0.70 [95%CI
1.40-2.80]; P = 0.51). There was slight heterogeneity between the two
groups (I2 = 58%), so a random effects model was used.
 Conclusion(s): In conclusion, patients with more severe scarring
after cardiac surgery may have more severe depressive symptoms, but
adequately powered randomized controlled trials are needed to confirm
these results. Copyright © 2025 Wang, Liu and Lin.

<21>
Accession Number
2038844351
Title
2025 American Association for Thoracic Surgery (AATS) Expert Consensus
Document: Surgical management of acute myocardial infarction and
associated complications.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(5) (pp 1327-1344),
2025. Date of Publication: 01 Nov 2025.
Author
Kaczorowski D.J.; Takeda K.; Atluri P.; Cevasco M.; Cogswell R.;
D'Allesandro D.; Daneshmand M.A.; Jeevanandam V.; Kapur N.K.; Milano C.;
Ono M.; Potapov E.; Ramzy D.; Silvestry S.C.; Soltesz E.; Uriel N.
Institution
(Kaczorowski) Department of Cardiothoracic Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
(Takeda) Department of Surgery, Columbia University Medical Center, New
York, NY, United States
(Atluri, Cevasco) Department of Surgery, Hospital of the University of
Pennsylvania, Philadelphia, Pa, United States
(Cogswell) Cardiovascular Division, University of Minnesota, Minneapolis,
Minn, United States
(D'Allesandro) Department of Surgery, Massachusetts General Hospital,
Boston, Mass, United States
(Daneshmand) Department of Surgery, Emory University, Atlanta, GA, United
States
(Jeevanandam) Department of Surgery, University of Chicago Medicine,
Chicago, Ill, United States
(Kapur) Division of Cardiology, Tufts Medicine, Boston, Mass, United
States
(Milano) Department of Surgery, Duke University, Durham, NC, United States
(Ono) Department of Surgery, The University of Tokyo Hospital, Tokyo,
Japan
(Potapov) Department of Thoracic and Cardiovascular Surgery, Deutsches
Herzzentrum der Charite, Berlin, Germany
(Ramzy) Department of Cardiothoracic and Vascular Surgery, UT Health
Houston McGovern School of Medicine, Houston, Tex, United States
(Silvestry) Department of Surgery, University of Arizona College of
Medicine, Tucson, Ariz, United States
(Soltesz) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Uriel) New York Presbyterian-Columbia University Irving Medical Center,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Complications of acute myocardial infarction (AMI) can result
in significant morbidity and mortality. This document reports the findings
and recommendations of a multidisciplinary group of experts on the
management of patients with complications of AMI, with particular focus on
the use of mechanical circulatory support in this context. Method(s):
Through the American Association of Thoracic Surgery Clinical Practice
Standards Committee, a committee of multidisciplinary experts, including
both cardiologists and cardiothoracic surgeons, was established. A list of
topics was developed. Committee members were divided into subgroups that
developed relevant questions. A systematic literature review was then
performed, and the results were synthesized into clinical recommendations.
Expert consensus was then established using the Delphi process.
 Result(s): Based on the results of the systematic literature review,
as well as the clinical expertise of the committee, clinical
recommendations were developed. Each of these recommendations, the
strength of each recommendation, and the level or quality of evidence on
which the recommendation was based are presented here. Topics addressed
include general considerations, revascularization strategies, cardiogenic
shock, papillary muscle rupture, postinfarction ventricular septal defect,
free wall rupture, arrhythmias, and the use of durable therapies in this
context. Conclusion(s): AMI may result in cardiogenic shock,
malignant arrhythmias, or mechanical complications, each of which is
associated with high mortality. Prompt management of these complications,
including consideration for mechanical circulatory support, is
warranted. Copyright © 2025

<22>
Accession Number
2040653224
Title
Applying positive end-expiratory pressure to facemask ventilation improves
post-induction lung atelectasis: a three-arm randomized controlled trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 509. Date
of Publication: 01 Dec 2025.
Author
Yang L.; Wu L.; Ye J.; Zhao Z.; Zhang J.
Institution
(Yang, Wu, Ye, Zhang) Department of Anesthesiology, Fudan University
Shanghai Cancer Center, No. 270 DongAn Road, Xuhui District, Shanghai,
China
(Zhang) Department of Oncology, Shanghai Medical College, Fudan
University, Shanghai, China
(Zhao) Department of Critical Care Medicine, the First Affiliated Hospital
of Guangzhou Medical University, Guangzou, China
(Zhao) School of Biomedical Engineering, Guangzhou Medical University,
No.1 Xinzao Road, Panyu District, Guangzhou, China
(Zhao) Institute of Technical Medicine, Furtwangen University, Villingen-
Schwenningen, Germany
Publisher
BioMed Central Ltd
Abstract
Background: Induction of general anesthesia is associated with rapid-onset
lung atelectasis, which increases intrapulmonary shunt and potentially
impairs oxygenation. We aimed to evaluate whether applying positive
end-expiratory pressure (PEEP) to facemask ventilation during induction of
general anesthesia can reduce post-induction lung atelectasis.
 Method(s): In this single-center, three-arm randomized controlled
trial, one hundred and twenty ASA I-II patients undergoing elective
non-cardiothoracic cancer surgery under general anesthesia were randomly
assigned into three groups. Facemask ventilation was initiated in
volume-controlled mode with preassigned PEEP levels (0, 5, or 10
cmH<inf>2</inf>O) after anesthetic administration. Electrical impedance
tomography (EIT) was used to continuously assess lung atelectasis during
induction of general anesthesia, including baseline spontaneous breathing,
facemask ventilation, and post-intubation mechanical ventilation. The
primary outcome was the dorsal change in end-expiratory lung volume (EELV)
2 min after endotracheal intubation. The secondary outcomes included
driving pressure, EIT-derived ventilation homogeneity, systemic
hemodynamics, and PaO<inf>2</inf>/FiO<inf>2</inf> ratio. Result(s):
Atelectasis (defined as EELV < 0) occurred in both the PEEP<inf>0</inf>
and PEEP<inf>5</inf> groups during facemask ventilation [-58.8% (-110.4%,
4.0%) and - 34.2% (-200%, 19.2%), respectively] and after induction
[-26.9% (-127.4%, 33.6%) and - 33.2% (-52.8%, 5.0%), respectively], but
not in the PEEP<inf>10</inf> group [25.3% (-12%, 104.7%)]. Facemask
ventilation with 10 cmH<inf>2</inf>O PEEP demonstrated better dorsal lung
recruitment than both lower PEEP levels (P < 0.05), reduced post-induction
driving pressure (P < 0.05), and improved ventilation homogeneity (P <
0.05). Hemodynamics and PaO<inf>2</inf>/FiO<inf>2</inf> ratio were
comparable among the three groups. Conclusion(s): Use of 10
cmH<inf>2</inf>O PEEP during induction of general anesthesia effectively
mitigated dorsal lung collapse by optimizing respiratory mechanics without
inducing overdistension and hemodynamic compromise. It is worth
investigating whether this improvement can be extended to the
postoperative period. Trial registration number: NCT06900426 (registered
at clinicaltrials, principal investigator: Jun Zhang, registration date:
March 17, 2025). Copyright © The Author(s) 2025.

<23>
Accession Number
619949956
Title
Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with
left-sided double-lumen endobronchial tube in one-lung ventilation in
thoracic surgery in the morbidly obese.
Source
Brazilian Journal of Medical and Biological Research. 51(2) (no
pagination), 2018. Article Number: e6825. Date of Publication: 2018.
Author
Zhang Z.J.; Zheng M.L.; Nie Y.; Niu Z.Q.
Institution
(Zhang, Zheng, Nie, Niu) Department of Anesthesiology, The Cangzhou
Central Hospital, Cangzhou, Hebei, China
Publisher
Associacao Brasileira de Divulgacao Cientifica
Abstract
This study aimed to evaluate the feasibility and performance of
Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway
(LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in
morbidly obese patients in one-lung ventilation (OLV). In a prospective,
randomized double-blind controlled clinical trial, 80 morbidly obese
patients (ASA I-III, aged 20-70) undergoing general anesthesia for
elective thoracic surgeries were randomly allocated into groups Arndt
(n=40) and L-DLT (n=40). In group Arndt, a LMATM Proseal was placed
followed by an Arndt-endobronchial blocker. In group L-DLT, patients were
intubated with a left-sided double-lumen endotracheal tube. Primary
endpoints were the airway establishment, ease of insertion, oxygenation,
lung collapse and surgical field exposure. Results showed similar ease of
airway establishment and tube/device insertion between the two groups.
Oxygen arterial pressure (PaO<inf>2</inf>) of patients in the Arndt group
was significantly higher than L-DLT (154+/-46 vs 105+/-52 mmHg; P<0.05).
Quality of lung collapse and surgical field exposure in the Arndt group
was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05).
Duration of surgery and anesthesia were significantly shorter in the Arndt
group (2.4+/-1.7 vs 3.1+/-1.8 and 2.8+/-1.9 vs 3.8+/-1.8 h, respectively;
P<0.05). Incidence of hoarseness of voice and incidence and severity of
throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h
after surgery were significantly lower in the Arndt group (P<0.05).
Findings suggested that Arndt-endobronchial blocker combined with LMA can
serve as a promising alternative for morbidly obese patients in OLV in
thoracic surgery. Copyright © 2018, Associacao Brasileira de
Divulgacao Cientifica. All rights reserved.

<24>
Accession Number
2037661777
Title
Computed tomography coronary angiography as an alternative to invasive
coronary angiography in preoperative evaluation for mitral surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 170(5) (pp 1422-1425),
2025. Date of Publication: 01 Nov 2025.
Author
Patil A.R.; Zheng A.; Israel Y.; Shah A.; El-Eshmawi A.; Pandis D.;
Anyanwu A.C.; Adams D.H.; Boateng P.
Institution
(Patil, Zheng, El-Eshmawi, Pandis, Anyanwu, Adams, Boateng) Mount Sinai
Health System, New York, NY, United States
(Israel) Icahn School of Medicine, New York, NY, United States
(Shah) Quality Operations and Clinical Data Registries, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: To assess the effectiveness of noninvasive coronary computed
tomography angiography (CTA) as an alternative to traditional invasive
coronary angiography (ICA) for preoperative evaluation of low-risk
patients with an indication for nonemergent mitral surgery and to assess
any difference in adverse outcomes from this strategy. Method(s):
This was a retrospective cohort study from a single center with data
collected from July 2014 to June 2020 for 1576 patients undergoing mitral
valve surgery of all etiologies, excluding patients requiring coronary
artery bypass surgery. We performed a 1:2 propensity score matching for
patients evaluated with CTA (n = 345) to those evaluated with ICA (n =
602). The primary outcome was a composite of major adverse events in the
immediate postoperative period, including death, stroke, new-onset renal
failure, postoperative cardiac arrest, need for unplanned coronary artery
bypass grafting or percutaneous coronary re-vascularization. The odds
ratio was calculated for occurrence of major adverse events in the CTA
group compared with the catheterization group. Result(s): The mean
age (standard deviation) was 55.62 years (11.54) for the CTA group and
58.22 years (10.11) for the ICA group. In the CTA group 334 (96.8%) and
from the ICA group 582 (96.7%) patients underwent mitral valve repair.
Thirteen (3.8%) patients in the CTA group experienced a major adverse
event compared with 25 (4.2%) patients in the ICA group. Of these, there
were no mortalities in the CTA group but 1 (0.2%) operative mortality in
the ICA group. Four (1.2%) patients in the CTA group had a postoperative
stroke compared with 3 (0.5%) patients in the ICA group. One (0.3%)
patient in the CTA group required renal-replacement therapy
postoperatively compared with 11 (1.8%) in the ICA group. Percutaneous
coronary intervention was required in 1 (0.3%) patient in CTA group and 2
(0.3%) patients in ICA group for a coronary complication of valve surgery
despite nonobstructive coronary anatomy being confirmed in both groups
preoperatively. The odds ratio for having a major adverse event when
worked up by CTA compared with ICA was 0.904 (0.443, 1.761).
 Conclusion(s): There were no increased odds of experiencing a major
adverse event for low-risk patients undergoing elective mitral valve
surgery and preoperative coronary evaluation with CTA compared with ICA.
These data have modified our practice pattern, where we now offer coronary
CTA to all elective patients who are low risk for coronary artery
disease. Copyright © 2025 The American Association for Thoracic
Surgery

<25>
Accession Number
2040652752
Title
Role of vitamin D supplementation in prevention of new onset atrial
fibrillation in post-coronary artery bypass graft patients in vitamin D
deficient and insufficient populations: a systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
744. Date of Publication: 01 Dec 2025.
Author
Lanka N.; Onadipe O.; Yuce S.; Fahim B.; Fatima M.; Shah H.
Institution
(Lanka) Lokmanya Tilak Municipal Medical College, Mumbai, India
(Onadipe) Lagos State Health Service Commission, Lagos, Lagos Island,
Nigeria
(Yuce) Istanbul Provincial Health Directorate, Ministry of Health,
Istanbul, Turkey
(Fahim) Faculty of Medicine, Sohag University, Sohag, Egypt
(Fatima) Osmania Medical College, Hyderabad, India
(Shah) The New York Medical College Graduate Medical Education Program at
St. Mary's General Hospital and St. Clare's Health, Passaic, Denville, NJ,
United States
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication following coronary artery bypass grafting (CABG),
contributing to increased morbidity, prolonged hospitalization, and
elevated healthcare costs. Emerging evidence suggests that vitamin D (Vit.
D), via its anti-inflammatory effects and modulation of the
renin-angiotensin-aldosterone system (RAAS), may have a cardioprotective
role. Objective(s): This systematic review and meta-analysis aimed to
evaluate the efficacy of preoperative Vit. D supplementation in reducing
the incidence of POAF among CABG patients, with a focus on populations
with Vit. D deficiency and insufficiency. Method(s): Our study was
conducted in accordance with the PRISMA 2020 Guidelines. The electronic
databases PubMed, Cochrane Library and Google Scholar were searched from
2014 to 2024. Randomized controlled trials and retrospective observational
studies involving adult subjects, evaluating Vit. D deficient and/or
insufficient patients who have undergone CABG and received Vit. D
supplementation in addition to standard care, compared to patients
receiving standard care alone or with placebo, and reporting incidence of
new-onset POAF were included. Statistical analysis was performed using
RevMan v5.4 software, utilizing a random effects model with heterogeneity
assessed using the I2 statistic. Result(s): A total of
four randomized controlled trials were included in our study, evaluating a
sample size of 694 (Vitamin D group- 342, Control group- 352; mean age-
61.8 years, 42.6% females). Our meta-analysis revealed that preoperative
Vit. D supplementation significantly reduced the incidence of POAF in
post-CABG patients with sub-optimal Vit. D levels (RR = 0.55, 95% CI:
0.40-0.76, p = 0.0003, I2 = 1%). However, no significant effect
was noted in the Vit. D insufficient population. Supplementation did not
significantly affect length of hospital stay (MD = -0.62, 95% CI:
-0.74-0.50, p = 0.28) or duration of intubation (MD = 0.00, 95% CI:
-0.26-0.26, p = 0.99). Conclusion(s): Preoperative Vit. D
supplementation appears beneficial in reducing POAF risk in deficient CABG
patients, but not in insufficient populations. These findings support
targeted supplementation as a potential adjunct in perioperative care,
though further large-scale studies are warranted to define optimal dosing
strategies and broader applicability. Copyright © The Author(s)
2025.

<26>
Accession Number
2019013771
Title
Association between sarcoidosis and cardiovascular Outcomes: A systematic
review and Meta-analysis.
Source
IJC Heart and Vasculature. 41 (no pagination), 2022. Article Number:
101073. Date of Publication: 01 Aug 2022.
Author
Jaiswal V.; Peng Ang S.; Sarfraz Z.; Butey S.; Vinod Khandait H.; Song D.;
Ee Chia J.; Maroo D.; Hanif M.; Ghanim M.; Chand R.; Biswas M.
Institution
(Jaiswal) AMA School Of Medicine, Makati, Philippines
(Peng Ang) Department of Internal Medicine, Rutgers Health/Community
Medical Center, NJ, United States
(Sarfraz) Fatima Jinnah Medical University, Lahore, Pakistan
(Butey) Indira Gandhi Government Medical College, Nagpur, India
(Vinod Khandait, Chand) Department of Internal Medicine, Trinitas Regional
Medical Center, Elizabeth, NJ, United States
(Song) Department of Internal Medicine, Icahn School of Medicine at Mount
Sinai Hospital, NY, United States
(Ee Chia) School of Medicine, International Medical University, Kuala
Lumpur, Malaysia
(Maroo) Maulana Azad Medical College, New Delhi, India
(Hanif) Department of Internal Medicine, Suny Upstate Medical University,
NY, United States
(Ghanim) Henry Ford Healthcare System, Detroit, MI, United States
(Biswas) General Cardiology and Advanced Heart Failure, Wellspan
Cardiology, Lancaster, PA, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Sarcoidosis is a chronic inflammatory disorder of unknown
etiology associated with high morbidity and mortality. Its association
with cardiovascular outcomes is under-documented. Aim(s): The aim of
this study was to assess the adverse cardiovascular outcomes in patients
with sarcoidosis compared with that of non-sarcoidosis. Methodology:
Online databases including PubMed, Embase and Scopus were queried from
inception until March 2022. The outcomes assessed included all-cause
mortality (ACM) and incidence of ventricular tachycardia (VT), heart
failure (HF) and atrial arrhythmias (AA). Result(s): A total of 6
studies with 22,539,096 participants (42,763 Sarcoidosis, 22,496,354
Non-Sarcoidosis) were included in this analysis. The pooled prevalence of
sarcoidosis was 13.1% (95% CI 1% to 70%). The overall mean age was 47
years. The most common comorbidities were hypertension (12.7% vs 12.5%),
and diabetes mellitus (5.5% vs 4%) respectively. The pooled analysis of
primary endpoints showed that all-cause mortality (RR, 2.08; 95% CI: 1.17
to 3.08; p = 0.01) was significantly increased in sarcoidosis patients.
The pooled analysis of secondary endpoints showed that the incidence of VT
(RR, 15.3; 95% CI: 5.39 to 43.42); p < 0.001), HF (RR, 4.96; 95% CI: 2.02
to 12.14; p < 0.001) and AA (RR, 2.55; 95% CI: 1.47 to 4.44); p = 0.01)
were significantly higher with sarcoidosis respectively compared to
non-sarcoidosis. Conclusion(s): Incidence of VT, HF and AA was
significantly higher in patients with CS. Clinicians should be aware of
these adverse cardiovascular events associated with
sarcoidosis. Copyright © 2022 The Authors

<27>
Accession Number
612844581
Title
Interposed abdominal compression-cardiopulmonary resuscitation after
cardiac surgery.
Source
Interactive cardiovascular and thoracic surgery. 19(6) (pp 985-989), 2014.
Date of Publication: 01 Dec 2014.
Author
Li J.; Wang J.; Li T.
Institution
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China
(Wang) Cardiovascular Center of Hainan Medical College, Affiliated
Hospital of Hainan Medical College, Haikou, China
(Li) Cardiovascular Center of Hainan Medical College, Affiliated Hospital
of Hainan Medical College, Haikou, China
Abstract
OBJECTIVES: The management of cardiac arrest after cardiac surgery differs
from the management of cardiac arrest under other circumstances. In other
studies, interposed abdominal compression-cardiopulmonary resuscitation
(IAC-CPR) resulted in a better outcome compared with conventional CPR. The
aim of the present study was to determine the feasibility, safety and
efficacy of IAC-CPR compared with conventional CPR in patients with
cardiac arrest after cardiac surgery.
METHODS: Data on all cardiac surgical patients who suffered a sudden
cardiac arrest during the first 24 h after surgery were collected
prospectively. Cardiac arrest was defined as the cessation of cardiac
mechanical activity with the absence of a palpable central pulse, apnoea
and unresponsiveness, including ventricular fibrillation, asystole and
pulseless electrical activity. Forty patients were randomized to either
conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially
performed by compressing the abdomen midway between the xiphoid and the
umbilicus during the relaxation phase of chest compression. If spontaneous
circulation was not restored after 10-15 min, the surgical team would
immediately proceed to resternotomy. The endpoints of the study were
safety, return of spontaneous circulation (ROSC) >5 min, survival to
hospital discharge and survival for 6 months.
RESULTS: With IAC-CPR, there were more patients in terms of ROSC, survival
to hospital discharge, survival for 6 months and fewer CPR-related
injuries compared with patients who underwent conventional CPR.
CONCLUSIONS: IAC-CPR is feasible and safe and may be advantageous in cases
of cardiac arrest after cardiac surgery. Copyright © The Author
2014. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<28>
Accession Number
2041078176
Title
Disparities while listing for orthotopic heart transplantation: A
systematic review and meta-analysis.
Source
Transplantation Reviews. 39(4) (no pagination), 2025. Article Number:
100968. Date of Publication: 01 Dec 2025.
Author
Phutinart S.; Thamthanaruk A.; Siranart N.; Chuanchai W.; Sowalertrat W.;
Chumpangern Y.; Pajareya P.
Institution
(Phutinart, Thamthanaruk, Chuanchai, Pajareya) Faculty of Medicine, King
Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok,
Thailand
(Siranart) Department of Gastroenterology and Hepatology, Mayo Clinic,
Rochester, MN, United States
(Sowalertrat) Department of Radiology, Prince of Songkhla University,
Bangkok, Thailand
(Chumpangern) Faculty of Medicine, Siriraj Hospital, Mahidol University,
Bangkok, Thailand
Publisher
Elsevier Inc.
Abstract
Background: Disparities in orthotopic heart transplant (OHT) listing exist
due to race, gender, insurance access, socioeconomic status (SES) and
access to healthcare. This study aims to investigate the impact of these
factors on the inequities encountered within the pre-transplantation
process. Method(s): Literature search was conducted up to July 2024,
focusing on disparities in organ transplant outcomes. The primary endpoint
was the recipient acceptance rate. Secondary endpoints were donor
acceptance, waitlist urgency (status 1, 1A, or 1A exception), waitlist
mortality (death while on the list), and waitlist duration (time from
listing to transplantation). Result(s): A total of 40 studies
involving 506,459 patients at listing for OHT were included. Disparities
in education level, gender, and insurance were not associated with
recipient acceptance rate. However, black patients have a significantly
lower recipient acceptance rate compared to the white patients (HR 0.86,
95 % CI: 0.84-0.89, I2 = 15.8 %). For waitlist urgency, black
patients were more likely to be listed for status 1 (OR 1.24, 95 % CI:
1.11-1.39, I2 = 85.2 %). For waitlist mortality, there was no
significant association with race, gender, insurance, income and education
level, but the introduction of the 2018 policy led to a significantly
lower waitlist mortality (HR 0.61, 95 % CI: 0.52-0.72, I2 = 0.0
%). Conclusion(s): Race remains a primary determinant of inequity in
transplant access. Addressing racial disparity is crucial for achieving
equitable access to care for all patients with end-stage heart
disease. Copyright © 2025 The Authors

<29>
Accession Number
2041117357
Title
Does Autologous Platelet-Rich Plasma Improve Blood Conservation and
Postoperative Outcomes in Acute Type A Aortic Dissection Surgery? A
Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Santos K.; Oya K.; Umibe T.; Patel N.; Abo T.; Sakai W.; Plonek T.
Institution
(Santos, Patel) New Vision University School of Medicine, Tbilisi, Georgia
(Santos, Plonek) Department of Cardiothoracic Surgery, Medisch Spectrum
Twente, Enschede, Netherlands
(Oya, Umibe, Abo, Sakai) Department of Surgery, National Center for Global
Health and Medicine, Tokyo, Japan
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate whether autologous platelet-rich plasma (aPRP)
improves blood conservation and postoperative outcomes in emergency
surgery for acute type A aortic dissection (ATAAD). Design(s):
Systematic review and meta-analysis of randomized controlled trials and
observational studies. Setting(s): Cardiac surgery centers from
multiple institutions. Participant(s): Six studies comprising 2,150
adult patients undergoing ATAAD repair, of whom 906 (42.1%) received
intraoperative aPRP. Intervention(s): Use of intraoperative aPRP
versus no aPRP during ATAAD repair. Measurements and Main Results:
Primary outcomes included reoperation for bleeding and allogeneic blood
product transfusion volumes. Secondary outcomes were mechanical
ventilation duration, hospital stay, and postoperative complications. aPRP
was associated with significantly shorter mechanical ventilation time (MD
-13.8 hours; 95% CI -23.9 to -3.7; p = 0.008), lower incidence of
prolonged ventilation (OR 0.3; 95% CI 0.2 to 0.7; p = 0.004), reduced
reoperation rates (OR 0.4; 95% CI 0.2 to 0.7; p = 0.005), and decreased
platelet (MD -2.2 units; 95% CI -3.5 to -0.9; p = 0.001) and
cryoprecipitate use (MD -1.9 units; 95% CI -3.0 to -0.8; p < 0.001). No
differences were observed in mortality, hospital stay, or rates of
neurological or renal complications. Subgroup analysis of randomized
controlled trial and propensity-matched data confirmed several of these
findings and additionally showed reduced plasma transfusion volumes.
 Conclusion(s): In ATAAD surgery, aPRP may reduce transfusion needs,
reoperations, and ventilation duration without increasing adverse
outcomes. Given that most evidence is observational, high-quality
randomized trials are needed to confirm these findings. Copyright
© 2025 Elsevier Inc.

<30>
Accession Number
2040665136
Title
Fetal Surgery for Congenital Heart Diseases: A Systematic Review and
Single-Arm Meta-analysis.
Source
Advances in Therapy. (no pagination), 2025. Date of Publication: 2025.
Author
de Azevedo Teixeira L.K.; Provinciatto H.; Callado G.Y.; de Oliveira
Nieblas C.; Granese R.; Araujo Junior E.
Institution
(de Azevedo Teixeira, de Oliveira Nieblas, Araujo Junior) Discipline of
Woman Health, Municipal University of Sao Caetano do Sul (USCS), SP, Sao
Caetano do Sul, Brazil
(Provinciatto, Araujo Junior) Department of Obstetrics, Paulista School of
Medicine, Federal University of Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
(Callado) Department of Woman Health, Albert Einstein Israelite College of
Health Sciences, Albert Einstein Israelite Hospital, SP, Sao Paulo, Brazil
(Granese) Department of Biomedical and Dental Sciences and
Morphofunctional Imaging, "G. Martino" University Hospital, Messina, Italy
Publisher
Adis
Abstract
Introduction: Congenital heart diseases (CHD) are the most common
congenital anomalies, and fetal cardiac interventions (FCI) have been
developed to improve perinatal outcomes. We aimed to conduct a systematic
review and meta-analysis of observational studies to evaluate the effects
of FCI on CHD. Method(s): We searched PubMed/Medline, Embase, and the
Cochrane Central Register of Controlled Trials from inception to April
2025 without language restrictions. References of included studies and
prior reviews were also screened. The protocol was registered in the
International Prospective Register of Systematic Reviews (PROSPERO; ID
CRD42024599628). Eligible studies included observational cohorts
evaluating intrauterine procedures for CHD. Data were synthesized using
random effects models in RStudio (version 4.2.2), and study quality was
assessed with the Newcastle-Ottawa Quality Assessment Form for Cohort
Studies (NOS). Result(s): Twelve studies including 485 fetuses with
CHD were analyzed. The pooled overall survival rate after fetal cardiac
intervention was 57.4% (95% confidence interval [CI] 39.8-73.3), with
survival ranging from 20.0% to 90.2% across studies. The pooled perinatal
mortality rate was 31.5% (95% CI 21.0-44.2), with estimates ranging from
9.8% to 66.7%. Substantial heterogeneity was observed for both outcomes
(I2 > 75%). Conclusion(s): FCI for CHD are associated with
moderate overall survival but substantial perinatal mortality.
Standardized protocols, refined patient selection, and multicenter
collaboration are needed to improve outcomes and guide clinical
decision-making. Copyright © The Author(s) 2025.

<31>
Accession Number
2041116691
Title
Nonsteroidal Anti-Inflammatory Drugs as Part of a Multimodal Postoperative
Pain Management Strategy in Patients Undergoing Cardiac Surgery: A
Meta-Analysis of 11 Randomized Clinical Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Beshr M.S.; Shembesh R.H.; Salama A.H.; Kara A.O.; Arora R.C.; Abuajamieh
M.; Arhaym E.; Grant M.C.; Gregory A.J.; Elhadi M.
Institution
(Beshr) Faculty of Medicine and Health Sciences, Sana'a University,
Sana'a, Yemen
(Shembesh) Faculty of Medicine, Libyan International Medical University,
Benghazi, Libyan Arab Jamahiriya
(Salama) University of Health Sciences, Hamidiye International School of
Medicine, Istanbul, Turkey
(Kara, Arhaym) Faculty of Medicine, University of Benghazi, Benghazi,
Libyan Arab Jamahiriya
(Arora) Division of Cardiac Surgery, Harrington Heart and Vascular
Institute, University Hospitals, Cleveland, Ohio, United States
(Abuajamieh) Faculty of Medicine, Cairo University, Cairo, Egypt
(Grant) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine
and Libin Cardiovascular Institute, Cumming School of Medicine, University
of Calgary, Calgary, AB, Canada
(Elhadi) College of Medicine, Korea University, Seoul, South Korea, South
Korea
Publisher
W.B. Saunders
Abstract
Background: Effective and safe pain management is crucial for optimal
recovery after cardiac surgery. Traditionally, opioids have been the
mainstay for postoperative pain control, but their negative health effects
have led to a recent shift toward multimodal analgesia to minimize opioid
use. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been
controversial owing to concerns about bleeding, acute kidney injury (AKI),
graft patency, and cardiovascular risks. Despite these concerns, many
perioperative teams continue to use NSAIDs alongside opioids as part of
multimodal analgesia. This meta-analysis evaluated the efficacy and safety
of NSAIDs as a multimodal pain management tool following cardiac surgery.
 Method(s): An electronic search was conducted on November 15, 2024,
using PubMed, Scopus, Web of Science, Embase, and Cochrane databases. Only
controlled trials that combined NSAIDs with opioids for pain management
following cardiac surgeries were included. The primary outcome was the
visual analog scale (VAS), a 0 to 10 scale measuring pain intensity
assessed at 6, 12, 18, 24, and 48 hours. Total opioid consumption was
measured at 6, 12, 24, and 48 hours. Secondary outcomes included
myocardial infarction, atrial fibrillation, kidney function,
gastrointestinal bleeding, nausea, and vomiting. The mean difference (MD)
was used for continuous outcomes, and the odds ratio (OR) was used for
dichotomous outcomes. A random-effects model was applied for the analysis.
 Result(s): Out of the 1,194 articles screened, 11 articles, totaling
1,463 patients, were included in the meta-analysis. The NSAID group
demonstrated significantly lower VAS scores at the 12-hour (MD, -1.19, 95%
confidence interval [CI], -1.83 to -0.56; p < 0.001), 24-hour (MD, -0.61;
95% CI, -0.97 to -0.24; p = 0.001), 18-hour (MD, -1.43; 95% CI, -2.58 to
-0.28; p = 0.01), and 48-hour (MD, -0.68; 95% CI, -0.87 to -0.49; p <
0.001) time points. However, no significant differences in VAS scores were
observed at the 6-hour mark. Regarding opioid consumption, the NSAID group
demonstrated significantly lower opioid consumption at the 24-hour (MD,
-8.10; 95% CI, -10.60 to -5.61; p < 0.001) and 48-hour (MD, -7.13; 95% CI,
-12.44 to -1.82; p = 0.009); however, no differences were observed at the
6-hour and 12-hour marks. Finally, there were no significant differences
between the NSAID and control groups in the incidence of gastrointestinal
bleeding, atrial fibrillation, myocardial infarction, or AKI.
 Conclusion(s): NSAID use was associated with modestly reduced VAS
scores at 12, 18, 24, and 48 hours, while opioid consumption was
significantly lower at 24 and 48 hours postoperatively. Short-term NSAID
use can be effective in reducing pain and opioid requirements. Although no
significant difference in complications was observed, the analysis was
limited by small sample sizes. More extensive randomized controlled trials
are needed to assess the effectiveness and safety of NSAIDs as part of a
multimodal analgesic strategy. Copyright © 2025 Elsevier Inc.

<32>
Accession Number
2041157397
Title
Veno-pulmonary extracorporeal membrane oxygenation for concomitant right
ventricular and respiratory support: A systematic review of utilization
patterns and outcomes.
Source
Perfusion (United Kingdom). (no pagination), 2025. Article Number:
02676591251389383. Date of Publication: 2025.
Author
Nasher N.; Mounzer M.; Mallur K.; Fayek F.B.; Rahimov D.; Rame J.E.;
Alvarez R.J.; Entwistle J.W.; Rajagopal K.; Hoopes C.W.;
Tchantchaleishvili V.
Institution
(Nasher, Rahimov, Entwistle, Rajagopal, Hoopes, Tchantchaleishvili)
Department of Cardiac Surgery, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
(Mounzer, Mallur, Fayek) Sidney Kimmel Medical College, Thomas Jefferson
University, Philadelphia, PA, United States
(Rame, Alvarez) Division of Cardiology, Department of Medicine, Thomas
Jefferson University Hospital, Philadelphia, PA, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Veno-pulmonary artery extracorporeal membrane oxygenation (V-P
ECMO) is a configuration of extracorporeal life support (ECLS) for
patients with isolated or predominantly right ventricular (RV) failure and
inadequate gas exchange due to severe respiratory failure. We aimed to
systematically review the existing literature to better understand its
utilization patterns and associated outcomes. Method(s): The
electronic search identified all studies reporting the characteristics and
outcomes of V-P ECMO use in adult patients. Patient-level data for 110
patients from 60 case reports and case series were extracted and analyzed.
 Result(s): The median patient age was 45 [IQR, 32-56] years, and 63%
were male. Patients most commonly presented with moderate to severe RV
dysfunction (90%), along with acute hypoxic respiratory failure (64%) and
severe pulmonary hypertension (23%). On presentation, 85% of patients were
placed on ventilatory support for a median duration of 13 [5-32] days. V-P
ECMO was initiated in the setting of a primary cardiorespiratory pathology
in 75% of cases, and major chest surgery in 25% of cases. A percutaneous
dual-lumen cannula was used in 64% of cases, of which 29% required an
additional cannula. The median duration of V-P ECMO support was 12 [7-31]
days. Overall, 42% of patients recovered, 26% underwent lung
transplantation, and 9% underwent heart transplantation. In-hospital
mortality was 22%. At a median follow-up time of 81 [44-181] days, overall
survival was 75%. Conclusion(s): V-P ECMO can be utilized in place of
traditional ECLS strategies with favorable outcomes across various
settings. Copyright © The Author(s) 2025

<33>
Accession Number
2041037561
Title
Heparin administration at first medical contact vs immediately before
primary percutaneous coronary intervention: the HELP-PCI trial.
Source
European Heart Journal. 46(39) (pp 3888-3901), 2025. Date of Publication:
14 Oct 2025.
Author
Xu C.; Qiu L.; Li B.; Yao W.; Wu H.; Hu L.; Xu G.; Zhu D.; Li Z.; Xiao C.;
Liu B.; Shen X.; Deng Z.; Zhuo C.; Su H.; Yang K.; Zhang Y.; Li C.; Lv X.;
Hong L.; Guo F.; Wu X.; Xu H.; Li M.; He L.; Wu W.; Lei Y.; Li D.; Li H.;
Chen S.; Bao H.; Xiong X.; Chen J.; Lan X.; Zheng Q.; Yang G.; Zhang M.;
Yang J.; Jiang H.
Institution
(Chen, Xu, Qiu, Jiang) Department of Cardiology, Renmin Hospital of Wuhan
University, Cardiovascular Research Institute of Wuhan University, No. 99.
Ziyang Rd., Wuhan, China
(Li) Department of Cardiology, Xianning Central Hospital, Xianning, China
(Yao) Department of Cardiology, Suizhou Central Hospital, Suizhou, China
(Wu, Yang) Department of Cardiology, The First College of Clinical Medical
Science, Three Gorges University, Yichang Central People's Hospital, Hubei
Key Laboratory of Ischemic Cardiovascular Disease, Yichang, China
(Hu) Department of Cardiology, Tongcheng People's Hospital, Xianning,
China
(Xu) Department of Cardiology, Ezhou Central Hospital, Ezhou, China
(Zhu, Li) Department of Cardiology, Xiantao First People's Hospital,
Xiantao, China
(Wu) Department of Cardiology, Xiangyang Central Hospital, Xiangyang,
China
(Xiao) Department of Cardiology, Songzi People's Hospital, Jingzhou, China
(Liu) Department of Cardiology, People's Hospital of Jingshan, Jingmen,
China
(Shen) Department of Cardiology, Chibi General Hospital, Xianning, China
(Deng) Department of Cardiology, Jiangxia First People's Hospital, Wuhan,
China
(Zhuo) Department of Cardiology, Anlu People's Hospital, Xiaogan, China
(Su) Department of Cardiology, Caidian People's Hospital, Wuhan, China
(Yang) Department of Cardiology, Jingzhou Central Hospital, Jingzhou,
China
(Zhang) Department of Cardiology, Shiyan People's Hospital, Shiyan, China
(Zhang) Department of Cardiology, Wuhan Puren Hospital, Wuhan, China
(Li) Department of Cardiology, Hubei Zhongshan Hospital, Wuhan, China
(Lv) Department of Cardiology, CR & WISCO General Hospital, Wuhan, China
(Hong, Guo) Department of Cardiology, Wuhan Fifth Hospital, Wuhan, China
(Wu) Department of Cardiology, General Hospital of Yangtze River Shipping,
Wuhan, China
(Xu) Department of Cardiology, Guoyao Dongfeng General Hospital, Shiyan,
China
(Li) Department of Cardiology, Xiangyang Hospital of Traditional Chinese
Medicine, Xiangyang, China
(He) Department of Cardiology, Wuhan No. 1 Hospital, Wuhan, China
(Wu) Department of Cardiology, Xishui People's Hospital, Huanggang, China
(Lei) Department of Cardiology, The Central Hospital of Enshi Tujia and
Miao Autonomous Prefecture, Enshi, China
(Li) Department of Cardiology, Wuhan No.3 Hospital, Wuhan, China
(Li, Chen) Department of Cardiology, Huanggang Central Hospital,
Huanggang, China
(Bao) Department of Cardiology, Jiangling People's Hospital, Jingzhou,
China
(Xiong) Department of Cardiology, Laohekou First Hospital, Xiangyang,
China
(Liu) Department of Cardiology, Wuhan No.6 Hospital, Wuhan, China
(Yang) Department of Cardiology, Wuhan Hanyang Hospital, Wuhan, China
(Chen, Lan) Department of Cardiology, Wuxue First People's Hospital,
Huanggang, China
(Zheng) Department of Cardiology, Xianning First People's Hospital,
Xianning, China
(Yang) Department of Cardiology, Tianmen First People's Hospital, Tianmen,
China
(Zhang) Department of Cardiology, Wuhan Hospital of Traditional Chinese
Medicine, Wuhan, China
Publisher
Oxford University Press
Abstract
Background and Aims The beneficial effect of pre-treatment with
unfractionated heparin (UFH) at first medical contact (FMC) before primary
percutaneous coronary intervention (PPCI) in all-comers with ST-elevation
myocardial infarction (STEMI) remains uncertain. Methods HELP-PCI was an
investigator-initiated, randomized controlled trial conducted at 36
clinical centres in China. Patients with STEMI presenting <=12 h after
symptom onset undergoing PPCI were randomly assigned (1:1) to intravenous
administration with UFH (100 U/kg) at FMC or in the Cath Lab through a
catheter sheath. The primary endpoint was Thrombolysis in Myocardial
Infarction flow grade (TFG)-3 of infarct-related artery (IRA) at
diagnostic angiography before PPCI. The secondary outcome was complete
epicardial and myocardial reperfusion after PPCI and major adverse cardiac
and cerebrovascular events (MACCE; defined as the composite of all-cause
death, cardiac death, heart failure hospitalizations, re-infarction, stent
thrombosis, unplanned revascularization, and stroke) at 12 months. Safety
outcome was 30-day Bleeding Academic Research Consortium (BARC) type >=2
bleeding. Results A total of 999 patients with STEMI undergoing PPCI were
randomly assigned to receive either UFH administration at FMC (n = 505) or
in the Cath Lab (n = 494). Pre-treated population at FMC showed a higher
frequency of TFG-3 of IRA compared with the Cath Lab group (23.6% vs
17.6%; odds ratio, 1.44; 95% confidence interval, 1.06-1.97; P = .02).
There were no significant differences in secondary endpoints or in the
safety endpoint, including 12-month MACCE, complete epicardial and
myocardial reperfusion, and major bleeding. Conclusions Pre-treatment with
loading-dose UFH at FMC was associated with an improvement of spontaneous
reperfusion of IRA without increasing the risk of major
bleeding. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<34>
Accession Number
2035001545
Title
Adjustment of positive end-expiratory pressure based on body mass index
during general anaesthesia: a randomised controlled trial*.
Source
Anaesthesia. 80(11) (pp 1322-1332), 2025. Date of Publication: 01 Nov
2025.
Author
Selpien H.; Penon J.; Thunecke D.; Schadler D.; Lautenschlager I.;
Ohnesorge H.; Eimer C.; Wolf C.; Sablewski A.; Becher T.
Institution
(Selpien, Penon, Thunecke, Schadler, Lautenschlager, Ohnesorge, Eimer,
Wolf, Sablewski, Becher) Department for Anaesthesiology and Intensive Care
Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Lung-protective ventilation is essential for preventing
postoperative pulmonary complications. While maintaining a low driving
pressure and optimising PEEP is of importance, the ideal strategy remains
contentious. This study evaluated whether adjusting PEEP based on BMI,
compared with standard PEEP, could reduce driving pressure and
peri-operative loss of lung aeration. Method(s): We conducted a
randomised controlled, patient-blinded, single-centre superiority trial
with two parallel groups. Adult patients undergoing surgery with general
anaesthesia who required tracheal intubation were assigned randomly to
either standardised PEEP (PEEP = 5 cmH<inf>2</inf>O; group PEEP-5) or PEEP
set according to BMI (PEEP = BMI/3 cmH<inf>2</inf>O; group PEEP-BMI/3).
Patients' lungs were ventilated using a volume-controlled mode with tidal
volumes of 7 ml.kg-1 predicted body weight. Lung aeration
scores were assessed using ultrasound pre- and postoperatively.
 Result(s): Sixty patients were enrolled and allocated randomly.
Adjustment of PEEP according to BMI/3 was associated with a significantly
lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4
[5.2-14.9]) cmH<inf>2</inf>O in group PEEP-5 and 7.9 (7.2-8.5 [5.9-14.1])
cmH<inf>2</inf>O in group PEEP-BMI/3 (p = 0.027) and higher mean (SD)
respiratory system compliance (group PEEP-5, 0.83 (0.20) ml
cmH<inf>2</inf>O-1 kg-1 predicted body weight vs.
group PEEP-BMI/3, 0.95 (0.17) ml cmH<inf>2</inf>O-1
kg-1 predicted body weight; p = 0.020). Lung ultrasound
revealed a reduced postoperative loss of lung aeration in patients
allocated to the BMI/3 group. Patients allocated to the BMI-adjusted group
required less supplemental oxygen, had less newly developed atelectasis
and had higher oxygen saturations upon arrival in the post-anaesthesia
care unit. Discussion(s): In patients without major pulmonary disease
who were undergoing non-cardiothoracic surgeries with tracheal intubation,
adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and
reduced postoperative loss of lung aeration. This approach provides a
straightforward and pragmatic method for individualising PEEP in patients
undergoing general anaesthesia. Copyright © 2025 The Author(s).
Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<35>
Accession Number
2034838898
Title
Saline-based modified del Nido cardioplegia versus multidose St. Thomas
cardioplegia in canine mitral valve repair: A randomized controlled trial.
Source
Veterinary Surgery. 54(7) (pp 1366-1377), 2025. Date of Publication: 01
Oct 2025.
Author
Kurogochi K.; Takahashi A.; Nii Y.; Chen A.; Nishiyama M.; Furusato S.;
Sugiya H.; Uechi M.
Institution
(Kurogochi, Takahashi, Nii, Chen, Nishiyama, Furusato, Sugiya, Uechi)
JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
(Kurogochi) Department of Clinical Sciences, North Carolina State
University, College of Veterinary Medicine, Raleigh, NC, United States
(Furusato) Department of Health Data Science, Yokohama City University,
Yokohama, Japan
Publisher
John Wiley and Sons Inc
Abstract
Objective: To compare the utility of a saline-based modified del Nido
(mDN) cardioplegia solution with a conventional institutional technique
(multidose St. Thomas blood cardioplegia) for mitral valve repair (MVR) in
dogs. Study design: Prospective, randomized, open-label trial. Animals:
Forty client-owned dogs with myxomatous mitral valve disease (stage B2 and
C) eligible for MVR were divided into control and modified mDN groups.
 Method(s): Cardioplegia was induced in the control group using 50%
blood containing St. Thomas solution every 10 min. In the mDN group, a
cardioplegia solution containing 20% blood was administered once or when
required. As the primary outcome, serum cardiac troponin I levels were
compared 12 h postoperatively between the groups. The other clinical
findings were evaluated as secondary outcomes. Result(s): Troponin
levels 12 h after surgery were a median of 27.8 ng/mL (interquartile
range, 15.1-43.2) in the control group and 19.4 ng/mL (15.2-33.6) in the
mDN group (p =.478). The sinus rhythm recovery time following aortic
cross-clamp removal was 362 s (103-995) in the control group and 60 s
(44-605) in the mDN group (p =.027). The total amount of crystalloid
cardioplegia solution required was 12.6 mL/kg (11.3-15.0) in the control
group and 23.6 mL/kg (18.0-35.1) in the mDN group (p <.001).
 Conclusion(s): Cardiac troponin I levels did not show differences
between the groups. The saline-based mDN cardioplegia facilitated earlier
sinus rhythm recovery. Clinical significance: Saline-based mDN
cardioplegia may be a viable alternative for canine MVR. Copyright
© 2025 Japan Animal Specialty Medical Institute Inc. Veterinary
Surgery published by Wiley Periodicals LLC on behalf of American College
of Veterinary Surgeons.

<36>
Accession Number
2040952561
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. 67(9) (no pagination), 2025.
Article Number: ezaf288. Date of Publication: 01 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, MA,
Boston, 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, NB, 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,
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
Publisher
European Association for Cardio-Thoracic Surgery
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. Methods 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. Results 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). Conclusions 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. Copyright © 2025 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<37>
Accession Number
2035276627
Title
Risk Factors for Hearing Loss Are Comparable in Preterm Versus Term
Children: A Systematic Review.
Source
Acta Paediatrica, International Journal of Paediatrics. 114(11) (pp
2763-2782), 2025. Date of Publication: 01 Nov 2025.
Author
Roehrs P.; Rohlfs A.-K.; Vonthein R.; Simon C.; Spiegler J.
Institution
(Roehrs) Department of Paediatrics, University Hospital of Luebeck,
Luebeck, Germany
(Rohlfs) Department of Otorhinolaryngology, Head and Neck Surgery, Section
of Phoniatrics and Paedaudiology, University Hospital of Ulm, Ulm, Germany
(Vonthein) Institute of Medical Biometry and Statistics, University of
Luebeck, Luebeck, Germany
(Simon) University of Wuerzburg, Wuerzburg, Germany
(Spiegler) Department of Paediatrics, University Hospital of Wuerzburg,
Wuerzburg, Germany
Publisher
John Wiley and Sons Inc
Abstract
Aim: Hearing loss occurs more frequently in preterm children. However, the
influence of prematurity itself is unclear. We examined whether risk
factors for hearing loss differ between preterm and term infants.
 Method(s): We conducted a systematic search of three databases in
March 2023 for studies comparing risk factors for hearing loss in preterm
and term children. Studies on postnatal trauma, chemotherapy or infections
after the age of 5 years were excluded. Risk of bias was assessed. Data
were extracted and analyzed using logistic regression to yield odds ratios
(95% confidence interval). Result(s): Of 10 300 studies screened, 16
met the inclusion criteria, including 9059 preterm and 10 048 term
children. Only one study compared risk factors between preterm and term
infants as primary outcomes. It identified an increased risk in the
preterm but not term group with mechanical ventilation exceeding 5 days,
sepsis, and ototoxic medication. No significant differences were found
when both groups shared these risk factors, suggesting that prematurity
may not be an independent risk factor. Other studies reported variable
results. Conclusion(s): Evidence of different effect sizes of risk
factors in preterm and term children remains inconclusive. Preterm
children acquire more risk factors in the neonatal period. Copyright
© 2025 The Author(s). Acta Paediatrica published by John Wiley & Sons
Ltd on behalf of Foundation Acta Paediatrica.

<38>
Accession Number
2040492458
Title
Median Effective Volume of 0.25% Ropivacaine for Bilateral Transversus
Thoracis Muscle Plane Block in Patients Undergoing Open Cardiac Surgery.
Source
Journal of Pain Research. 18 (pp 5321-5329), 2025. Date of Publication:
2025.
Author
Sun J.; Liu C.; Gong X.; Chen R.; Deng S.; Zha Y.; Ji S.; Jin Z.; Chen H.
Institution
(Sun, Liu, Gong, Chen, Zha, Ji, Jin, Chen) Department of Pain Management,
the First Affiliated Hospital, Wenzhou Medical University, Zhejiang,
Wenzhou, China
(Sun) Department of Anesthesiology, The Second Affiliated Hospital of
Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
(Deng) Ruian Tangxia People's Hospital, Wenzhou, Ruian, China
Publisher
Dove Medical Press Ltd
Abstract
Background: The median effective dose of ropivacaine required to achieve
an effective transversus thoracis muscle plane block (TTP) has not been
established. This study aimed to determine the EV50 of 0.25% ropivacaine
for TTP using Dixon's up-and-down method. Method(s): This prospective
study involved 21 patients with American Society of Anesthesiologists
physical status II to III, aged 20 to 60 years, with a BMI of 18 to 30
kg/m2, who were scheduled for open cardiac surgery. Bilateral TTP was
performed preoperatively, and 30 minutes post-block, the cold sensory
decrease area (CSDA) was marked and recorded. The initial volume of 0.25%
ropivacaine administered was 20mL. The effective block was defined as the
CSDA encompassing thoracic nerves 2 to 6, which dictated a 2 mL increment
or decrement in the subsequent patient's dosage. The study concluded when
volumes reached 5 mL or 40 mL for 7 patients, or after 7 turning points.
 Result(s): A total of 21 cases were evaluated. Twelve (57.1%) of 40
received an effective block, while nine (42.9%) patients received a
non-effective block. Analysis using SPSS 26.0 revealed the median
effective volume (EV50) of 16.36mL for 0.25% ropivacaine and the 95%
effective volume (EV95) of 19.81mL. Conclusion(s): In open cardiac
surgery, the median effective volume of 0.25% ropivacaine for TTP is 16.36
mL (95% CI 14.35 to 18.43), while the 95% effective volume is 19.81 mL
(95% CI 18.60 to 22.75). Trial Registration Number:
ChiCTR2300073449. Copyright © 2025 Sun et al.

<39>
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. 135(5) (pp 1359-1362), 2025. Date of
Publication: 01 Nov 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

<40>
Accession Number
2040605286
Title
Efficacy and safety of tranexamic acid in cardiac surgery: a systematic
review and network meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 503. Date
of Publication: 01 Dec 2025.
Author
Pan X.; Tang M.; Xu Z.; Yu H.; Huang J.; Liang P.
Institution
(Pan, Xu, Yu, Liang) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, China
(Tang) West China School of Medicine, Sichuan University, Chengdu, China
(Huang) Department of Anesthesiology & Perioperative Medicine, University
of Louisville, Louisville, KY, United States
(Liang) Day Surgery Center, General Practice Medical Center, West China
Hospital, Sichuan University, No.37 Guoxue, Chengdu, China
Publisher
BioMed Central Ltd
Abstract
Background: Tranexamic acid (TXA) is recommended for reducing blood loss
and transfusion in cardiac surgery. However, there are concerns regarding
the safety profile of TXA, especially its proconvulsant effects. We
conducted this study to investigate the efficacy and safety of tranexamic
acid in cardiac surgery. Method(s): We searched PubMed, Embase and
Cochrane Central Register of Controlled Trials from inception to December
11, 2024. Randomised controlled trials assessed the hemostatic effects of
TXA in cardiac surgery were included. Two authors independently selected
studies and assessed the quality of eligible trials. The main endpoints
were red blood cell transfusion and thrombotic outcomes. The results were
calculated with pairwise and network meta-analysis. Result(s): Data
was provided by 18,141 participants from 64 trials. High-dose continuous
(OR: 0.38, 95%CI: [0.31, 0.47]), low-dose continuous (OR: 0.44, 95%CI:
[0.34, 0.56]), high-dose single (OR: 0.50, 95%CI: [0.43, 0.57]), and
low-dose single (OR: 0.52, 95%CI: [0.40, 0.67]) TXA significantly reduce
the rate of red blood cell transfusion. Furthermore, in high-risk
patients, high-dose continuous administration further reduces transfusion
risk compared to low-dose continuous administration (OR: 1.22, 95%CI:
[1.01, 1.75]). Topical TXA does not significantly reduce the rate of red
blood cell transfusion (OR: 0.80, 95%CI: [0.60, 1.07]); conversely, it is
associated with a higher rate of red blood cell transfusion compared to
intravenous administration. Both intravenous and topical TXA
administration reduce postoperative blood loss. High-dose continuous
administration further reduces the risk of reoperation (OR: 1.70, 95%CI:
[1.03, 2.80]) and the need for fresh frozen plasma transfusion (OR: 1.33,
95%CI: [1.01, 1.74]) compared to low-dose continuous administration.
Neither intravenous nor topical TXA increases the incidence of
postoperative thrombotic complications. High-dose single administration is
associated with a significantly increased risk of postoperative seizures
(OR: 6.66, 95%CI: [1.85, 24.02]). Conclusion(s): This meta-analysis
further confirms that intravenous TXA administration, regardless of dose
or administration regimen, significantly reduces postoperative blood loss
and red blood cell transfusions in adult cardiac surgery, without
increasing the incidence of serious adverse events except for seizures.
Future studies should incorporate patient-specific factors, comorbidities,
and bleeding risks to determine the optimal TXA dosing strategy that
balances risks and benefits. Trial registration: Our prespecified protocol
was registered with PROSPERO (CRD42022380404). Copyright © The
Author(s) 2025.

<41>
Accession Number
2040605979
Title
Bibliometric analysis reveals global thymoma research trends
collaborations and emerging frontiers from 2010 to 2024.
Source
Discover Oncology. 16(1) (no pagination), 2025. Article Number: 1867. Date
of Publication: 01 Dec 2025.
Author
Yu Z.; Li Y.-H.; Han Q.; Wang X.-P.; Yu X.-T.; Cui J.; Gao X.; Yang X.-G.;
Yu L.
Institution
(Yu, Yu, Cui, Gao, Yang, Yu) Department of Thoracic Surgery, Beijing
Tongren Hospital, Capital Medical University, No.2 Xihuan Road, Daxing
District, Beijing, China
(Li, Han, Wang) The Fourth Clinical School of Capital Medical University,
Beijing, China
Publisher
Springer Science and Business Media B.V.
Abstract
Objective: To map global thymoma research trends (2010-2024) through
bibliometric analysis. Method(s): Analysis of 2,078 publications from
Web of Science/PubMed using Bibliometrix, VOSviewer, and CiteSpace.
Metrics included productivity (countries/institutions/authors), thematic
evolution, collaboration networks, and citation impact. Result(s):
The analysis reveals a steady increase (6.2% CAGR) in the volume of
thymoma-related publications over the past decade. Key journals included
Journal of Thoracic Oncology and Annals of Thoracic Surgery. Prolific
authors like Marx Alexander (25 publications) and institutions such as
Fudan University (67 publications) dominated the field. Keyword analysis
revealed sustained focus on "myasthenia gravis," "surgery," and
"thymectomy," with emerging interest in "immunotherapy" and "molecular
biology." High-impact articles addressed autoimmune associations and novel
therapies (e.g., sunitinib). Global collaboration networks highlighted
strong partnerships among the U.S., Europe, and Asia, though logistical
and policy barriers may have limited China's broader international
engagement. Conclusion(s): Thymoma research has evolved toward
molecular and therapeutic innovation, emphasizing immunotherapy and
precision medicine. Despite growth, geographical disparities and
understudied areas (e.g., long-term outcomes) persist. Future efforts
should prioritize multidisciplinary collaboration, biomarker discovery,
and multicenter trials to optimize clinical strategies. Copyright
© The Author(s) 2025.

<42>
Accession Number
2040474793
Title
Risk prediction models for permanent pacemaker implantation following
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1563597. Date of Publication: 2025.
Author
Mao Y.; Liu Q.; Fan H.; He W.; Ouyang X.; Wang X.; Li E.; Qiu L.; Dong H.
Institution
(Mao, Fan, He, Ouyang, Wang, Qiu, Dong) Department of Nursing, Xianyang
Central Hospital, Xianyang, China
(Liu) Department of Orthopedic Surgery, Xianyang Central Hospital,
Xianyang, China
(Li) Interventional Operating Room, Xianyang Central Hospital, Xianyang,
China
Publisher
Frontiers Media SA
Abstract
Objective: To systematically evaluate the methodological quality and
predictive performance of risk prediction models for permanent pacemaker
implantation (PPMI) following transcatheter aortic valve replacement
(TAVR), identify key predictive factors, and assess the risk of bias and
clinical applicability of these models. Method(s): A comprehensive
search was conducted across multiple databases, including PubMed, Web of
Science, The Cochrane Library, Embase, Cumulative Index to Nursing and
Allied Health Literature (CINAHL), China National Knowledge Infrastructure
(CNKI), Wanfang Database, China Science and Technology Journal Database
(VIP), and SinoMed. The search included all records from database
inception to January 1, 2025. Two independent researchers screened studies
and extracted relevant data. Result(s): A total of 11 studies were
included, covering 11 risk prediction models with sample sizes ranging
from 184-35,410. The incidence of PPMI after TAVR varied between 7.3% and
31.0%. Frequently identified predictors (present in at least two studies)
included right bundle branch block (RBBB), self-expandable valves, PR
interval, QRS interval, and atrioventricular block (AVB). All models
reported the area under the receiver operating characteristic curve
(AUROC), ranging from 0.660-0.916, with seven studies providing
calibration metrics. Internal validation was performed in three studies,
while one study included both internal and external validation. Ten
studies were assessed as having a high risk of bias, primarily due to
deficiencies in data analysis. The pooled AUROC for the nine validated
models was 0.76 (95% confidence interval: 0.72-0.80), indicating moderate
discriminatory ability. Conclusion(s): Existing risk prediction
models for PPMI after TAVR demonstrate moderate predictive performance but
are limited by a high risk of bias, as assessed using the Prediction Model
Risk of Bias Assessment Tool (PROBAST). Future research should focus on
developing more robust models through larger sample sizes, rigorous
methodologies, and multi-center external validation. Systematic Review
Registration: The protocol for this study is registered with
https://www.crd.york.ac.uk/PROSPERO/view/CRD42025629869, PROSPERO
CRD42025629869. Copyright 2025 Mao, Liu, Fan, He, Ouyang, Wang, Li,
Qiu and Dong.

<43>
Accession Number
2039873174
Title
Left atrial appendage occlusion in patients with atrial fibrillation and
previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: A
systematic review and meta-analysis.
Source
International Journal of Stroke. 20(9) (pp 1049-1059), 2025. Date of
Publication: 01 Oct 2025.
Author
Mavridis T.; Archontakis-Barakakis P.; Chlorogiannis D.-D.; Charidimou A.
Institution
(Mavridis) Department of Neurology, Tallaght University Hospital (TUH),
The Adelaide and Meath Hospital, Dublin, Incorporating the National
Children's Hospital (AMNCH), Dublin, Ireland
(Archontakis-Barakakis) Redington-Fairview General Hospital, Skowhegan,
ME, United States
(Chlorogiannis) Department of Radiology, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Charidimou) Department of Neurology, Boston University Medical Center,
Boston University School of Medicine, Boston, MA, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Patients with atrial fibrillation (AF) on oral anticoagulation
(OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral
amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left
atrial appendage occlusion (LAAO) has emerged as a potential alternative
to OAC for stroke prevention in high-bleeding-risk AF patients. Small
observational studies suggest that LAAO may be safe and feasible in
patients with ICrH, when using single or dual antiplatelet therapy or
short-term OAC post-procedure, though data remain limited. This systematic
review and meta-analysis aims to consolidate evidence on the safety and
efficacy of LAAO in patients with prior ICrH or CAA. Method(s): We
conducted a systematic review and meta-analysis examining the safety and
efficacy of LAAO in patients with non-valvular AF and prior ICrH and/or
CAA. PubMed/MEDLINE and EMBASE (via Scopus) databases were systematically
searched from inception until 29 February 2024. Eligible studies included
randomized control trials, observational studies, and case series (10
participants) reporting stroke events in patients with AF and previous
history of ICrH and/or CAA undergoing LAAO. Pooled incidence rates (IRs)
with corresponding 95% confidence intervals (CIs) were calculated for
primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and
secondary outcomes. Result(s): Fourteen studies including 1235
patients met inclusion criteria. The pooled average follow-up period was
17.1 months. The pooled IRs for ischemic stroke, recurrent ICrH, and major
hemorrhage were 2% (95% CI: 1-3%, I2 = 2%), 2% (95% CI: 0.4-3%,
I2 = 45%) and 3% (95% CI: 1-5%, I2 = 54%),
respectively. In prespecified subgroup analyses of studies focusing on
patients with intraparenchymal hemorrhage and/or CAA, pooled IRs for
ischemic stroke, recurrent ICrH, and major hemorrhage IR of 4% (95% CI:
1-8%), 4% (95% CI: 0.4-10%) and 6% (95% CI: 3-12%), respectively.
 Conclusion(s): LAAO may be a safe and effective treatment for
selected AF patients with a history of ICrH and/or CAA, but the quality of
evidence is poor. Future randomized controlled trials are essential to
validate LAAO's efficacy and long-term safety. Copyright © 2025
World Stroke Organization

<44>
Accession Number
2040509848
Title
Impact of recent COVID-19 infection on liver and kidney transplantation -
a worldwide meta-analysis and systematic review.
Source
Frontiers in Immunology. 16 (no pagination), 2025. Article Number:
1626391. Date of Publication: 2025.
Author
Pollmann N.S.; Dondorf F.; Rauchfuss F.; Settmacher U.; Pollmann L.;
Selzner M.
Institution
(Pollmann, Dondorf, Rauchfus, Settmacher, Pollmann) Department of General,
Visceral, and Vascular Surgery, Jena University Hospital, Jena, Germany
(Selzner) Ajmera Transplant Centre, Toronto General Hospital, University
Health Network, Toronto, ON, Canada
Publisher
Frontiers Media SA
Abstract
Introduction: The shortage of suitable donor organs represents an ongoing
global challenge for organ transplantation. During the COVID-19 pandemic,
the number of transplantable organs was especially limited. To date, the
impact of recent coronavirus-19 (COVID-19) infection on liver and kidney
transplant recipients has not been systematically analyzed, which is
essential for the development of future transplant management.
 Method(s): We conducted a systematic review and meta-analysis to
assess the clinical outcomes of recent COVID-19 infection in the donor (1)
or the recipient (2). A total of 17 studies were considered for systematic
review, seven of these were included for meta-analysis. Result(s):
Transplantation of COVID-19 positive donors did not result in an impaired
graft survival for liver or kidney transplantation up to 180-days of
follow up. Additionally, a positive COVID-19 donor status was not
associated with decreased overall survival in kidney transplant recipients
within 180 days of transplantation. Nevertheless, an association was found
with decreased overall survival in liver transplant recipients within the
180-day follow-up period. Discussion(s): However, the heterogeneity
of studies investigating COVID-19 infection of the recipient did not allow
a classification of the significance of COVID-19 positive recipients.
Conclusively, a COVID-19 positive donor status should not be considered as
an exclusive factor for declining a suitable liver or kidney for
transplantation. Systematic review registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier
CRD42024562551. Copyright © 2025 Pollmann, Dondorf, Rauchfus,
Settmacher, Pollmann and Selzner.

<45>
Accession Number
2040605293
Title
Comparison of perioperative analgesic efficacy between serratus anterior
plane block and thoracic paravertebral block in adult patients undergoing
thoracic and breast surgeries: a systematic review and meta-analysis.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 493. Date
of Publication: 01 Dec 2025.
Author
Wang J.; Li T.
Institution
(Wang, Li) Department of Anesthesiology, Yuncheng Central Hospital
Affiliated to Shanxi Medical University, No. 3690, Hedong East Street,
Yanhu District, Shanxi Province, Yuncheng, China
Publisher
BioMed Central Ltd
Abstract
Background: Serratus anterior plane block (SAPB) and thoracic
paravertebral block (TPVB) are widely used regional anesthesia techniques
for postoperative analgesia and are generally considered safe and
effective. However, the comparative efficacy remains inconclusive. This
systematic review and meta-analysis of randomized controlled trials (RCTs)
aims to evaluate the perioperative analgesic efficacy of SAPB versus TPVB
in adult patients undergoing thoracic and breast surgeries.
 Method(s): A comprehensive literature search was conducted in PubMed,
EMBASE, Web of Science, Cochrane library, ClinicalTrial.gov, and Google
Scholar up to February 28, 2025. Primary outcomes included time to first
analgesic request (TFAR), 24-h total analgesic consumption (TAC)
postoperatively, and 24-h postoperative pain scores at rest. Secondary
outcomes comprised pain scores at various postoperative timepoints,
intraoperative fentanyl consumption, length of hospital stay, patient
satisfaction with analgesia, and incidence of complications. A
random-effect model was applied for the meta-analysis. Result(s):
Twenty-eight 28 RCTs comprising 1796 patients were included. No
significant differences were found between SAPB and TPVB in TFAR (mean
difference [MD] = -0.68 h, 95% confidence interval [CI]: -1.55 to 0.18, P
= 0.122), 24-h pain scores at rest (MD = 0.14, 95%CI: -0.14 to 0.42, P =
0.334), other postoperative pain scores, length of hospital stay, patient
satisfaction, or incidence of postoperative nausea and vomiting (risk
ratio [RR] = 0.87, 95%CI: 0.63 to 1.20, P = 0.310). Despite statistically
significant, the difference of 24-h TAC comparing SAPB to TPVB (MD = 1.73
mg intravenous morphine equivalents, 95%CI: 0.54 to 2.92, P = 0.005) did
not exceed the minimal clinically important difference (MCID) of 10 mg.
SAPB also resulted in greater intraoperative fentanyl consumption (MD =
13.85 mcg, 95%CI: 3.86 to 23.84, P = 0.007) but a significantly lower
incidence of hypotension (RR = 0.39, 95%CI: 0.20 to 0.76, P = 0.006).
Subgroup analyses showed that TPVB provided superior, but non-clinically
significant, opioid-sparing benefits in thoracic procedures (3.38 mg) and
when compared to superficial SAPB (3.11 mg). Conclusion(s): SAPB
offers comparable analgesic efficacy to TPVB, with a more favorable safety
profile but slightly higher opioid consumption. However, the increased
opioid use does not exceed the MCID. Therefore, SAPB is a clinically
effective and safe alternative to TPVB for perioperative regional
analgesia in thoracic and breast surgeries. Copyright © The
Author(s) 2025.

<46>
Accession Number
2040550457
Title
Redefining Aortic Valve Replacement: The Transition from Open Surgery to
Transcatheter Innovation.
Source
Journal of Clinical Medicine. 14(19) (no pagination), 2025. Article
Number: 6761. Date of Publication: 01 Oct 2025.
Author
Lodge F.; Soliman F.; Kandula V.; Tagliafierro M.; Pirelli L.
Institution
(Lodge, Soliman, Kandula, Tagliafierro, Pirelli) Division of
Cardiothoracic Surgery, Department of Surgery, Columbia University Irving
Medical Center, New York, NY, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Aortic valve replacement (AVR) has evolved dramatically, transitioning
from open surgery to minimally invasive and transcatheter approaches. This
review examines the historical and technological advancements in AVR,
focusing on the evolution of mechanical and bioprosthetic valves,
valve-sparing techniques, and the Ross procedure. Mechanical valves offer
superior durability but require lifelong anticoagulation, while
bioprosthetic valves avoid this need at the expense of long-term
durability. Transcatheter aortic valve replacement (TAVR), originally
reserved for high-risk patients, is now used across all risk profiles due
to growing evidence of safety and efficacy from major trials like PARTNER
and Core Valve. Despite its benefits, TAVR presents some challenges,
including paravalvular leak, pacemaker implantation, and uncertain
long-term durability, especially in younger patients. Valve-in-valve
techniques, novel valve designs, and anti-calcification treatments offer
promising solutions. Looking forward, the integration of artificial
intelligence and personalized procedural planning will play a key role in
optimizing outcomes. As AVR technology advances, careful patient selection
and a multidisciplinary approach remain essential to guiding
individualized treatment decisions. Copyright © 2025 by the
authors.

<47>
Accession Number
2040551201
Title
Rescue Procedure in a Rare Case of Iatrogenic Vertebral Artery Puncture
and Review of the Literature.
Source
Journal of Clinical Medicine. 14(19) (no pagination), 2025. Article
Number: 6945. Date of Publication: 01 Oct 2025.
Author
Brandt J.; Musigmann M.; Akkurt B.H.; Kohler M.; Krahling H.
Institution
(Brandt, Musigmann, Akkurt, Kohler) University Clinic for Radiology,
University of Munster, University Hospital Munster,
Albert-Schweitzer-Campus 1, Munster, Germany
(Krahling) University Clinic for Radiology, Department for Interventional
Neuroradiology, University of Munster, University Hospital Munster,
Albert-Schweitzer-Campus 1, Munster, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objective: The insertion of venous catheters into supra-aortic vessels is
a standard procedure in the treatment of a large number of diseases.
Incorrect placement of venous catheters into and accidental perforation of
arterial vessels is a rare but serious complication that can lead to
severe bleeding, dissections, and strokes. Material(s) and Method(s):
We present a case of iatrogenic malposition of a Broviac catheter into the
right vertebral artery and its successful treatment through stenting of
the perforation site using a Walrus balloon catheter to achieve a secure
treatment position and eventually cover the perforation site.
Additionally, we conducted a systematic literature review on endovascular
rescue procedures in inadvertent injuries of the supra-aortic arteries
related to venous catheter placement. Result(s): A balloon guide
catheter was used to achieve a secure treatment position for the
deployment of a stent graft covering the perforation site, ensuring no
significant arterial hemorrhage occurred during the removal of the
incorrectly placed Broviac catheter. The review of the literature on
endovascular rescue procedures for supra-aortic arterial vessel damage
caused by venous catheter placement revealed that endovascular treatment
has been successful in all reported cases of catheter-related supra-aortic
arterial injury. Primary stent graft placement without additional actions
was the most common treatment approach. Conclusion(s): In the
treatment of iatrogenic injuries to the supra-aortic vessels, endovascular
treatment strategies represent a safe, reliable, and generally recognized
option and thus are used much more frequently than surgical procedures.
Key point: In rare cases of accidental malposition of venous catheters
into supra-aortic arterial vessels, endovascular insertion of a stent
graft covering the perforation site using a balloon guide catheter can be
a safe treatment option. Copyright © 2025 by the authors.

<48>
Accession Number
2041001750
Title
Left atrial appendage occlusion plus oral anticoagulation in stroke
patients despite ongoing anticoagulation: rationale and design of the
ADD-LAAO clinical trial.
Source
REC: Interventional Cardiology. 7(3) (pp 140-145), 2025. Date of
Publication: 01 Jul 2025.
Author
Amaro S.; Cruz-Gonzalez I.; Estevez-Loureiro R.; Millan X.; Nombela-Franco
L.; Gomez-Hospital J.; Flores-Umanzor E.; Lopez-Mesonero L.; Macineiras
J.; Prats-Sanchez L.; Simal P.; Cardona P.; Teruel L.; Cepas-Guillen P.;
Arzamendi D.; Freixa X.
Institution
(Amaro) Departamento de Neurologia, Hospital Clinic de Barcelona,
Barcelona, Spain
(Cruz-Gonzalez) Departamento de Cardiologia, Hospital Universitario de
Salamanca, Salamanca, Spain
(Estevez-Loureiro) Departamento de Cardiologia, Hospital Universitario
Alvaro Cunqueiro, Pontevedra, Vigo, Spain
(Millan, Arzamendi) Departamento de Cardiologia, Hospital de la Santa Creu
i Sant Pau, Barcelona, Spain
(Nombela-Franco) Departamento de Cardiologia, Hospital Clinico San Carlos,
Madrid, Spain
(Gomez-Hospital, Teruel) Departamento de Cardiologia, Hospital
Universitari de Bellvitge, Barcelona, Spain
(Flores-Umanzor, Cepas-Guillen, Freixa) Departamento de Cardiologia,
Hospital Clinic de Barcelona, Barcelona, Spain
(Lopez-Mesonero) Departamento de Neurologia, Hospital Universitario de
Salamanca, Salamanca, Spain
(Macineiras) Departamento de Neurologia, Hospital Universitario Alvaro
Cunqueiro, Vigo, Spain
(Prats-Sanchez) Departamento de Neurologia, Hospital de la Santa Creu i
Sant Pau, Barcelona, Spain
(Simal) Departamento de Neurologia, Hospital Clinico San Carlos, Madrid,
Spain
(Cardona) Departamento de Neurologia, Hospital Universitari de Bellvitge,
Barcelona, Spain
Publisher
Sociedad Espanola de Cardiologia
Abstract
Introduction and objectives: The prevalence of atrial fibrillation and the
number of patients experiencing ischemic strokes despite oral
anticoagulation (OAC) are both on the rise, which presents a significant
challenge due to the absence of clear and uniform treatment
recommendations for these patients. To date, there is no formal
combination merging into a high anticoagulant efficacy profile while
keeping a low bleeding risk. Transcatheter left atrial appendage occlusion
(LAAO) in combination with OAC might provide a balance between safety and
efficacy. The objective of this study is to evaluate whether, in ischemic
stroke patients, despite anticoagulation, the combination of LAAO plus
long-term anticoagulation-direct oral anticoagulants or vitamin K
antagonist when indicated-is associated with a lower rate of recurrent
cardioembolic events at 12 months vs the optimal medical therapy
recommended by the neurologist. Method(s): A total of 380 patients
with ischemic stroke despite OAC will be included. Patients will be
randomized on a 1:1 ratio to receive the optimal medical therapy (control)
or the combination of LAAO plus OAC or OAC. The primary endpoint of the
study will be the occurrence of a cardioembolic event-ischemic stroke or
arterial peripheral embolism-within the first 12 months after inclusion.
 Conclusion(s): This study is one of the first randomized clinical
trials to compare the LAAO plus OAC combination and optimal medical
therapy in patients who have experienced ischemic strokes despite being on
OAC. If results confirm the superiority of LAAO plus OAC, it could lead to
a paradigm shift in treatment guidelines for these patients. Copyright
© 2025 Sociedad Espanola de Cardiologia. Publicado por Permanyer
Publications. Este es un articulo open access bajo la licencia CC BY-NC-ND
4.0.

<49>
Accession Number
2040972314
Title
iHEART trial: study protocol for a German multicentre randomised
controlled trial on the feasibility and acceptance of an internet-based
preoperative intervention to optimise patient expectations and improve
outcomes after heart surgery.
Source
BMJ Open. 15(9) (no pagination), 2025. Article Number: e092482. Date of
Publication: 17 Sep 2025.
Author
Compere V.N.; Balci S.; Heinz C.; Schade-Brittinger C.; Rastan A.J.;
Salzmann-Djufri M.; Niemann B.; Boening A.; Choi Y.-H.; Zarski A.-C.;
Laferton J.; Euteneuer F.; Rief W.; Salzmann S.
Institution
(Compere, Balci, Rief, Salzmann) Division of Clinical Psychology and
Psychotherapy, University of Marburg, Marburg, Germany
(Heinz, Schade-Brittinger) Coordinating Center for Clinical Trials (KKS),
University of Marburg, Marburg, Germany
(Rastan) Department for Cardiovascular Surgery, Heart Center, University
Hospital of Giessen and Marburg, Marburg, Germany
(Salzmann-Djufri, Niemann, Boening) Department for Cardiovascular Surgery,
University Hospital Giessen, Giessen, Germany
(Choi) Department of Cardiac Surgery, Department of Cardiology, Department
for Heart Surgery, Kerckhoff Clinic Heart Centrum, Bad Nauheim, Germany
(Zarski) Department of Clinical Psychology, Division of eHealth in
Clinical Psychology, University of Marburg, Marburg, Germany
(Laferton) Institute for Mental Health and Behavioral Medicine, Department
of Medicine, HMU Health and Medical University Potsdam GmbH, Potsdam,
Germany
(Euteneuer) MSB Medical School Berlin GmbH, Department of Psychology,
Clinical Psychology and Psychotherapy, Berlin, Germany
(Salzmann) HMU Health and Medical University Erfurt GmbH, Erfurt, Germany
Publisher
BMJ Publishing Group
Abstract
Introduction Treatment expectations are a key mechanism of placebo effects
in clinical trials. In a previous study (PSY-HEART-I), preoperative
expectation optimisation improved quality of life 6months postcardiac
surgery. However, barriers such as travel distance, staffing shortages and
COVID-19 limited participation. This study evaluates the feasibility and
acceptability of iEXPECT, a brief internet-based intervention designed to
optimise expectations before heart surgery. Methods and analysis In this
three-arm, multicentre randomised controlled trial, 160 patients
undergoing elective coronary artery bypass graft surgery are randomised
to: (a) standard of care (SOC); (b) SOC plus iEXPECT with phone-based
guidance (iEXPECT enhanced) or (c) SOC plus iEXPECT with email-based
guidance (iEXPECT limited). The intervention includes four 20min online
modules addressing surgical benefits, side effects and coping strategies.
Modules are accompanied by personalised guidance provided through feedback
on each module via email or telephone (three before surgery, three booster
sessions at 6, 12 and 18 weeks postsurgery). Assessments occur at baseline
(5-21 days before surgery), preoperatively (day before surgery), 7days
postsurgery and 6 months later. Primary feasibility outcomes include
recruitment (>=1 participant/week/centre), retention (>=49% completing
6-month follow-up including biomarkers) and engagement (>=75% completing
>=1 presurgery module). Acceptability is measured by self-reported
enjoyment, usefulness and impact, with acceptance defined as mean scores
>3.4 (5-point Likert scale) and CSQ-I ratings. Secondary outcomes include
psychological measures, inflammatory markers and heart rate variability.
Ethics and dissemination Ethical approval was granted by the Ethics
Committees of Philipps University Marburg (AZ 229/23 BO) and the
University of Giessen (AZ 186/23). All participants provide written
informed consent. Results will be shared via publications, conferences and
public outreach with relevant consumer advocacy groups. Trial registration
number DRKS00033284. Copyright © Author(s) (or their employer(s))
2025. Re-use permitted under CC BY. Published by BMJ Group.

<50>
Accession Number
2034793263
Title
The Comparative Effectiveness and Safety of Ambulatory Care Warfarin
Management by Non-physician Providers Versus Usual Medical Care: A
Systematic Review and Meta-analysis.
Source
Journal of Pharmacy Practice. 38(6) (pp 540-550), 2025. Date of
Publication: 01 Dec 2025.
Author
Sharow A.; Champigny J.; Gamble J.-M.; Houle S.K.D.; Carter C.; Nagge J.
Institution
(Sharow, Champigny, Gamble, Houle, Carter, Nagge) University of Waterloo,
School of Pharmacy, Kitchener, ON, Canada
Publisher
SAGE Publications Inc.
Abstract
Introduction: Growing evidence suggests that non-physician providers
(NPPs) can effectively and safely manage warfarin therapy. This systematic
review and meta-analysis aimed to evaluate warfarin management by NPPs
compared to usual medical care (UMC) in ambulatory patients.
 Method(s): We conducted a systematic search of PubMed (MEDLINE), Ovid
Embase, Ovid International Pharmaceutical Abstracts, Scopus, CINAHL
(EBSCO), and the Cochrane Central Register of Controlled Trials (CENTRAL)
from inception to January 2024. Studies were included if they were
randomized controlled trials or quasi-experimental designs comparing
warfarin management across professions. Two independent reviewers
performed title and abstract screening, full-text review, data extraction,
and risk of bias assessment. Results were pooled using random effects
models. Result(s): Of 19 122 citations identified, 6 met the
inclusion criteria. NPPs included pharmacists (4), nurse practitioners
(1), and multidisciplinary teams (1). Meta-analysis showed no significant
difference in time spent in therapeutic range (TTR) (mean difference [MD]
1.64%; 95% confidence interval [CI]-1.86 to 5.16, I2= 0%)) for
NPPs vs UMC. There were no differences in thrombosis (relative risk [RR]
1.23; 95% CI 0.36 to 4.23, I2= 0%), hemorrhage (RR = 1.07; 95%
CI 0.44 to 2.63, I2= 0%), mortality (RR = 0.94; 95% CI 0.33 to
2.67, I2= 0%), or patient satisfaction (standardized mean
difference [SMD] 0.56; 95% CI -0.04 to 1.15, I2= 85%).
 Conclusion(s): NPP management resulted in similar TTR as UMC. Due to
few thromboembolic and hemorrhagic events, more studies are needed to
determine the effects of NPP warfarin management on clinical
outcomes. Copyright © The Author(s) 2025. This article is
distributed under the terms of the Creative Commons Attribution 4.0
License (https://creativecommons.org/licenses/by/4.0/) which permits any
use, reproduction and distribution of the work without further permission
provided the original work is attributed as specified on the SAGE and Open
Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

<51>
Accession Number
2036166070
Title
The safety and efficacy of intravenous administration of tranexamic acid
in off-pump coronary artery bypass grafting: a systematic review and
meta-analysis.
Source
Frontiers in Medicine. 12 (no pagination), 2025. Article Number: 1643712.
Date of Publication: 2025.
Author
Zou Z.-Y.; Song J.-R.; Zhang Q.-H.; Huang X.-J.; Yao Y.-T.
Institution
(Zou, Song, Huang) Fuwai Yunnan Hospital, Chinese Academy of Medical
Sciences, Affiliated Cardiovascular Hospital of Kunming Medical
University, Yunnan, Kunming, China
(Zhang) Department of Anesthesiology, Qujing Maternal and Child
Health-care Hospital, Yunnan, Qujing, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, Beijing, China
(Yao) Department of Anesthesiology, Critical Care and Pain Medicine,
Center of Outcomes Research, University of Texas, Houston, TX, United
States
(Yao) Outcomes Research Consortium, Houston, TX, United States
Publisher
Frontiers Media SA
Abstract
Study objective: To assess the efficacy and safety of tranexamic acid
(TXA) on off-pump coronary artery bypass (OPCAB) surgery. Design(s):
Meta-analysis. Method(s): Relevant trials were identified by
computerized searches of PUBMED, Cochrane Library, EMBASE, OVID, China
National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Data till
Aug 8th, 2025, were searched using search terms "Tranexamic acid,"
"coronary artery bypass grafting," "off-pump," "randomized controlled
trial" database search was updated on Aug 10th, 2025. Primary outcomes
included intraoperative and postoperative bleeding. Result(s):
Nineteen randomized controlled trials were finally included in the current
study. Intravenous TXA reduced intraoperative and postoperative bleeding
volume (including 2, 4, 6, and 24-h postoperative bleeding). It also
decreased the rate and volume of red blood cell (RBC) and fresh frozen
plasma (FFP) transfusions, with no effect on reoperation rates due to
postoperative bleeding. At 24h postoperatively, TXA increased platelet
counts, hemoglobin concentrations, and prothrombin time (PT), while
decreasing activated partial thromboplastin time (APTT), fibrinogen
levels, and D-dimer concentrations. Importantly, TXA did not elevate the
risk of postoperative complications (e.g., mortality, myocardial
infarction, cerebrovascular accidents, thrombotic events) and had no
impact on levels of CK-MB, creatinine, interleukin-6, or lengths of
intensive care unit (ICU) and hospital stays. Conclusion(s):
Intravenous TXA is effective in reducing perioperative bleeding and
transfusion requirements in OPCAB without increasing the risk of major
postoperative complications, supporting its clinical utility in this
setting. More well-designed and adequately powered RCTs are needed to
confirm this further. Copyright © 2025 Zou, Song, Zhang, Huang
and Yao.

<52>
Accession Number
2034828621
Title
A randomized controlled trial on the impact of anesthetic agents on renal
function in cardiac surgery with cardiopulmonary bypass.
Source
Molecular and Cellular Biochemistry. 480(10) (pp 5399-5410), 2025. Date of
Publication: 01 Oct 2025.
Author
Fan T.; Zhao Z.; Liu J.; Ma W.; Tian J.; Ma G.
Institution
(Fan, Zhao, Liu, Ma, Tian, Ma) The First Affiliated Hospital of Xinxiang
Medical University, Henan, China
Publisher
Springer
Abstract
Acute kidney injury (AKI) is a frequent and severe problem following heart
surgery, particularly in procedures involving cardiopulmonary bypass
(CPB). This research investigates the Randomized Controlled Trial (RCT) on
the impact of agents of anesthetic on renal function in patients receiving
elective cardiac surgery and CPB, comparing propofol-based and volatile
anesthetic-based regimens. A sum of 61 patients was randomly assigned into
two regions: one receiving a propofol-based regimen and the other, a
volatile anesthetic regimen, both combined with opioid analgesia. Renal
function was assessed preoperatively and postoperatively at 24 and 48 h
using serum creatinine and cystatin C levels. Perioperative inflammatory
markers were deliberate to evaluate inflammation-mediated renal impairment
multivariate logistic regression identified risk factors for AKI, and
independent t-tests compared renal function parameters between regimens.
Patients receiving propofol exhibited significantly lower rates of AKI
(p<0.05) and reduced inflammatory marker levels associated to the volatile
anesthetic regimen. These results present that propofol anesthesia
provides a protecting influence on renal function, likely due to its
anti-inflammatory properties. The research emphasizes the necessity of
choosing the right anesthetic for postoperative kidney outcomes by
tailoring anesthetic regimens to mitigate AKI risk in high-risk
populations. Propofol's protective role against AKI offers potential
clinical value, particularly in cardiac surgeries requiring CPB. Further
investigation with bigger cohorts and continued follow-up are necessary
for verifying these findings and exploring their broader applicability in
cardiac anesthesia. Copyright © The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature
2025.

<53>
Accession Number
2034824174
Title
Dexmedetomidine as a Ropivacaine Adjuvant in a Thoracic Paravertebral
Block Combined With an Erector Spinae Plane Block for Improving Early
Quality of Recovery After Transapical Transcatheter Aortic Valve
Implantation.
Source
Kaohsiung Journal of Medical Sciences. 41(10) (no pagination), 2025.
Article Number: e70058. Date of Publication: 01 Oct 2025.
Author
Dong G.-L.; Qiu R.-E.; Xu C.-Z.
Institution
(Dong, Qiu, Xu) Department of Anesthesiology, The Quzhou Affiliated
Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou,
China
Publisher
John Wiley and Sons Inc
Abstract
The study aimed to investigate the effectiveness of dexmedetomidine (Dex)
as an adjuvant for ropivacaine in a thoracic paravertebral block (TPVB)
combined with an erector spinae plane block (ESPB) for improving early
quality of recovery and postoperative pain after transapical transcatheter
aortic valve implantation (TAVI). A total of 89 patients who were
scheduled to undergo transapical TAVI under general anesthesia were
allocated into Group RS and Group RD by using a computer-generated
random-number list. Group RS (n = 45) received 35 mL of 0.5% ropivacaine
with 5 mL of a normal saline mixture in TPVB combined with ESPB and Group
RD (n = 44) received 35 mL of 0.5% ropivacaine with 1 mug/kg Dex in 5 mL
of normal saline. The RD group exhibited significantly higher global
QoR-15 scores with lower visual analog scale (VAS) scores at 12 and 24 h
postoperatively than the RS group. The RD group needed fewer press times
of PCIA than the RS group. The postoperative sufentanil consumption was
significantly less in the RD group than that in the RS group. A longer
time to first use of flurbiprofen with less remedial doses of flurbiprofen
consumption within 48 h postoperatively was required for the RD group than
that for the RS group. The two groups did not differ in the incidence of
side effects. The findings of the study suggest that adding Dex to
ropivacaine in TPVB combined with ESPB is effective in improving early
quality of recovery and alleviating postoperative pain for patients
undergoing transapical TAVI under general anesthesia. Copyright ©
2025 The Author(s). The Kaohsiung Journal of Medical Sciences published by
John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical
University.

<54>
Accession Number
2041115178
Title
Controversies in valvular heart disease: insights from cardiac imaging.
Source
Trends in Cardiovascular Medicine. (no pagination), 2025. Date of
Publication: 2025.
Author
van der Bijl P.; Ajmone Marsan N.; Bax J.J.
Institution
(van der Bijl, Ajmone Marsan, Bax) Department of Cardiology, Leiden
University Medical Centre, Leiden, Netherlands
(van der Bijl) SAEndovascular, Netcare Kuils River Hospital, Cape Town,
South Africa
Publisher
Elsevier Inc.
Abstract
Numerous controversies still exist in the diagnosis and management of
valvular heart disease, for example, the benefit of treating moderate
aortic stenosis (AS) or asymptomatic, severe AS and the appropriate
selection criteria for transcatheter edge-to-edge mitral valve repair.
While numerous imaging parameters have been linked to the risk of sudden
cardiac death in mitral valve prolapse, their relative merits are unknown
and this is a challenging population to risk-stratify. No large,
randomized data exist to guide selection of patients for transcatheter
repair of tricuspid regurgitation or valve intervention in severe
pulmonary regurgitation. Multimodality cardiac imaging provides unique
insights into these important questions. Copyright © 2025 The
Author(s)

<55>
Accession Number
2041001538
Title
Worsening tricuspid regurgitation after mitral valve surgery: a
meta-analysis and meta-regression.
Source
International Journal of Cardiology. 443 (no pagination), 2026. Article
Number: 133931. Date of Publication: 15 Jan 2026.
Author
Aviel G.; Hirsh-Raccah B.; Idais I.; Ghannam R.A.; Komodei M.;
Lipey-Dyamant A.; Wald O.; Korach A.
Institution
(Aviel, Idais, Ghannam, Komodei, Lipey-Dyamant, Wald, Korach) Department
of Cardiothoracic Surgery, Hadassah Medical Center, Jerusalem, Israel
(Hirsh-Raccah) Department of Cardiology, Hadassah Medical Center,
Jerusalem, Israel
(Hirsh-Raccah) Division of Clinical Pharmacy, Institute for Drug Research,
School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem,
Jerusalem, Israel
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: Reports of tricuspid valve regurgitation (TR) following mitral
valve (MV) surgery are unclear. This study aims to estimate the prevalence
of worsening TR (WTR) following MV surgery for non-rheumatic mitral
regurgitation and the benefit of concomitant tricuspid annuloplasty.
 Method(s): Electronic databases including Embase, PubMed,
GoogleScholar, and Cochrane Library were searched between 2013 and 2024. A
systematic review of the literature was conducted to include cohort
studies, case-control studies and randomized-controlled trials. WTR was
defined as >= moderate TR or an increase in TR severity of >=2 grades on
follow-up echocardiography. A random effects meta-analysis was performed.
Subgroup analysis was conducted to estimate the benefit of a concomitant
TV annuloplasty. A meta-regression was conducted to identify potential
variables accounting for between-study heterogeneity. Sensitivity analyses
were used to confirm the robustness of the reported results.
 Result(s): Of 8923 studies identified, 8 studies were included in the
final analysis involving 2978 patients and 14,592 patient years (MV
surgery-only group = 1991 patients, TV annuloplasty group = 987). WTR
occurred in 9 % (95 %CI:4-22) of patients after MV surgery over a pooled
follow-up of 4.9 [3.1-6.7] years. A concomitant TV annuloplasty resulted
in a significant reduction in the prevalence of WTR (OR = 0.27, 95 %CI:
0.13-0.57, p = 0.0079). A trend for lower overall mortality was detected
in the TV annuloplasty group (OR = 0.73, 95 %CI: 0.5-1.08). The pooled
estimates were not significantly affected using a leave-one-out analysis
meta-analysis. Conclusion(s): Despite surgical treatment of
non-rheumatic mitral regurgitation, TR progresses in a considerable number
of patients. Concomitant tricuspid annuloplasty significantly decreases
the prevalence of WTR without affecting mortality. Copyright ©
2025 Elsevier B.V.

<56>
Accession Number
2040844300
Title
Intravascular Imaging vs Angiography Guidance for PCI of Severely
Calcified Lesions: The ECLIPSE Trial.
Source
JACC: Cardiovascular Interventions. 18(19) (pp 2338-2351), 2025. Date of
Publication: 13 Oct 2025.
Author
Stone G.W.; Genereux P.; Maehara A.; Lewis B.E.; Shlofmitz R.A.; Dohad S.;
Choudary J.; Dahle T.; Pineda A.M.; Shunk K.; Mahmud E.; Weisz G.; Collins
M.B.; Alaswad K.; Kumar G.; Solankhi N.; Dulas D.; Altman J.D.; Kraemer
C.; Stiefel K.M.; Jones D.E.; Buccola J.R.; Kirtane A.J.
Institution
(Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Maehara, Kirtane) Cardiovascular Research Foundation, New York, NY,
United States
(Maehara, Weisz, Collins, Kirtane) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Lewis) Loyola University Medical Center, Chicago, IL, United States
(Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
(Dohad) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Choudary) Reid Health Physicians Associates, Richmond, IN, United States
(Dahle) CentraCare Heart & Vascular Center, St. Cloud, MN, United States
(Pineda) Duke University Medical Center, Durham, NC, United States
(Shunk) University of California-San Francisco, San Francisco, CA, United
States
(Shunk) San Francisco VA Medical Center, San Francisco, California, United
States
(Mahmud) University of California-San Diego, San Diego, CA, United States
(Alaswad) Henry Ford Hospital, Detroit, MI, United States
(Kumar) Emory Healthcare, Atlanta, GA, United States
(Kumar) Atlanta VA Medical Center, Atlanta, GA, United States
(Solankhi) University of Louisville, Louisville, KY, United States
(Dulas) Metropolitan Heart and Vascular Institute, Coon Rapids, MN, United
States
(Altman) Colorado Heart and Vascular, Lakewood, CO, United States
(Kraemer, Stiefel, Jones, Buccola) Abbott Vascular, Santa Clara,
California, United States
Publisher
Elsevier Inc.
Abstract
Background: Few studies have examined whether intravascular imaging (IVI)
guidance during percutaneous coronary intervention (PCI) of calcified
lesions improves clinical outcomes. Objective(s): The aim of this
study was to determine from a large-scale randomized trial of PCI in
severely calcified lesions whether IVI guidance improves event-free
survival. Method(s): In the ECLIPSE (Evaluation of Treatment
Strategies for Severe Calcific Coronary Arteries: Orbital Atherectomy vs.
Conventional Angioplasty Technique Prior to Implantation of Drug-Eluting
Stents) trial, 2,005 patients with severely calcified lesions were
randomized to orbital atherectomy (OA) vs balloon angioplasty (BA) prior
to drug-eluting stent placement. IVI with optical coherence tomography or
intravascular ultrasound (IVUS) was allowed at operator discretion. The
primary clinical outcome was the 1-year rate of target vessel failure
(TVF). Result(s): IVI guidance was used in 1,246 of 2,005 patients
(62.1%), including optical coherence tomography in 819 and/or IVUS in 513,
while 759 of 2,005 patients (37.9%) underwent PCI with angiographic
guidance alone. Median follow-up duration was 365 days (Q1-Q3: 365-365
days). The 1-year Kaplan-Meier estimated rate of TVF was lower among
patients with IVI guidance compared with angiographic guidance alone (9.3%
vs 13.2%; adjusted HR: 0.74; 95% CI: 0.56-0.97; P = 0.03). The effect of
IVI guidance was consistent in patients randomized to OA vs BA
(P<inf>interaction</inf> = 0.48). The 1-year rate of TVF was 7.7% after
optical coherence tomographic guidance compared with 12.2% after IVUS
guidance (adjusted HR: 0.78; 95% CI: 0.52-1.18; P = 0.24).
 Conclusion(s): IVI guidance during PCI of severely calcified lesions
was associated with improved 1-year clinical outcomes compared with
angiographic guidance alone, whether OA or BA was used for vessel
preparation prior to drug-eluting stent placement. The adjusted difference
in 1-year TVF rates were not significantly different with optical
coherence tomographic guidance and IVUS guidance. Copyright ©
2025 The Authors

<57>
Accession Number
2040875086
Title
Body Composition and Treatment Response in Heart Failure With Preserved
Ejection Fraction: Interpreting the Adipokine Hypothesis.
Source
Journal of the American College of Cardiology. 86(16) (pp 1256-1259),
2025. Date of Publication: 21 Oct 2025.
Author
Vest A.R.; Ilonze O.J.; Umapathi P.; Harrington J.
Institution
(Vest) Kaufman Center for Heart Failure Treatment and Recovery, Department
of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute,
Cleveland Clinic, Cleveland, OH, United States
(Ilonze) Division of Cardiovascular Medicine, Krannert Cardiovascular
Research Center, Indiana University School of Medicine, Indianapolis, IN,
United States
(Umapathi) Division of Cardiology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Harrington) Division of Cardiology, University of Colorado Medical
School, Aurora, CO, United States
(Harrington) Colorado Prevention Center, Aurora, CO, United States
Publisher
Elsevier Inc.

<58>
Accession Number
2036806304
Title
Liposomal Bupivacaine in Ultrasound-Guided Paravertebral Block Reduces
Opioid Consumption and Accelerates Recovery After Thoracic Surgery: A
Randomized Controlled Trial.
Source
Drug Design, Development and Therapy. 19 (pp 9137-9149), 2025. Date of
Publication: 2025.
Author
Wang L.-L.; Zhu Y.; Hui L.-Y.; Zhang X.; He J.-S.; Zhang N.-L.; Dong Y.;
Feng W.
Institution
(Wang, Zhu, Zhang, He, Feng) Department of Anesthesiology, The Affiliated
Hospital of Qingdao University, Shandong Province, Qingdao, China
(Wang, Hui, Zhang) Neuropsychiatry Research Institute, The Affiliated
Hospital of Qingdao University, Qingdao University, Shandong Province,
Qingdao, China
(Dong) Neuropsychiatry Research Institute, The Affiliated Hospital of
Qingdao University, Qingdao University, Shandong Province, Qingdao, China
Publisher
Dove Medical Press Ltd
Abstract
Background: Liposomal bupivacaine (LB) can provide prolonged analgesia,
which may reduce patients' opioid consumption, improve comfort, and
facilitate recovery. Looser tissue and lower vascularity in the
paravertebral space may facilitate LB diffusion and duration, so we
investigated the effects of LB in multimodal analgesia after thoracic
surgery with paravertebral block. Method(s): In this single-center,
double-blind, randomized, parallel-controlled trial, 102 patients
undergoing elective thoracoscopic surgery were randomized 1:1 to thoracic
paravertebral block with LB (6.67 mg/mL) or ropivacaine hydrochloride (RH;
0.33%). The primary outcome was opioid consumption within 72 h
postoperatively. Secondary outcomes included pain ratings at 6, 12, 24,
48, and 72 h postoperatively; rescue analgesia; time to first ambulation
and defecation; post-anesthesia care unit and hospital length of stay; and
adverse events. Result(s): One patient was excluded due to block
failure, leaving 101 patients (LB group, n = 51; RH group, n = 50). LB
significantly reduced 72-h opioid consumption compared to RH (difference =
-181.4 mg; 95% CI: -232.8, -130.0 mg; P < 0.001), and fewer patients in
the LB group required rescue analgesia compared to the RH group (OR: 0.33;
95% CI: 0.13, 0.82; P < 0.05). Pain scores at 24 h were lower in the LB
group than RH group (difference = -0.44; 95% CI: -0.84, -0.04; P < 0.05),
with no differences at other timepoints. The LB group had shorter time to
first ambulation than the RH group [median time (IQR): 20 (18-24) h vs 26
(22-32) h; HR: 3.81; 95% CI: 2.32, 6.19; P < 0.001] and shorter time to
defecation [median time (IQR): 56 (42-65) h vs 72 (57-80) h; HR: 3.98; 95%
CI: 2.46, 6.44; P < 0.001]. Conclusion(s): Ultrasound-guided
paravertebral block with LB may reduce postoperative opioid consumption
and enhance recovery in patients undergoing thoracic surgery. Trial
Registration: Chinese Clinical Trials Registry Platform (chictr.org.cn):
ChiCTR2400091217. Copyright © 2025 Wang et al.

<59>
Accession Number
2013196155
Title
Effects of bilateral Pecto-intercostal Fascial Block for perioperative
pain management in patients undergoing open cardiac surgery: a prospective
randomized study.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 175. Date
of Publication: 01 Dec 2021.
Author
Zhang Y.; Gong H.; Zhan B.; Chen S.
Institution
(Zhang, Gong, Chen) Department of Anesthesiology, First Affiliated
Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang,
Jiangxi, China
(Zhan) Department of cardiology, The second Affiliated Hospital of
Nanchang University, NO.1 minde Street, Nanchang, Jiangxi, China
Publisher
BioMed Central Ltd
Abstract
Background: Open cardiac surgical patients may experience severe acute
poststernotomy pain. The ultrasound-guided Pecto-intercostal Fascial Block
(PIFB) can cover anterior branches of intercostal nerves from T2 to T6.
The aim of this study was to investigate the effect of bilateral PIFB in
patients undergoing open cardiac surgery. Method(s): A group of 108
patients were randomly allocated to either receive bilateral PIFB (PIFB
group) or no nerve block (SALI group). The primary endpoint was
postoperative pain. The secondary outcome measures included intraoperative
and postoperative sufentanil and parecoxib consumption, time to
extubation, time to first feces, length of stay in the ICU and the length
of hospital stay. Insulin, glucose, insulin resistance and interleukin
(IL)-6 at 1, 2, 3 days after surgery were mearsured. The homeostasis model
assessment (HOMA-IR) was used to measure perioperative insulin resistance.
 Result(s): The PIFB group reported significantly less sufentanil and
parecoxib consumption than the SALI group. Compared to the PIFB group, the
SALI group had higher Numerical Rating Scale (NRS) pain scores at 24 h
after operation both at rest and during coughing. The time to extubation,
length of stay in the ICU and length of hospital stay were significantly
decreased in the PIFB group compared with the SALI group. The PIFB group
had a lower insulin, glucose, IL-6, HOMA-IR level than the SALI group 3
days after surgery. Conclusion(s): Bilateral PIFB provides effective
analgesia and accelerates recovery in patients undergoing open cardiac
surgery. Trial registration: This study was registered in the Chinese
Clinical Trial Registry (ChiCTR 2000030609) on 08/03/2020. Copyright
© 2021, The Author(s).

<60>
Accession Number
2040881081
Title
Relationship between blood concentration of zinc and selenium and
prognosis in post-acute myocardial infarction: A protocol for systematic
review and meta-analysis.
Source
PLOS ONE. 20(10 October) (no pagination), 2025. Article Number: e0333264.
Date of Publication: 01 Oct 2025.
Author
Teixeira Gomes A.F.; Barboza da Silva L.M.; Carneiro R.B.S.;
Dantas-Komatsu R.C.S.; de Medeiros G.C.B.S.; Silbiger V.N.; Reis B.Z.;
Luchessi A.D.
Institution
(Teixeira Gomes, Luchessi) Postgraduate Program in Health Sciences, Center
for Health Sciences, Federal University of Rio Grande do Norte, Rio Grande
do Norte, Natal, Brazil
(Barboza da Silva, de Medeiros, Reis) Postgraduate Program in Nutrition,
Center for Health Sciences, Federal University of Rio Grande do Norte, Rio
Grande do Norte, Natal, Brazil
(Carneiro) Multidisciplinary Residency Training Program, Onofre Lopes
University Hospital, Federal University of Rio Grande do Norte, Rio Grande
do Norte, Natal, Brazil
(Dantas-Komatsu) Postgraduate Program in Pharmaceutical Sciences, Center
for Health Sciences, Federal University of Rio Grande do Norte, Rio Grande
do Norte, Natal, Brazil
(de Medeiros) Postgraduate Program in Public Health, Center for Health
Sciences, Federal University of Rio Grande do Norte, Rio Grande do Norte,
Natal, Brazil
(de Medeiros, Reis) Department of Nutrition, Center for Health Sciences,
Federal University of Rio Grande do Norte, Rio Grande do Norte, Natal,
Brazil
(Silbiger) Translational Medicine, The Hospital for Sick Children,
Toronto, ON, Canada
(Silbiger) Department of Clinical and Toxicological Analysis, Federal
University of Rio Grande do Norte, Rio Grande do Norte, Natal, Brazil
Publisher
Public Library of Science
Abstract
Acute Myocardial Infarction (AMI) is characterized by the presence of
injury caused by an ischemic event, which leads to various complications,
including Heart Failure (HF), the most severe functional stage of the
heart, reducing both quality of life and life expectancy. Among the
factors involved in this process, essential trace elements such as zinc
and selenium stand out, as they are related to cardiovascular health and
may help mitigate the harmful changes resulting from AMI. The objective of
this protocol is to detail the development of two systematic reviews to
gather scientific evidence on the relationship between zinc and selenium
and the prognosis following AMI. This protocol was developed in accordance
with the Preferred Reporting Items for Systematic Review and Meta-Analysis
Protocols (PRISMA-P) guideline and registered in the International
Prospective Register of Systematic Reviews (PROSPERO) under the code
CRD42024574424. Search strategies will be conducted using a combination of
controlled and uncontrolled terms combined with Boolean operators, and the
following databases will be used: MEDLINE/PubMed, EMBASE, LILACS, Scopus,
Web of Science, Trip database, and World Wide Science. Cohort studies that
evaluated zinc and selenium in the prognosis after AMI will be included.
Two trained researchers will independently select articles, extract data,
and assess the risk of bias and the quality of the evidence. A narrative
synthesis will be performed, and the main findings will be presented in
tables. If possible, a meta-analysis will also be conducted. Copyright
© 2025 Teixeira Gomes et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.

<61>
Accession Number
2037140462
Title
Comparative analysis of cardiac ct and invasive coronary angiography for
suspected stable coronary artery disease and subsequent functional testing
and revascularization: A prespecified secondary discharge randomized trial
analysis.
Source
Radiology: Cardiothoracic Imaging. 7(4) (no pagination), 2025. Article
Number: e240526. Date of Publication: 01 Aug 2025.
Author
Dodd J.D.; Bosserdt M.; Oleksiak A.; Vattay B.; Moller M.B.; Benedek T.M.;
Campbell F.; Rodriguez-Palomares J.F.; Flynn S.; Serna-Higuita L.M.; Sox
H.; Dewey M.
Institution
(Dodd, Flynn) Department of Radiology, St. Vincent's University Hospital,
Elm Park, Dublin, Ireland
(Dodd, Flynn) School of Medicine, University College Dublin, Dublin,
Ireland
(Bosserdt, Dewey) Department of Radiology, Charite-Universitatsmedizin
Berlin, Freie Universitat Berlin and Humboldt-Universitat zu Berlin,
Berlin, Germany
(Oleksiak) Department of Intensive Cardiac Therapy, National Institute of
Cardiology, Warsaw, Poland
(Vattay) Heart and Vascular Center, Semmelweis Egyetem, Budapest, Hungary
(Moller) Department of Cardiology, Rigshospitalet Hjertecentret,
Copenhagen, Denmark
(Benedek) University of Medicine, Pharmacy, Sciences and Technology, Targu
Mures, Romania
(Campbell) Department of Cardiology, Ulster Hospital-Southeastern Health
and Social Care Trust, Belfast, United Kingdom
(Rodriguez-Palomares) Department of Cardiovascular Diseases, Vall d'Hebron
Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona,
Spain
(Rodriguez-Palomares) Department of Medicine, Vall d'Hebron Institut de
Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
(Rodriguez-Palomares) Department of Cardiology, Universitat Autonoma de
Barcelona, Cardiovascular Imaging Unit, Aortic Diseases Unit, Barcelona,
Spain
(Serna-Higuita) Department of Clinical Epidemiology and Applied
Biostatistics, Universitatsklinikum Tubingen, Tubingen, Germany
(Sox) Geisel School of Medicine, Hanover, NH, United States
(Dewey) DZHK (German Centre for Cardiovascular Research), Berlin, Germany
(Dewey) Berlin University Alliance, Berlin, Germany
(Dewey) Deutsches Herzzentrum der Charite, Berlin, Germany
(Dewey) Berlin Institute of Health at Charite-Universitatsmedizin Berlin,
Berlin, Germany
Publisher
Radiological Society of North America Inc.
Abstract
Purpose: To compare functional testing and management after cardiac
CT-first versus invasive coronary angiography (ICA)-first strategies in
participants with stable chest pain and low to intermediate probability of
obstructive coronary artery disease (CAD) initially referred for ICA.
 Material(s) and Method(s): This study was a prespecified secondary
analysis of the prospective, multicenter, randomized DISCHARGE (Diagnostic
Imaging Strategies for Participants with Stable Chest Pain and
Intermediate Risk of Coronary Artery Disease) trial (ClinicalTrials.gov
no. NCT02400229) conducted between October 2015 and April 2019. The
primary outcome was functional testing rates at each of the study sites
after first test; secondary outcomes included revascularization, major
postprocedure complications, and angina after a 3.5-year follow-up, all
stratified by CAD severity. Comparisons were performed using adjusted
multiple regression. Result(s): Of 3561 participants (mean age, 60.1
years +/- 10.1 [SD]; 2002 [56.2%] female), 3414 were included in the final
analysis. CT-first resulted in more functional testing for obstructive CAD
without high-risk anatomy as compared with ICA-first (114 of 214 [53.3%]
vs 62 of 255 [24.3%]; adjusted odds ratio [OR], 3.55; 95% CI: 2.40, 5.28;
P<inf>interaction</inf><.001). Revascularizations were lower for CT-first
in obstructive CAD with high-risk anatomy (146 of 251 [58.2%] vs 161 of
196 [82.1%]; adjusted OR, 0.3; 95% CI: 0.19, 0.47) and without high-risk
anatomy (81 of 214 [37.9%] vs 152 of 255 [59.6%]; adjusted OR, 0.41; 95%
CI: 0.28, 0.60). ICA-first had more major complications with high-risk
anatomy (11 of 196 [5.6%] vs five of 251 [2.0%]) and non-high-risk anatomy
(11 of 255 [4.3%] vs two of 214 [0.9%]) than CT-first. Angina rates were
similar (38 of 465 [8.2%] vs 32 of 451 [7.1%]; adjusted OR, 1.13; 95% CI:
0.69, 1.86). Conclusion(s): A CT-first strategy increased functional
testing, was influenced by CAD severity, and reduced revascularizations
and major complications with similar angina rates after a 3.5-year
follow-up compared with an ICA-first strategy in participants with stable
chest pain. Copyright © RSNA, 2025.

<62>
Accession Number
2041039063
Title
Impact of propofol or sevoflurane on the renoprotective effect of remote
ischaemic preconditioning in cardiac surgery: the HypnoRenalRIP randomised
clinical trial.
Source
British Journal of Anaesthesia. (no pagination), 2025. Date of
Publication: 2025.
Author
Zarbock A.; Schone L.M.; Kellum J.A.; Gerss J.; Weiss R.; Booke H.;
Meersch M.
Institution
(Zarbock, Schone, Weiss, Booke, Meersch) Department of Anaesthesiology,
Intensive Care Medicine and Pain Medicine, University Hospital Munster,
Munster, Germany
(Zarbock) Department of Anesthesiology, Critical Care and Pain Medicine,
The University of Texas Health Science Center at Houston, Houston, TX,
United States
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Elsevier Ltd
Abstract
Background: Remote ischaemic preconditioning (RIPC) might reduce acute
kidney injury after cardiac surgery. Protective effects appear to be
restricted to patients with early and transient increases in two cell
cycle arrest markers, tissue inhibitor of metalloproteinases-2 (TIMP-2)
and insulin-like growth factor-binding protein 7 (IGFBP7), in urine.
Studies suggest that propofol can attenuate the preconditioning effect on
the myocardium. This study investigated whether propofol diminishes the
renoprotective effect associated with the early transient increases in
TIMP-2 and IGFBP7. Method(s): This was a single-centre, prospective
randomised double-blind 2x2 factorial clinical trial of high-risk patients
undergoing cardiac surgery. Patients were randomised to receive either
propofol+sham-RIPC, propofol+RIPC, sevoflurane+sham-RIPC, or
sevoflurane+RIPC. The primary outcome measure was the change in the
product of urinary concentrations of TIMP-2 and IGFBP7 ([TIMP-2].[IGFBP7])
from before to after the intervention. Result(s): We enrolled 160
participants in the trial (propofol+sham-RIPC: n=20, propofol+RIPC: n=60,
sevoflurane+sham-RIPC: n=20, sevoflurane+RIPC: n=60). The median change in
[TIMP-2].[IGFBP7] as an indicator of response to RIPC was greater in
participants receiving sevoflurane (0.070; interquartile range, -0.120 to
0.418) compared with those receiving propofol (-0.015; interquartile
range, -0.138 to 0.068; P=0.022). Conversely, elevated [TIMP-2].[IGFBP7]
as a sign of renal stress in response to surgery was detected in all
groups except for sevoflurane+RIPC (P=0.001). There were no statistically
significant differences in patient-centred outcomes between groups.
 Conclusion(s): Transient increases in [TIMP-2].[IGFBP7] induced by
RIPC, which were associated with renoprotective effects, were only seen
with sevoflurane anaesthesia, but not when propofol was used. The
association of biomarker concentrations and choice of anaesthetic agent
suggests that propofol can attenuate the renoprotective effects of remote
ischaemic preconditioning. Clinical trial registration:
DRKS00014989 Copyright © 2025 The Author(s)

<63>
Accession Number
2034459476
Title
Role of nicorandil in preventing contrast-induced nephropathy in patients
undergoing cardiac catheterization procedures: an updated systematic
review and meta-analysis.
Source
International Urology and Nephrology. 57(11) (pp 3671-3685), 2025. Date of
Publication: 01 Nov 2025.
Author
Khan A.A.; Tahir M.Z.; Maryam K.U.E.; Uzair M.; Haram; Faheem M.S.B.;
Zainab; Abdullah A.; Anwer A.; Ashraf D.A.; Ahmed A.K.; Rahim S.; Arshad
M.S.
Institution
(Khan, Maryam, Ashraf) Department of Internal Medicine, Foundation
University Medical College Islamabad, Islamabad, Pakistan
(Tahir) Department of Internal Medicine, Punjab Medical College,
Faisalabad, Pakistan
(Uzair) Ziauddin Medical College, Karachi, Pakistan
(Haram) Rehman Medical College, Peshawar, Pakistan
(Faheem) Department of Internal Medicine, Karachi Institute of Medical
Sciences, KIMS, Sindh, Karachi, Pakistan
(Zainab) Allama Iqbal Medical College, Lahore, Pakistan
(Abdullah, Anwer) Amna Inayat Medical College, Sheikhupura, Pakistan
(Ahmed) Jinnah Medical and Dental College, Karachi, Pakistan
(Rahim) King Edward Medical University, Lahore, Pakistan
(Arshad) Dow University of Health Sciences, Islamabad, Pakistan
Publisher
Springer Science and Business Media B.V.
Abstract
Background: Contrast-induced nephropathy (CIN) is a major risk for
patients undergoing coronary angiography (CAG) and percutaneous coronary
intervention (PCI). Method(s): PubMed, MEDLINE, Embase, Google
Scholar, and Web of Science were searched through May 2024 to include
randomized controlled trials (RCTs) assessing the efficacy and safety of
nicorandil administration in patients following CAG or PCI. Outcomes of
interest included the CIN incidence, major adverse events, serum
creatinine, serum cystatin C, BUN and eGFR. Risk ratios (RRs) and standard
mean differences (SMDs) with 95% confidence intervals (CIs) were
calculated using random-effects model. Statistical heterogeneity was
assessed using I2 statistics. Result(s): Twelve studies (n = 2931
patients) were included in the final analysis. Nicorandil significantly
reduced the CIN incidence (RR: 0.40 [0.31,0.52]; p < 0.00001), with
consistent results for oral (RR: 0.35 [0.25,0.48]; p < 0.00001) and
intravenous administration (RR: 0.52 [0.30,0.92]; p = 0.02) (p-interaction
= 0.22). Oral nicorandil reduced the risk of major adverse events (RR:
0.71 [0.51,0.99]; p = 0.05). Among patients on nicorandil, serum
creatinine levels were significantly lower at 48 h (SMD: -0.30
[-0.52,-0.07]; p = 0.009), and 72 h post-intervention (SMD: -0.42
[-0.71,-0.13]; p = 0.004). Nicorandil significantly reduced serum cystatin
C levels at 48 h post-intervention (SMD: -0.56 [-1.01,-0.01]; p = 0.02).
However, nicorandil did not significantly affect eGFR values at 24-h (SMD:
0.12 [-0.21,0.45]; p = 0.46), 48-h (SMD: 0.08 [-0.19,0.35]; p = 0.58), and
72-h (SMD: 0.34 [-0.13,0.81]; p = 0.16). Conclusion(s): Nicorandil
administration reduces the CIN incidence and improves renal biomarkers in
patients undergoing CAG and PCI. Large-scale trials with longer follow-up
periods are warranted to confirm renoprotective effects of
nicorandil. Copyright © The Author(s), under exclusive licence to
Springer Nature B.V. 2025.

<64>
Accession Number
2035548834
Title
Parvovirus B19-associated myocarditis in children: A systematic review of
clinical features, management and outcomes.
Source
European Journal of Clinical Investigation. 55(11) (no pagination), 2025.
Article Number: e70102. Date of Publication: 01 Nov 2025.
Author
Veronese G.; Colombo G.; Garascia A.; Adorisio R.; Bonanomi E.; Ammirati
E.
Institution
(Veronese, Bonanomi) Pediatric Intensive Care Unit, ASST Papa Giovanni
XXIII, Bergamo, Italy
(Veronese) Department of Cardiothoracic Surgery, Heart and Vascular
Centre, Maastricht University Medical Centre, Maastricht, Netherlands
(Colombo, Garascia, Ammirati) De Gasperis Cardio Center, Niguarda
Hospital, Milan, Italy
(Adorisio) Heart Failure, Transplant and Mechanical Assist Device Unit,
IRCCS Bambino Gesu Children's Hospital, Rome, Italy
(Ammirati) University of Milan-Bicocca, School of Medicine and Surgery,
Monza, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Parvovirus B19 (PVB19) has emerged as a relevant etiologic
agent of paediatric myocarditis, particularly during recent
epidemiological surges in Europe and the United States. Despite increasing
recognition, current knowledge remains fragmented, and standardised
diagnostic and therapeutic strategies are lacking. Method(s): We
conducted a systematic review of the literature up to May 2025, including
40 studies encompassing 53 individual case reports, 107 patients from
registry-based cohorts, and 4 tissue-based investigations. Result(s):
Clinical presentation was frequently fulminant, with cardiogenic shock,
severe left ventricular dysfunction, and need for mechanical circulatory
support in up to 47% of cases. Mortality rates ranged from 10% to 30%,
with heart transplantation rates varying between 5% and 42% across
cohorts. Diagnosis relied primarily on blood polymerase chain reaction
(PCR), while serology showed limited diagnostic utility. Histological
confirmation via endomyocardial biopsy (EMB) was variably applied across
studies, and myocardial viral load quantification was reported in only one
study. Case series and cohort studies confirmed early age of onset (median
16-24 months), respiratory or gastrointestinal prodromes, and poor
outcomes in fulminant presentations. Tissue-based studies revealed high
myocardial PVB19 loads in acute myocarditis, particularly in infants, but
also demonstrated viral persistence in asymptomatic individuals,
complicating causal inference. Immunomodulatory therapy was administered
in up to 58% of cases, although its clinical impact remains uncertain due
to heterogeneity in treatment protocols. No antiviral treatments have been
evaluated to date. Conclusion(s): These findings highlight the need
for standardised diagnostic criteria incorporating PCR, serology, imaging,
and, where appropriate, EMB and viral load assessment. Given recent
epidemiologic surges and high morbidity, prospective multicentre studies
and surveillance efforts are urgently required to refine clinical
algorithms and improve outcomes in paediatric PVB19
myocarditis. Copyright © 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.

<65>
Accession Number
2025575159
Title
Vitamin D supplementation and major cardiovascular events: D-Health
randomised controlled trial.
Source
BMJ. 381 (no pagination), 2023. Article Number: e075230. Date of
Publication: 2023.
Author
Thompson B.; Waterhouse M.; English D.R.; McLeod D.S.; Armstrong B.K.;
Baxter C.; Romero B.D.; Ebeling P.R.; Hartel G.; Kimlin M.G.; Rahman S.T.;
van der Pols J.C.; Venn A.J.; Webb P.M.; Whiteman D.C.; Neale R.E.
Institution
(Thompson, Waterhouse, McLeod, Baxter, Romero, Rahman, Webb, Whiteman,
Neale) Population Health Program, QIMR Berghofer Medical Research
Institute, Herston, QLD, Australia
(English) Melbourne School of Population Health, University of Melbourne,
Carlton, VIC, Australia
(Armstrong) School of Public Health, The University of Sydney, Sydney,
NSW, Australia
(Ebeling) Department of Medicine, School of Clinical Sciences, Monash
University, Clayton, VIC, Australia
(Hartel) Statistics Unit, QIMR Berghofer Medical Research Institute,
Herston, QLD, Australia
(Kimlin) School of Biomedical Science, Faculty of Health, Queensland
University of Technology, Kelvin Grove, QLD, Australia
(van der Pols) School of Exercise and Nutrition Sciences, Faculty of
Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
(Venn) Menzies Institute for Medical Research, University of Tasmania,
Hobart, TAS, Australia
Publisher
BMJ Publishing Group
Abstract
Objective To investigate whether supplementing older adults with monthly
doses of vitamin D alters the incidence of major cardiovascular events.
Design Randomised, double blind, placebo controlled trial of monthly
vitamin D (the D-Health Trial). Computer generated permuted block
randomisation was used to allocate treatments. setting Australia from 2014
to 2020. ParticiPants 21 315 participants aged 60-84 years at enrolment.
Exclusion criteria were self-reported hypercalcaemia, hyperparathyroidism,
kidney stones, osteomalacia, sarcoidosis, taking >500 IU/day supplemental
vitamin D, or unable to give consent because of language or cognitive
impairment. interventiOn 60 000 IU/month vitamin D<inf>3</inf> (n=10 662)
or placebo (n=10 653) taken orally for up to five years. 16 882
participants completed the intervention period: placebo 8270 (77.6%);
vitamin D 8552 (80.2%). Main OutcOMe Measures The main outcome for this
analysis was the occurrence of a major cardiovascular event, including
myocardial infarction, stroke, and coronary revascularisation, determined
through linkage with administrative datasets. Each event was analysed
separately as secondary outcomes. Flexible parametric survival models were
used to estimate hazard ratios and 95% confidence intervals. results 21
302 people were included in the analysis. The median intervention period
was five years. 1336 participants experienced a major cardiovascular event
(placebo 699 (6.6%); vitamin D 637 (6.0%)). The rate of major
cardiovascular events was lower in the vitamin D group than in the placebo
group (hazard ratio 0.91, 95% confidence interval 0.81 to 1.01),
especially among those who were taking cardiovascular drugs at baseline
(0.84, 0.74 to 0.97; P for interaction=0.12), although the P value for
interaction was not significant (<0.05). Overall, the difference in
standardised cause specific cumulative incidence at five years was -5.8
events per 1000 participants (95% confidence interval -12.2 to 0.5 per
1000 participants), resulting in a number needed to treat to avoid one
major cardiovascular event of 172. The rate of myocardial infarction
(hazard ratio 0.81, 95% confidence interval 0.67 to 0.98) and coronary
revascularisation (0.89, 0.78 to 1.01) was lower in the vitamin D group,
but there was no difference in the rate of stroke (0.99, 0.80 to 1.23).
cOnclusiOns Vitamin D supplementation might reduce the incidence of major
cardiovascular events, although the absolute risk difference was small and
the confidence interval was consistent with a null finding. These findings
could prompt further evaluation of the role of vitamin D supplementation,
particularly in people taking drugs for prevention or treatment of
cardiovascular disease. Copyright © 2023 BMJ Publishing Group.
All rights reserved.

<66>
Accession Number
2021071301
Title
Association of gestational diabetes mellitus with overall and type
specific cardiovascular and cerebrovascular diseases: systematic review
and meta-analysis.
Source
BMJ. 378 (no pagination), 2022. Article Number: e070244. Date of
Publication: 2022.
Author
Xie W.; Wang Y.; Xiao S.; Qiu L.; Yu Y.; Zhang Z.
Institution
(Xie, Zhang) Department of Rheumatology and Clinical Immunology, Peking
University First Hospital, Beijing, China
(Wang, Yu) Department of Endocrinology, Peking University First Hospital,
Beijing, China
(Xiao) Department of Gastroenterology, Sichuan Provincial People's
Hospital, University of Electronic Science and Technology of China,
Chengdu, China
(Xiao) Department of Gastroenterology, Peking University Third Hospital,
Beijing, China
(Qiu) Department of Cardiology, Peking University First Hospital, Beijing,
China
Publisher
BMJ Publishing Group
Abstract
Objective To quantify the risk of overall and type specific cardiovascular
and cerebrovascular diseases as well as venous thromboembolism in women
with a history of gestational diabetes mellitus. Design Systematic review
and meta-analyses. Data sOurces PubMed, Embase, and the Cochrane Library
from inception to 1 November 2021 and updated on 26 May 2022. review
methODs Observational studies reporting the association between
gestational diabetes mellitus and incident cardiovascular and
cerebrovascular diseases were eligible. Data, pooled by random effects
models, are presented as risk ratios (95% confidence intervals). Certainty
of evidence was appraised by the Grading of Recommendations, Assessment,
Development, and Evaluations. results 15 studies rated as moderate or
serious risk of bias were included. Of 513 324 women with gestational
diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of
more than eight million control women without gestational diabetes, 78 895
had cardiovascular and cerebrovascular disease. Compared with women
without gestational diabetes mellitus, women with a history of gestational
diabetes mellitus showed a 45% increased risk of overall cardiovascular
and cerebrovascular diseases (risk ratio 1.45, 95% confidence interval
1.36 to 1.53), 72% for cardiovascular diseases (1.72, 1.40 to 2.11), and
40% for cerebrovascular diseases (1.40, 1.29 to 1.51). Women with
gestational diabetes mellitus showed increased risks of incident coronary
artery diseases (1.40, 1.18 to 1.65), myocardial infarction (1.74, 1.37 to
2.20), heart failure (1.62, 1.29 to 2.05), angina pectoris (2.27, 1.79 to
2.87), cardiovascular procedures (1.87, 1.34 to 2.62), stroke (1.45, 1.29
to 1.63), and ischaemic stroke (1.49, 1.29 to 1.71). The risk of venous
thromboembolism was observed to increase by 28% in women with previous
gestational diabetes mellitus (1.28, 1.13 to 1.46). Subgroup analyses of
cardiovascular and cerebrovascular disease outcomes stratified by study
characteristics and adjustments showed significant differences by region
(P=0.078), study design (P=0.02), source of data (P=0.005), and study
quality (P=0.04), adjustment for smoking (P=0.03), body mass index
(P=0.01), and socioeconomic status (P=0.006), and comorbidities (P=0.05).
The risk of cardiovascular and cerebrovascular diseases was, however,
attenuated but remained significant when restricted to women who did not
develop subsequent overt diabetes (all gestational diabetes mellitus:
1.45, 1.33 to 1.59, gestational diabetes mellitus without subsequent
diabetes: 1.09, 1.06 to 1.13). Certainty of evidence was judged as low or
very low quality. cOnclusiOns Gestational diabetes mellitus is associated
with increased risks of overall and type specific cardiovascular and
cerebrovascular diseases that cannot be solely attributed to conventional
cardiovascular risk factors or subsequent diabetes. Copyright ©
2022 BMJ Publishing Group. All rights reserved.

<67>
Accession Number
2035395968
Title
Rationale and design of the randomized 'early ventricular assist
device'-Trial (VAD-DZHK3).
Source
ESC Heart Failure. 12(5) (pp 3731-3740), 2025. Date of Publication: 01 Oct
2025.
Author
Knosalla C.; Farber G.; Rieth A.J.; Wachter R.; Placzek M.; Albert W.;
Hasenfuss G.; Falk V.; Friede T.
Institution
(Knosalla, Albert, Falk) Department of Cardiothoracic and Vascular
Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany
(Knosalla, Albert, Falk) Charite - Universitatsmedizin Berlin, corporate
member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin,
Berlin, Germany
(Knosalla, Albert, Falk) German Center for Cardiovascular Research (DZHK),
partner site Berlin, Berlin, Germany
(Knosalla) Department of Thoracic and Cardiovascular Surgery Saarland,
University Medical Center and Saarland University, Homburg, Germany
(Farber) Department of Cardiothoracic Surgery, University Hospital Jena,
Friedrich Schiller University of Jena, Jena, Germany
(Rieth) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Rieth) German Center for Cardiovascular Research (DZHK), partner site
Rhine-Main, Frankfurt am Main, Germany
(Wachter) Department of Cardiology, University Hospital Leipzig, Leipzig,
Germany
(Wachter, Hasenfus) Clinic for Cardiology and Pneumology, Heart Research
Center, University Medical Center Gottingen, Gottingen, Germany
(Wachter, Hasenfus, Falk) Department of Health Science and Technology, ETH
Zurich, Zurich, Switzerland
(Placzek, Friede) German Center for Cardiovascular Research (DZHK),
partner site Gottingen, Gottingen, Germany
(Placzek, Friede) Department of Medical Statistics, University Medical
Center Gottingen, Gottingen, Germany
Publisher
John Wiley and Sons Inc
Abstract
Aims: Bridge to transplantation (BTT) with durable, continuous-flow left
ventricular assist devices (LVAD) of patients is a well-established
treatment concept in patients awaiting heart transplantation (HTx).
However, the role of elective LVAD implantation in patients with less
advanced HF, but increased risk of decompensation remains uncertain.
 Methods and Results: The VAD-DZHK3 trial is an
investigator-initiated, randomized controlled trial designed to assess
whether an early strategy of elective LVAD implantation improves outcomes
compared with a conventional approach involving optimal medical therapy
and delayed device implantation only after clinical deterioration.
Eligible patients are those with end-stage HF listed for cardiac
transplantation. This is an event-driven study, that is, the study is
completed once 120 events of the primary composite endpoint have been
observed and all patients have at least 1 year of follow-up unless they
died earlier. Patients meeting inclusion criteria who decline
randomization are enrolled in a parallel observational registry reflecting
standard care. The primary efficacy endpoint is survival free from high
urgent cardiac transplantation, disabling stroke and HF hospitalizations
(including emergency room HF visits >6 h). Conclusion(s): The
VAD-DZHK3 trial will provide guidance on the optimal timing and patient
selection for LVAD implantation in heart transplant candidates,
potentially redefining current standards of care. Copyright ©
2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd
on behalf of European Society of Cardiology.

<68>
Accession Number
2041002440
Title
Prevalence and Associated Factors of Postoperative Fever in Pediatric
Congenital Heart Surgery: A Systematic Review.
Source
International Cardiovascular Research Journal. 19(1) (no pagination),
2025. Article Number: e161516. Date of Publication: 01 Dec 2025.
Author
Nabavi S.S.; Behbahani S.M.S.; Shahandashti F.J.; Toloueitabar Y.;
Hamedpour H.; Gholizadeh B.; Moradi-Joo E.
Institution
(Nabavi) Department of General Surgery, Imam Khomeini Hospital, Golestan
Hospital, School of Medicine, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Behbahani) Ayatollah Taleghani Hospital, Shahid Beheshti Hospital, School
of Medicine, Abadan University of Medical Sciences, Abadan, Iran, Islamic
Republic of
(Shahandashti, Toloueitabar) Shaheed Rajaie Cardiovascular Medical and
Research Center, Tehran, Iran, Islamic Republic of
(Hamedpour) Department of Nursing-Midwifery, Islamic Azad University of
Ahwaz, Ahwaz, Iran, Islamic Republic of
(Gholizadeh) Department of Cardiac Surgery, Atherosclerosis Research
Center, Golestan Hospital, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran, Islamic Republic of
(Moradi-Joo) Abadan University of Medical Sciences, Abadan, Iran, Islamic
Republic of
Publisher
Brieflands
Abstract
Context: Post-operative fever in pediatric congenital heart surgery is a
common and challenging complication that can affect recovery,
hospitalization duration, and healthcare costs. Objective(s): This
systematic review aimed to investigate the prevalence, associated factors,
and management approaches of this condition. Data Sources: A
comprehensive search was conducted across Persian (SID, Magiran,
IranMedex) and English (PubMed, Scopus, Web of Science) databases. Search
keywords included "Post-operative fever", "Congenital heart surgery", and
their Persian equivalents. Study Selection: Out of 860 identified
articles, 25 studies were selected for the final analysis after screening.
The quality of the articles was assessed using the Critical Appraisal
Skills Programme (CASP) and AMSTAR tools. Data Extraction: Data were
analyzed using RevMan software. Result(s): The prevalence of
post-operative fever in pediatric congenital heart surgeries ranged from
10% to 25%, influenced by factors such as surgery duration, the complexity
of congenital defects, patients' nutritional status, and quality of care.
More complex and prolonged surgeries showed higher rates of fever.
Additionally, biomarkers such as C-reactive protein (CRP) and
procalcitonin (PCT) were identified as predictive tools for fever risk.
Effective management through the use of prophylactic antibiotics, proper
nutrition, and close monitoring of patient conditions helped reduce the
incidence of this complication. Fever-related outcomes, such as prolonged
hospital stays and elevated healthcare costs, were frequently observed.
 Conclusion(s): This study highlights the need for multifaceted
management of post-operative fever in pediatric congenital heart
surgeries. Reducing surgery duration, standardizing management protocols,
and improving care quality can help decrease its prevalence. Furthermore,
developing comprehensive research in resource-limited areas is recommended
to enhance treatment quality and mitigate the negative outcomes of
fever. Copyright © 2025, Nabavi et al.

<69>
Accession Number
2040952560
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. 67(9) (no pagination), 2025.
Article Number: ezaf297. Date of Publication: 01 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, New
York, NY, United States
(Sandner, Mantaj) Department of Cardiac and Thoracic Aortic Surgery,
Medical University of Vienna, Vienna, Austria
Publisher
European Association for Cardio-Thoracic Surgery
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. 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. 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). 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. Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<70>
Accession Number
2039972487
Title
Ultrasound Guided Versus Conventional Closure Device Deployment Following
Transfemoral Endovascular Procedures: A Systematic Review and
Meta-analysis.
Source
European Journal of Vascular and Endovascular Surgery. 70(4) (pp 469-479),
2025. Date of Publication: 01 Oct 2025.
Author
Kalaja I.; Smeets R.R.; Wegner M.; Macherey-Meyer S.; Heyne S.;
Espinola-Klein C.; Mees B.M.E.; Meertens M.M.
Institution
(Kalaja, Espinola-Klein, Meertens) Department for Cardiology III -
Angiology, University Medical Centre of the Johannes Gutenberg-University,
Mainz, Germany
(Smeets) Department of Vascular Surgery, Slingeland Hospital, Doetinchem,
Netherlands
(Smeets, Mees) Department of Vascular Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(Wegner) Department of Vascular and Endovascular Surgery, Faculty of
Medicine, University Hospital Cologne, University of Cologne, Cologne,
Germany
(Macherey-Meyer, Heyne, Meertens) Clinic III for Internal Medicine,
University of Cologne, Faculty of Medicine and University Hospital
Cologne, Cologne, Germany
Publisher
W.B. Saunders Ltd
Abstract
Objective: Femoral access site complications influence short term survival
and outcomes in patients undergoing endovascular procedures. While
ultrasound guided puncture is a reliable method to reduce such
complications, ultrasound guidance is rarely used for closure device
deployment. Data Sources: Web of Science, PubMed, and the Cochrane
Library. Review Methods: A systematic literature search was conducted to
assess the safety and efficacy of ultrasound guided vascular closure
device deployment compared with vascular closure device deployment without
ultrasound guidance, referred to as conventional closure. All studies
reporting on ultrasound guided closure in transfemoral arterial
interventions were eligible, and those directly comparing ultrasound
guided with conventional closure were included in the meta-analysis.
 Result(s): Overall, 2 738 patients receiving ultrasound guided
closure were included: 1 025 for introducer sheaths measuring 12 F or
larger and 1 713 for introducer sheaths smaller than 12 F. The incidence
of access complications was 5.7% (range 0.8 - 21.6%) for large sheath
procedures and 2.6% (range 0.9 - 4.7%) for small sheath procedures. The
meta-analysis, which included 2 339 patients who received ultrasound
guided closure and 1 175 who underwent conventional closure, showed that
ultrasound guided closure was associated with reduced access site
complications compared with conventional closure (odds ratio [OR] 0.49,
95% confidence interval [CI] 0.37 - 0.65; p < .001). This was consistently
seen both for small sheath (OR 0.45, 95% CI 0.28 - 0.75; p = .002) and
large sheath procedures (OR 0.50, 95% CI 0.37 - 0.71; p < .001), but with
a low certainty of evidence in the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) analysis. Conclusion(s):
Ultrasound guided vessel closure of the femoral artery appeared to be
associated with a lower rate of overall access site complications compared
with conventional closure techniques. Therefore, ultrasound guided closure
might offer the potential to increase procedural and patient safety in
percutaneous arterial access. Copyright © 2025 The Authors

<71>
Accession Number
2041013755
Title
Comparison of Pre-incisional Ultrasound-guided vs. Post-incisional
Surgeon-administered Parasternal Blocks for Analgesia in Pediatric
Congenital Cardiac Surgery: A Randomized Controlled Trial.
Source
Bali Journal of Anesthesiology. 9(3) (pp 136-142), 2025. Date of
Publication: 01 Jul 2025.
Author
Ahmed I.M.E.; Atia A.M.A.; Saad F.O.A.; Mohamed A.A.-K.; Ahmed M.A.A.
Institution
(Ahmed, Atia, Saad, Mohamed, Ahmed) Department of Anesthesia and Intensive
Care, Faculty of Medicine, Assiut University, Assiut, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Effective perioperative pain management in pediatric cardiac
surgery remains challenging due to the complex nature of sternotomy pain
and chest drain-related discomfort. This study compared the analgesic
efficacy and intraoperative hemodynamic effects of ultrasound-guided
pre-incisional parasternal intercostal fascial plane block with
surgeon-administered post-incisional parasternal block (PSB) in children
undergoing congenital heart surgery. Material(s) and Method(s): In
this randomized, double-blind controlled trial, 80 children aged 2-12
years with non-cyanotic congenital heart defects undergoing elective
open-heart surgery with cardiopulmonary bypass were randomized to receive
either PIFP (Group P) or surgeon-administered post-incisional PSB (Group
S). The primary outcome was time to first rescue analgesia
post-extubation. Secondary outcomes included intraoperative fentanyl
consumption, hemodynamic parameters, postoperative pain scores using the
modified objective pain score (MOPS), total nalbuphine consumption, and
intensive care unit (ICU) length of stay. Result(s): Eighty children
were randomized equally into two groups. Intraoperative fentanyl
consumption was significantly lower in Group P (120 [110, 182.5] microg)
compared to Group S (175 [164, 210] microg; P < 0.001). Time to first
rescue analgesia post-extubation was similar between groups (20 [20-24]
vs. 20 [16-24] h, P = 0.125). Postoperative nalbuphine consumption (P =
0.114), MOPS (P > 0.05 across multiple time points), and length of ICU
stay (P = 0.32) were also comparable. Conclusion(s): Pre-incisional
ultrasound-guided PSB reduces intraoperative opioid consumption and
improves hemodynamic stability without affecting postoperative analgesic
outcomes compared to surgeon-administered post-incisional block. Both
techniques provide effective analgesia in pediatric cardiac
surgery. Copyright © 2025 Bali Journal of Anesthesiology.

<72>
Accession Number
2040500455
Title
Efficacy and safety of continuation vs. interruption of anticoagulation
during transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
734. Date of Publication: 01 Dec 2025.
Author
Adamu U.G.; Badianyama M.; Patel A.; Mutyaba A.; Tsabedze N.
Institution
(Adamu, Badianyama, Patel, Mutyaba, Tsabedze) Division of Cardiology,
Department of Internal Medicine, School of Clinical Medicine, Faculty of
Health Sciences, University of the Witwatersrand, York Road, Johannesburg,
Parktown, South Africa
Publisher
BioMed Central Ltd
Abstract
Background: The appropriate periprocedural management of oral
anticoagulation in transcatheter aortic valve implantation (TAVI) patients
who require long-term anticoagulation remains controversial.
 Purpose(s): This systematic review and meta-analysis compare the
efficacy and safety of periprocedural continuation versus interruption of
anticoagulation in patients undergoing TAVI with an indication for
long-term anticoagulation. Method(s): We searched PubMed, Embase, and
Cochrane Central databases to identify relevant articles. We included both
observational and randomized controlled trials. Data were analysed using
random-effects model to calculate the odds ratio (OR) with 95% confidence
intervals (CIs). A p <.05 was considered statistically significant.
 Result(s): Four studies comprising 3,144 patients, with
anticoagulation continued in 1,500 (47.7%) patients were included. There
were no difference between periprocedural continuation and interruption of
anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI:
0.64-1.10; p =.19), major bleeding (OR: 0.98; 95% CI: 0.57-1.68; p =.95),
major vascular complications (OR: 0.93; 95% CI: 0.72-1.20; p =.60), and
myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20-1.77; p =.36). However,
the incidence of stroke was significantly lower in the continuation group
(OR: 0.61; 95% CI: 0.39-0.94; p =.03). The incidence of blood transfusion
was not significantly different between the continuation and interruption
groups (OR: 0.86; 95% CI: 0.42-1.77; p =.68). Conclusion(s): In this
meta-analysis comparing periprocedural continuation of anticoagulation to
interruption of therapy in patients undergoing TAVI with concomitant
indications for long-term anticoagulation, continuation of anticoagulation
was associated with a lower incidence of stroke without increasing the
risk of bleeding. These findings suggest a potentially favourable safety
profile in favour of continuation of anticoagulant therapy, they should be
interpreted with caution and validated in larger and well-designed
randomised trials. The review protocol was prospectively registered with
the International Prospective Register of Systematic Reviews (PROSPERO),
registration number (CRD42024607149). Copyright © The Author(s)
2025.

<73>
Accession Number
2036810214
Title
The impact of remote ischemic preconditioning on postoperative outcomes in
pediatric cardiac surgery: an updated systematic review and meta-analysis.
Source
European Journal of Pediatrics. 184(11) (no pagination), 2025. Article
Number: 668. Date of Publication: 01 Nov 2025.
Author
Campos L.R.; Carpi G.C.; da Silva A.B.N.; Carneiro J.V.; Luchese S.
Institution
(Campos) Universidade de Ribeirao Preto (UNAERP), Av. Costabile Romano,
2201 - Nova Ribeirania, Sao Paulo, Ribeirao Preto, Brazil
(Carpi, Luchese) Hospital de Clinicas de Porto Alegre (HCPA), Rio Grande
Do Sul, Porto Alegre, Brazil
(da Silva) Department of Medicine, Federal University of Para (UFPA),
Para, Belem, Brazil
(Carneiro) Pontifical Catholic University of Parana (PUCPR), Parana,
Curitiba, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Remote ischemic preconditioning (RIPreC) has been regarded as a promising
strategy to reduce ischemia-reperfusion injury to the heart and other
organs caused by cardiopulmonary bypass. While RIPreC has demonstrated
potential benefits in adult cardiac surgery, particularly in reducing
postoperative kidney and cardiac dysfunction, evidence in pediatric
populations remains limited and inconsistent. This updated systematic
review and meta-analysis aims to address these gaps and clarify the
efficacy of RIPreC in children undergoing cardiac surgery. A comprehensive
search was conducted across PubMed, EMBASE, Cochrane Library, Web of
Science, and ClinicalTrials.gov for randomized controlled trials (RCTs)
comparing RIPreC with placebo or standard care in pediatric cardiac
surgery. Primary outcomes included all-cause mortality, duration of
mechanical ventilation, ICU length of stay, aortic cross-clamp time, and
postoperative arrhythmia. Meta-analyses were performed using
random-effects models to calculate standardized mean differences (SMDs) or
risk ratios (RRs), with 95% confidence intervals (CIs). Risk of bias was
assessed using the Cochrane RoB 2.0 tool. Fifteen RCTs involving 1570
pediatric patients were included, and 14 were eligible for meta-analysis.
RIPreC significantly reduced the duration of mechanical ventilation
compared to control (SMD = -0.42; 95% CI -0.79 to -0.06; p = 0.02),
although heterogeneity was high (I2 = 85.7%). No significant
differences were found for ICU length of stay (MD = -0.17 days; 95% CI
-0.55 to 0.20), aortic cross-clamp time (MD = 3.22 min; 95% CI -0.52 to
6.97), postoperative arrhythmia (RR = 0.69; 95% CI 0.39 to 1.20), or
all-cause mortality (RR = 1.11; 95% CI 0.34 to 3.64). Conclusion(s):
RIPreC may reduce the duration of mechanical ventilation in pediatric
cardiac surgery, but its effects on other outcomes remain uncertain.
Further, high-quality trials are warranted to strengthen the evidence base
and guide clinical application. (Table presented.) Copyright ©
The Author(s), under exclusive licence to Springer-Verlag GmbH Germany,
part of Springer Nature 2025.

<74>
Accession Number
2040844305
Title
CLASP IID Trial and Registry: 2-Year Outcomes of Transcatheter Repair for
Degenerative Mitral Regurgitation.
Source
JACC: Cardiovascular Interventions. 18(19) (pp 2392-2404), 2025. Date of
Publication: 13 Oct 2025.
Author
Makkar R.; Zahr F.; Chakravarty T.; Chadderdon S.; Makar M.; Ruf T.F.;
Kipperman R.M.; Rassi A.N.; Hausleiter J.; Smith R.L.; Szerlip M.; Goldman
S.; Lim D.S.; Inglessis-Azuaje I.; Yadav P.; Lurz P.; Kister T.; Davidson
C.J.; Mumtaz M.; Gada H.; Kar S.; Kodali S.K.; Laham R.; Hiesinger W.; Fam
N.P.; Kessler M.; O'Neill W.W.; Whisenant B.; Kliger C.; Rudolph V.;
Hermiller J.; Dhoble A.; Smalling R.; Latib A.; Lazkani M.; Choo J.;
Garcia S.; Rodes-Cabau J.; Schofer N.; Baldus S.; Kapadia S.; Koulogiannis
K.; Marcoff L.; Gillam L.D.; von Bardeleben R.S.
Institution
(Makkar, Chakravarty, Makar) Cedars-Sinai Medical Center, Los Angeles, CA,
United States
(Zahr, Chadderdon) Oregon Health & Science University, Portland, OR,
United States
(Ruf, von Bardeleben) University Medical Centre Mainz, Mainz, Germany
(Kipperman, Koulogiannis, Marcoff, Gillam) Atlantic Health System
Morristown Medical Center, Morristown, NJ, United States
(Rassi) Kaiser Permanente San Francisco Medical Center, San Francisco, CA,
United States
(Hausleiter) Klinikum der Universitat Munchen, Munich, Germany
(Smith, Szerlip) Baylor Scott and White, The Heart Hospital Plano, Plano,
TX, United States
(Goldman) Lankenau Medical Center, Wynnewood, PA, United States
(Lim) University of Virginia Health System Hospital, Charlottesville, VA,
United States
(Inglessis-Azuaje) Massachusetts General Hospital, Boston, MA, United
States
(Yadav) Piedmont Heart Institute, Atlanta, GA, United States
(Lurz, Kister) University of Leipzig, Leipzig, Germany
(Davidson) Northwestern University, Chicago, IL, United States
(Mumtaz, Gada) UPMC Pinnacle, Harrisburg, PA, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kodali) Columbia University Medical Center, New York, NY, United States
(Laham) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Hiesinger) Stanford University Medical Center, Palo Alto, CA, United
States
(Fam) St. Michael's Hospital, Toronto, ON, Canada
(Kesler) University of Ulm, Ulm, Germany
(O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Kliger) Northwell-Lenox Hill, New York, NY, United States
(Rudolph) Ruhr-Universitat Bochum, Bad Oeynhausen, Bochum, Germany
(Hermiller) St. Vincent Heart Center of Indiana, Indianapolis, IN, United
States
(Dhoble, Smalling) Memorial Hermann Heart and Vascular Institute/UT
Health, Houston, TX, United States
(Latib) Montefiore Medical Center, Bronx, NY, United States
(Lazkani) UC Health Medical Center of the Rockies, Loveland, CO, United
States
(Choo, Garcia) The Christ Hospital, Cincinnati, OH, United States
(Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec
City, QC, Canada
(Schofer) University Heart and Vascular Center Hamburg, Hamburg, Germany
(Baldus) University Hospital Cologne, Cologne, Germany
(Kapadia) Cleveland Clinic Foundation, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: One-year outcomes from the CLASP IID Trial (Edwards PASCAL
TrAnScatheter Valve RePair System Pivotal Clinical Trial; NCT03706833) and
Registry established the PASCAL transcatheter valve repair system as a
safe and effective treatment for prohibitive-risk degenerative mitral
regurgitation (DMR). Longer-term follow-up is ongoing. Objective(s):
This paper reports the CLASP IID Trial and Registry 2-year outcomes.
 Method(s): In the CLASP IID Trial, prohibitive-risk patients with
3+/4+ DMR, deemed suitable for both the PASCAL and MitraClip systems, were
randomized 2:1 (PASCAL: n = 204; MitraClip: n = 96). Patients with complex
anatomy deemed ineligible for randomization were enrolled in the CLASP IID
Registry (N = 98) and treated with the PASCAL system. Result(s): In
the randomized cohort, significant and sustained MR reduction was achieved
at 2 years. MR <=2+ rate was 95.0% (96/101) in the PASCAL group vs 91.5%
(54/59) in the MitraClip group (P = 0.500), and MR <=1+ rate was 77.2%
(78/101) vs 67.8% (40/59) (P = 0.198), respectively. Kaplan-Meier
estimates for freedom from all-cause mortality, cardiovascular mortality,
heart failure hospitalization, and nonelective mitral valve
reinterventions were 80.8% vs 86.2% (P = 0.216), 88.6% vs 90.4% (P =
0.666), 86.4% vs 94.3% (P = 0.058), and 97.9% vs 97.9% (P = 0.962),
respectively. In the registry cohort, 91.9% (34/37) achieved MR <=2+ and
64.9% (24/37) achieved MR <=1+. Kaplan-Meier estimates for freedom from
all-cause mortality, cardiovascular mortality, heart failure
hospitalization, and nonelective mitral valve reinterventions were 77.2%,
84.0%, 85.1%, and 99.0%, respectively. Significant improvements in
functional status and quality of life were observed in both cohorts.
 Conclusion(s): Two-year outcomes from the CLASP IID Trial and
Registry show favorable survival, and significant and sustained MR
reduction with functional and quality-of-life improvements, confirming
sustained safety and effectiveness of the PASCAL system in treating a
broad population of DMR patients. Copyright © 2025 American
College of Cardiology Foundation

<75>
Accession Number
2040758069
Title
Machine Learning Applications in the Diagnosis and Prediction of Aortic
Dissection: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
3328006. Date of Publication: 2025.
Author
Eini P.; Serpoush H.; Rezayee M.; Tremblay J.
Institution
(Eini) Cardiovascular Imaging Research Center, Rajaie Cardiovascular
Institute, Tehran, Iran, Islamic Republic of
(Eini) Infectious Disease Research Center, Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Serpoush) College of Medicine, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
(Rezayee, Tremblay) College of Human Medicine, Michigan State University,
Lansing Campus, Lansing, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Aortic dissection is a life-threatening condition requiring
rapid and accurate diagnosis. Machine learning (ML) models have shown
promise in enhancing diagnostic performance using imaging modalities, but
their pooled efficacy remains unclear. This systematic review and
meta-analysis evaluates the diagnostic accuracy of ML models for detecting
aortic dissection. Method(s): Following PRISMA guidelines, we
searched PubMed, Scopus, Embase, Web of Science, and ProQuest up to March
10, 2025, identifying 775 articles. After removing duplicates, 358
articles were screened, 28 underwent full-text review, and 21 studies were
included, with 18 providing sufficient metrics for meta-analysis. The
MIDAS module in Stata was used to pool sensitivity, specificity, and area
under the receiver operating characteristic curve (AUROC) for the
best-performing models, assessed via a bivariate mixed-effects model. Risk
of bias was evaluated using PROBAST + AI. Result(s): The 21 studies
included 261,477 patients (mean age 58.74 years, 66.67% male),
predominantly from China (11 studies). Imaging modalities included CT
angiography (10 studies) and noncontrast/contrast-enhanced CT (five
studies). The best models (18 studies, 7957 positive, 41,852 negative
cases) achieved a pooled sensitivity of 0.92 (95% CI: 0.87-0.96), a
specificity of 0.95 (95% CI: 0.91-0.98), and an AUROC of 0.98 (95% CI:
0.96-0.99). Deep learning models (DenseNet121, Attention U-Net)
predominated. Moderate to substantial heterogeneity in both pooled
sensitivity (I2 = 64.85%) and specificity (I2 =
62.87%), likely due to diverse ML algorithms and imaging protocols, was
identified. Conclusion(s): ML models show strong diagnostic
performance for detecting aortic dissection, highlighting their promise
for clinical use. However, the standardization of methodologies is
essential to reduce variability and promote broader clinical
implementation. Copyright © 2025 Pooya Eini et al. Journal of
Cardiac Surgery published by John Wiley & Sons Ltd.

<76>
[Use Link to view the full text]
Accession Number
648918693
Title
Multivariable Prediction Models for Atrial Fibrillation after Cardiac
Surgery: A Systematic Review and Critical Appraisal.
Source
Anesthesiology. (no pagination), 2025. Date of Publication: 21 Oct 2025.
Author
Fields K.G.; Milner G.D.M.; Ma J.; Dhiman P.; Redfern O.C.; Karamnov S.;
He J.; Gerry S.; Alhassan H.; Providencia R.; Lip G.Y.H.; Bedford J.P.;
Clifton D.A.; O'Brien B.; Watkinson P.J.; Collins G.S.; Muehlschlegel J.D.
Institution
(Fields, Karamnov, He) Department of Anesthesiology, Perioperative and
Pain Medicine, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA, United States
(Milner, Redfern, Bedford) Kadoorie Centre for Critical Care Research and
Education, Nuffield Department of Clinical Neurosciences, University of
Oxford, Oxford, United Kingdom
(Ma, Dhiman, Gerry, Collins) Centre for Statistics in Medicine, Nuffield
Department of Orthopedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Oxford, United Kingdom
(Alhassan) Division of Cardiology, Department of Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
(Providencia) Institute of Health Informatics Research, University College
London, London, United Kingdom; Department of Cardiac Electrophysiology,
Barts Heart Centre, St. Bartholomew's Hospital, Barts Health National
Health Service Trust, London, United Kingdom
(Lip) Liverpool Centre for Cardiovascular Science at University of
Liverpool, Liverpool John Moores University and Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom; Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
(Clifton) Institute of Biomedical Engineering, Department of Engineering
Science, University of Oxford, Oxford, United Kingdom; Oxford Suzhou
Centre for Advanced Research, University of Oxford, Suzhou, China
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Deutsches Herzzentrum der Charite, Charite Universitatsmedizin
Berlin, Berlin, Germany; Department of Perioperative Medicine, St.
Bartholomew's Hospital and Barts Heart Centre, Barts Health National
Health Service Trust, London, United Kingdom; Outcomes Research
Consortium, UTHealth, Houston, Texas
(Watkinson) Kadoorie Centre for Critical Care Research and Education,
Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, United Kingdom; Oxford University Hospitals National Health
Service Trust, Oxford, United Kingdom; National Institute for Health and
Care Research Biomedical Research Centre, Oxford University Hospitals
National Health Service Foundation Trust, Oxford, United Kingdom
(Muehlschlegel) Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins University School of Medicine, Baltimore, MD, Liberia
Abstract
Atrial fibrillation is a common complication of cardiac surgery. Multiple
models exist to estimate the risk of atrial fibrillation after cardiac
surgery (AFACS) and improve targeting of preventative measures, yet none
have been consistently adopted into clinical use. This study performed a
comprehensive systematic review, assessing quality and risk of bias of
studies describing the development or external validation of AFACS
prediction models. Although some models performed well in development and
external validation (median C-statistic for apparent validation alone,
0.71; range, 0.60 to 0.98; external validation, 0.61; range, 0.51 to
0.77), all model analyses were rated at high risk of bias. Common causes
for this were small sample size, data-driven predictor selection, and
inadequate internal validation. Overall, no individual model could be
recommended for clinical use given the methodologic limitations
identified, emphasizing the need for improvements in future AFACS
prediction models to facilitate improved targeting of
prophylaxis. Copyright © 2025 American Society of
Anesthesiologists. All Rights Reserved.

<77>
Accession Number
2037264012
Title
COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE IN
ATTENUATION OF PRESSOR RESPONSE TO VIDEO LARYNGOSCOPY AND INTUBATION UNDER
GENERAL ANAESTHESIA IN ADULT PATIENTS.
Source
International Journal of Medicine and Public Health. 15(4) (pp 153-164),
2025. Date of Publication: 01 Oct 2025.
Author
Manjusruthi B.; Subramanyam V.; Kavya C.H.
Institution
(Manjusruthi) Department of Anaesthesia, Government Medical College, AP,
Kadapa, India
(Subramanyam, Kavya) Department of Anaesthesia, Government Medical
College, AP, Kadapa, India
Publisher
Pink Petals Publications Pvt Ltd
Abstract
Background: The aim of this study was to compare intravenous Magnesium
sulphate and Dexmedetomidine for attenuation of pressor response to video
laryngoscopy and intubation under general anaesthesia. Material(s)
and Method(s): The present study was a double blinded, prospective,
randomized study conducted in Government general hospital, Kadapa during
the period 2023-24. After obtaining institutional ethical committee
approval and informed consent, 60 ASA I and II subjects in the age group
of 20-60 years planned for elective surgeries were enrolled in this study.
They were randomly allocated to one of the two study groups by using
computer generated random numbers, Group D (Dexmedetomidine group) and
Group M (Magnesium sulphate group). Result(s): The study aimed to
determine the effectiveness of dexmedetomidine (1 mug/kg) and magnesium
sulphate (30 mg/kg) in reducing video laryngoscopy-induced hemodynamic
responses when using the King Vision device for subsequent endotracheal
intubation. In the present study, both groups showed equivalent
demographic profiles during baseline measurements since they had no
substantial differences in age, sex, body weight, Mallampati
classification and ASA physical status. The agents proved effective in
reducing the hemodynamic changes that occur when using video laryngoscopy
with the King Vision device before endotracheal intubation.
Dexmedetomidine proved to control heart rate and blood pressure better
than magnesium sulphate did after endotracheal tube intubation. Heart rate
decreased by 17% below the baseline after dexmedetomidine administration
while magnesium sulphate maintained a decrease of only 5.5%. The research
data demonstrated significant differences between groups during both the
intubation process and next three-minute period (p < 0.001).
Dexmedetomidine showed better blood pressure control of systolic and
diastolic pressure and mean arterial pressure (p < 0.05 across all
parameters) which confirmed its strong sympatholytic properties in this
context. Treatment with both agents revealed good results regarding safety
conditions. Among the group receiving dexmedetomidine, 2 patients (6.7%)
developed bradycardia while no such occurrences were observed in the
patients treated with magnesium sulphate (p=0.492). This difference was
not statistically significant. Dexmedetomidine produced significantly
higher sedation (RSS 2.80 +/- 0.48) than Magnesium Sulphate (RSS 2.07 +/-
0.69; p < 0.001). Conclusion(s): The randomized controlled trial
evidence shows dexmedetomidine together with magnesium sulphate provides
efficient stabilization of the hemodynamic response occurring during video
laryngoscopy and endotracheal intubation procedures. Dexmedetomidine
controls heart rate and blood pressure better than magnesium sulphate does
initially after intubation yet magnesium provides gentle stabilization
benefits. Copyright © 2025, Pink Petals Publications Pvt Ltd. All
rights reserved.

<78>
Accession Number
2037249620
Title
VARC-HBR criteria validation in TAVI patients on oral anticoagulation.
Source
EuroIntervention. 21(18) (pp 1081-1089), 2025. Date of Publication: 2025.
Author
Overduin D.C.; van Ginkel D.J.; Bor W.L.; Kobari Y.; Aarts H.M.; Dubois
C.; De Backer O.; Rooijakkers M.J.P.; Rosseel L.; Veenstra L.; van der
Kley F.; van Bergeijk K.H.; Van Mieghem N.M.; Agostoni P.; Voskuil M.;
Schotborgh C.E.; Ijsselmuiden A.J.J.; Van Der Heyden J.A.S.; Hermanides
R.S.; Barbato E.; Mylotte D.; Fabris E.; Frambach P.; Dujardin K.;
Ferdinande B.; Peper J.; Rensing B.J.W.M.; Timmers L.; Swaans M.J.;
Brouwer J.; Nijenhuis V.J.; Adriaenssens T.; Vriesendorp P.A.;
Montero-Cabezas J.M.; El Jattari H.; Halim J.; Van den Branden B.J.L.;
Leonora R.; Vanderheyden M.; Lauterbach M.; Wykrzykowska J.J.; van 't Hof
A.W.J.; van Royen N.; Tijssen J.G.P.; Delewi R.; Ten Berg J.M.
Institution
(Overduin, van Ginkel, Bor, Peper, Rensing, Timmers, Swaans, Brouwer,
Nijenhuis, Ten Berg) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Kobari, De Backer) The Heart Center, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Aarts, Tijssen, Delewi) Department of Cardiology, Amsterdam UMC,
Amsterdam, Netherlands
(Aarts, Voskuil) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Dubois, Adriaenssens) Department of Cardiovascular Medicine, University
Hospital Leuven, Leuven, Belgium
(Rooijakkers, Nijenhuis, van Royen) Department of Cardiology, Radboud
University Medical Center, Nijmegen, Netherlands
(Rosseel, Vanderheyden) Department of Cardiology, Hartcentrum Aalst,
Aalst, Belgium
(Veenstra, Ijsselmuiden, Vriesendorp, van 't Hof, Ten Berg) Department of
Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
(Veenstra, Ijsselmuiden, Vriesendorp, van 't Hof, Ten Berg) Cardiovascular
Research Institute Maastricht (CARIM), Maastricht, Netherlands
(van der Kley, Montero-Cabezas) Department of Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(van Bergeijk, Wykrzykowska) Department of Cardiology, University Medical
Center Groningen, Groningen, Netherlands
(Van Mieghem) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Agostoni, El Jattari) Department of Cardiology, Hospital Aan de Stroom
(ZAS) Middelheim, Antwerp, Belgium
(Schotborgh) Department of Cardiology, Haga Hospital, The Hague,
Netherlands
(Van Der Heyden) Department of Cardiology, Sint-Jan Hospital, Brugge,
Belgium
(Hermanides, Leonora) Department of Cardiology, Isala Hospital, Zwolle,
Netherlands
(Barbato) Department of Clinical and Molecular Medicine, Sapienza
University of Rome, Rome, Italy
(Barbato) Department of Cardiology, Sant'Andrea University Hospital, Rome,
Italy
(Mylotte) Department of Cardiology, University Hospital Galway, Galway,
Ireland
(Fabris) Cardiothoracovascular Department, University of Trieste, Trieste,
Italy
(Frambach) Department of Cardiology, Institut National de Chirurgie
Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
(Dujardin, Lauterbach) Department of Cardiology, AZ Delta, Roeselare,
Belgium
(Ferdinande) Department of Cardiology, Hospital Oost-Limburg, Genk,
Belgium
(Halim) Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg,
Netherlands
(Van den Branden) Department of Cardiology, Amphia Hospital, Breda,
Netherlands
Publisher
Europa Group
Abstract
BACKGROUND: Bleeding remains a frequent complication after transcatheter
aortic valve implantation (TAVI). Recently, the Valve Academic Research
Consortium High Bleeding Risk (VARC-HBR) criteria were introduced to
identify patients at (very) high risk of bleeding. AIMS: This study aimed
to evaluate the validity of the VARC-HBR criteria for predicting bleeding
risk in TAVI patients and to compare its performance with other existing
criteria. METHOD(S): Data were obtained from the POPular PAUSE TAVI
trial, a randomised clinical trial that evaluated the safety and efficacy
of continuation versus interruption of oral anticoagulation during TAVI.
Major and minor bleeding risk criteria were identified at baseline, and
bleeding events were recorded up to 30 days after TAVI. Patients were
classified into three groups: those with <=1 minor criterion (moderate
risk), those with 1 major or 2 minor criteria (high risk), and those with
>=2 major or >=3 minor criteria (very high risk). RESULT(S): A total
of 856 patients were included: 332 (39%) were classified at moderate
bleeding risk, 337 (39%) at high bleeding risk, and 187 (22%) at very high
bleeding risk. Major bleeding occurred in 4.2% of moderate-risk patients,
9.5% in the high-risk group, and 15.0% in the very high-risk group
(p<0.001). Receiver operating characteristic analysis showed moderate
discriminative performance (area under the curve=0.64, 95% confidence
interval: 0.58-0.70). Despite higher-than-expected event rates, the
VARC-HBR criteria demonstrated good calibration with observed outcomes.
 CONCLUSION(S): The VARC-HBR criteria effectively identified distinct
subgroups with a stepwise increase in major bleeding post-TAVI. However,
their predictive performance for individual risk was
moderate. Copyright © Europa Group 2025. All rights reserved.

<79>
Accession Number
648916569
Title
Impact of complete revascularisation in relation to left ventricular
function in patients with ST-segment elevation myocardial infarction and
multivessel disease: a post hoc analysis of the COMPLETE randomised trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
21(20) (pp e1198-e1208), 2025. Date of Publication: 20 Oct 2025.
Author
Tiong D.; Pinilla-Echeverri N.; Wood D.A.; Mehran R.; Storey R.F.; Feldman
L.; Moreno R.; Rao S.; Cantor W.J.; Welsh R.; Bainey K.R.; Cohen E.A.;
Tsang M.B.; Sibbald M.; Natarajan M.K.; Wijesena D.; Mani T.; Nguyen H.;
Cairns J.A.; Mehta S.R.
Institution
(Tiong, Pinilla-Echeverri, Tsang, Sibbald, Natarajan, Mehta) McMaster
University and Hamilton Health Sciences, Hamilton, ON, Canada
(Pinilla-Echeverri, Wijesena, Mani, Nguyen, Mehta) Population Health
Research Institute, McMaster University and Hamilton Health Sciences,
Hamilton, ON, Canada
(Wood, Cairns) University of British Columbia, Vancouver, BC, Canada
(Mehran) The Zena A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, USA
(Storey) Division of Clinical Medicine, University of Sheffield,
Sheffield, United Kingdom
(Feldman) INSERM U-1148, AP-HP, Hopital Bichat, Paris, France
(Moreno) University Hospital La Paz, IdiPAZ, Spain and Universidad
Autonoma de Madrid, Madrid, Spain
(Rao) NYU Langone Health System, New York, NY, USA
(Cantor) Southlake Regional Health Centre, Canada and University of
Toronto, Toronto, ON, Canada
(Welsh, Bainey) Mazankowski Alberta Heart Institute, University of
Alberta, Edmonton, AB, Canada
(Cohen) Sunnybrook Health Sciences Centre, University of Toronto, Toronto,
ON, Canada
Abstract
BACKGROUND: The COMPLETE trial demonstrated a reduction in cardiovascular
(CV) death or new myocardial infarction (MI) after complete, rather than
culprit-only, revascularisation in patients with ST-segment elevation
myocardial infarction (STEMI) and multivessel disease (MVD). However, it
is unknown whether this benefit varies according to baseline left
ventricular ejection fraction (LVEF). AIMS: We aimed to determine the
effects of complete versus culprit-only revascularisation according to
LVEF. METHOD(S): Baseline LVEF was available for 2,214 of 4,041
randomised patients. The effect of both strategies on the first co-primary
outcome of CV death or new MI and the second co-primary outcome of CV
death, new MI, or ischaemia-driven revascularisation (IDR) was determined
within the prespecified LVEF ranges of <45% (N=660) and >=45% (N=1,554).
An analysis of clinical outcomes by LVEF according to thirds was also
conducted. RESULT(S): Patients with LVEF <45% experienced a
significantly higher incidence of the first co-primary outcome compared
with those with LVEF >=45% (4.2%/year vs 2.8%/year; hazard ratio [HR]
1.51, 95% confidence interval [CI]: 1.15-1.98; p=0.003). Compared with a
culprit-only strategy, complete revascularisation consistently reduced the
first co-primary outcome in patients with LVEF <45% (3.0%/year vs
5.5%/year; HR 0.55, 95% CI: 0.36-0.86) and those with LVEF >=45%
(2.4%/year vs 3.2%/year; HR 0.74, 95% CI: 0.52-1.04; interaction p=0.31).
Complete revascularisation also consistently reduced the second co-primary
outcome in patients with LVEF <45% (3.5%/year vs 7.3%/year; HR 0.49, 95%
CI: 0.33-0.74) and those with LVEF >=45% (2.7%/year vs 6.3%/year; HR 0.44,
95% CI: 0.33-0.60; interaction p=0.67). Consistent results were observed
for both co-primary outcomes when LVEF was further stratified into
categories of LVEF <=35%, 36-49% and >=50%. CONCLUSION(S): Among
patients presenting with STEMI and MVD, those with reduced LVEF are at
higher risk of ischaemic events than patients with preserved LVEF. There
is a consistent benefit of complete revascularisation regardless of
baseline LVEF.

<80>
Accession Number
648918313
Title
Suture-based versus plug-based closure for large-bore arterial access: an
individual patient-level meta-analysis of randomised trials.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
21(20) (pp e1222-e1233), 2025. Date of Publication: 20 Oct 2025.
Author
Dumpies O.; van Wiechen M.; Jobs A.; Abdelhafez A.; Detto Loria J.R.;
Richter I.; Feistritzer H.-J.; Majunke N.; Noack T.; Desch S.; Thiele H.;
Dumonteil N.; Tchetche D.; van Mieghem N.; Abdel-Wahab M.
Institution
(Dumpies, Jobs, Abdelhafez, Detto Loria, Richter, Feistritzer, Majunke,
Desch, Thiele, Abdel-Wahab) Department of Cardiology, Heart Center Leipzig
at University of Leipzig, Leipzig, Germany
(van Wiechen, van Mieghem) Department of Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Noack) Department of Cardiac Surgery, Heart Center Leipzig at University
of Leipzig, Leipzig, Germany
(Dumonteil, Tchetche) Department of Cardiology, Clinique Pasteur,
Toulouse, France
Abstract
BACKGROUND: Percutaneous large-bore arteriotomy closure devices are either
suture- or plug-based. The comparative efficacy and safety of both
techniques and optimal patient selection remain controversial. AIMS: We
aimed to conduct a patient-level meta-analysis of randomised trials
comparing suture-based ProGlide versus plug-based MANTA large-bore
vascular closure devices (VCDs). METHOD(S): We searched PubMed, the
Cochrane Central Register of Controlled Trials, and Google Scholar for
randomised controlled trials comparing vascular closure with the
ProGlide-based and the MANTA-based technique. The primary endpoint of this
analysis was access site-related vascular complications defined according
to the Valve Academic Research Consortium-3 criteria. RESULT(S): We
identified 2 trials that enrolled a total of 722 patients undergoing
transcatheter aortic valve implantation. The primary endpoint was
significantly less common after vascular closure with the ProGlide-based
technique (odds ratio [OR] 0.54, 95% confidence interval [CI]: 0.35-0.82).
Access site-related bleeding events were also less common with the
ProGlide-based technique (OR 0.41, 95% CI: 0.18-0.94). Prespecified
subgroup analyses did not reveal any subgroup favouring the plug-based
technique. Clinical outcomes with the MANTA-based technique were better in
larger-sized vessels. Patients who received the ProGlide-based technique
were less likely to undergo endovascular stenting or vascular surgery (OR
0.22, 95% CI: 0.06-0.79). CONCLUSION(S): In this patient-level
meta-analysis of randomised trials, the ProGlide-based technique for
large-bore arterial access was superior to the MANTA-based technique in
terms of vascular and bleeding complications.

<81>
Accession Number
2041146958
Title
Everolimus and Low-Dose Tacrolimus After Heart Transplant in Children: A
Randomized Clinical Trial.
Source
JAMA. 334(15) (pp 1339-1348), 2025. Date of Publication: 21 Oct 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, United States
(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, GA, United States
(Carlo) University of Alabama at Birmingham, Birmingham, United States
(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, United States
(Deshpande) Children's National Health System, Washington, DC, 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) Children's Wisconsin, 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) The Children's Hospital at Montefiore, Bronx, NY, United States
(Lytrivi) Columbia University Medical Center, New York, 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, Cincinnati Children's Hospital and Medical Center
and Department of Pediatrics, University of Cincinnati College of
Medicine, 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
Publisher
American Medical Association
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. 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. 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. 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. 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.
 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). 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. Copyright © 2025 American Medical Association. All
rights reserved.

<82>
Accession Number
2040744287
Title
Effects of Intraoperative Ventilation Strategies on Ventilation
Inhomogeneity and Inflammatory Response in Pediatric Cardiac Surgery-A
Randomized Pilot Study.
Source
Paediatric Anaesthesia. (no pagination), 2025. Date of Publication: 2025.
Author
Billstein C.; Schenk A.; Vergnat M.; Jakobs P.; Frede S.; Putensen C.P.;
Muders T.; Schindler E.
Institution
(Billstein, Jakobs, Frede, Putensen, Muders, Schindler) Department of
Anesthesiology and Intensive Care Medicine, University Hospital Bonn,
Bonn, Germany
(Schenk) Institute of Medical Biometry, Informatics and Epidemiology,
University Hospital Bonn, Bonn, Germany
(Vergnat) Department of Pediatric Cardiac Surgery, University Hospital
Bonn, Bonn, Germany
Publisher
John Wiley and Sons Inc
Abstract
Background: Respiratory arrest during cardiopulmonary bypass (CPB) in
pediatric cardiac surgery risks lung dysfunction including derecruitment,
atelectasis, and inflammation. Continuous positive airway pressure (CPAP)
and lung-protective ventilation (LPV) during aortic cross-clamping show
inconsistent results in mitigating these risks. Aim(s): To
investigate whether LPV during aortic cross-clamping under CPB affects
postoperative respiratory mechanics and ventilation inhomogeneity compared
to apnea or CPAP. Method(s): This prospective, randomized pilot study
compared three ventilation strategies during aortic cross-clamping under
CPB: apnea, CPAP (5 mbar), and LPV. LPV was standardized using
pressure-controlled ventilation at a positive end-expiratory pressure of 5
mbar, individualized driving pressure (20% of the pre-cross clamp
inspiratory pressure), and age-adjusted respiratory rate. Recruitment
maneuvers were applied at the end of CPB. Respiratory mechanics were
assessed. Ventilation distribution was measured preoperatively and
postoperatively under spontaneous breathing and mechanical ventilation
using Electrical Impedance Tomography. Blood was analyzed pre- and
postoperatively for pulmonary and systemic inflammatory markers.
Feasibility of LPV was assessed. Statistical analysis used linear
mixed-effects models. Result(s): Driving pressure increased (11.8
(2.6) to 12.9 (2.6) mbar) and dynamic compliance decreased (9.9 (7.3) to
8.5 (7.4) Pa L-1) statistically significantly preoperatively to
postoperatively. The number of ventilated pixels increased statistically
significantly from spontaneous breathing (408.2 (77.2)) to mechanical
ventilation (495.1 (44.9)) and returned toward baseline postoperatively
(433.9 (72.6)). The Center of Ventilation shifted statistically
significantly ventrally during mechanical ventilation (0.491 (0.039) to
0.442 (0.027)) and normalized afterward (0.485 (0.037)). These changes
were unaffected by the ventilation strategy. Biomarker analysis showed no
statistically significant changes between groups. LPV during aortic
cross-clamping was feasible. Conclusion(s): In this pilot study,
ventilation strategies did not differ in their effect on ventilation
distribution, respiratory mechanics, or inflammatory markers when
recruitment maneuvers were uniformly applied after CPB. LPV was feasible.
Trial Registration: German Clinical Trials Register: DRKS00030219;
https://drks.de/search/de/trial/DRKS00030219. Copyright © 2025
The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.

<83>
Accession Number
648912695
Title
Interventions to reduce short term post-operative mortality in low-and
middle-income countries (LMIC): A systematic review of randomised
controlled trials.
Source
Colorectal Disease. Conference: 20th Scientific and Annual Conference of
the European Society of Coloproctology, ESCP 2025. Paris France.
27(Supplement `1) (no pagination), 2025. Date of Publication: 01 Aug 2025.
Author
Phelan L.; Sampaio-Alves M.; Agbeko A.E.; Haque P.D.; Zola S.; Nepogodiev
D.; Bhangu A.; Glasbey J.
Institution
(Phelan, Nepogodiev, Bhangu, Glasbey) National Institute for Health
Research Global Health Research Unit on Global Surgery, Department of
Applied Health Sciences, University of Birmingham, Birmingham, United
Kingdom
(Sampaio-Alves) University of Porto, Faculty of Medicine, Porto, Portugal
(Agbeko) Ghana Hub-NIHR Global Health Research Unit on Global Surgery,
University of Developmental Studies, Tamale, Ghana
(Haque) India Hub-National Institute for Health Research Global Health
Research Unit on Global Surgery-, Christian Medical College and Hospital,
Ludhiana, India
(Zola) Benin Hub-NIHR Global Health Research Unit on Global Surgery,
University of Abomey Calavi, Cotonou City, Benin
Publisher
John Wiley and Sons Inc
Abstract
Aim: Postoperative mortality is the third leading cause of death
worldwide. Patients in low-and middle-income countries (LMICs) are at
disproportionately increased risk and it is likely many deaths are
preventable. We consolidated evidence of interventions to reduce death in
LMICs. Method(s): A systematic review of all randomised controlled
trials (RCTs) that tested interventions to reduce short term mortality (up
to 90 postoperative days) after non-cardiac surgery and included patients
from LMICs, as classified by the World Bank. The search was conducted on
PubMed, EMBASE via OVID, SCI and ESCI (WoS), Cochrane Library, Global
Health (EBSCO) and the VHL, and reported according to PRIMSA guidelines
(PROSPERO CRD42024604760). Result(s): Of 14,153 papers included in
the search, 15 met the inclusion criteria. Two were conducted across
multiple countries (one across Africa, one across three continents), the
remainder were all in single countries, seven were in one upper-middle
income country (China). There were three pre-operative, five
intra-operative and two post-operative interventions evaluated. Five
spanned multiple periods. Eight interventions were classified as simple
and seven as complex. Three trials reported a reduction in mortality. One
introduced an educational package combined with outreach visits focused on
maternal death reviews and best practice implementation, resulting in a
significant reduction deaths post caesarean delivery (p = 0.0034). The
other two evaluated liberal versus restrictive blood transfusion
strategies and had divergent conclusions. The overall adherence to
randomised interventions was higher for simple (82.86-100%) than complex
interventions (40-100%). Conclusion(s): Surgical deaths are a
critical public health emergency, but there have been few targeted efforts
to prevent these in settings where need is greatest. As causes of death
are likely to be multifaceted, complex interventions with co-developed
implementation strategies are urgently required.

<84>
Accession Number
2041238503
Title
Intraoperative cell-salvaged versus allogeneic red blood cell transfusions
in high-bleeding-risk cardiovascular surgery: Protocol for a
single-center, randomized, parallel-group, noninferiority trial.
Source
PLOS ONE. 20(10 OCTOBER) (no pagination), 2025. Article Number: e0334397.
Date of Publication: 01 Oct 2025.
Author
Tsukinaga A.; Yoshitani K.; Ogata S.; Mihara T.; Ito S.; Kanazawa H.;
Shimokawa A.; Masuda S.; Morinaga M.; Ito Y.; Miura S.; Kawamoto N.; Inoue
Y.; Fukushima S.; Matsuda H.; Maeda T.
Institution
(Tsukinaga, Yoshitani, Kanazawa, Shimokawa, Masuda, Morinaga, Ito, Miura,
Maeda) Department of Anesthesiology, National Cerebral and Cardiovascular
Center, Osaka, Suita, Japan
(Tsukinaga, Yoshitani) Department of Transfusion, National Cerebral and
Cardiovascular Center, Osaka, Suita, Japan
(Ogata) Department of Preventive Medicine and Epidemiology, National
Cerebral and Cardiovascular Center, Osaka, Suita, Japan
(Mihara) Department of Health Data Science, Graduate School of Data
Science, Yokohama City University, Kanagawa, Yokohama, Japan
(Mihara) Department of Anesthesiology, Yokohama City University School of
Medicine, Kanagawa, Yokohama, Japan
(Ito) Department of Clinical Medicine and Development, National Cerebral
and Cardiovascular Center, Osaka, Suita, Japan
(Kawamoto, Fukushima) Department of Cardiac Surgery, National Cerebral and
Cardiovascular Center, Osaka, Suita, Japan
(Inoue, Matsuda) Department of Cardiovascular Surgery, National Cerebral
and Cardiovascular Center, Osaka, Suita, Japan
Publisher
Public Library of Science
Abstract
Introduction Patients who undergo cardiac surgery have a high risk of
significant blood loss and anemia. While allogeneic red blood cell (RBC)
transfusions are effective, they are associated with increased morbidity
and mortality. Intraoperative cell salvage may reduce reliance on
allogeneic transfusions. Although intraoperative RBC salvage is
recommended for cardiovascular surgery under cardiopulmonary bypass, there
are concerns about increased bleeding due to coagulopathy in patients with
a high bleeding risk, and its clinical impact remains unclear. This study
aims to evaluate whether salvaged RBC transfusion is noninferior to
allogeneic transfusion in terms of postoperative blood loss in patients
with a high bleeding risk. Methods This single-center, randomized,
two-arm, parallel group, interventional clinical trial will include 142
participants aged>=40 years with a high bleeding risk who undergo elective
cardiovascular surgery with cardiopulmonary bypass. Participants will be
randomly assigned to receive either salvaged RBC or allogeneic RBC
transfusions intraoperatively. The primary outcome is postoperative chest
tube blood loss within 12 hours from the end of surgery. Noninferiority
will be demonstrated if the upper limit of the 95% confidence interval for
the mean difference in blood loss between the salvaged and allogeneic
groups is<200mL. Secondary outcomes comprise the RBC transfusion volume
intraoperatively and for 12 hours from the end of surgery, prevalence of
re-thoracotomy within 48 hours from the end of surgery, and prevalence of
>= 1000mL postoperative chest tube blood loss within 12 hours from the end
of surgery. These outcomes will be analyzed using the modified
intention-to-treat set and repeated, for sensitivity reasons, for the
per-protocol set. Discussion Our trial aims to determine the
noninferiority of intraoperative RBC salvage compared with allogeneic
blood transfusions regarding postoperative blood loss and to promote its
use in surgical procedures with a high bleeding risk. Trial registration
The trial was registered with the Japan Registry of Clinical Trials
(jRCT1052240102) on July 30, 2024. Copyright © 2025 Tsukinaga et
al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<85>
Accession Number
648890690
Title
Bridging High-Risk Neonates with Obstructive TAPVR Using Vertical Vein
Stenting: Institutional Outcomes Combined with Meta-analysis of Mortality
Risk Factors.
Source
Pediatric Cardiology. Conference: Pediatric and Congenital Interventional
Cardiovascular Society, PICS 2025. Chicago, IL United States.
46(Supplement 1) (pp S79-S80), 2025. Date of Publication: 01 Aug 2025.
Author
Hesari M.; Ganta S.; Ryan J.; Gordon B.; Nigro J.; El-Said H.
Institution
(Hesari, Ganta, Gordon, Nigro, El-Said) Department of Pediatrics,
University of California, La Jolla, San Diego, United States
(Hesari, Gordon, El-Said) Rady Children's Hospital Division of Cardiology,
San Diego, United States
(Hesari) Jacobi/Einstein Hospital, New York, United States
(Ganta, Nigro) Department of Surgery, University of California, La Jolla,
San Diego, United States
(Ryan) Helen and Will Webster Foundation 3D Innovations Lab, Rady
Children's Hospital, San Diego, United States
(Ryan) Department of Neurological Surgery, San Diego, United States
Publisher
Springer
Abstract
Background: Total anomalous pulmonary venous return (TAPVR) is a rare
congenital heart defect associated with high neonatal mortality,
especially in the presence of pulmonary venous obstruction (PVO),
single-ventricle physiology, heterotaxy syndrome, prematurity, low birth
weight, and complex anatomic subtypes such as infradiaphragmatic or mixed
TAPVR. While early surgical repair remains the standard approach, it
carries substantial risk in unstable neonates with multiple comorbidities.
This study evaluates the use of vertical vein (VV) and ductus venosus (DV)
stenting as a temporizing strategy in high-risk neonates and integrates
findings from a structured meta-analysis to assess the impact of
individual risk factors on mortality. Method(s): We retrospectively
reviewed high-risk neonates with obstructive TAPVR treated at our center
from April 2019 to April 2025 who underwent VV or DV stenting to stabilize
physiology prior to surgical repair. Demographics, procedural details, and
clinical outcomes were analyzed. In parallel, we conducted a meta-analysis
of published TAPVR cohorts to evaluate the influence of risk
factors-including anatomic subtype, obstructed drainage, single-ventricle
anatomy, prematurity, and heterotaxy-on mortality and reoperation rates. A
forest plot was constructed to visualize pooled mortality estimates by
risk factor. Result(s): Eight neonates underwent attempted VV/DV
stenting, with seven successful procedures. The cohort included patients
with single-ventricle physiology (n=4), heterotaxy (n=4),
infradiaphragmatic TAPVR (n=4), and prematurity (n=4). Three required
reintervention for in-stent restenosis. One patient who did not undergo
stenting died after emergent surgery. Of the six who proceeded to surgical
repair, two have undergone successful Glenn palliation, one underwent
heart transplantation, and three remain under follow-up with stable
outcomes (Fig. 1, 2). The meta-analysis, encompassing >2,000 patients from
multiple studies, confirmed that single ventricle physiology, heterotaxy
syndrome, infradiaphragmatic or mixed TAPVR, and preoperative PVO were
independently associated with elevated mortality (30'50%), in contrast to
biventricular, non-obstructed cases (<10%). Additionally, cardiopulmonary
bypass and aortic cross-clamp times, as well as age at surgery <30 days,
were identified as risk factors for reintervention due to recurrent PVO.
(Fig.3) Conclusion(s): VV and DV stenting represent safe and
effective bridging strategies for high-risk neonates with obstructive
TAPVR. This temporizing approach may allow for physiologic stabilization,
growth, and improved outcomes following delayed surgical repair. When
combined with meta-analytic evidence, our findings underscore the
prognostic weight of specific anatomical and clinical features in TAPVR,
and support individualized risk-based decision-making in surgical timing
and interventional planning.

<86>
Accession Number
648890672
Title
A Comparison Between the Outcomes and Late Complications After Surgical
and Transcatheter Correction of Superior Sinus Venosus Defects.
Source
Pediatric Cardiology. Conference: Pediatric and Congenital Interventional
Cardiovascular Society, PICS 2025. Chicago, IL United States.
46(Supplement 1) (pp S37-S40), 2025. Date of Publication: 01 Aug 2025.
Author
Sagar P.; Thejaswi P.; Sivakumar K.
Institution
(Sagar, Thejaswi, Sivakumar) Madras Medical Mission, Chennai, India
Publisher
Springer
Abstract
Background: Transcatheter (TC) correction of sinus venosus defects (SVD)
is emerging as alternative to surgical correction (SC). Current surgical
modifications may reduce superior vena caval (SVC) or right upper
pulmonary vein (RUPV) stenosis and sick sinus syndrome (SSS) after SC.
 Method(s): This retrospective study analyzed the outcomes and
follow-up of consecutive SC and TC done in the last 14 years. TC was
offered to children only when the parents refused surgery and accepted the
follow-up protocol for imaging studies. Follow-up Transesophageal
echocardiography (TEE), computed tomography (CT) or magnetic resonance
(MR) was done after all TC to identify complications such as residual
shunt, venous obstruction and thrombus within the stent. SC follow-up was
confined to thoracic echocardiography, unless patients consented for TEE
or CT. Result(s): A total of 275 patients underwent SVD correction
between January 2011 and August 2024 at our institution. 125 patients were
electively planned for SC, either because they were young or when they
took an informed decision for SC after counseling about both the options.
150 patients opted for TC and underwent balloon interrogation after an
informed consent. When balloon testing was successful in closing the SVD
and redirecting the RUPV to the left atrium in 127 patients, they were
taken up for TC. The remaining 23 patients along with the 125 patients who
were primarily referred for surgery, underwent SC. Patient
characteristics: While SC and TC had an equal gender distribution, the
former were more often significantly younger and smaller than the latter.
The median age of SC and TC were 12.5 years and 34 years respectively. The
proportion of young children was significantly more in SC whereas patients
older than 40 years was more in the TC.(Table 1) TC group, being older,
was more often symptomatic compared to the younger SC group. Even though
comorbidities such as diabetes, hypertension, coronary artery and chronic
kidney diseases were more common in TC, they were not significant.
Pre-procedural evaluation: Around two-thirds of were done only after TTE
as the sole imaging modality. TEE was additionally used in adults before
SC. As TTE was unable to detect presence of high-draining additional
pulmonary veins, they were detected only in 10% of SC. However, most TC
patients had a preprocedural CT and/or TEE imaging to plan the
intervention.(Table 2) Identification of additional pulmonary veins was
significantly more in the TC as preinterventional CT imaging was more
often used. Presence of bilateral SVC, additional oval fossa defects and
mitral or tricuspid regurgitation resulting from dilated annuli were
similarly distributed in both groups. Echocardiography identified PAH more
often in TC group which had more adults. One-fourth of SC underwent
hemodynamic assessment with cardiac catheterization. The calculated shunt
ratio and vascular resistances were similar between the groups.
Transcatheter group: 127 patients who had a positive balloon test
underwent covered stent management.(Table 3) Intubation and ventilation to
facilitate an intra-procedural TEE monitoring, retrograde trans-arterial
RUPV cannulation for angiography and pressure measurement as well as
formation of a femoral-jugular veno-venous circuit were employed only in
our early experience in less than a third of the patients. Pulmonary vein
protection was followed in 30% of patients and this was achieved through
the transseptal sheath. One-third of patients underwent elective placement
of two overlapping stents. Overlap with another covered stent provided the
additional required stent length, while overlap with an uncovered stent
allowed drainage of the innominate vein through the side-struts in
patients with short SVC anchor or the additional high-draining pulmonary
veins into the SVC without obstructing them. After expanding the initially
chosen stents across the SVD, 22 patients needed additional covered stents
for addressing residual flows from caudal migration of the initial stent
or fabric leaks. A total of 191 stents were used in the 127 patients.
While two patients who had stent embolization before removal of the
guidewire were managed by placing additional overlapping covered stents
from the jugular vein, three patients had procedural failure due to stent
embolization after removal of the guidewire, managed by immediate surgery.
Concomitant procedures included device closure of additional secundum
defects in seven patients and staged percutaneous coronary interventions
in three patients.[14,19] Four patients developed left innominate vein
occlusion by the fabric of the covered stent and were successfully
recanalized immediately.[20] There was an early post-procedural mortality
in a 60-year-old male with moderate PAH and heart failure, three weeks
later due to subarachnoid hemorrhage, seizures and ventilator-associated
pneumonia despite successful covered stent expansion. Surgical group:
Surgical patients comprised 125 patients who opted electively for SC along
with the 23 patients who failed the balloon interrogation as well as the 3
patients who had stent embolization. Double-patch repair was the most
common SC technique in three-fifths of the patients. Warden procedure
accounted for one-fifth of SC.(Table 4) Concomitant procedures included
closure of additional secundum defects, tricuspid or mitral valve repair
and coronary bypass graft. Acute postoperative complications in 9.1% of SC
included atrial tachyarrhythmias in nine patients, pericarditis in three
and pneumothorax in two patients. The duration of mechanical ventilation,
intensive unit stay and total hospitalization was expectedly significantly
longer in SC compared to TC.(Table 5) There was no mortality or procedural
failure after SC. Follow-up data: The median follow-up duration was 21
months for SC and 14 months for TC.(Table 6) All TC patients invariably
underwent an advanced imaging modality during follow-up to identify late
problems. TEE, the preferred modality due to high spatio-temporal
resolution was used in 90% of patients and CT or MR was used in the rest,
especially in young where TEE was not practical. Elective follow-up TEE or
CT imaging was performed in only 20% of SC. There were no SVC or RUPV
obstruction after TC. Seven patients had asymptomatic non-obstructive
intraluminal layered stent thrombus and they were treated successfully
with monitored coumadin therapy. The thrombus disappeared within 3-6
months of anticoagulation. There were 21 SVC stenosis(13.8%) and one RUPV
narrowing (0.6%) after SC. Seven of these patients(4.6%) underwent SVC
stent angioplasty. 4 SC (2.6%) and 8 TC (6.4%) patients had a small
residual shunt. Two patients after TC underwent reintervention with device
closure of residual leak on follow-up, while others were clinically not
significant and not addressed. Routine ECG as well as Holter studies in
appropriate patients on follow-up showed no significant sinus nodal
dysfunction in TC but after 10 SC(6.6%), though none required a pacemaker.
While reinterventions after SC were SVC stent angioplasty in seven
patients(4.6%), it was residual leak device closures in two TC
patients(1.6%). Discussion(s): Surgical correction (SC) has
traditionally been the standard approach for sinus venosus defect (SVD)
due to its complex anatomy, involving anomalous right upper pulmonary vein
(RUPV) drainage and overriding superior vena cava (SVC). However, surgery
is associated with significant complications such as SVC stenosis (3'10%),
RUPV occlusion (1'2%), and sinus nodal dysfunction (5'10%). These
complications were often underreported, as systematic post-operative
imaging and Holter monitoring were not routine. A recent meta-analysis of
1320 SC patients reported reintervention in 1.36%, SVC obstruction in
1.76%, and pacemaker requirement in 2.23%. In contrast, transcatheter
closure (TC) has emerged as a viable alternative using covered stents
across the cavoatrial junction. Balloon interrogation was key in
evaluating feasibility, and recent advancements-such as hybrid stents and
pulmonary vein protection techniques-enabled treatment of complex
anatomies. In our series, TC was more common in adults, who comprised
86.7% of the TC group compared to 43.9% in SC. Adults often had
comorbidities and pulmonary hypertension, favoring TC over surgery.
Although early complications such as stent embolization and caudal
migration occurred, they reduced with procedural experience. Our follow-up
protocol with transesophageal echocardiography or CT/MR imaging in >90%
ensured accurate detection of residual shunts, thrombosis, or narrowing.
Reinterventions were low and manageable in both groups, though
underdiagnosis may exist in SC due to less stringent follow-up.
 Conclusion(s): The recently introduced transcatheter closure offered
comparable results to surgery with procedural failure identified only in
2.4% of patients, primarily in the early phase of the learning curve.
There was no procedural mortality in the current era with both approaches.
While reinterventions in the first decade of follow-up were SVC stenosis
angioplasty in surgical patients, it was residual defect closure with
multifunction occluders in transcatheter patients. Challenges in
transcatheter closure were successfully managed by pulmonary vein
protection, allowed high-draining vein drainage through open struts of the
stent as well as device closure of oval fossa defects. Transcatheter
closure seems to be a potential surgical alternative, especially in adults
and those with PAH and comorbidities. Long-term follow-up of the same
cohort in the next two decades is mandatory to study the real-world
efficacy of these two strategies.

<87>
Accession Number
648889920
Title
Innovative Guidewire Technique for Transseptal Puncture During Pulmonary
Vein Angioplasty in an Infant with Repaired Total Anomalous Pulmonary
Venous Return.
Source
Pediatric Cardiology. Conference: Pediatric and Congenital Interventional
Cardiovascular Society, PICS 2025. Chicago, IL United States.
46(Supplement 1) (pp S98-S100), 2025. Date of Publication: 01 Aug 2025.
Author
Hall A.; Jocson C.; Kimball T.; Mejia E.
Institution
(Hall, Jocson, Kimball, Mejia) Louisiana State University, New Orleans,
United States
(Hall, Jocson, Kimball, Mejia) Manning Family Children's, New Orleans,
United States
Publisher
Springer
Abstract
Introduction: Since its initial description in 1959, transseptal puncture
(TSP) using the Brockenbrough technique has become a widely utilized
method for accessing the left heart during cardiac catheterization. TSP
enables a broad range of diagnostic and interventional procedures,
including electrophysiologic studies, mitral valve interventions,
pulmonary vein isolation, and left atrial appendage occlusion. In addition
to traditional mechanical techniques, radiofrequency-assisted TSP has also
been employed. (1,2) In this case report, we present a novel approach
utilizing the stiff end of a guidewire to traverse the atrial septum and
establish a septal connection in an infant with pulmonary vein stenosis
following repair of total anomalous pulmonary venous return (TAPVR). Case
Presentation: We present the case of a 7-week-old male weighing 4.76 kg,
born at term via spontaneous vaginal delivery, who was postnatally
diagnosed with obstructed supracardiac total anomalous pulmonary venous
return (TAPVR) and a patent foramen ovale (PFO). On the third day of life,
the patient underwent surgical repair. The procedure involved opening the
confluence of the pulmonary veins and making incisions into their proximal
orifices. The left atrial wall was anastomosed to the proximal vertical
vein to establish unobstructed pulmonary venous drainage. The vertical
vein was intentionally left patent to accommodate planned delayed sternal
closure. Additionally, PFO closure was performed during the operation. The
patient was successfully weaned from cardiopulmonary bypass, with initial
hemodynamic support provided for stabilization. Intraoperative epicardial
echocardiography demonstrated good biventricular function and unobstructed
antegrade flow from all pulmonary veins to the confluence with a mean
gradient of 4 mmHg. Following the procedure, the patient was transferred
to the pediatric cardiac intensive care unit, where recovery progressed
without complication. Delayed sternal closure with vertical vein ligation
was performed two days later. Following discontinuation of inotropic
support and sedation, he was successfully extubated. He demonstrated a
good recovery in the inpatient cardiac unit and was subsequently
discharged home in stable condition on post-operative day nine.
Pre-discharge echocardiogram showed a mean gradient of 2-3 mmHg across the
confluence. At his two-week outpatient follow-up, he was clinically stable
and asymptomatic. A repeat echocardiogram was planned for the four-week
follow-up appointment. At his subsequent visit, he remained asymptomatic,
however oxygen saturations were notably lower than previous measurements.
A mean gradient of 30 mmHg across the pulmonary venous confluence
anastomosis was noted on echo, suggestive of severe residual stenosis,
with additional findings of a dilated right ventricle, mildly decreased
function, and supra-systemic right ventricular systolic pressure. Given
the severity of the obstruction, hospital admission was facilitated
directly from the clinic for further management. A chest CT done that
afternoon demonstrated the pulmonary venous confluence with stenosis at
its connection to the left atrium and associated dilation of the main
pulmonary artery. The following morning, the patient was brought to the
cardiac catheterization laboratory for pulmonary vein intervention under
transesophageal echocardiographic guidance. An initial attempt at
transseptal puncture using a BRK needle was unsuccessful due to an
inability to advance the needle-sheath assembly beyond the pelvic brim.
Given concerns for potential vascular injury or perforation, the needle
was withdrawn. Transseptal access was subsequently achieved using the
stiff end of a 0.014" BMW wire (Abbott, USA) modified with a 60 degree
bend, which was advanced through a coaxial system composed of a 6-Fr JR
Guide Launcher (Medtronic, USA) and a 4-Fr Glide catheter (Terumo, Japan)
with the aid of a Progreat microcatheter (Terumo, Japan) (Figure 1). The
stiff end of the wire was then exchanged for the floppy end to facilitate
septostomy (Figure 2). A 2.5 mm x 15 mm Trek balloon (Abbott, USA) was
advanced via the right femoral vein across the atrial septum and inflated
to a maximum pressure of 15 ATM. Serial balloon dilations were then
performed using 5 mm x 2 cm, 8 mm x 2 cm, and 10 mm x 2 cm Sterling
balloons (Boston Scientific, USA). Transesophageal echocardiography
confirmed the creation of an unrestrictive atrial communication with
bidirectional shunting (Figure 3). Subsequently, the left lower pulmonary
vein and right pulmonary vein confluence were treated with angioplasty
utilizing Wolverine cutting (Boston Scientific, USA), AngioSculpt
(Philips, USA), and Sterling balloons (Boston Scientific, USA). Final
angiographic and hemodynamic measurements indicated relief of the
stenoses. The patient tolerated the procedure well and initially recovered
in the pediatric cardiac intensive care unit, where he was extubated the
following day. Aspirin therapy was initiated. After continued monitoring,
he was discharged home with plans for close outpatient follow-up.
 Discussion(s): Transseptal puncture is a necessary procedure to
create an unrestricted atrial septal defect (ASD) in infants with complex
congenital heart disease to allow for mixing of blood at the level of the
atria and relief of atrial hypertension. (1) It is used for catheter
ablations, preoperative diagnostic procedures for congenital heart disease
(CHD), as well as urgent hemodynamic interventions. The Brockenbrough
technique was first introduced into clinical practice in 1959 and has
since been adopted as common practice for transseptal atrial puncture. The
technique mainly uses mechanical force to puncture the interatrial septum
at the fossa ovalis with a long flexible needle. (3) Another commonly
utilized technique is the radiofrequency technique, in which a high
frequency electrical current is used to pierce the interatrial septum
instead of mechanical force from the needle. (2) Muller et al. and Aydemir
et al. assessed the safety of the Brockenbrough technique for TSP in
pediatric patients with CHD. Muller et al. reported a high overall success
rate of 98.8%, with increased complication rates in urgent cases,
particularly those requiring hemodynamic intervention. (2) Aydemir et al.
focused on children under 20 kg, finding a lower success rate of 78% and a
10% complication rate, all in patients with CHD. (1) Both studies suggest
that while TSP is generally safe and effective in pediatric populations,
patients with CHD face a higher risk of complications especially in urgent
settings. Hu et al. introduced a modified angioplasty guidewire-assisted
technique for TSP as an alternative to the conventional Brockenbrough and
radiofrequency methods. This approach involves creating a sieve-like mesh
in the interatrial septum using the stiff end of the guidewire, followed
by confirming left atrial access with the floppy tip under fluoroscopy,
eliminating the need for contrast. In a multicenter randomized controlled
trial, the technique showed a higher one-time success rate, shorter
procedure time, and better sheath alignment compared to conventional
methods, with no significant difference in complication rates. However,
the study was limited to adults and did not differentiate between patients
with normal or congenital heart anatomy. (4) In this case report, the
novel modified angioplasty guidewire-assisted technique was used for a
pediatric patient with known CHD who required an urgent procedure for
hemodynamic stability. At this point in time, there are no other
documented cases in the literature of using this approach for TSP in a
pediatric patient. The patient recovered with no further complications
from the procedure. From this case, the modified angioplasty
guidewire-assisted technique may be a useful alternative in situations in
which the necessary equipment for the conventional Brockenbrough method is
not available or if the conventional approach is technically challenging.
Additionally, this may be a cost-efficient approach in resource-challenged
settings Conclusion(s): This case highlights an innovative use of the
modified stiff end of a BMW wire to perform transseptal puncture, serving
as a critical step in balloon atrial septostomy and pulmonary vein
angioplasty for an infant with pulmonary vein stenosis after TAPVR repair.
In settings where standard transseptal equipment may be limited or
technically challenging due to patient size, particularly in infants, this
approach offers a feasible and effective alternative. Additionally, the
widespread availability and lower cost of the BMW wire make it an
attractive option for resource-limited centers.

<88>
Accession Number
2037207289
Title
Comment on "Hypotension after induction of anesthesia with remimazolam or
etomidate: a non-inferiority randomized controlled trial in patients
undergoing coronary artery bypass grafting".
Source
Korean Journal of Anesthesiology. 78(5) (pp 508-509), 2025. Date of
Publication: 01 Oct 2025.
Author
Toker M.K.; Altiparmak B.
Institution
(Toker, Altiparmak) Department of Anesthesiology and Reanimation, Faculty
of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
Publisher
Korean Society of Anesthesiologists

<89>
Accession Number
2040691375
Title
Sentinel Cerebral Protection System in TAVI: An Updated Meta-Analysis of
Randomized and Propensity-Matched Studies.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2025.
Date of Publication: 2025.
Author
Braite M.; Portilho N.D.P.; Lara L.B.D.S.M.C.; Cavalcante D.V.S.; Scheffer
E.C.; Machado M.F.; Neto I.Q.C.; Barbosa E.R.F.; Tarantini G.
Institution
(Braite) Hospital of Love, Sao Paulo, Barretos, Brazil
(Portilho) Federal District Military Firefighter Brigade, Distrito
Federal, Brasilia, Brazil
(Lara) IDOMED-Instituto de Educacao Medica, Rio de janeiro, Brazil
(Cavalcante) University of North Texas Health Science Center, Fort Worth,
TX, United States
(Scheffer) EMESCAM-Escola Superior de Ciencias da Santa Casa de
Misericordia de Vitoria, Espirito Santo, Brazil
(Machado) UNIFIPMOC-Faculdades Integradas Pitagoras de Montes Claros,
Minas Gerais, Brazil
(Neto) Department of Radiology, University of Wisconsin-Madison, Madison,
WI, United States
(Barbosa) Military Police of Goias State, Valparaiso de Goias, Brazil
(Tarantini) Department of Cardiac, Thoracic and Vascular Sciences and
Public Health, University of Padova, Padova, Italy
Publisher
John Wiley and Sons Inc
Abstract
Backgrounds: Stroke remains a serious complication of transcatheter aortic
valve implantation (TAVI). The Sentinel cerebral embolic protection (CEP)
system is designed to mitigate this risk by capturing embolic debris, but
its clinical benefit remains uncertain. Aim(s): This meta-analysis
evaluated the impact of Sentinel CEP on stroke and related outcomes in
TAVI. Method(s): PubMed, Embase, and Cochrane were searched for
randomized controlled trials (RCTs) and propensity score-matched (PSM)
studies comparing TAVI with and without Sentinel CEP. The outcomes were
periprocedural ischemic stroke, total stroke, disabling stroke, 30-day
mortality, in-hospital mortality, composite death or stroke, acute kidney
injury (AKI), and major vascular complications. Risk ratios (RRs) with 95%
confidence intervals (CIs) were pooled using a random-effects model.
 Result(s): Eight studies (five RCTs, three PSM studies) encompassing
33,111 patients were analyzed, with 50.1% receiving Sentinel. In pooled
analysis, Sentinel CEP significantly reduced 30-day mortality (RR 0.75,
95% CI 0.58-0.97; p = 0.03) and AKI (RR 0.90, 95% CI 0.82-0.98; p = 0.01).
No significant effect was observed for periprocedural ischemic stroke (RR
0.92, CI 0.79-1.07; p = 0.28), total stroke (RR 0.79, CI 0.59-1.05; p =
0.10), in-hospital mortality (RR 0.86, CI 0.57-1.31; p = 0.47), composite
death or stroke, or major vascular complications. RCT-only analyses
confirmed no significant effect on any outcome. Conclusion(s):
Sentinel CEP was associated with lower 30-day mortality and AKI in pooled
cohorts, but did not reduce stroke. The absence of benefit in RCTs
underscores the need for further studies in high-risk TAVI
populations. Copyright © 2025 Wiley Periodicals LLC.

<90>
Accession Number
2041143327
Title
Comparative outcomes of on-label and off-label transcatheter aortic valve
replacement for aortic regurgitation: A systematic review and
meta-analysis.
Source
Open Heart. 12(2) (no pagination), 2025. Article Number: e003482. Date of
Publication: 01 Jul 2025.
Author
Peng Y.; Lin Y.; Su Z.; Nie S.; Nie R.; Chen Y.
Institution
(Peng, Lin, Su, Nie, Nie, Chen) Department of Cardiovascular Medicine, Sun
Yat-Sen Memorial Hospital, Guangdong, Guangzhou, China
Publisher
BMJ Publishing Group
Abstract
Background Transcatheter aortic valve replacement (TAVR) has emerged as an
alternative treatment for aortic regurgitation (AR) in patients at high
surgical risk. However, evidence comparing outcomes of different
new-generation devices remains limited. Objectives To compare clinical
outcomes of on-label, off-label self-expanding (SE) and off-label
balloon-expandable (BE) TAVR devices in AR patients. Methods A systematic
review and meta-analysis were conducted, including studies reporting
clinical outcomes of new-generation TAVR devices in AR. The primary
outcome was 1-year all-cause mortality. Secondary outcomes included
procedural success, moderate or severe AR and perioperative complications.
Subgroup and meta-regression analyses assessed the impact of valve type
and clinical variables. Results 32 studies involving 2682 patients were
included. 1-year mortality was 10.4% (95% CI: 7.2% to 14.7%) with no
significant difference among valve types. Technical success was highest
with on-label devices (97%), followed by off-label:BE (92%) and
off-label:SE (85%) (p<0.001). Valve migration occurred in 2% of on-label,
7% of off-label:BE and 10% of off-label:SE cases (p=0.004). Moderate or
severe AR was observed in 2% of on-label, 4% of off-label:BE and 8% of
off-label:SE recipients (p<0.001). Meta-regression identified coronary
heart disease as an independent predictor of 1 year mortality (p=0.026),
while other factors showed no significant association. Conclusions
On-label devices were associated with improved procedural outcomes,
including lower rates of valve migration and residual AR, although 1-year
mortality did not differ significantly between device groups. Further
prospective studies with longer follow-up are needed to assess valve
durability and long-term clinical outcomes. Copyright © Author(s)
(or their employer(s)) 2025.

<91>
Accession Number
2041218523
Title
Effect of sevoflurane on hemodynamic response during cardiopulmonary
bypass in cardiac surgery patients: A randomized controlled trial.
Source
Journal of Cardiovascular and Thoracic Research. 17(3) (pp 159-166), 2025.
Date of Publication: 01 Sep 2025.
Author
Lam V.T.; Ly N.M.
Institution
(Lam) Department of Anesthesiology and Pain Management, Vinmec Times City
International Hospital, Hanoi, Vietnam
(Ly) Department of Anesthesia and Critical Care, 108 Military Central
Hospital, Hanoi, Vietnam
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: Sevoflurane has little effect on hemodynamics and has been
shown to have a hemodynamic stabilizing effect in the pre-and
post-cardiopulmonary bypass (CPB) period in patients undergoing cardiac
surgery. However, clinical data on the effect of sevoflurane on the
hemodynamic response during CPB in patients undergoing cardiac surgery are
lacking. This study investigated whether the hemodynamic stabilizing
effect of sevoflurane is demonstrated during CPB time in cardiac surgery
patients. Method(s): Fifty-five patients undergoing cardiac surgery
under CPB were randomly assigned to anesthesia with sevoflurane
(intervention group) or propofol (control group) during CPB. The primary
outcomes were changes in hemodynamic parameters and the need for inotropes
and vasopressors during CPB. Secondary outcomes were morbidity and
mortality within 30 days after surgery. Result(s): The mean arterial
pressure (MAP) at 5 minutes after heartbeat recovery and the end of CPB as
well as central venous oxygen saturation (ScvO<inf>2</inf> ) at 5 minutes
after heartbeat recovery and cardiac index (CI) at the end of CPB of group
S-CPB (intervention group) were higher than those of group P-CPB (control
group). In addition, the proportion of patients using dobutamine and
noradrenaline during CPB was also lower in group S-CPB.
 Conclusion(s): In conclusion, in patients undergoing cardiac surgery
under CPB, the use of sevoflurane for anesthesia during CPB results in
hemodynamic stability with less need for inotropes and vasopressors during
CPB but morbidity and mortality within 30 days after surgery were not
significantly different when compared with the control
group. Copyright © 2025 The Author(s).

<92>
Accession Number
2041161321
Title
Ventricular Assist Devices in Adults With Transposition of the Great
Arteries and Systemic Right Ventricle: Systematic Literature Review.
Source
World Journal for Pediatric and Congenital Heart Surgery. (no
pagination), 2025. Article Number: 21501351251375987. Date of Publication:
2025.
Author
Abdelkader A.E.A.; Guglin M.
Institution
(Abdelkader, Guglin) Section of Heart Failure/Heart Transplantation/MCS
Services, Indiana University School of Medicine, Indianapolis, IN, United
States
Publisher
SAGE Publications Inc.
Abstract
Background: In adult patients with transposition of the great arteries
(TGA) and systemic right ventricle (sRV), the use of ventricular assist
devices (VADs) is uncommon. Method(s): We conducted a systematic
review of published studies to examine the indications, hemodynamic
effects, and outcomes of VADs in this patient population. We reviewed
English-language literature for case reports, case series, and reviews
that included individual patient data, such as demographics, hemodynamic
parameters, types of implanted VADs, and outcomes. Result(s): We
identified 107 patients, 76% (81/107) males, mean age 40.2 +/- 10.6 at the
time of implantation, 38.3% (41/107) with left TGA (L-TGA), and 61.7%
(66/107) with dextro-TGA (D-TGA). The VAD support resulted in hemodynamic
improvement, including a decrease in the mean pulmonary arterial pressure
(45 +/- 15 mm Hg before implantation to 25 +/- 9.3 mm Hg afterwards, P <
.001), pulmonary vascular resistance (6.3 +/- 4.9 Wood units (WU) to 2.4
+/- 1.35 WU, P < .001), right atrial pressure (16.4 +/- 7.3 mm Hg to 9.5
+/- 3.7 mm Hg, P = .009), and pulmonary capillary wedge pressure (25.45
+/- 7.12 mm Hg to 14.25 +/- 5.6 mm Hg, P < .001). The cardiac index
increased from 2.0 +/- 0.5 L/min/m2 to 2.8 +/- 0.6 L/min/m2 (P = .004).
The 1-year survival rate was 80.5%. Eventually, 31 (29%) underwent heart
transplantation, and 48 (54%) remained on VAD at the time of publication.
 Conclusion(s): Durable VADs provide hemodynamic improvement and
excellent survival in adults with a systemic right ventricle. Expanding
the use of VADs for this patient population would be
justified. Copyright © The Author(s) 2025

<93>
Accession Number
2041165616
Title
Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic
Review and Management Algorithm.
Source
Vascular and Endovascular Surgery. (no pagination), 2025. Article Number:
15385744251387791. Date of Publication: 2025.
Author
Pegler A.; Sivakumaran Y.
Institution
(Pegler, Sivakumaran) Department of Vascular Surgery, Princess Alexandra
Hospital, Brisbane, QLD, Australia
Publisher
SAGE Publications Inc.
Abstract
Background: Aortic dissection following endovascular aneurysm repair
(EVAR) may be iatrogenic or a de-novo event. This study aims to
systematically review all cases of dissection following EVAR to identify
complications specific to each scenario and develop a management algorithm
depending on the clinical presentation. Method(s): A comprehensive
literature search of MEDLINE, Embase, and CENTRAL databases was performed
for all studies relating to dissection following EVAR or
fenestrated/branched EVAR (F/BrEVAR). Data collected included timing
(differentiating iatrogenic and de-novo events), entry tear location,
endograft involved, complications, management, and subsequent outcomes.
Due to limited data availability, descriptive data was collected and
outcomes compared depending on dissection type and timing. Risk of bias
was assessed using a standardised tool for case reports. Result(s):
46 patients in 37 studies were included. Complications included endograft
compression (52.2%), endoleak (15.2%), and rupture (13.0%). Compression
was less likely in endografts with proximal fixation (41.9%), compared to
those without (69.2%). Type A dissection after EVAR required cardiac
surgery with a high mortality (20.0%). In Type B dissection, 2 cases were
diagnosed intra-operatively during F/BrEVAR, 1 died. 8 were diagnosed <4
weeks post-operatively, all managed medically with no complications or
mortality. 31 were diagnosed >4 weeks, with mortality of 25.8% and high
rates of endograft compression (58.1%), endoleak (16.1%), and rupture
(19.4%). Conclusion(s): Aortic dissection following EVAR may cause
endograft compression, endoleak, or rupture, with significant mortality.
Complications are more frequent following Type A dissection and late Type
B dissection. Early Type B dissection may be amenable to medical
management. Copyright © The Author(s) 2025

<94>
Accession Number
2041004958
Title
Inclusion and reporting by age, sex, and ethnicity in clinical studies of
high-risk medical devices approved in the European Union.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. (no
pagination), 2025. Article Number: qcaf007. Date of Publication: 2025.
Author
Coughlan J.J.; Byrne R.A.; Siontis G.C.M.; McGovern L.; Durand R.; Lubbeke
A.; Bano A.; Fraser A.G.
Institution
(Coughlan, Byrne, McGovern, Durand) Department of Cardiology, Mater
Private Network, Cardiovascular Research Institute (CVRI) Dublin, Eccles
Street 73, Dublin, Ireland
(Coughlan, Byrne) School of Pharmacy and Biomolecular Sciences, RCSI
University of Medicine and Health Sciences, 123 St Stephen's Green,
Dublin, Ireland
(Siontis) Department of Cardiology, Bern University Hospital, University
of Bern, Freiburgstrasse 18, Bern, Switzerland
(Lubbeke) Division of Orthopedic Surgery & Traumatology, Geneva University
Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneve,
Switzerland
(Lubbeke) Botnar Research Centre, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Rd,
Headington, Oxford, United Kingdom
(Bano) Institute of Social and Preventive Medicine, University of Bern,
Mittelstrasse 43, Bern, Switzerland
(Fraser) Department of Cardiology, University Hospital of Wales, Heath
Park Way, Cardiff, United Kingdom
Publisher
Oxford University Press
Abstract
Introduction Adequate inclusion and representation of patients in clinical
studies is critical for the generalizability of research findings. The aim
of this analysis was to determine inclusion and reporting by age, sex, and
ethnicity in clinical studies of high-risk medical devices (orthopaedic,
diabetes, and cardiovascular) approved in the European Union. Methods This
is an analysis of data from three co-ordinated systematic reviews of
clinical evidence for high-risk medical devices. This analysis includes
641 studies, reporting on more than 1.9 million patients treated with
high-risk orthopaedic, diabetes, and cardiovascular medical devices. The
main outcomes were the proportions of studies providing data on the age,
sex, and ethnicity of participants, and the performance of stratified
analyses based on these factors. Results The majority (>90%) of studies in
all three device categories (orthopaedics, diabetes, and cardiovascular)
provided data on the age and sex of participants, but only a minority
(<10%) provided information on ethnicity. Female patients comprised over
half of the patients in the included orthopaedic and diabetes device
studies, but <40% of patients in the included cardiovascular device
studies (P < 0.001). A minority of studies performed analyses stratified
by age (14.6%) or sex (10.4%), although those were more frequently
reported in randomized studies. Conclusions Almost all studies in this
analysis provided demographic data on age and sex, but only a small
minority had analysed whether these factors had any impact on device
performance. Very few studies provided information on the ethnicity of
study participants. Cardiovascular device studies enrolled a lower
proportion of female patients in comparison to orthopaedic and diabetes
device studies. Study registration Cardiovascular device systematic
review: PROSPERO (CRD42022308593). Diabetes device systematic review:
PROSPERO (CRD42022366871). Orthopaedic device systematic review: open
science framework (https://osf.io/6gmyx). Copyright © The
Author(s) 2025. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<95>
Accession Number
2041169559
Title
Recombinant Factor VIIa Versus Prothrombin Complex Concentrate in Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Cadd M.; Puntis D.; Bullard S.; Green S.; Kilpatrick T.; Hardy B.; Seavill
M.
Institution
(Cadd, Puntis, Green, Kilpatrick, Hardy) Anaesthetic Department, Royal
Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust,
Brighton, United Kingdom
(Bullard) Department of Anaesthesia, Royal Brompton Hospital, Guy's and St
Thomas' NHS Foundation Trust, London, United Kingdom
(Seavill) Department of Anaesthesia, St George's University Hospitals NHS
Foundation Trust, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Perioperative hemorrhage during cardiac surgery is a frequent occurrence
and can result in significant morbidity and mortality for patients.
Prothrombin complex concentrate (PCC) and recombinant factor VIIa (rFVIIa)
are therapies that have been used extensively in cardiac surgery with some
promise, but with some concern around acute kidney injury (AKI) and
thromboembolic disease with rFVIIa use. In this meta-analysis and
systematic review, the authors summarize the evidence regarding the
effects of PCC and rFVIIa on chest tube output, incidence of adverse
events, and mortality of adult patients undergoing cardiac surgery. A
total of 962 patients from seven retrospective observational studies were
included in the pooled analysis. There was a significant reduction in the
primary outcome: total chest tube output (mean difference: -301.01 mL, 95%
confidence interval [CI] -550.54 to -51.48). PCC was associated with a
significant reduction in total thromboembolic disease (odds ratio: 0.55,
95% CI 0.34 to 0.89), deep vein thrombosis (odds ratio 0.28, 95% CI 0.15
to 0.52), and cryoprecipitate transfusion (mean difference: -3.93, 95% CI
-7.64 to -0.21). There were no significant differences between groups in
the incidence of AKI or mortality. Five studies were deemed at moderate
risk of bias, and two at serious risk. PCC has been shown to have a
beneficial effect on reducing chest tube output and incidence of
thromboembolic disease, with no increase in AKI compared with
rFVIIa. Copyright © 2025 Elsevier Inc.

<96>
Accession Number
2040714012
Title
Strategies for Enhancing Anticoagulation Adherence in Adult Patients After
Cardiac Valve Replacement: An Evidence-Based Summary.
Source
Patient Preference and Adherence. 19 (pp 3239-3250), 2025. Date of
Publication: 2025.
Author
Peng Y.; Huang J.; Qin S.; Guo B.; Hu Q.; Xu D.; Gao C.; Hu F.
Institution
(Peng, Qin, Guo, Hu, Gao, Hu) Department of Cardiovascular Surgery,
Zhongnan Hospital of Wuhan University, 169 Donghu Road, Hubei, Wuhan,
China
(Huang) Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan
University, 169 Donghu Road, Hubei, Wuhan, China
(Xu) Department of Critical Care Medicine, Zhongnan Hospital of Wuhan
University, Hubei, Wuhan, China
(Hu) Nursing Department, Zhongnan Hospital of Wuhan University, Hubei,
Wuhan, China
(Hu) Center for Critical Care and Anesthesia Nursing Research, Hubei,
Wuhan, China
Publisher
Dove Medical Press Ltd
Abstract
Background: Heart valve replacement is one of the primary treatments for
valvular heart disease. Postoperatively, patients require long-term
anticoagulation therapy to prevent life-threatening thromboembolic events.
However, poor patient adherence to anticoagulation can lead to
complications such as thrombosis and embolism, adversely impacting patient
prognosis. This study aimed to systematically search for the best
available evidence on anticoagulation adherence management to provide
evidence-based guidance for the clinical practice concerning adult
patients after heart valve replacement. Method(s): Following the "6S"
evidence resource model, evidence retrieval was conducted in a top-down
manner, collecting relevant guidelines, best practices, evidence
summaries, systematic reviews, and expert consensuses. The search period
was limited to databases from January 1, 2015, to May 31, 2025. Two
evidence-trained researchers independently appraised the quality of the
included literature. Evidence was then extracted and summarized according
to the JBI evidence grading and recommendation system. Result(s): A
total of 13 articles were finally included, comprising 5 clinical
decisions, 1 evidence summary, 3 guidelines, 2 systematic reviews, 1
expert consensus, and 1 randomized controlled trial. Eighteen best
evidence statements were summarized from four dimensions: symptom
assessment, monitoring modalities and methods, quality control and
management, and patient education. Conclusion(s): This study
summarized the best evidence for anticoagulation adherence management
after heart valve replacement across four dimensions. This can provide
guidance for clinical or community healthcare professionals in developing
and implementing interventions and practice programs to improve patient
adherence to anticoagulation, thereby improving clinical outcomes and
quality of life for patients post-heart valve replacement. Copyright
© 2025 Peng et al.

<97>
Accession Number
2041040171
Title
Comparison of Epidural Analgesic Efficacy of Direct Thoracic versus
Caudally Inserted Catheter Positioned in Thoracic Space in Children
Undergoing Cardiac Surgery.
Source
Annals of Cardiac Anaesthesia. 28(4) (pp 439-444), 2025. Date of
Publication: 01 Oct 2025.
Author
Sharma V.K.; Vaishnavi A.
Institution
(Sharma, Vaishnavi) Department of Cardiac Anaesthesia, Dr. D. Y. Patil
Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth,
Maharashtra, Pune, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Effective pain management during paediatric cardiac surgery
is essential to prevent complications such as metabolic, neuroendocrine,
and immunological disturbances. Thoracic epidural anesthesia (TEA) offers
significant benefits in terms of pain relief and postoperative recovery.
However, its application in children is challenging due to the risk of
dural puncture and nerve injury. This study compares the efficacy of two
techniques: direct thoracic space insertion and caudal-to-thoracic space
catheter placement for TEA in pediatric cardiac surgery. Material(s)
and Method(s): This prospective, randomized study was conducted at a
tertiary center with 40 children undergoing elective cardiac surgery.
Participants were randomized into two groups: Group A (Direct Thoracic
Space) and Group B (Caudal-to-Thoracic Space). Epidural catheter insertion
was followed by a bolus of bupivacaine and morphine, and continuous
infusion for postoperative pain control. Hemodynamic parameters, Face,
Legs, Activity, Cry, Consolability (FLACC) scores for pain, and analgesic
requirements were monitored. Result(s): Both groups exhibited similar
hemodynamic responses, with statistically significant differences in
systolic blood pressure at 60 and 72 h (P < 0.05) favoring the Direct
Thoracic group. Postoperative pain control, assessed using FLACC scores,
was marginally better in Group A, but differences were not statistically
significant. No major complications were observed. Discussion(s):
While both methods provided comparable analgesia and hemodynamic
stability, the direct thoracic approach was slightly more effective in
pain management. The caudal to thoracic method remains technically simpler
and more accessible, making it a viable alternative. Conclusion(s):
Both techniques provide effective analgesia, with no major complications.
The caudal to thoracic approach offers a safer, simpler alternative to
direct thoracic catheter placement in pediatric cardiac
surgery. Copyright © 2025 Annals of Cardiac Anaesthesia.

<98>
Accession Number
2037260733
Title
Nursing Care Across the Clinical Continuum of TAVI: A Systematic Review of
Multidisciplinary Roles.
Source
Journal of Clinical Medicine. 14(13) (no pagination), 2025. Article
Number: 4535. Date of Publication: 01 Jul 2025.
Author
Jendrzejczak A.; Klukow J.; Czerwik-Marcinkowska J.; Styk W.; Zmorzynski
S.
Institution
(Jendrzejczak, Klukow) Chair of Nursing Management and Clinical Nursing,
Institute of Clinical Sciences, Faculty of Health Sciences, Academy of
Zamosc, Zamosc, Poland
(Czerwik-Marcinkowska) Institute of Biology, Jan Kochanowski University,
Kielce, Poland
(Styk) Academic Laboratory of Psychological Tests, Medical University,
Lublin, Poland
(Zmorzynski) Institute of Human Sciences, Faculty of Health Sciences,
Academy of Zamosc, Pereca Street 2, Zamosc, Poland
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Aortic stenosis is a common heart disease,
particularly among elderly patients. Transcatheter aortic valve
implantation (TAVI) offers a minimally invasive alternative method to
surgical valve replacement for high-risk patients. Although clinical
guidelines for TAVI are well established, standardized nursing care
pathways are lacking. This systematic review aims to clarify the nursing
role in the pre-, peri-, and postoperative phases of TAVI. Method(s):
This review was conducted in accordance with the PRISMA guidelines. After
applying the eligibility criteria, ten studies were selected from five
databases: PubMed, Scopus, CINAHL, Web of Science, and the Cochrane
Library. The work was registered in the PROSPERO database with the ID
number CRD420251061863. Result(s): The analysis revealed the
following: (1) a strong emphasis on preoperative patient education, often
led by nurse coordinators; (2) perioperative nursing roles in conscious
sedation protocols and early mobilization; (3) a lack of standardized
rehabilitative protocols, especially in the preoperative phase; and (4) an
emerging but insufficiently evaluated role of the TAVI nurse coordinator
in multidisciplinary care. Most studies concentrated on postoperative
care, outcomes, follow-up, and rehabilitation, but the small sample sizes
limited the strength of the conclusions. Conclusion(s): Nurses play a
vital role in multidisciplinary TAVI teams. There is an urgent need for
evidence-based nursing guidelines to standardize care, improve clinical
outcomes, and address the needs of TAVI patients. This review highlights
the pivotal contribution of nursing to the success of TAVI. Copyright
© 2025 by the authors. Licensee MDPI, Basel, Switzerland.

<99>
Accession Number
648901749
Title
Transfusion thresholds and other strategies for guiding red blood cell
transfusion.
Source
The Cochrane database of systematic reviews. 10 (pp CD002042), 2025. Date
of Publication: 20 Oct 2025.
Author
Carson J.L.; Stanworth S.J.; Dennis J.A.; Fergusson D.A.; Pagano M.B.;
Roubinian N.H.; Turgeon A.F.; Valentine S.; Trivella M.; Doree C.; Hebert
P.C.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, New Brunswick, NJ, United States
(Stanworth) John Radcliffe Hospital, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Stanworth) Radcliffe Department of Medicine, NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, United Kingdom
(Stanworth, Doree) Systematic Review Initiative, NHS Blood and Transplant,
Oxford, United Kingdom
(Dennis) Musculoskeletal Research Unit, University of Bristol, Bristol,
United Kingdom
(Fergusson) Methodological and Implementation Research Program, Ottawa
Hospital Research Institute, Ottawa, Canada
(Pagano) Department of Laboratory Medicine and Pathology, University of
Washington, Seattle, WA, United States
(Roubinian) Kaiser Permanente Northern California Division of Research,
Pleasanton, CA, United States
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, Universite Laval, Quebec City, Quebec,
Canada
(Turgeon) Population Health and Optimal Health Practices (Trauma -
Emergency - Critical Care Medicine), CHU de Quebec-Universite Laval
Research Centre, Quebec City, Canada
(Valentine) University of Massachusetts, Worcester, MA, United States
(Trivella) Division of Cardiovascular Medicine, University of Oxford,
Oxford, United Kingdom
(Hebert) Canadian Institutes of Health Research, Government of Canada, ON,
Canada
Abstract
BACKGROUND: The optimal haemoglobin threshold for use of red blood cell
(RBC) transfusions in anaemic patients remains an active area of research.
Blood is a limited resource, and there are concerns about risks, including
transmitted infections. If a liberal transfusion strategy does not improve
clinical outcomes, or if it is equivalent, then adopting a more
restrictive approach should be recognised as the standard of care.
 OBJECTIVE(S): The aim of this review update was to compare 30-day
mortality and other clinical outcomes for participants randomised to
restrictive versus liberal red blood cell (RBC) transfusion thresholds
(triggers) for all clinical conditions. The restrictive transfusion
threshold uses a lower haemoglobin concentration as a threshold for
transfusion (most commonly, 7.0 g/dL to 8.0 g/dL), and the liberal
transfusion threshold uses a higher haemoglobin concentration to direct
transfusion (most commonly, 9.0 g/dL to 10.0 g/dL). Increasingly,
investigators are considering other strategies including physiological
triggers (i.e. central venous oxygen saturation), alone or in combination
with such thresholds, to determine when a transfusion is indicated, so it
is important to assess this growing body of evidence in tandem.
 SEARCH METHOD(S): We searched CENTRAL, MEDLINE, Embase, Transfusion
Evidence Library, Web of Science Conference Proceedings Citation Index,
trial registries and PubMed on 14 October 2024. We checked reference lists
of published reviews and papers for additional trials. SELECTION CRITERIA:
We included randomised trials of surgical or medical participants that
recruited adults or children. We excluded studies that focused on preterm
neonates. Eligible trials assigned intervention groups based on different
transfusion strategies or thresholds, usually defined by a haemoglobin
concentration below which a RBC transfusion would be administered. We
included trials in which investigators had allocated participants to
higher thresholds or more liberal transfusion strategies compared to more
restrictive ones, which might include no transfusion. DATA COLLECTION AND
ANALYSIS: We used standard Cochrane methods. We pooled risk ratios across
trials using a random-effects model. We assessed risk of bias using the
Cochrane RoB 1 tool, and assessed the certainty of evidence using GRADE.
We defined participants randomly allocated to the lower transfusion
threshold as being in the 'restrictive transfusion' group and those
randomly allocated to the higher transfusion threshold as being in the
'liberal transfusion' group. MAIN RESULTS: Adult threshold comparison We
included 61 trials (27,639 participants), across a range of clinical
contexts: orthopaedic, cardiac or vascular surgery; critical care;
neurocritical care; gastrointestinal bleeding; trauma; acute myocardial
infarction; haematological malignancies and postpartum haemorrhage. The
haemoglobin concentration used to define the restrictive transfusion group
in most trials was between 7.0 g/dL and 8.0 g/dL. The main outcomes were
exposure to blood transfusion, 30-day mortality, neurologic function,
myocardial infarction, congestive heart failure, cerebral vascular
accident, infection and thromboembolism. Studies were generally at low
risk of bias. Restrictive transfusion strategies reduced the risk of
receiving at least one RBC transfusion by 42% when combining all clinical
contexts (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.52 to 0.65;
high-certainty evidence), with a large amount of heterogeneity between
trials (I2 = 97%), reflecting diversity in the strength of estimates, not
the efficacy of the policy. When combining all clinical contexts,
restrictive transfusion strategies did not modify the risk of 30-day
mortality compared with liberal transfusion strategies (RR 1.01, 95% CI
0.90 to 1.14; 44 studies, 22,575 participants; high-certainty evidence) or
any of the other outcomes assessed including myocardial infarction,
stroke, thromboembolism or infection (moderate to high-certainty
evidence). There were two exceptions in clinical populations. In
gastrointestinal bleeding, 30-day mortality was lower with a restrictive
transfusion strategy (RR 0.63, 95% CI 0.42 to 0.95; 4 studies, 1574
participants). In critically ill patients with brain injury, unfavourable
neurological outcome at 6 to 12 months was lower with a liberal
transfusion strategy (RR 1.14, 95% CI 1.05 to 1.22; 4 studies, 2297
participants) (moderate-certainty evidence). Transfusion-specific
reactions are uncommon, but occurred more frequently with the liberal
strategy (Peto odds ratio 0.47, 95% CI 0.36 to 0.62; 18 studies, 11,505
participants). Paediatric threshold comparison We included eight trials
(2764 participants), across a limited range of clinical contexts (critical
care, cardiac surgery, haematological malignancies and severe malarial
anaemia). The haemoglobin concentration used to define the restrictive
group in critical care and haematological malignancies trials was between
6.5 g/dL and 8.0 g/dL, and between 7.0 g/dL and 9 g/dL in cardiac surgery
trials, depending on the cardiac abnormality and stage of repair. Studies
were generally at low risk of bias. There was no clear difference in
30-day mortality between restrictive and liberal transfusion strategies,
although confidence intervals were wide (RR 1.22, 95% CI 0.72 to 2.08; 7
studies, 2571 participants; low-certainty evidence). There was
moderate-certainty evidence of no clear difference between threshold
strategies for infection; very low-certainty evidence of little to no
difference for thrombosis and very low-certainty evidence of little to no
difference for the outcomes multiple organ dysfunction and cerebrovascular
accident. Physiological triggers Nine trials in adults (3818 participants)
and one trial in children (100 participants) were identified. These tested
different interventions and measures of physiological parameters in
diverse clinical populations. The risk of bias was variable. Meta-analysis
was not appropriate due to heterogeneity. AUTHORS' CONCLUSION(S): A
restrictive transfusion strategy significantly decreased the proportion of
adults and children exposed to RBC transfusion. In most clinical contexts,
there was no evidence of harm from a restrictive compared with a liberal
transfusion strategy. Neurocritically ill patients, however, have better
neurological outcomes at 6 to 12 months with a liberal transfusion
strategy. Further work is needed to improve our understanding of outcomes
beyond mortality, and to what degree the optimal strategies for
transfusion should be modified in some patient populations, including
different types of acute bleeding, cancers and subgroups of patients with
myocardial infarction and other neurological injuries. New studies need to
recognise the clinical context and the limitations of the adoption of a
single threshold of haemoglobin, and to consider evaluating the use of
physiological parameters to modify transfusion. Copyright © 2025
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<100>
Accession Number
648902144
Title
Which Nonpharmacological Sleep Interventions Are Most Effective After
Cardiac Surgery?: A Network Meta-analysis.
Source
The Journal of cardiovascular nursing. (no pagination), 2025. Date of
Publication: 20 Oct 2025.
Author
Lee S.; Park C.G.; Chen P.; Saban K.
Institution
(Lee) RN Marcella Niehoff School of Nursing, Loyola University Chicago,
Sueyeon Lee, Maywood, IL, United States
(Park) PhD College of Nursing, University of Illinois Chicago, Chang Gi
Park
(Chen) MSN, RN College of Nursing, University of Illinois Chicago
(Saban) Karen Saban, PhD, RN, CNRN, FAHA, FAAN Marcella Niehoff School of
Nursing, Loyola University Chicago, Maywood, Illinois
Abstract
BACKGROUND: Sleep disturbances are common after cardiac surgery. Although
nonpharmacological interventions such as cognitive behavioral therapy
(CBT), relaxation, and sleep hygiene practices have shown effectiveness
for improving sleep, their relative impact remains unclear.
 OBJECTIVE(S): We applied network meta-analysis (NMA) to compare
multiple nonpharmacological interventions and identify the most effective
approach for improving sleep quality in patients after cardiac surgery.
 METHOD(S): Following PRISMA-NMA guidelines, comprehensive searches
across 6 databases were conducted in February 2025. Randomized controlled
trials examining nonpharmacological interventions to improve sleep quality
in postsurgical cardiac patients were included. All trials used the
Pittsburgh Sleep Quality Index as the outcome measure. We performed NMA
using STATA to determine the most effective intervention. RESULT(S):
Nineteen studies involving 1944 participants were examined. Interventions
included education, relaxation, CBT, family-centered care, resistance
exercise, aromatherapy, use of eye masks and earplugs, and combined
therapies. Nonpharmacological interventions significantly improved sleep
quality after cardiac surgery (standardized mean difference, 1.02; 95%
confidence interval, -1.50 to -0.54). Among the interventions, CBT emerged
as the most effective (surface under the cumulative ranking curve =
88.5%). CONCLUSION(S): Our findings highlight the clinical value of
CBT for postsurgical sleep management and support development of
standardized guidelines for its implementation. Future research should
explore a broader range of nonpharmacological interventions, assess their
effectiveness across different types of cardiac surgeries, and investigate
alternative CBT models such as online or shortened versions tailored to
this population. Integrating CBT into routine postoperative care could
enhance patient sleep, recovery, and well-being after cardiac
surgery. Copyright © 2025 Wolters Kluwer Health, Inc. All rights
reserved.

<101>
Accession Number
2037216934
Title
Rosuvastatin versus atorvastatin treatment in adults with coronary artery
disease: secondary analysis of the randomised LODESTAR trial.
Source
BMJ. 383 (no pagination), 2023. Article Number: e075837. Date of
Publication: 2023.
Author
Lee Y.-J.; Hong S.-J.; Kang W.C.; Hong B.-K.; Lee J.-Y.; Lee J.-B.; Cho
H.-J.; Yoon J.; Lee S.-J.; Ahn C.-M.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Hong M.-K.; Kwon H.M.; Kim J.-Y.; Min P.K.; Yoon Y.W.; Lee
B.K.; Rim S.-J.; Choi E.-Y.; Oh P.C.; Kim K.S.; Choi J.Y.; Ryu J.K.; Hong
S.P.; Kim C.Y.; Yang T.-H.; Ahn M.-S.; Ahn S.G.; Lee J.-W.; Son J.-W.;
Yoon H.-J.; Lee C.H.; Hwang J.; Cho Y.-K.; Hur S.-H.; Han S.; Nam C.-W.;
Kim H.; Park H.-S.; Kim I.-C.; Cho Y.-H.; Jeong H.-J.; Kim J.-H.; Lim C.;
Suh Y.; Hwang E.S.; Lee J.H.; Lee S.Y.; Kwon S.U.; Kim S.-Y.; Park K.-H.;
Kim H.K.
Institution
(Lee, Hong, Lee, Ahn, Kim, Kim, Ko, Choi, Hong) Division of Cardiology,
Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu,
Seoul, South Korea
(Kang, Oh) Gachon University College of Medicine, Incheon, South Korea
(Hong, Kwon, Kim, Min, Yoon, Lee, Rim, Choi) Gangnam Severance Hospital,
Seoul, South Korea
(Lee) Kangbuk Samsung Hospital, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Lee) Daegu Catholic University Medical Centre, Daegu, South Korea
(Cho, Yang) Inje University Busan Paik Hospital, Busan, South Korea
(Yoon, Ahn, Ahn, Lee, Son) Wonju Severance Christian Hospital, Wonju,
South Korea
(Jang) CHA University College of Medicine, Seongnam, South Korea
(Kim, Choi, Ryu, Hong, Kim, Han) Daegu Catholic University Medical Center,
Daegu, South Korea
(Yoon, Lee, Hwang, Cho, Hur, Nam, Kim, Park, Kim) Keimyung University
Dongsan Medical Center, Daegu, South Korea
(Cho, Jeong, Kim, Lim, Suh, Hwang, Lee) Myongji Hospital, Hanyang
University College of Medicine, Ilsan, South Korea
(Lee, Kwon) Inje University Ilsan Paik Hospital, Ilsan, South Korea
(Kim) Jeju National University Hospital, Jeju, South Korea
(Park, Kim) Chosun University Hospital, Gwangju, South Korea
Publisher
BMJ Publishing Group
Abstract
Objective To compare the long term efficacy and safety of rosuvastatin
with atorvastatin treatment in adults with coronary artery disease. Design
Randomised, open label, multicentre trial. setting 12 hospitals in South
Korea, September 2016 to November 2019. ParticiPants 4400 adults (age >=19
years) with coronary artery disease. interventiOns Participants were
assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196)
using 2x2 factorial randomisation. Main OutcOMe Measures The primary
outcome was a three year composite of all cause death, myocardial
infarction, stroke, or any coronary revascularisation. Secondary outcomes
were safety endpoints: new onset diabetes mellitus; hospital admissions
due to heart failure; deep vein thrombosis or pulmonary thromboembolism;
endovascular revascularisation for peripheral artery disease; aortic
intervention or surgery; end stage kidney disease; discontinuation of
study drugs owing to intolerance; cataract surgery; and a composite of
laboratory detected abnormalities. results 4341 of the 4400 participants
(98.7%) completed the trial. Mean daily dose of study drugs was 17.1 mg
(standard deviation (SD) 5.2 mg) in the rosuvastatin group and 36.0 (12.8)
mg in the atorvastatin group at three years (P<0.001). The primary outcome
occurred in 189 participants (8.7%) in the rosuvastatin group and 178
(8.2%) in the atorvastatin group (hazard ratio 1.06, 95% confidence
interval 0.86 to 1.30; P=0.58). The mean low density lipoprotein (LDL)
cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the
rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group
(P<0.001). The rosuvastatin group had a higher incidence of new onset
diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%;
hazard ratio 1.39, 95% confidence interval 1.03 to 1.87; P=0.03) and
cataract surgery (2.5% v 1.5%; 1.66, 1.07 to 2.58; P=0.02). Other safety
endpoints did not differ between the two groups. cOnclusiOns In adults
with coronary artery disease, rosuvastatin and atorvastatin showed
comparable efficacy for the composite outcome of all cause death,
myocardial infarction, stroke, or any coronary revascularisation at three
years. Rosuvastatin was associated with lower LDL cholesterol levels but a
higher risk of new onset diabetes mellitus requiring antidiabetics and
cataract surgery compared with atorvastatin. Copyright © 2023 BMJ
Publishing Group. All rights reserved.

<102>
Accession Number
2041012068
Title
Physiology-guided versus angiography-guided strategies for valve surgery
accompanying coronary heart disease: a protocol for systematic review and
meta-analysis.
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e089109. Date of
Publication: 13 Oct 2025.
Author
Zhang J.; Xie W.; Zhu Y.; Zhao Q.
Institution
(Zhang, Xie, Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin
Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
(Zhang) Department of Cardiothoracic Surgery, Wujin Hospital affiliated
with Jiangsu University, Jiangsu, Changzhou, China
Publisher
BMJ Publishing Group
Abstract
Background and objectives Cardiovascular diseases, particularly those
involving valvular and coronary conditions, lead to significant global
mortality. Current strategies combine surgeries like valve replacement and
coronary artery bypass grafting, which can increase perioperative risks.
Research indicates that physiology-guided strategies such as fractional
flow reserve and quantitative flow ratio improve outcomes by guiding more
precise surgical interventions. This study aims to compare
physiology-guided and angiography-guided surgical strategies, focusing on
evaluating their efficacy and safety in treating patients with combined
valvular and coronary pathologies. Methods and analysis We will search
PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and WHO
International Clinical Trials Registry Platform for studies comparing
outcomes of physiology-guided and angiography-guided strategies for
patients with valvular diseases combined with coronary heart disease. All
English articles published before 31 May 2024 will be considered. The
primary outcomes will be major adverse cardiovascular events and graft
occlusion rate. The secondary outcomes will be cardiac death, myocardial
infarction, stroke, repeat revascularisation, and so on. The Jadad score
and Newcastle-Ottawa Scale will be used to assess the quality of
randomised controlled trials (RCTs) and non-RCTs, respectively. The Q-test
and I2 statistic will be used to assess the heterogeneity. For the primary
outcome, we will perform the subgroup analysis if sufficient studies are
available. We will also conduct leave-one-out sensitivity analysis to
assess the impact of each individual study on the overall results. The
protocol follows the Cochrane Handbook for Preferred Reporting Items for
Systematic Reviews and Meta-Analysis Protocols guidelines. Ethics and
dissemination This study is a secondary analysis of previous studies and
therefore does not require ethical approval. Our research will be
disseminated in peer-reviewed publications. Copyright © Author(s)
(or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<103>
Accession Number
2041058164
Title
Neoadjuvant camrelizumab combined with chemoradiotherapy and
watch-and-wait strategy versus neoadjuvant chemoradiotherapy followed by
surgery in locally advanced oesophageal squamous cell carcinoma: study
protocol of a randomised controlled trial (PALACE-3).
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e093538. Date of
Publication: 15 Oct 2025.
Author
Wang X.; Li C.; Cao Y.; Kang X.; Leng X.; Zheng Y.; Zheng B.; Guo W.; Jing
H.; Han Y.; Chen C.; Li Y.; Li H.
Institution
(Wang, Li, Cao, Guo, Jing, Li) Department of Thoracic Surgery, Ruijin
Hospital, Shanghai, China
(Kang) Department of Thoracic Surgery, Peking Union Medical College
Hospital, Beijing, China
(Leng, Han) Department of Thoracic Surgery, Sichuan Cancer Hospital and
Institute, Sichuan, Chengdu, China
(Zheng) Department of Thoracic Surgery, Henan Cancer Hospital, Affiliated
Cancer Hospital of Zhengzhou University, Henan, Zhengzhou, China
(Zheng, Chen) Department of Thoracic Surgery, Fujian Medical University
Union Hospital, Fujian, Fuzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Combining immunotherapy with neoadjuvant chemoradiotherapy
(neoCRT) has been shown to be safe, achieving a pathological complete
response (pCR) rate of 56% in patients with locally advanced oesophageal
squamous cell carcinoma (ESCC) in the PALACE-1 trial. This high pCR rate
encourages us to explore the feasibility of postponing surgery after
immunotherapy combined with neoCRT under active surveillance. This study
aims to assess the efficacy, safety and patient-reported quality of life
(QOL) of camrelizumab combined with neoCRT and watch-and-wait strategy
versus neoCRT followed by surgery in locally advanced resectable ESCC.
Methods and analysis The PALACE-3 trial is a multicentre, open-label,
randomised non-inferiority trial expected to recruit 356 patients from six
high-volume centres in China. The study is planned to start in May 2024
and end in December 2028. Eligible patients will be randomly assigned (1:1
ratio) to either camrelizumab combined with neoCRT and watch-and-wait
strategy or neoCRT followed by surgery (standard surgery). In the active
surveillance group, patients achieving a clinical complete response (cCR)
to camrelizumab combined with neoCRT will undergo active surveillance,
while those with residual disease or locoregional recurrence will undergo
immediate surgery. Patients in the standard surgery group will proceed to
surgery after neoCRT. The primary endpoint is the 3-year overall survival
(OS) rate. The secondary endpoints include cCR rate, salvage surgery
incidence, objective response rate, adverse events during the neoadjuvant
therapy, pCR, tumour regression grade, R0 resection rate, lymph node
ratio, perioperative complications, disease-free survival (DFS) and 3-year
DFS rate, OS and health-related QOL. Ethics and dissemination This study
has been approved by the Ethics Committee of Shanghai Jiao Tong University
School of Medicine Affiliated Ruijin Hospital (Shanghai, China), as well
as the ethics committees of the following participating centres: National
Cancer Centre/National Clinical Research Centre for Cancer/Cancer
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College (Beijing, China); Sichuan Cancer Hospital and Institute, Sichuan
Cancer Centre, School of Medicine, University of Electronic Science and
Technology of China (Chengdu, China); The Affiliated Cancer Hospital of
Zhengzhou University, Henan Cancer Hospital (Zhengzhou, China); Fujian
Medical University Union Hospital (Fuzhou, China). Complete information
about the study status, relevant events and results will be regularly
updated on the project's webpage on ClinicalTrials.gov. Written informed
consent (Supplemental Material) will be obtained from each participant.
All research outputs will be published in peer-reviewed journals and
presented at national or international conferences. Copyright ©
Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<104>
Accession Number
2041123171
Title
Partial upper sternotomy vs full median sternotomy in obese patients
undergoing aortic valve replacement: A meta-analysis.
Source
World Journal of Cardiology. 17(9) (no pagination), 2025. Article Number:
110838. Date of Publication: 2025.
Author
Gupta A.; Chikhradze T.; Arshad A.; Sakrani R.A.; Khan Z.; Getahun M.;
Shaikh S.R.A.; Syed W.; Baweja T.; Remesan A.; Lewis C.; Doshi J.; Khawar
M.; Hussain A.; Khawar M.M.
Institution
(Gupta, Khan) Department of Cardiology, Avalon University School of
Medicine, Willemstad, Netherlands
(Chikhradze, Lewis) Department of Cardiology, Tbilisi State Medical
University, Tbilisi, Georgia
(Arshad) Department of Medicine, Medway Maritime Hospital NHS Foundation
Trust, Gillingham, United Kingdom
(Sakrani) Department of Cardiology, Dow International Medical College,
Sindh, Karachi, Pakistan
(Getahun) Department of Cardiology, University of Gondar, Adama, Ethiopia
(Shaikh) Department of Cardiology, Ivane Javakhishvili Tbilisi State
University, Tbilisi, Georgia
(Syed, Khawar, Khawar) Department of Cardiology, King Edward Medical
University, Punjab, Lahore, Pakistan
(Baweja) Department of Cardiology, Hamdard Institute of Medical Sciences
and Research, Delhi, New Delhi, India
(Remesan) Department of Cardiology, St Martinus University, Willemstad,
Netherlands
(Doshi) Department of Cardiology, University Hospital Lewisham, London,
United Kingdom
Department of Medicine, King Edward Medical University, Punjab, Lahore,
Pakistan
(Hussain) Department of Cardiology, Chitwan Medical College, Bharatpur,
Nepal
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND Obese patients (body mass index >= 30 kg/m2) undergoing
isolated aortic valve replacement (AVR) face increased surgical risks due
to comorbidities. Partial upper sternotomy (PUS), a minimally invasive
approach, may reduce complications compared to full median sternotomy
(FMS). We hypothesize that PUS improves outcomes over FMS in obese
patients undergoing AVR. AIM To compare the efficacy and safety of PUS vs
FMS in obese patients undergoing isolated AVR. METHODS This systematic
review and meta-analysis followed PRISMA guidelines, searching PubMed,
EMBASE, and Cochrane databases for observational studies comparing PUS vs
FMS in obese patients undergoing AVR. Outcomes were analyzed using odds
ratios (OR), mean differences (MD), 95% confidence intervals (CI), I2
statistic, and Newcastle-Ottawa Scale was used for quality assessment.
RESULTS Four observational studies involving 677 patients were analyzed.
PUS reduced intensive care unit stay (MD -2.67 days, 95%CI: -4.43 to
-0.90, P = 0.003, I2 = 78%) but increased cardiopulmonary bypass time (MD
5.62 minutes, 95%CI: -0.36 to 11.59, I2 = 55%). No differences were
observed in renal failure (OR 1.13, 95%CI: 0.63-2.94, I2 = 0%), atrial
fibrillation (OR 0.81, 95%CI: 0.43-1.54, I2 = 30%), reexploration (OR
1.09, 95%CI: 0.48-2.47, I2 = 0%), postoperative bleeding (OR 1.48, 95%CI:
0.53-4.15, I2 = 60%), wound infection (OR 1.23, 95%CI: 0.70-2.14, I2 =
0%), hospital stay (MD 0.51 days, 95%CI: -4.13 to 5.15, I2 = 90%), or
cross-clamp time (MD 4.03 minutes, 95%CI: -0.75 to 8.80, I2 = 50%).
CONCLUSION PUS is safe and effective for obese patients undergoing AVR,
reducing intensive care unit stay and enhancing recovery, provided
surgical expertise is available. Copyright ©The Author(s) 2025.
Published by Baishideng Publishing Group Inc. All rights reserved.

<105>
Accession Number
2040656287
Title
Challenges and solutions for optimizing outcomes in patients undergoing
surgical left atrial appendage closure.
Source
Future Cardiology. (no pagination), 2025. Date of Publication: 2025.
Author
Huang C.; Chen Z.; Li S.; Lu H.; Zhang X.
Institution
(Huang, Chen, Li, Lu, Zhang) Department of Cardiovascular Surgery, The
First Affiliated Hospital, Jinan University, Guangzhou, China
Publisher
Taylor and Francis Ltd.
Abstract
Left atrial appendage closure (LAAC) during cardiac surgery is a pivotal
strategy for stroke prevention in atrial fibrillation (AF), gaining
recognition in guidelines (Class I AHA 2023, Class IIa ESC 2024). This
review identifies critical challenges and proposes solutions for
optimizing outcomes. Challenges 1) Patient Selection: Significant
controversy exists regarding extending LAAC to high-stroke-risk patients
without documented AF;(CHA2DS2-VASc >=2), where 50% of post-cardiac
surgery strokes occur, creating an evidence-practice gap. Conflicting
meta-analyses exist (Baudo et al. vs. Kowalewski et al.). 2) Technique
Standardization: Marked heterogeneity in surgical techniques (suture,
excision, stapling) and lack of standardized protocols lead to highly
variable success rates (0%-100%), unlike standardized clipping (AtriClip;
> 93% success). 3)Post-procedural Management: Unresolved debates persist
on optimal post-surgical antithrombotic regimens and the standalone
efficacy of LAAC vs. anticoagulation. Solutions 1) Ongoing RCTs (LeAAPS,
LAA-CLOSURE, LAACS-2) aim to define LAAC efficacy in non-AF populations.
2) Implement evidence-based standardized operating procedures (SOPs) for
each technique, prioritizing validated clipping devices. Promote unified
imaging criteria (transesophageal echocardiography(TEE) intra-operation,
Cardiac Computed Tomography Angiography(CCTA) follow-up) per AHA 2023
guidelines. 3) The LAA-CLIP trial is evaluating thoracoscopic clipping vs.
DOACs, potentially supporting anticoagulation simplification post-LAAC.
Addressing these challenges through standardization and targeted trials is
crucial for maximizing LAAC efficacy. Copyright © 2025 Informa UK
Limited, trading as Taylor & Francis Group.

<106>
Accession Number
2041168697
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. (no pagination), 2025. Article Number:
17474930251383626. Date of Publication: 2025.
Author
Fonseca H.A.R.; 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), Sao Paulo, Brazil
(Nicolau) Instituto do Coracao (InCor), Hospital das Clinicas, Faculdade
de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Berwanger) The George Institute for Global Health UK, Imperial College
London, London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: An in-hospital double-dose influenza vaccination strategy's
effect on preventing major adverse 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.
 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. Result(s): The trial enrolled 1801 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 (862 patients) in the double-dose vaccine group
versus 12.1% wins (872 patients) in the standard-dose vaccination group
(WR: 0.94; 95% CI: 0.72-1.24; p = 0.69) without a history of stroke.
However, in-hospital double-dose vaccination favored individuals (34
patients) 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 (34 patients). 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. ClinicalTrials.gov number:
NCT04001504. Copyright © 2025 World Stroke Organization

<107>
Accession Number
2041218524
Title
Iatrogenic aortic valve injury following mitral valve surgery: A
systematic review.
Source
Journal of Cardiovascular and Thoracic Research. 17(3) (pp 153-158), 2025.
Date of Publication: 01 Sep 2025.
Author
D'Alonzo M.; Cuko B.; Ternacle J.; Busuttil O.; Dib N.; Sicouri S.; De
Vincentiis C.; Labrousse L.; Modine T.; Ramlawi B.; Baudo M.
Institution
(D'Alonzo) Cardiac Surgery Unit, Poliambulanza Foundation Hospital,
Brescia, Italy
(Cuko, Ternacle, Busuttil, Dib, Labrousse, Modine) Department of
Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de
Haut-Leveque, Bordeaux University Hospital, Pessac, France
(Sicouri, Ramlawi, Baudo) Department of Cardiac Surgery Research, Lankenau
Institute for Medical Research, Main Line Health, Wynnewood, PA, United
States
(De Vincentiis) Department of Cardiac Surgery, IRCCS Policlinico San
Donato, Milan, Italy
(Ramlawi) Department of Cardiac Surgery, Lankenau Heart Institute, Main
Line Health, Wynnewood, PA, United States
Publisher
Tabriz University of Medical Sciences
Abstract
Iatrogenic aortic regurgitation after mitral valve surgery is the
consequence of either direct stitching-related perforation or indirect
distortion of aortomitral fibrous continuity by the mitral
ring/prosthesis. This review aims at describing the reported cases of
iatrogenic aortic valve regurgitation following mitral valve surgery,
focusing primarily on its management. PubMed, ScienceDirect, DOAJ, and
Cochrane databases were searched from inception until December 2023 for
case reports and case series describing iatrogenic aortic valve
regurgitation following mitral valve surgery. The literature review found
17 articles describing 20 cases of new onset aortic valve regurgitation
after mitral valve surgery. Among them, 5 patients did not undergo
reoperation, either due to medical decision or patient refusal. The
non-coronary cusp was predominantly affected (11 cases), the left coronary
cusp involved in 4 cases, and a mixed mechanism occurred in 5 cases.
Subsequent surgical interventions included aortic valve replacements in 5
cases and aortic valve repair in 4 cases. A suggested management decision
algorithm is finally proposed. Iatrogenic aortic valve regurgitation after
mitral valve surgery remains an unfortunate complication. Attention should
be given to prevent this complication. Intraoperative transesophageal
echocardiography plays a crucial role for early detection. Management
strategies vary from medical therapy to surgical interventions. The
reparative strategy requires a surgical procedure associated with
significant mortality. Copyright © 2025 The Author(s).

<108>
Accession Number
2041175215
Title
Comparison of post-operative inflammatory biomarkers between minimal
invasive extracorporeal circulation and conventional extracorporeal
circulation in cardiac surgery. A meta-analysis of 15 randomized control
trials.
Source
Perfusion (United Kingdom). (no pagination), 2025. Article Number:
02676591251385872. Date of Publication: 2025.
Author
Motawea K.R.; Ibrahim M.; Amer A.E.; Kandil O.; Abourady Y.; Pelletier M.;
Abu-Omar Y.; El-Diasty M.
Institution
(Motawea, Abourady, Abu-Omar, El-Diasty) Division of Cardiac Surgery,
Harrington Heart and Vascular Institute, University Hospitals Cleveland
Medical Centre, Cleveland, OH, United States
(Ibrahim) Banner University Medical Center, Phoenix, AZ, United States
(Amer, Kandil) Faculty of Medicine, Alexandria University, Alexandria,
Egypt
(Pelletier) Division of Cardiac Surgery, Yale School of Medicine, New
Haven, CT, United States
Publisher
SAGE Publications Ltd
Abstract
Background/Aim: Recent literature suggested that the use of Minimal
Invasive Extracorporeal Circulation (MIECC) may mitigate the inflammatory
response in patients undergoing cardiac surgery. We aimed to perform a
meta-analysis to compare post-operative inflammatory biomarkers between
MIECC and conventional cardiopulmonary bypass in cardiac surgery.
 Method(s): We searched PubMed, Web of Science, Scopus, and Cochrane
Library for randomized control trials (RCTs) that quantified systemic
inflammatory mediators after the use of MIECC compared to conventional
extracorporeal circulation (CECC). Result(s): Fifteen RCTs with a
total of 1189 patients were identified. The inflammatory markers that were
investigated included Tumor Necrosis Factor alpha (TNF-alpha), Interleukin
6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10), Elastase,
C-Reactive protein (CRP) in addition to leucocyte count. No significant
difference between both groups was detected for TNF-alpha and IL-6 at (30
minutes, 1 to 2 hours, 6 hours, 24 hours, and 48 hours), IL-8 at (30
minutes and 48 hours), Interleukin 10 at 6 hours, Elastase at (30 minutes
to 1 hour, and 24 hours), CRP at 48 hours, and leucocytic count at (2
hours, 6 hours, 24 hours, and 48 hours). Pooled analysis showed a
significant association between MIECC group and lower levels of TNF-alpha
at 6 hours (p-value <.0001), IL-8 at 6 hours (p-value = .0005) and 24
hours (p-value = .005), IL-10 at 24 hours (p-value <.00,001), and Elastase
at 6 hours (p-value = .04). However, CRP was lower, at 24 hours, in the
CECC group (MD = 1.42, 95% CI = 0.13 to 2.71, p-value = .03).
 Conclusion(s): Our findings suggest that MIECC may be associated with
lower levels of systemic inflammatory mediators early after cardiac
surgery. However, the impact of this reduction on clinical outcomes needs
to be defined to justify the use of MIECC in the routine clinical
practice. Copyright © The Author(s) 2025

<109>
Accession Number
648873737
Title
Intensive Blood Pressure Control in Older Patients With Hypertension:
6-Year Results of the STEP Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 08 Sep 2025.
Author
Song Q.; Peng X.; Bai J.; Yang R.; Ling Q.; Chen S.; Ji Y.; Dong X.; Wang
X.; Wu S.; Wang T.-D.; Yu X.; Liu H.; Ren J.; Zhou X.; Chen R.; Yang L.;
Yang J.; Tian G.; Zhang H.; Zhao D.; Chen F.; Li D.; Yu J.; Zhang J.; Yang
Z.; Zhang W.; Cai J.
Institution
(Song, Peng, Ling) Hypertension Center, Beijing Anzhen Hospital, Capital
Medical University, Beijing Institute of Heart, Lung, and Blood Vessel
Diseases, Beijing, China; Hypertension Center, Fuwai Hospital, State Key
Laboratory of Cardiovascular Disease, National Center for Cardiovascular
Diseases, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing, China
(Bai, Yang, Yang, Cai) Hypertension Center, Beijing Anzhen Hospital,
Capital Medical University, Beijing Institute of Heart, Lung, Blood Vessel
Diseases, Beijing, China
(Chen, Ji, Dong, Wang, Zhang) Hypertension Center, Fuwai Hospital, State
Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, Beijing, China
(Wu) Department of Cardiology, Kailuan General Hospital, Tangshan, China
(Wang) Cardiovascular Center and Division of Cardiology, College of
Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)
(Yu) Internal Medicine Department, Benxi Railway Hospital, Benxi, China
(Liu) Department of Cardiology, Zhoukou City Central Hospital, Zhoukou,
China
(Ren) Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of
Medical Sciences, Taiyuan, China
(Zhou) Department of Cardiology, Renmin Hospital of Wuhan University,
Wuhan, China
(Chen) Department of Cardiology, Zhenjiang First People's Hospital,
Zhenjiang, China
(Yang) Department of Geriatric Medicine, Yan'an Hospital Affiliated to
Kunming Medical University, Kunming, China
(Yang) Hypertension Department, People's Hospital of Ji Xian District,
Tianjin, China
(Tian) Department of Cardiology, First Affiliated Hospital, Xian Jiaotong
University, Xi'an, China
(Zhang) General Ward Department, Hospital of Shunyi District, Beijing,
China
(Zhao) Department of Cardiology, First Affiliated Hospital of Harbin
Medical University, Harbin, China
(Chen) Cardiac Care Center, First People's Hospital of Yinchuan, Yinchuan,
China
(Li) Department of Cardiology, Wuxiang County People's Hospital, Changzhi,
China
(Yu) Department of Cardiology, Lanzhou University Second Hospital,
Lanzhou, China
(Zhang) Department of Cardiology, First Hospital of Shanxi Medical
University, Taiyuan, China
Abstract
BACKGROUND: The STEP (Strategy of Blood Pressure Intervention in the
Elderly Hypertensive Patients) trial showed that intensive systolic blood
pressure (SBP) control reduced cardiovascular risk. OBJECTIVE(S):
Study investigators conducted an extended follow-up of the STEP trial to
determine the longer-term effects of intensive blood pressure (BP)
control. METHOD(S): In this randomized controlled trial, 8,511
patients with hypertension were randomly assigned to the intensive
treatment group, with an SBP target of 110 mm Hg to <130 mm Hg, or the
standard treatment group, with an SBP target of 130 mm Hg to <150 mm Hg.
After the original trial ended, all surviving patients, either in the
standard group or the intensive treatment group previously, received
intensive treatment in the extended period, referred to as the delayed
intensive treatment group or the sustained intensive treatment group. The
primary outcome was a composite of stroke, acute coronary syndrome, acute
decompensated heart failure, coronary revascularization, atrial
fibrillation, or death resulting from cardiovascular causes. The Fine-Gray
subdistribution hazard model was used to estimate the HR between the 2
groups, and g-formula methods were initiated to compare overall primary
outcome risks with intensive treatment initiated from randomization and
initiated every year after randomization. RESULT(S): After a median
follow-up of 6.11 years, the mean SBP was 127.9 mm Hg in the sustained
intensive treatment group and 129.5 mm Hg in the delayed intensive
treatment group. The incidence rate of primary outcome was 1.12% per year
in the sustained intensive treatment group, compared with 1.33% per year
in the delayed intensive treatment group (HR: 0.82; 95% CI: 0.71-0.96). No
difference in safety event rates between the 2 groups was observed except
for hypotension, which occurred more frequently in the sustained intensive
treatment group. Furthermore, analyses using the parametric g-formula
showed that compared with the standard BP treatment, intensive treatment
initiating from randomization (0 month) yielded the greatest benefit
(relative risk [RR]: 0.83; 95% CI: 0.70-0.96), with an attenuated
cardiovascular benefit for later initiation from 12 months (RR: 0.88; 95%
CI: 0.76-0.99). CONCLUSION(S): Our results suggested that sustained
intensive BP control could benefit patients with hypertension compared
with delayed intensive treatment in the longer-term follow-up. The earlier
intensive treatment is initiated after the hypertension diagnosis, the
greater the cardiovascular benefits will be. (Strategy of Blood Pressure
Intervention in the Elderly Hypertensive Patients [STEP];
NCT03015311). Copyright © 2025 The Authors. Published by Elsevier
Inc. All rights reserved.

<110>
Accession Number
648882020
Title
Outcomes of Bloodless Cardiac Surgery in Jehovah's Witnesses: A Meta-
Analysis of Comparative Studies Since 2000.
Source
Transfusion. Conference: Annual Meeting of the Association for the
Advancement of Blood and Biotherapies, AABB 2025. San Diego, CA United
States. 65(Supplement 2) (pp 32A), 2025. Date of Publication: 01 Sep 2025.
Author
Tran M.; Rezk K.; Stoterau L.
Institution
(Rezk, Stoterau) University of California, Los Angeles, United States
(Tran) University of California, Irvine, United States
Publisher
John Wiley and Sons Inc
Abstract
Background/Case Studies: Jehovah's Witnesses (JWs) refuse allogeneic blood
transfusions on religious grounds, posing ethical and clinical challenges
in procedures such as cardiac surgery, where transfusion is often
considered essential. However, modern blood conservation techniques
including erythropoietin (EPO), iron supplementation, and cell salvage may
enable comparable outcomes without transfusion. This study evaluates
whether JWs undergoing bloodless cardiac surgery experience different
outcomes than non-Witness patients (Control) receiving transfusions. Study
Design/Methods: We conducted a systematic search of PubMed on April 14,
2025, using the MeSH terms 'Cardiac Surgery' and 'Jehovah's Witness*.'
Inclusion criteria were comparative studies published in English since
2000 involving adult cardiac surgery patients with outcome data for both
JWs and controls. Studies were excluded if they were single-patient case
reports, noncardiac or pediatric procedures, or lacked sufficient data.
Out of 313 results, 10 studies met inclusion criteria. Primary outcomes
included 30-day mortality, kidney injury, and blood loss. Where possible,
statistical comparison of binary outcomes was performed using
two-proportion z-tests on pooled data across studies. For variables not
uniformly defined or not reported in a comparable format (e.g., AKI
criteria, median-only values), trends were summarized descriptively.
Results/Findings: Across studies, JW sample sizes ranged from 27 to 113
patients. JW patients had significantly lower diabetes prevalence (25.7%
vs 33.2%, p = 0.0086). No significant differences were found in pooled
rates of hypertension (p = 0.198), prior cardiac surgery (p = 0.409), or
sex (p = 0.343). Post-operatively, no significant difference in 30-day
mortality was observed between JW and control groups in most studies (3.6%
vs 3.4%, p = 0.873). Kidney injury rates were comparable or lower in JW
groups. Although quantitative blood loss was inconsistently reported,
qualitative data did not suggest worse bleeding outcomes. JWs commonly
received preoperative anemia optimization with EPO and IV iron, as well as
intraoperative cell salvage. Conclusion(s): Bloodless cardiac surgery
in JW patients is associated with outcomes comparable to those of patients
receiving transfusions, provided appropriate perioperative strategies are
used. These findings support the safety and efficacy of blood conservation
techniques, not only for JWs but potentially for broader cardiac surgical
populations.

<111>
Accession Number
648882112
Title
Reduced Hemoglobin Use with Amustaline/Glutathione Pathogen-Reduced Red
Cells in a Randomized, Controlled Trial in Complex Cardiac Surgery.
Source
Transfusion. Conference: Annual Meeting of the Association for the
Advancement of Blood and Biotherapies, AABB 2025. San Diego, CA United
States. 65(Supplement 2) (pp 330A-331A), 2025. Date of Publication: 01 Sep
2025.
Author
Welsby I.; Snyder E.; Sekela M.; Corash L.; Liu K.; Mufti N.; Benjamin R.
Institution
(Welsby) Duke University Medical Center, Durham, NC, United States
(Snyder) Yale University, School of Medicine, New Haven, CT, United States
(Sekela) Gill Heart Institute University of Kentucky, Lexington, KY,
United States
(Corash, Liu, Mufti, Benjamin) Cerus Corporation, Concord, CA, United
States
Publisher
John Wiley and Sons Inc
Abstract
Background/Case Studies: The Red Cell Pathogen Inactivation (ReCePI) trial
was a Phase III, randomized Transfusions within 7 Days of Surgery
non-inferiority study comparing amustaline/glutathione pathogen-reduced
(PR) and conventional red blood cells (RBCs) for the support of acute
anemia during and for 7 days after complex cardiac or thoracic-aorta
surgery. Study Design/Methods: The primary endpoint was the incidence of
acute kidney injury (AKI) defined as a change in serum creatinine (>=0.3
mg/dL) from baseline within 48 hours of surgery. Blood utilization
(components and total Hb transfused) was assessed. Patient hemoglobin (Hb)
levels were recorded at baseline, daily for 7 days and at 28 days after
surgery. Surgical and postoperative blood loss were estimated from medical
records. Results/Findings: Subjects (581) were randomized in 18 US
hospitals and 321 (159 Test and 162 Control) RBCtransfused recipients
comprised the modified intentto- treat (mITT) population. Test and Control
subjects had similar histories, baseline characteristics, surgeries and
7-day total blood loss (median [IQR] Test 1500 [940- 2475] mL, Control
1733 [1060-2880] mL, p = 0.31) and had comparable Hb levels at baseline,
post-surgery (median (IQR] 9.8 [8.9-10.9] g/dL Test, 9.6 [8.6-10.6] g/dL
Control, p = 0.16) and for 28 days. PR RBC units contained -5% less total
Hb (median [IQR] Test 58.0 (53.0-62.0) g Hb vs. Control 61.0 (57.0-66.0) g
Hb, p < 0.001) and were stored longer prior to transfusion (median [IQR]
Test 23.8 (16.9-29.4) days vs. Control 21.8 (15.0-28.3) days, p < 0.001).
The Test arm received x10% less total study plus non-study RBC Hb over
7-days (median Test 169.0g Hb vs. Control 188.0g Hb, p = 0.01). Both
groups received a median of 3 RBC components, However, Test subjects
32/159 (20.1%) required 5 or more RBC units within 7 days compared to
Control 48/162 (29.6%, p = 0.05), and more Control subjects required
non-study RBC transfusions due to exceeding the available RBC supply [Test
35/159 (22.0%) subjects vs. Control 45/162 (27.8%) subjects]. Plasma
utilization was significantly less in the Test group (median Test 2 units
vs. Control 2 units, P = 0.02) while platelet and cryoprecipitate use were
not different. The incidence of AKI was 29.3% (46/157) for Test and 28.0%
(45/161) for Control subjects in the mITT group. Non-inferiority for the
incidence of AKI was achieved in both the mITT (p < 0.001) and the per
protocol analyses (P = 0.03). Adverse events, serious adverse events and
deaths on study were not different. Conclusion(s): PR RBCs and
conventional RBCs demonstrated equivalent support for patients undergoing
cardiac or thoracic-aorta surgery while using x10% less transfused total
RBC Hb and fewer plasma units. The incidence of AKI was non-inferior to
that with conventional RBCs.

<112>
Accession Number
648881918
Title
A Randomized, Controlled Pilot Clinical Trial of Extended-stored
Cold-stored Platelets in 100% Plasma for Cardiothoracic Surgical Bleeding:
The CHASE Trial.
Source
Transfusion. Conference: Annual Meeting of the Association for the
Advancement of Blood and Biotherapies, AABB 2025. San Diego, CA United
States. 65(Supplement 2) (pp 30A-31A), 2025. Date of Publication: 01 Sep
2025.
Author
Miles J.; Chauhan A.; Ting L.; Klotz P.; Pulido J.; Lehr E.; Youssef S.;
Alcorn K.; Ryan P.; Stout D.; Stolla M.
Institution
(Miles, Chauhan, Klotz, Alcorn, Stolla) Bloodworks Northwest, United
States
(Ting) Stasys Medical, United States
(Pulido, Lehr, Youssef, Ryan, Stout) Swedish Medical Center, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background/Case Studies: Cold-stored platelets (CSPs) were recently
approved to be stored for up to 14 days and transfused to bleeding
patients. The available clinical data on CSPs are very limited. In this
pilot trial, we tested the feasibility of conducting a randomized
controlled trial in cardiac surgery patients using extended-stored CSPs in
100% plasma. Study Design/Methods: We conducted a single center,
randomized, controlled, double-blind, pilot study in adult patients
undergoing elective redo or complex cardiothoracic surgery. Patients were
allocated to receive either standard of care, room temperature-stored
platelets (RTPs) for up to 7 days, or CSPs stored between 10 and 14 days
based on a week-based block randomization scheme. Up to three units of
shroud-blinded study platelets were transfused from the start of surgery
to up to 24h after. The primary outcome was defined as recruitment and
accrual feasibility. Numerous efficacy and safety endpoints were assessed.
All platelet units were screened for aggregates using a standard RTP
release criteria score as recommended by AABB standards. Results/Findings:
In total, 15 patients received RTPs, and 9 received CSPs (including three
patients who received both). Because of the continuous occurrence of
aggregates in CSPs and the resulting excess of subjects receiving RTPs,
the final 9 transfused participants were allocated to receive CSPs.
Results reported here are from a post hoc 'as-treated' analysis. No
significant difference in the number of RBCs, plasma units, or platelet
units was observed between the study groups. The total amount of chest
tube drainage was not significantly different between the groups. The
thromboelastography testing showed no significant differences at baseline,
30min, and 24h after transfusion. However, it revealed significantly
smaller maximum amplitudes 4h after transfusion with CSPs compared to RTPs
(p = 0.02). In contrast, recipients of CSPs formed significantly larger
aggregates 1h after transfusion (p = 0.04) and generated significantly
higher contractile forces under in vitro shear 1h and 4h after transfusion
(p = 0.003 and p = 0.03). Only one death within 28 days occurred in the
RTP transfusion group, while none occurred in the CSPs group. The average
platelet age at transfusion for CSPs was 11.2 days versus 3.4 days for
RTP. Overall, 179 CSP units were ordered for transfusion in this trial. We
found that most CSPs (58%) were not usable for transfusion using
conventional RTP release criteria, mainly due to the presence of
aggregates. Conclusion(s): Due to the abundance of aggregates in
CSPs, this pilot trial does not support the feasibility of CSPs in 100%
plasma using RTP release criteria. Our study highlights the need for
discussion on whether revised release criteria for CSPs are needed and
safe. Oral Abstract Session: New Insights to Patient Blood Management.

<113>
Accession Number
648885882
Title
The effectiveness of music on pain during heel blood collection in
premature infants: A randomized controlled trial.
Source
Infant behavior & development. 81 (pp 102157), 2025. Date of Publication:
16 Oct 2025.
Author
Dogan P.; Karakul A.; Engur D.; Oncel M.Y.
Institution
(Dogan) Izmir Katip Celebi University, Faculty of Health Science,
Department of Pediatric Nursing, Izmir, Turkey
(Karakul) Tarsus University, Faculty of Health Sciences, Department of
Nursing, Mersin, Turkey
(Engur) Izmir S.B.U Tepecik Teaching and Research Hospital, Izmir, Turkey
(Oncel) Izmir Buca Seyfi Demirsoy Teaching and Research Hospital, Izmir,
Turkey
Abstract
Newborns are exposed to pain during heel blood collection. The experience
of pain in newborns can lead to both physiological and behavioral changes.
The aim of this study was examine the effect of music (classical music and
lullaby) on pain during the heel blood collection in premature infants.
This single blind randomized controlled study was conducted between
October, 2022 and April, 2023 in the Neonatal Intensive Care Unit at a
university hospital. A total of 60 premature infants were randomly
allocated to three groups: the Control Group, the Classical Music Group,
and the Lullaby Group. Pain, oxygenation saturation levels, heart rate and
respiratory rate were measured before, during, after the heel blood
collection procedure. There were no statistically significant differences
in the demographic data of the infants in the classical music, lullaby,
and control groups. After heel blood collection procedure, pain levels,
heart rate and respiratory rate of premature infants in the lullaby groups
measurement were lower than the classical and control group. No
significant difference was found in terms of oxygen saturation between the
groups. In premature infants, in the lullaby group listening to during
heel blood collection was more effective in reducing pain compared to the
control group and classical music. This indicates lullaby can potentially
be an effective method in alleviating pain during heel blood
collection. Copyright © 2025 Elsevier Inc. All rights reserved.

<114>
Accession Number
648886006
Title
The effectiveness of high versus lower enteral protein intake, considering
energy intake, on clinical outcomes in critically ill children: A
systematic review and meta-analysis.
Source
Clinical nutrition (Edinburgh, Scotland). 54 (pp 220-232), 2025. Date of
Publication: 08 Oct 2025.
Author
Jotterand Chaparro C.; Bertoni Maluf V.A.; Pabion C.; Stern F.; Moullet
C.; Kiszio B.; Pugliese M.-T.; Ramelet A.-S.; Morice C.; Valla F.V.; Tume
L.N.
Institution
(Jotterand Chaparro) Department of Nutrition and Dietetics, Geneva School
of Health Sciences, HES-SO University of Applied Sciences and Arts Western
Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland; Bureau
d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A
JBI Centre of Excellence, Switzerland
(Bertoni Maluf) Department of Nutrition and Dietetics, Geneva School of
Health Sciences, HES-SO University of Applied Sciences and Arts Western
Switzerland ,Rue des Caroubiers 25, Carouge, Switzerland
(Pabion, Moullet) Department of Nutrition and Dietetics, Geneva School of
Health Sciences, HES-SO University of Applied Sciences and Arts Western
Switzerland ,Rue des Caroubiers 25, Carouge, Switzerland
(Stern, Pugliese) Geneva School of Health Sciences, HES-SO University of
Applied Sciences and Arts Western Switzerland ,Avenue de Champel 47,
Geneva, Switzerland
(Kiszio) Bureau d'Echange des Savoirs pour des praTiques exemplaires de
soins (BEST): A JBI Centre of Excellence, Switzerland; La Source, School
of Nursing Sciences, HES-SO University of Applied Sciences and Arts of
Western Switzerland, Lausanne, Switzerland
(Ramelet) Bureau d'Echange des Savoirs pour des praTiques exemplaires de
soins (BEST): A JBI Centre of Excellence, Switzerland; University
Institute of Higher Education and Research in Healthcare, Faculty of
Biology and Medicine, University of Lausanne, Switzerland; Lausanne
University Hospital, Lausanne, Switzerland
(Morice) Geneva University Hospital, Geneva, Switzerland
(Valla) Nutrition support team, Hospices Civils de Lyon, 103 grande rue de
la Croix-Rousse, Lyon, France
(Tume) Department of Nutrition and Dietetics, Geneva School of Health
Sciences, HES-SO University of Applied Sciences and Arts Western
Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland; Faculty of
Health, Social Care & Medicine, Edge Hill University, St Helens Road,
Ormskirk L39 4QP UK
Abstract
BACKGROUND & AIMS: The optimal protein intake for critically ill children
remains uncertain. This systematic review aimed to evaluate the
effectiveness of high versus lower enteral protein intake, accounting for
energy intake, on clinical and nutritional outcomes in children
hospitalized in pediatric intensive care units (PICU). METHOD(S):
Following the JBI methodology, a comprehensive search was conducted across
Medline, CINAHL Ultimate, Embase, and Cochrane Library from inception to
March 18, 2024. Randomized controlled trials (RCTs) involving critically
ill children admitted to PICU for >=48 h and receiving enteral nutrition
were eligible. Studies comparing protein intake of <1.1 g/kg/day or >2
g/kg/day to internationally recommended intakes were included. Two
independent reviewers screened, selected, extracted the data, and assessed
the risk of bias using the JBI critical appraisal checklist for RCTs; a
third reviewer resolved any disagreements. Meta-analyses were performed
for nitrogen balance, PICU length of stay, prealbumin and blood urea
levels using a random-effects model to account for between-study
heterogeneity. RESULT(S): Eight RCTs were included, assessing high (n
= 6) and low (n = 2) enteral protein intake versus the recommended intake,
mostly in infants aged 2-4 months, with bronchiolitis or after cardiac
surgery. Four studies presented an unclear risk of bias and four a high
risk. High protein intake (~3 g/kg/day) was associated with significantly
higher nitrogen balance values (effect size: 0.59; 95 % CI: 0.18-1.01; p =
0.0055) compared to the recommended intake (~1.6 g/kg/day) but had no
impact on PICU length of stay and was associated with increased blood urea
levels. Among four RCTs assessing gastrointestinal tolerance, two reported
increased diarrhea or gastric retention. Data on low versus recommended
intake were limited to two studies. CONCLUSION(S): High enteral
protein intake may increase nitrogen balance in this PICU population, but
potential adverse effects and the lack of evidence for clinical benefit
raise concerns about its safety. Further well-powered RCTs are needed to
evaluate the effects of protein doses within the 1-2.2 g/kg/day ranges in
more diverse PICU populations. REGISTRATION AND PUBLICATION OF THE
PROTOCOL: This study protocol was registered in PROSPERO (number:
CRD42022315325) and subsequently published in JBI Evidence Synthesis (DOI:
10.11124/JBIES-22-00133). Copyright © 2025 The Authors. Published
by Elsevier Ltd.. All rights reserved.

<115>
Accession Number
648881269
Title
Hemostatic Efficacy of Prothrombin Complex Concentrate for Managing
Coagulopathic Bleeding in Surgical Patients: Results from the LEX-209 and
LEX-211 (FARES-II) Phase 3 Trials.
Source
Transfusion. Conference: Annual Meeting of the Association for the
Advancement of Blood and Biotherapies, AABB 2025. San Diego, CA United
States. 65(Supplement 2) (pp 18A-19A), 2025. Date of Publication: 01 Sep
2025.
Author
Karkouti K.; Sarode R.; Goldstein J.; Milling T.; Callum J.; Bartoszko J.;
Werner S.; Levy J.; Tanaka K.
Institution
(Karkouti, Bartoszko) Department of Anesthesiology and Pain Medicine,
University of Toronto, Toronto, ON, Canada
(Sarode) Division of Transfusion Medicine and Hemostasis, Departments of
Pathology and Internal Medicine (Hematology/Oncology), University of
Texas, Southwestern Medical Center, Dallas, TX, United States
(Goldstein) Department of Emergency Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Milling) Departments of Neurology and Surgery and Perioperative Care,
Dell Medical School, University of Texas at Austin, Austin, TX, United
States
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Werner) Octapharma, USA Inc., Paramus, NJ, United States
(Levy) Department of Anesthesiology, Duke University, School of Medicine,
Durham, NC, United States
(Tanaka) Department of Anesthesiology, University of Oklahoma, Health
Sciences Center, Oklahoma City, OK, United States
Publisher
John Wiley and Sons Inc
Abstract
Background/Case Studies: Prothrombin complex concentrates (PCCs) are
increasingly used in surgical patients to manage bleeding by enhancing
thrombin generation and supporting clot initiation/formation. Elevated
international normalized ratio (INR) >1.5 increases postoperative bleeding
risk in patients receiving vitamin K antagonists (VKAs) or those with
coagulopathy following major surgeries, including cardiopulmonary bypass
(CPB). The LEX-209 and LEX-211 Phase 3 randomized controlled trials
assessed the efficacy and safety of investigational PCC
(Octaplex/Balfaxar) in patients undergoing urgent VKA reversal or cardiac
surgery with elevated INR. Study Design/Methods: LEX-209 (NCT02740335) was
a double-blind, non-inferiority trial comparing investigational vs.
control PCC (Beriplex/Kcentra) in adults (>=18 years) with INR >=2.0
receiving VKAs prior to urgent surgery. LEX-211 (FARES-II; NCT05523297)
was an unblinded, non-inferiority trial comparing investigational PCC vs.
frozen plasma (FP) in adults with INR >1.5 following CPB during cardiac
surgery. Primary endpoints were hemostatic efficacy (LEX-209) and need for
additional hemostatic intervention from 60 min to 24 h after intervention
initiation (LEX-211). Secondary endpoints included INR correction and
safety. Results/Findings: Overall, 318 patients were treated with
investigational PCC (LEX-209: n = 105; LEX-211: n = 213). Patient baseline
characteristics were well balanced between groups in both studies. Table 1
summarizes investigational PCC dosing and infusion timings. In LEX-209,
investigational PCC was non-inferior to control PCC, with effective
hemostasis achieved postoperatively in 94.3% vs. 94.2% of patients,
respectively. INR correction to <=1.5 at 30 min post-infusion was achieved
in 78.1% in the investigational group vs. 71.8% in the control group
(proportion difference 0.06; 95% CI, -0.06, 0.18). In LEX-211,
investigational PCC was superior to FP in achieving effective hemostasis
(p < 0.001) and led to a greater change in INR from within 30 min before
to 60 min after investigational medicinal product start (mean decrease of
33.9% vs. 24.9%; least-squares mean -0.15; 95% CI, -0.26, -0.04; p =
0.008). Safety profiles were similar between investigational and control
PCC groups in LEX-209, while fewer severe treatmentemergent adverse
events, including acute kidney injury, were observed for PCC over FP in
LEX-211. Conclusion(s): PCC administration demonstrated rapid INR
correction in VKA-associated coagulopathy vs. control PCC and
significantly greater INR reduction following CPB-associated coagulopathy
vs. FP. The investigational PCC was efficacious and well-tolerated, with
potential safety benefits over FP, supporting its use in the surgical
management of bleeding.

<116>
Accession Number
648851605
Title
The overlooked challenge of perioperative hypertension: unveiling
pathophysiology and redefining management strategies.
Source
Current medical research and opinion. (pp 1-15), 2025. Date of
Publication: 16 Oct 2025.
Author
Saputra P.B.T.; Widarti W.; Yolanda S.; Hidayat R.A.; Putra R.M.;
Kriswidyatomo P.; Faizah N.N.; Alkaff F.F.
Institution
(Saputra, Hidayat, Putra) Department of Cardiology and Vascular Medicine,
Faculty of Medicine, Universitas Airlangga - Dr, Soetomo General Academic
Hospital, Surabaya, Indonesia
(Widarti) Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
(Yolanda) Universitas Airlangga Hospital, Universitas Airlangga, Surabaya,
Indonesia
(Kriswidyatomo) Department of Anesthesiology and Reanimation, Faculty of
Medicine, Universitas Airlangga - Universitas Airlangga Hospital,
Surabaya, Indonesia
(Faizah) Division of Cardiovascular Medicine, Graduate School of Medicine,
Kobe University, Kobe, Japan
(Alkaff) Division of Nephrology, Department of Internal Medicine,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(Alkaff) Department of Anatomy, Histology, Pharmacology, Division of
Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga,
Surabaya, Indonesia
Abstract
Hypertension, defined as a systolic blood pressure (BP) >= 140 mmHg or
diastolic BP >= 90 mmHg, presents a significant challenge in perioperative
settings. Perioperative hypertension-elevated BP occurring in
preoperative, intraoperative, or postoperative phases-is highly prevalent,
affecting 20-25% of patients undergoing non-cardiac procedures and up to
80% of those undergoing cardiac surgeries. This review aims to provide an
in-depth examination of perioperative hypertension, emphasizing its impact
on patient outcomes, current management strategies, and the need for
standardized guidelines. This review synthesizes existing literature on
perioperative hypertension, including its definitions, classifications,
pathophysiology, and management approaches. Evidence from observational
studies, clinical trials, and expert guidelines is analyzed to highlight
gaps and best practices in perioperative BP control. A comprehensive
literature review was conducted using scientific databases. Studies
examining the incidence, complications, and management strategies of
perioperative hypertension were included. Quantitative findings on the
association between perioperative BP variations and clinical outcomes were
also reviewed. Perioperative hypertension significantly increases the risk
of adverse cardiovascular events, including myocardial infarction, stroke,
and renal failure, contributing to longer hospital stays and higher
healthcare costs. Patients with significant intraoperative systolic BP
elevations had markedly higher risks of adverse outcomes, including
approximately 1.5-fold higher mortality and a doubling of renal failure
risk. Additionally, hypertension is a leading cause of elective surgery
postponement. Despite its high prevalence, comprehensive management
guidelines remain inadequate, resulting in inconsistent BP control
strategies and suboptimal patient outcomes. The management of
perioperative hypertension requires a more standardized and evidence-based
approach. Current strategies emphasize individualized BP targets,
optimization of antihypertensive therapy, and intraoperative hemodynamic
stability. However, the lack of universally accepted guidelines hinders
effective BP management. Future research should focus on developing
standardized protocols to improve perioperative outcomes and reduce
complications related to hypertension.

<117>
Accession Number
2041062624
Title
Cardiac geometry alterations following bariatric surgery in severely obese
adolescents: a one-year follow-up study of a randomised controlled trial.
Source
Cardiology in the Young. (no pagination), 2025. Date of Publication:
2025.
Author
Talib A.; Roebroek Y.; Paulus G.; de Boom F.; Winkens B.; Bouvy N.; van
Heurn E.
Institution
(Talib, Roebroek, Paulus, de Boom, Bouvy, van Heurn) Department of
Surgery, Maastricht University Medical Center, Maastricht, Netherlands
(Talib, Roebroek, Paulus, de Boom, Bouvy, van Heurn) NUTRIM School for
Nutrition and Translational Research in Metabolism, Maastricht University,
Maastricht, Netherlands
(Roebroek) Department of General Surgery, Maxima Medical Center,
Veldhoven, Netherlands
(Paulus) Department of General Surgery, Spaarne Gasthuis, Hoofddorp,
Netherlands
(Winkens) Department of Methodology and Statistics, CAPHRI Care and Public
Health Research Institute, Maastricht University, Maastricht, Netherlands
(Bouvy, van Heurn) Department of Surgery, Leiden University Medical
Center, Leiden, Netherlands
Publisher
Cambridge University Press
Abstract
Background: Severe obesity in adolescents is a public health crisis of
increasing concern. Cardiac maladaptation, such as left ventricular
hypertrophy, increases the risk of future cardiovascular disease. This
study aims to evaluate the impact of weight loss surgery on cardiac
geometry in morbidly obese adolescents. Method(s): A single-centre,
randomised controlled trial titled comparing laparoscopic adjustable
gastric banding with multidisciplinary lifestyle intervention against a
control group with multidisciplinary lifestyle intervention alone. The
trial included severely obese adolescents aged 14-16 who had not responded
to a minimum of 12 months of multidisciplinary lifestyle intervention. The
primary outcome measured was the percentage change in total body weight
one year after surgery. Left ventricular geometry was evaluated
ultrasonographically before and one year after bariatric surgery.
 Result(s): In the intervention and control group, a total of 10 and 8
patients received both the baseline and follow-up ultrasonographic
examination. BMI significantly decreased in the intervention group
compared to the control group (-6.75; 95% CI: -10.28 - -3.23). Moreover,
left ventricular mass index (-8.21; 95% CI: -15.43 - -0.98) and relative
left ventricular wall thickness (-0.04; 95% CI: -0.07 - 0.00)
significantly decreased within the intervention group, reflecting
amelioration of adverse remodelling, albeit without statistically
significant intervention effect when compared to the control group.
 Conclusion(s): Significant weight loss through bariatric surgery may
improve left ventricular geometry in severely obese adolescents. These
findings support the potential of bariatric surgery not only for reducing
weight loss but also for improving cardiac health. Copyright ©
The Author(s), 2025. Published by Cambridge University Press.

<118>
Accession Number
2041048912
Title
Perioperative safety of lumbar decompression surgery performed under
continuous low-dose aspirin administration.
Source
Brain and Spine. Conference: Brain & Spine. Maldives. 5(Supplement 3) (no
pagination), 2025. Article Number: 104522. Date of Publication: 01 Jan
2025.
Author
Takaoka H.; Takano K.; Osamu M.
Institution
(Takaoka, Takano, Osamu) Orthopedic surgery, New Tokyo Hospital, Matsudo,
Japan
Publisher
Elsevier B.V.
Abstract
Introduction Spinal surgery improves patients' quality of life but poses
bleeding risks, particularly for those taking low-dose aspirin (LDA). LDA,
commonly prescribed for cardiovascular disease prevention, inhibits
platelet function and may increase surgical bleeding risk. While a
meta-analysis of general surgeries found no significant differences in
bleeding or cardiovascular events between LDA continuation and
discontinuation, spinal surgeries were often excluded. Previous studies on
LDA and spinal surgery have reported inconsistent results regarding
intraoperative and postoperative bleeding risks. This study aimed to
evaluate the perioperative safety of LDA in patients undergoing lumbar
decompression surgery. Materials and Methods This retrospective study
analyzed 375 lumbar decompression surgeries performed at our institution
between 2014 and 2023. Among these, 98 patients taking LDA and 207
patients not taking LDA were included, excluding those on other
antiplatelet or anticoagulant medications. Propensity score matching based
on age, sex, and number of decompression levels resulted in 89 matched
patients in each group (LDA group [L] and non-LDA group [N]). Outcomes
included operative time, intraoperative blood loss, drain volume,
hemoglobin changes, blood transfusions, postoperative complications, and
hospital stay. Statistical analyses were conducted using chi-square and
Mann-Whitney U tests, with p<0.05 considered significant. Results
Operative time was comparable between groups (L: 147 minutes, N: 144
minutes; p=0.74). Intraoperative blood loss was significantly higher in
group L (70.3 ml vs. 46.4 ml; p=0.003). Drain volumes on the day of
surgery and total drain volumes showed no significant differences (160 ml
vs. 179 ml; p=0.37, and 341 ml vs. 358 ml; p=0.92, respectively).
Hemoglobin levels decreased more significantly in group L both on the day
after surgery (1.7 g/dL vs. 1.4 g/dL; p=0.06) and at 1 week
postoperatively (2.2 g/dL vs. 1.9 g/dL; p=0.04). Blood transfusion rates
were higher in group L (7.9% vs. 1.1%; p=0.06), though not statistically
significant. Postoperative hematoma evacuation occurred in one patient in
group N, and surgical site infections were observed in one patient in each
group. No serious bleeding complications were noted. The mean hospital
stay was similar (L: 10.5 days, N: 9.8 days; p=0.60). Conclusion LDA is
associated with increased intraoperative blood loss and a greater decrease
in postoperative hemoglobin levels. However, these risks are manageable,
and serious bleeding complications are rare. These findings suggest that
LDA can be safely continued in lumbar decompression surgery, minimizing
cardiovascular risks associated with its withdrawal while maintaining
perioperative safety. [Formula presented] [Formula
presented] Copyright © 2025

EPICORE Embase Updates

Saturday, November 1, 2025

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Followers

Blog Archive

About Me