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<1>
Accession Number
2034205200
Title
Etomidate vs Ketamine-Propofol for Induction of Anesthesia in Coronary
Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 29(4) (pp 246-257),
2025. Date of Publication: 01 Dec 2025.
Author
Kumar N.; Bardia A.; Fitzsimons M.G.; Essandoh M.; Mitchell J.; Falkson
S.R.; Dalia A.; Tang J.; Sawyer T.R.; Iyer M.H.
Institution
(Kumar, Bardia, Fitzsimons, Falkson, Dalia) Department of Anesthesia,
Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Essandoh, Tang, Iyer) Department of Anesthesiology, The Ohio State
University Wexner Medical Center, Columbus, OH, United States
(Mitchell) Department of Anesthesiology and Perioperative Medicine,
University of California Los Angeles, Los Angeles, CA, United States
(Sawyer) Central Michigan University College of Medicine, Mt. Pleasant,
MI, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Etomidate has minimal cardiovascular depressant effects at the
cost of endogenous cortisol production suppression, whereas propofol has
vasodilatory and myocardial depressant properties, which may be poorly
tolerated in the cardiac surgical population. To offset the undesirable
effects of propofol, ketamine can be co-administered to harness its
cardiac stimulatory properties. Though etomidate is a more cardio-stable
induction agent than propofol, its superiority over the combination of
propofol and ketamine-colloquially known as "ketofol"-remains
controversial. Method(s): United States National Library of Medicine
Database (MEDLINE) and Excerpta Medica Database (EMBASE) were searched for
randomized controlled trials published since 2010 comparing etomidate and
ketofol relative to propofol alone for induction of general anesthesia for
coronary artery bypass grafting (CABG). Key data collected included
post-induction nadir mean arterial pressure (MAP), heart rate, cardiac
index, systemic vascular resistance (SVR), and serum cortisol levels at 24
hours postoperatively. Variables were compared by calculating a weighted
mean difference (WMD) [95% confidence interval (CI)]. Result(s): This
analysis included 15 studies (1125 patients). Anesthetic induction with
etomidate was associated with a higher nadir MAP and SVR compared to
ketofol during the peri-induction period by WMD 4.77 mmHg [95% CI 0.31,
9.23, P = 0.04] and 42.22 dynes/cm5[95% CI 0.49-83.94, P =
0.05]. However, there was no difference in the frequency of needed boluses
of vasopressors or fluids for peri-induction hypotension.
 Conclusion(s): Though etomidate appears to provide a superior
hemodynamic profile compared to ketofol, both agents require similar
degrees of clinical response to hypotension during the induction of CABG
surgery patients. Copyright © The Author(s) 2025

<2>
Accession Number
2041286515
Title
Impact of Intraoperative Hyperoxia Versus Normoxia on Mortality and Organ
Injury in Cardiac Surgery: A Systematic Review and Meta-analysis of
Randomized Clinical Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Grillo I.T.C.; de Santana E.S.P.; Passos F.S.; Tanimoto L.E.; de Melo
J.C.; Kondo A.M.; Treml R.E.; Caldonazo T.
Institution
(Grillo, Tanimoto, de Melo) University of Buenos Aires, Buenos Aires,
Argentina
(de Santana) Federal University of Bahia, Salvador, Brazil
(Passos) Department of Thoracic Surgery, Mater Dei Hospital, Salvador,
Brazil
(Kondo) Albert Einstein Israeli Faculty of Health Sciences, Sao Paulo,
Brazil
(Treml) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, United States
(Caldonazo) Department of Cardiothoracic Surgery, Jena University
Hospital, Jena, Germany
(Caldonazo) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York, NY, United States
Publisher
W.B. Saunders
Abstract
Objective: To compare mortality and organ injury associated with
intraoperative hyperoxia and normoxia in cardiac surgery patients.
 Design(s): Systematic review and meta-analysis of randomized clinical
trials (RCTs). Setting(s): Tertiary care. Participant(s):
Patients who underwent cardiac surgery with cardiopulmonary bypass or
off-pump procedures. Intervention(s): Intraoperative hyperoxia or
normoxia. Measurements and Main Results: A systematic search of
PubMed, Embase, and the Cochrane Library identified RCTs comparing
hyperoxia versus normoxia in cardiac surgery. Primary outcomes were
in-hospital and 30-day mortality; secondary outcomes included
postoperative clinical and biochemical measures. Risk ratios (RRs), mean
differences (MDs), and standardized mean differences (SMDs) with 95%
confidence intervals (CIs) were calculated. Trial sequential analysis and
subgroup analysis based on the variable used to define oxygenation
(PaO2-based v FiO2-based thresholds) were performed to address
heterogeneity in oxygenation strategies. Nineteen RCTs (2,001 patients)
were included, with 982 patients (49.1%) experiencing hyperoxia.
In-hospital (9/798 [1.1%] v 10/799 [1.3%], RR 0.84, 95% CI 0.36 to 1.94, p
= 0.684) and 30-day mortality (1/282 [0.4%] v 4/280 [1.4%], RR 0.41, 95%
CI 0.08 to 2.28, p = 0.311) were not different between the groups.
However, the normoxia group had a higher postoperative
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (MD -31.49, 95% CI -47.13 to -15.85,
p < 0.01), whereas creatine kinase-MB (SMD 1.65, 95% CI 0.12 to 3.18, p =
0.03) and malondialdehyde (SMD 3.77, 95% CI 2.99 to 4.55, p < 0.01) were
higher in the hyperoxia group. Conclusion(s): Compared with normoxia,
hyperoxia during cardiac surgery does not impact in-hospital or 30-day
mortality but is associated with worsening physiological and biochemical
parameters. Copyright © 2025 The Authors

<3>
Accession Number
2040771397
Title
Prevalence and risk factors of frailty among cardiac surgery patients: a
systematic review and meta-analysis.
Source
Annals of Medicine. 57(1) (no pagination), 2025. Article Number: 2576638.
Date of Publication: 2025.
Author
Sarmadi S.; Sanaie N.; Zare-Kaseb A.
Institution
(Sarmadi, Zare-Kaseb) Student Research Committee, Department of
Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sanaie) Nursing, Department of Medical Surgical Nursing, School of
Nursing and Midwifery, Shahid Beheshti University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Frailty is common among cardiac surgery patients and is
associated with poor outcomes. Previous reviews have been limited by
outdated searches, narrow surgical populations, or reliance on a single
assessment tool. This study aimed to estimate the prevalence of frailty
and identify associated risk factors in patients undergoing cardiac
surgery. Method(s): We searched MEDLINE, Embase, Cochrane Library,
CINAHL, Web of Science, and Scopus, from inception to March 1, 2025.
Eligible studies reporting frailty prevalence in patients undergoing CABG,
valvular surgery, or heart transplantation were included. Intervention
studies, reviews, editorials, case series, and transcatheter procedures
were excluded. Risk of bias was assessed by the Joanna Briggs Institute
checklist. Random-effects meta-analysis provided pooled prevalence and
risk factor estimates. Result(s): Seventy-eight studies (n =
6,613,392) were included. The pooled frailty prevalence was 30.2% (95% CI:
28.3-32.0) with high heterogeneity (I2 = 99.99%, p <.001). Key
sociodemographic associations were increasing age (SMD = 0.29 [0.18,
0.40]) and male sex (OR = 0.55 [0.46, 0.65]). Lower hemoglobin (SMD =
-0.62 [-0.82, -0.42]) and albumin (SMD = -0.48 [-0.68, -0.28]) were
significant laboratory correlates; NYHA class IV (OR = 6.29 [4.07, 9.71])
and higher EuroSCORE II (SMD = 0.52 [0.37, 0.68]) were strong clinical
predictors. Comorbidities-including atrial fibrillation, liver, pulmonary,
renal, neurological dysfunction, and diabetes-were also associated with
frailty. Conclusion(s): Frailty impacts nearly one-third of cardiac
surgery patients and is associated with several, partly modifiable
factors. Preoperative screening using validated tools and focused
management of modifiable risks could enhance perioperative outcomes.
 Protocol Registration: PROSPERO registration number:
CRD420251015280. Copyright © 2025 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<4>
Accession Number
2040508036
Title
Beating Heart Versus Arrested Heart for Isolated Tricuspid Valve Surgery:
A Kaplan-Meier-Derived Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 20(5) (pp 442-451), 2025. Date of Publication: 01 Sep 2025.
Author
Baudo M.; Sicouri S.; Yamashita Y.; Magouliotis D.; Cabrucci F.; Ramlawi
B.
Institution
(Baudo, Sicouri, Yamashita, Magouliotis, Cabrucci, Ramlawi) Department of
Cardiac Surgery Research, Lankenau Institute for Medical Research, Main
Line Health, Wynnewood, PA, United States
(Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The aim of the current study was to analyze the clinical and
surgical outcomes of patients undergoing isolated tricuspid valve surgery
(ITVS) from the available literature. It currently remains uncertain
whether arrested heart (AH) surgery has superior postoperative outcomes
over beating heart (BH) for ITVS. Method(s): A systematic review and
meta-analysis were conducted by searching PubMed, ScienceDirect, Scopus,
DOAJ, SciELO, and Cochrane databases from 2000 until November 2024. The
protocol was registered with the International Prospective Register of
Systematic Reviews under the PROSPERO registration number CRD42024622618.
 Result(s): A total of 22 studies met the inclusion criteria. These
studies were published between 2012 and 2023 and included a combined total
of 1,627 patients, with 1,053 in the BH group and 574 in the AH group. The
present analysis showed that patients undergoing BH surgery were generally
more comorbid and more frequently underwent minimally invasive procedures
as compared with patients undergoing AH surgery. The BH and AH groups
reported no significant differences in postoperative outcomes. At
follow-up, BH was associated with higher recurrent >2+ tricuspid
regurgitation rates (P = 0.048), but this did not affect late survival
(hazard ratio [HR] = 0.90, 95% confidence interval [CI]: 0.68 to 1.19, P =
0.457) or reintervention for TV (HR = 1.18, 95% CI: 0.61 to 2.29, P =
0.622) rates. Conclusion(s): A consensus between BH and AH for ITVS
is still lacking. However, BH ITVS procedures appear to be the preferred
surgeon choice for higher-risk patients. At follow-up, the BH group showed
higher rates of recurrent tricuspid regurgitation >2+, without affecting
late survival or rates of TV reintervention. Copyright © The
Author(s) 2025

<5>
Accession Number
2041286638
Title
Combination of Serratus Anterior and Deep Parasternal Intercostal Plane
Blocks versus Erector Spinae Plane Block for Acute Pain Management After
Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Aydin M.E.; Karapinar Y.E.; Medetoglu Koksal E.N.; Yilmaz M.A.; Yayik
A.M.; Celik E.C.; Oral Ahiskalioglu E.; Erkut B.; Ahiskalioglu A.
Institution
(Aydin, Karapinar, Yilmaz, Yayik, Celik, Oral Ahiskalioglu, Ahiskalioglu)
Department of Anesthesiology and Reanimation, Ataturk University School of
Medicine, Erzurum, Turkey
(Medetoglu Koksal) Department of Anesthesiology and Reanimation,
University of Health Sciences, Erzurum City Hospital, Erzurum, Turkey
(Erkut) Department of Cardiovascular Surgery, Ataturk University School of
Medicine, Erzurum, Turkey
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the analgesic efficacy of bilateral erector spinae
plane block (ESPB) versus the combination of deep parasternal intercostal
plane block (DPIPB) and serratus anterior plane block (SAPB) for managing
acute pain after cardiac surgery. Design(s): Prospective, randomized,
assessor-blinded controlled trial Setting: A single institution, an
academic university hospital Participants: Sixty patients scheduled for
elective on-pump cardiac surgery through median sternotomy Interventions:
Patients were allocated at random into 2 groups: bilateral ESPB (n = 30)
and combined DPIPB and SAPB (n = 30). Measurements and Main Results:
The primary outcome was postoperative opioid consumption over the first 24
hours. Secondary outcomes included pain scores at rest and during
coughing, rescue analgesia requirements, and opioid-related adverse
effects. Cumulative opioid consumption was significantly lower in the ESPB
group compared to the DPIPB+SAPB group (mean, 330.00 +/- 206.82 microg v
464.17 +/- 232.74 microg; p = 0.022). No significant differences were
observed in pain scores at the sternotomy or drain sites at rest or during
coughing at any time point (p > 0.05). Additionally, there were no
significant differences in rescue analgesic requirements or opioid-related
side effects between the 2 groups (p > 0.05). Conclusion(s): In
patients undergoing open-heart surgery through median sternotomy,
bilateral ESPB provided more effective opioid-sparing analgesia compared
to the combined DPIPB+SAPB technique, despite similar subjective pain
scores and side effect profiles. These findings support the broader
dermatomal spread and prolonged efficacy of ESPB, although both techniques
appear to be clinically effective as components of multimodal analgesia
strategies. Copyright © 2025

<6>
Accession Number
2040809646
Title
The Impact of Additional Exercise Interventions on Physical Performance
and Muscle Strength of Frail Patients After Open-Heart Surgery: A
Randomized Trial.
Source
Medicina (Lithuania). 61(10) (no pagination), 2025. Article Number: 1812.
Date of Publication: 01 Oct 2025.
Author
Stonkuviene V.; Kubilius R.; Lendraitiene E.
Institution
(Stonkuviene, Kubilius, Lendraitiene) Department of Rehabilitation,
Faculty of Nursing, Medical Academy, Lithuanian University of Health
Sciences, Kaunas, Lithuania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background and Objectives: Frail patients after open-heart surgery often
experience worse treatment outcomes in improving physical performance and
muscle strength. As the functional recovery of frail patients after
open-heart surgery is slower, conventional rehabilitation is frequently
insufficient to achieve treatment goals. Therefore, the inclusion of
additional exercise interventions in cardiac rehabilitation is becoming
more relevant. The aim of this study was to assess and compare the
effectiveness of additional exercise interventions-multicomponent and
computer-based programs-applied along with conventional cardiac
rehabilitation in improving the functional capacity and strength of frail
patients after open-heart surgery. Material(s) and Method(s): The
population of this single-center, three-arm, parallel-group, randomized
controlled trial comprised 153 frail patients aged more than 65 years who
underwent open-heart surgery. All patients were randomized into three
groups: control (CG, n = 51), intervention 1 (IG-1, n = 51), and
intervention 2 (IG-2, n = 51). All groups received conventional
rehabilitation program six times/week, while the IG-1 additionally
received the multicomponent dynamic training program 3 times/week, and the
IG-2, the combined computer-based program 3 times/week. The primary
outcome measure was change in the Short Physical Performance Battery
(SPPB) score. Secondary outcome measures included the 6 min walk distance
(6MWD), peak workload, grip strength, and leg press. Primary and secondary
outcome measures were assessed before and after cardiac rehabilitation.
 Result(s): A total of 138 patients completed rehabilitation (46 in
each group), and their data were included in the main analysis that
followed a per-protocol approach. Although significant differences in the
primary outcome-the SPPB score-were found in each group while performing
within-group comparisons (p < 0.001), no significant pre-to-post
rehabilitation differences were observed compared to all three groups (p =
0.939), and the effect sizes were small. Regarding secondary outcome
measures, within-group comparison revealed significant differences in all
parameters of all groups (p < 0.05), except for the grip strength of both
hands in the IG-1. Between-group comparisons showed that the pre-to-post
6MWD difference between the CG and the IG-1 was significant (p = 0.014),
but the effect size was small (ES = 0.240). Moreover, significant
pre-and-post leg press 1RM differences (p < 0.001) were found between the
CG and the IG-1 as well as between the CG and the IG-2 with the effect
sizes being moderate (ES = 0.480) and large (ES = 0.613), respectively.
 Conclusion(s): Within-group comparison showed that all three
rehabilitation programs are effective in improving almost all parameters
of physical performance and muscle strength in frail patients after
open-heart surgery. However, between-group comparisons indicated that
computer-based interventions were more effective in improving leg press
1RM with a large effect size, while multicomponent training resulted in
more effective gains in the 6MWD, although with a small effect size. These
findings suggest that in clinical practice, computer-based exercise
programs may be more suitable for patients with muscle weakness, while
multicomponent exercise programs may be for those with reduced
endurance. Copyright © 2025 by the authors.

<7>
Accession Number
2041280721
Title
Anti-inflammatory therapy for recurrent in-stent restenosis (AI-ISR):
study protocol for a prospective, randomised, open-label, multicentre
clinical trial.
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e092235. Date of
Publication: 27 Oct 2025.
Author
Yu M.; Jiang Y.; Song Z.; Wei Z.-Y.; Tan F.; Liu X.; Zhang X.; Zhu F.; Shi
Y.; Huang J.; Yang W.-X.; Qian H.-Y.
Institution
(Yu, Jiang, Song, Wei, Tan, Liu, Zhang, Zhu, Shi, Yang, Qian) State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Huang, Qian) Center for Coronary Artery Disease, Division of Cardiology,
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of
Heart, National Clinical Research Center for Cardiovascular Diseases,
Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Recurrent in-stent restenosis (RISR) remains a major
therapeutic challenge in patients undergoing percutaneous coronary
intervention (PCI), with a high incidence of repeat revascularisation and
increased mortality. Immune-mediated inflammation has been implicated in
the pathogenesis of RISR. This trial aims to evaluate the clinical
efficacy and safety of two anti-inflammatory strategies-low-dose
colchicine and prednisone-on reducing ISR recurrence and cardiovascular
events. Methods and analysis This is a multicentre, prospective,
randomised, open-label controlled trial enrolling 252 patients with RISR.
Following successful PCI, patients are randomly assigned (1:1:1) to
receive: (1) standard medical therapy (control group); (2) colchicine
0.5mg/day (colchicine group) or (3) prednisone 0.5mg/kg/day, tapered
monthly to 5-10mg/day over 12 months (prednisone group). All groups
receive background standard therapy per guidelines. The primary endpoint
is angiographically confirmed ISR of the target lesion at 12 months post
PCI. Secondary endpoints include the incidence of major adverse
cardiovascular and cerebrovascular events (cardiovascular death,
myocardial infarction, stroke and target vessel revascularisation), target
lesion revascularisation and revascularisation of non-target coronary
lesions within 12 months. Ethics and dissemination This trial has received
ethical approval from the Ethics Committee of Fuwai Hospital (Chinese
Academy of Medical Sciences and Peking Union Medical College), which acts
as the central institutional review board. All participants will provide
written informed consent. Study results will be disseminated via
peerreviewed journals and conference presentations. 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.

<8>
Accession Number
2041322197
Title
Long-term risks of adverse kidney outcomes after acute kidney injury: a
systematic review and meta-analysis.
Source
Nephrology Dialysis Transplantation. 40(11) (pp 2143-2158), 2025. Date of
Publication: 01 Nov 2025.
Author
Veltkamp D.M.J.; Porras C.P.; Gant C.M.; Groenestege W.M.T.; Kok M.B.;
Verhaar M.C.; Van Solinge W.W.; Haitjema S.; Vernooij R.W.M.
Institution
(Veltkamp, Porras, Gant, Verhaar, Vernooij) Department of Nephrology and
Hypertension, University Medical Center Utrecht, Utrecht University,
Utrecht, Netherlands
(Veltkamp, Groenestege, Van Solinge, Haitjema, Vernooij) Central
Diagnostic Laboratory, University Medical Center Utrecht, Utrecht
University, Utrecht, Netherlands
(Porras, Vernooij) Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht,
Netherlands
(Kok) Saltro BV, Unilabs Netherlands, Utrecht, Netherlands
Publisher
Oxford University Press
Abstract
Background. Acute kidney injury (AKI) is associated with increased risks
of incidence or progression of chronic kidney disease (CKD), kidney
failure (KF), or major adverse kidney events (MAKE), however, it remains
unclear which individuals have higher risks. Hence, we systematically
reviewed the literature to explore differences in kidney dysfunction risks
between AKI stages, AKI durations, and clinical settings. Methods. We
performed a systematic search in PubMed and Embase to identify studies
that examined at least one outcome of interest in individuals with AKI
versus without AKI, with a minimum follow-up of one year. Hazard/odds
ratios (HR/OR) were pooled using random effects models. Heterogeneity
across patient and disease characteristics was examined using subgroup and
meta-regression analyses. Results. We searched 70 studies, encompassing 1
838 668 individuals, including 165 715 with AKI. All studies were of
moderate to high quality. Individuals with AKI had higher risks of CKD
incidence [AKI 25.8%/no AKI 8.7%; HR 2.36 [95% confidence interval (CI)
1.77-2.94)]], CKD progression [AKI 43.1%/no AKI 35.6%; HR 1.83 (95%CI
1.26-2.40)], KF [AKI 2.9%/no AKI 0.5%; HR 2.64 (95%CI 2.03-3.25)], and
MAKE [AKI 59.0%/no AKI 32.7%; OR 2.77 (95%CI 2.01-3.53)]. The pooled
effect estimates for CKD incidence after AKI lasting <3 days remained
significant [OR 2.37 (95%CI 1.68-3.07)], even in individuals with AKI
stage 1 only [HR 1.49 (95%CI 1.44-1.55)]. Diabetes mellitus, hypertension,
requiring acute dialysis, cardiovascular surgery, or coronary artery
disease were associated with higher CKD incidence or progression risks.
Conclusions. Risks for kidney dysfunction were higher for all individuals
with AKI. Risk estimates were heterogeneous between patient subgroups,
based on AKI stage, AKI duration, and clinical setting, yet even
individuals with the lowest stage or shortest duration of AKI remained at
higher risk for CKD incidence or progression. This highlights the need to
develop tailored follow-up strategies to recognize kidney function decline
post-AKI and initiate kidney protective measures in a timely
fashion. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the ERA.

<9>
Accession Number
2034368011
Title
Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New-Onset
Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A
Randomized Clinical Trial.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 29(4) (pp 284-290),
2025. Date of Publication: 01 Dec 2025.
Author
Alhadidy M.A.; Alansary A.M.; Elghareeb S.H.
Institution
(Alhadidy, Alansary, Elghareeb) Department of Anesthesiology, ICU and Pain
Management, Ain Shams University, Cairo, Egypt
Publisher
SAGE Publications Inc.
Abstract
Objective: Postoperative atrial fibrillation (POAF) occurs in 20%-40% of
patients following coronary artery bypass grafting (CABG), contributing to
significant morbidity. POAF is linked to elevated catecholamines,
oxidative stress, and inflammatory mediators. Dexmedetomidine, a centrally
acting alpha-2 agonist with sympatholytic and anti-inflammatory effects,
and hydrocortisone, which suppresses inflammatory mediators, may reduce
the incidence of POAF. Method(s): A prospective, double-blind
randomized controlled trial was conducted on 248 patients undergoing
elective on-pump CABG at Ain Shams University Hospital. Patients were
randomized into 2 groups: the Treatment Group received dexmedetomidine and
hydrocortisone, and the Placebo Group received standard care. The primary
endpoint was the occurrence of POAF within 7 days postoperatively.
 Result(s): All 248 patients (124 per group) completed the study. The
combined use of dexmedetomidine and hydrocortisone reduced POAF incidence
(4.8% vs 12.9%). ICU and hospital length of stay were also shorter in the
Treatment Group (2.77 +/- 1.12 vs 3.16 +/- 1.34 days, P = .012, and 6.63
+/- 1.56 vs 7.11 +/- 2 days, P = .035, respectively). No differences in
hypotension, bradycardia, or wound infections were observed.
Hyperglycemia, defined as blood glucose >180 mg/dl, occurred in 8.1% of
the Treatment Group and 6.5% of the Placebo Group. Conclusion(s):
Combining dexmedetomidine and hydrocortisone effectively reduces POAF
incidence after CABG, with manageable side effects. Multicenter trials are
warranted to confirm these findings. Date and Number of IRB Approval and
Clinical Trial Registry Number. Ain Shams University Protocol Record
(FMASU R 261/2022), ClinicalTrials.gov Identifier:
NCT05674253. Copyright © The Author(s) 2025

<10>
Accession Number
2035692568
Title
Effect of dual direct and alternating currents on pain induced by blood
sampling and intramuscular injection processes.
Source
Pain Management. 15(11) (pp 807-818), 2025. Date of Publication: 2025.
Author
Ezzati E.; Mahooti R.; Mohammadi S.; Kavyannejad R.
Institution
(Ezzati, Mohammadi) Department of Anesthesiology, School of Paramedical,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
(Mahooti) Emam Khomeini Hospital, Kermanshah University of Medical
Sciences, Kermanshah, Iran, Islamic Republic of
(Kavyannejad) Department of Physiology, School of Medicine, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
Publisher
Taylor and Francis Ltd.
Abstract
Objective: This study investigates the effects of cathodal, anodal, and
intermittent electrical stimulation on pain intensity associated with
arterial blood sampling, venous blood sampling, and intramuscular
injection. Method(s): In a triple-blind clinical trial, 160 patients
requiring arterial, venous blood sampling, and intramuscular injection
were randomly divided into four groups. Three intervention groups received
5 mA anodal, cathodal direct, or alternating currents during the
procedure, while the control group received only a topical eutectic
mixture of local anesthetics (EMLA). Pain intensity was measured using the
visual analog scale (VAS) immediately after the procedure, while procedure
duration, number of attempts, and heart rate changes were recorded as
secondary outcome. Result(s): All forms of electrical stimulation
significantly reduced procedural pain compared to EMLA. Cathodal direct
current demonstrated the greatest analgesic effect, with mean VAS score
reductions of 2-3 points across all procedures. The time required for
arterial blood sampling in the cathodal group was significantly less than
with EMLA, while no difference was observed in the procedure time and
frequency of attempts in other processes. Furthermore, electrical
stimulation groups, particularly the cathodal mode, exhibited lower
post-procedure heart rates, suggesting attenuated physiological stress
responses. Conclusion(s): We found that applying electric currents
during the procedure reduces the pain of blood sampling or injections. The
greatest analgesia was observed with cathodal direct current stimulation
compared to other groups. Clinical trial registration: Date of
registration: 27 January 2024. Clinical Trials.gov Identifier:
IRCT20240123060780N1. URL:
https://irct.behdasht.gov.ir/trial/75119. Copyright © 2025
Informa UK Limited, trading as Taylor & Francis Group.

<11>
Accession Number
2041273117
Title
No-touch versus conventional saphenous vein harvesting technique in
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2025. Article
Number: 02184923251388804. Date of Publication: 2025.
Author
Harta I.K.A.P.; Pertiwi P.F.K.; Sudarma I.W.; Yasa K.P.
Institution
(Harta, Sudarma, Yasa) Cardiothoracic and Vascular Surgery Division,
Department of Surgery, Faculty of Medicine, Udayana University, Bali,
Indonesia
(Harta, Pertiwi, Sudarma, Yasa) Prof. Dr I.G.N.G. Ngoerah General
Hospital, Bali, Indonesia
(Pertiwi) Faculty of Medicine, Udayana University, Bali, Indonesia
Publisher
SAGE Publications Inc.
Abstract
Background: The saphenous vein graft (SVG) remains widely used in coronary
artery bypass grafting (CABG). The no-touch (NT) technique offers
atraumatic procedures in vein harvesting. Its effectiveness is still
compared to conventional (CON) methods. Method(s): We conducted a
systematic review using electronic databases, focusing on studies that
compared the NT and CON techniques in CABG. The primary outcomes assessed
were major adverse cardiac and cerebrovascular events (MACCE), graft
patency, and leg complications. Kaplan-Meier estimates and the Cox
proportional hazards model were used to analyze MACCE-free survival. This
study has been registered on PROSPERO(CRD42024553619). Result(s): A
total of seven studies, including three randomized controlled trials and
four prospective cohort studies, encompassing 3859 patients, were included
in the analysis. The NT technique showed significantly higher overall
graft patency (OR 1.59; 95% CI 1.18-2.15; p < 0.001; I2 = 49%),
especially in the right coronary artery (OR 1.63; 95% CI 1.25-2.13; p <
0.001; I2 = 0%). However, the NT technique had a higher
incidence of leg complications (OR 2.49; 95% CI 1.73-3.60; p < 0.001;
I2 = 10%). No significant difference in 3-year MACCE-free
survival (log-rank p = 0.47). Conclusion(s): The NT SVG harvesting
technique has the potential to improve patency rates, especially when
utilized as a conduit to the right coronary artery
territory. Copyright © The Author(s) 2025

<12>
Accession Number
2035310142
Title
Resveratrol improves lipid profile and recovers heart function in
postoperative CABG patients.
Source
Molecular and Cellular Biochemistry. 480(11) (pp 5793-5803), 2025. Date of
Publication: 01 Nov 2025.
Author
Ahmadi P.; Akbarzadeh S.; Alizadeh M.; Mohammadi N.; Mahmoodi M.; Amini
A.; Netticadan T.; Rezaei M.; Movahed A.
Institution
(Ahmadi, Mohammadi) Bushehr University of Medical Sciences, Bushehr, Iran,
Islamic Republic of
(Akbarzadeh, Alizadeh, Movahed) Department of Clinical Biochemistry,
Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr,
Iran, Islamic Republic of
(Mahmoodi) Department of Biostatistics and Epidemiology, Addiction and
Lifestyle Research Center, Bushehr University of Medical Sciences,
Bushehr, Iran, Islamic Republic of
(Amini) Department of Internal Medicine, Faculty of Medicine, Bushehr
University of Medical Sciences, Bushehr, Iran, Islamic Republic of
(Netticadan) Canadian Centre for Agri-Food Research in Health and
Medicine, Winnipeg, Canada
(Rezaei) Department of Cardiovascular Surgery, Faculty of Medicine,
Bushehr University of Medical Sciences, Bushehr, Iran, Islamic Republic of
Publisher
Springer
Abstract
Cardiovascular diseases (CVD), especially coronary artery disease (CAD),
are among the most important causes of mortality in the world. Coronary
artery bypass grafting (CABG) is a standard treatment for this disease,
but it may be associated with complications in the postoperative period.
This study investigated the effect of resveratrol (RES), a potent
antioxidant and anti-inflammatory molecule, on cardiovascular indices and
oxidative stress in patients after CABG surgery. This randomized,
double-blind, placebo-controlled trial was carried out at the Bushehr
Heart Center in Bushehr, Iran. A total of 60 patients undergoing CABG were
randomly assigned in equal numbers to either the intervention group or the
control group. The intervention group received RES capsules for 60 days,
and the control group received a placebo for the same duration.
Cardiovascular function and biochemical parameters, including lipid
profile, cardiac enzymes, and markers of oxidative stress and
inflammation, were measured at the beginning and end of the intervention.
Compared to the control group, RES intake significantly reduced systolic
blood pressure (SBP), triglyceride (TG), total cholesterol (TC),
low-density lipoprotein (LDL), and improved ejection fraction (EF).
Although decreases in cardiac enzymes, including creatine phosphokinase
(CPK) and lactate dehydrogenase (LDH), were observed in the RES group,
these changes were not statistically significant. Also, the two groups
showed no significant differences in diastolic blood pressure (DBP), HDL,
or oxidative stress markers. RES supplementation protects patients after
CABG by improving cardiovascular function and lipid profiles. Trial
registration: IRCT20111119008129N12, first trial registration date:
2022-06-18. Copyright © The Author(s), under exclusive licence to
Springer Science+Business Media, LLC, part of Springer Nature 2025.

<13>
Accession Number
2035773512
Title
Echocardiographic and Clinical Outcomes of Concomitant Secondary Chordal
Cutting to Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A
Systematic Review and Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. 73(7) (pp 519-528), 2025. Date of
Publication: 01 Oct 2025.
Author
Heeringa T.J.P.; Hegeman R.R.M.J.J.; Houwelingen L.V.; Hoogewerf M.;
Stecher D.; Kelder J.C.; Harst P.V.D.; Swaans M.J.; Mokhles M.M.; Vaartjes
I.; Klein P.; Van Der Kaaij N.P.
Institution
(Heeringa, Houwelingen, Hoogewerf, Mokhles, Van Der Kaaij) Department of
Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht,
Netherlands
(Hegeman, Klein) Department of Cardiothoracic Surgery, St Antonius
Hospital, Nieuwegein, Utrecht, Netherlands
(Stecher) Department of Cardiothoracic Surgery, Medical Centre Leeuwarden,
Fryslan, Leeuwarden, Netherlands
(Kelder) Department of Clinical Epidemiology, St Antonius Hospital,
Nieuwegein, Utrecht, Netherlands
(Harst) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Swaans) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Utrecht, Netherlands
(Vaartjes) Department of Cardiovascular Epidemiology, Julius Center for
Health Sciences and Primary Care, Utrecht, Netherlands
(Klein) Department of Cardiothoracic Surgery, Amsterdam University Medical
Centres, Noord-Holland, Amsterdam, Netherlands
(Van Der Kaaij) Department of Cardiothoracic Surgery, Erasmus Medical
Centre, Zuid-Holland, Rotterdam, Netherlands
Publisher
Georg Thieme Verlag
Abstract
In patients who underwent surgical myectomy for hypertrophic obstructive
cardiomyopathy (HOCM), additional mitral valve repair may offer additional
benefits in terms of further reducing left ventricular outflow tract
(LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation
(MR). We performed a systematic review of the literature to evaluate the
evidence of surgical myectomy with additional secondary chordal cutting in
patients with HOCM. A systematic literature search in MEDLINE and EMBASE
was performed until April 2024. The primary outcome studied was
postoperative echocardiographic LVOT gradient. A random effects
meta-analysis of means was performed for the primary outcome. The
secondary outcomes studied were postoperative residual MR grade, 30-day
new permanent pacemaker implantation, and in-hospital mortality. From
1,911 unique publications, a total of 6 articles fulfilled the inclusion
criteria and comprised 471 patients with a pooled mean preoperative
resting LVOT gradient of 84 mm Hg (95% confidence interval [CI]: 76-91).
The postoperative pooled mean LVOT gradient was 11 mm Hg (95% CI: 10-12)
with a low heterogeneity (I 2= 44%). The residual LVOT gradient
exceeding 30 mm Hg was present in nine (1%) patients. MR grade 3 or 4 at
hospital discharge was present in seven (1%) patients. The 30-day new
permanent pacemaker implantation rate was 7% and the in-hospital mortality
was 0.4%. This systematic review and meta-analysis demonstrate that
combining surgical myectomy with secondary chordal cutting can be
performed safely and effectively eliminate LVOT obstruction in HOCM
patients. Further studies are needed to determine the additive
effectiveness of additional secondary chordal cuttings. Copyright
© 2025 Georg Thieme Verlag. All rights reserved.

<14>
Accession Number
2040789732
Title
Effectiveness of integrated nurse-physician management in post-PCI
coronary heart disease patients: an analysis based on follow-up data.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1571953. Date of Publication: 2025.
Author
Qiu X.; Ren S.
Institution
(Qiu) School of Nursing, Henan Technical Institute, Henan, Zhengzhou,
China
(Ren) Interventional Operating Room, The Third People's Hospital of Henan
Province, Henan, Zhengzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Post-PCI patients often require coordinated secondary
prevention and education. We evaluated whether an integrated
nurse-physician management program improves health behaviors, disease
knowledge, angina-related health status, and cardiac function vs. routine
care. Method(s): In a single-center, retrospective, non-randomized
cohort, adults after PCI received either an integrated program or routine
care. Outcomes were assessed at baseline, 1 month, and 3 months and
included: Health-Promoting Lifestyle Profile II (HPLP-II), Coronary Artery
Disease Education Questionnaire-Short Version (CADE-Q SV), Seattle Angina
Questionnaire (SAQ-overall), echocardiographic indices (e.g., LVEF, LVFS),
and physiological/biochemical markers (SBP, DBP, BMI, triglycerides, LDL).
The primary endpoint was change in SAQ-overall from baseline to 3 months.
Linear mixed-effects models with fixed effects for group, time, and group
x time and a subject-level random intercept estimated estimated marginal
means (EMMs) and the between-group difference-in-change (DELTADELTA) with
95% CIs. Multiplicity was controlled using Holm adjustment within
prespecified outcome families. Per-timepoint Welch's t-tests and
within-group paired t-tests served as sensitivity analyses.
 Result(s): 128 patients were analyzed (64 integrated; 64 routine). At
3 months, the integrated program produced a significantly greater
improvement in SAQ-overall vs. routine care (DELTADELTA favoring
integrated). HPLP-II and CADE-Q SV also improved more with the integrated
program, and echocardiographic indices showed a significant group x time
effect consistent with better recovery in the integrated group.
Physiological/biochemical markers exhibited mixed patterns: both groups
showed within-group reductions in SBP/DBP, triglycerides, and LDL, while
BMI decreased modestly and non-significantly in the observation group but
reached significance in the control group. Findings were directionally
robust in sensitivity analyses. Conclusion(s): Over 3 months
post-PCI, integrated nurse-physician management improved patient-reported
outcomes and cardiac function beyond routine care, while changes in
physiological/biochemical markers were variable. These results support
integrating structured nursing-led secondary prevention and education into
routine post-PCI management and warrant confirmation in prospective
randomized studies. Copyright 2025 Qiu and Ren.

<15>
Accession Number
2037260744
Title
Effect of Complete Revascularization in STEMI: Ischemia-Driven
Rehospitalization and Cardiovascular Mortality.
Source
Journal of Clinical Medicine. 14(13) (no pagination), 2025. Article
Number: 4793. Date of Publication: 01 Jul 2025.
Author
Sustersic M.; Bunc M.
Institution
(Sustersic, Bunc) Department of Cardiology, University Medical Centre
Ljubljana, Zaloska 7, Ljubljana, Slovenia
(Bunc) Institute of Pathological Physiology, Medical Faculty, University
of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) and
multivessel coronary artery disease (MVD) who undergo complete
revascularization (CR) have a more favorable prognosis than those who
receive incomplete revascularization (IR), as evidenced by recent
randomized controlled trials. Despite the absence of a survival benefit
associated with CR in these trials, positive outcomes were ascribed to
combined endpoints, such as repeat revascularization, myocardial
infarction, or ischemia-driven rehospitalization. In light of the
significant burden that rehospitalization from STEMI imposes on healthcare
systems, we examined the long-term effects of CR on ischemia-driven
rehospitalization and cardiovascular (CV) mortality in STEMI patients with
MVD. Method(s): In our retrospective study, we included patients with
STEMI and MVD who underwent successful primary percutaneous coronary
intervention (PCI) at the University Medical Centre Ljubljana between 1
January 2009, and 11 April 2011. The combined endpoint was ischemia-driven
rehospitalization and CV mortality, with a minimum follow-up period of six
years. Result(s): We included 235 participants who underwent CR (N =
70) or IR (N = 165) at index hospitalization, with a median follow-up time
of 7 years (interquartile range 6.0-8.2). The primary endpoint was
significantly higher in the IR group than in the CR group (47.3% vs.
32.9%, log-rank p = 0.025), driven by CV mortality (23.6% vs. 12.9%,
log-rank p = 0.047), as there was no difference in ischemia-driven
rehospitalization rate (log-rank p = 0.206). Ischemia-driven
rehospitalization did not influence CV mortality in the CR group (p =
0.49), while it significantly impacted CV mortality in the IR group (p =
0.03). After adjusting for confounders, there were no differences in CV
mortality between CR and IR groups (p = 0.622). Predictors of the combined
endpoint included age (p = 0.014), diabetes (p = 0.006), chronic kidney
disease (CKD) (p = 0.001), cardiogenic shock at presentation (p = 0.003),
chronic total occlusion (CTO) (p = 0.046), and ischemia-driven
rehospitalization (p = 0.0001). Significant risk factors for the combined
endpoint were cardiogenic shock at presentation (p < 0.001), stage 4
kidney failure (p = 0.001), age over 70 years (p = 0.004), female gender
(p = 0.008), and residual SYNTAX I score > 5.5 (p = 0.017).
 Conclusion(s): Patients with STEMI and MVD who underwent CR had a
lower combined endpoint of ischemia-driven rehospitalizations and CV
mortality than IR patients, but after adjustments for confounders, the
true determinants of the combined endpoint and risk factors for the
combined endpoint were independent of the revascularization
method. Copyright © 2025 by the authors. Licensee MDPI, Basel,
Switzerland.

<16>
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.

<17>
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.

<18>
Accession Number
2041273518
Title
Comparative efficacy and safety of prothrombin complex concentrate versus
fresh frozen plasma in cardiac surgery: A meta-analysis of randomized
controlled trials.
Source
Perfusion (United Kingdom). (no pagination), 2025. Article Number:
02676591251390674. Date of Publication: 2025.
Author
Khan T.M.; Khan G.T.; Ahmed M.; Uddin M.S.; Ali D.
Institution
(Khan, Khan, Ahmed, Uddin, Ali) Department of Medicine, Dow University of
Health Sciences, Karachi, Pakistan
Publisher
SAGE Publications Ltd
Abstract
Background: Postoperative bleeding due to acquired coagulopathy is a
common and serious complication following cardiac surgery. Fresh frozen
plasma (FFP) and prothrombin complex concentrate (PCC) are the principal
therapies used to correct coagulopathy in this setting. However, their
comparative effectiveness and safety remain uncertain. Method(s):
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials
were systematically searched through March 2025 to identify randomized
controlled trials (RCTs) comparing PCC and FFP in adult cardiac surgery
patients with postoperative coagulopathy. All analyses were performed
using Review Manager (Version 5.4; Copenhagen: The Nordic Cochrane Centre,
The Cochrane Collaboration, 2020). Result(s): Four RCTs including a
total of 671 patients were eligible for inclusion. Compared to FFP, PCC
was associated with significantly lower chest tube drainage volume (mean
difference [MD], -162.14; 95% CI: -264.47 to -59.81 mL; P = 0.002;
I2= 49%), reduced RBC transfusion rate (risk ratio [RR], 0.77;
95% CI: 0.65 to 0.91; P = 0.002; I2= 27%), and fewer mean RBC
units administered (MD, -0.86 units; 95% CI: -1.23 to -0.49 units; P <
0.001; I2= 0%). No significant differences were found between
groups in the rates of reoperation for bleeding, thromboembolic events,
stroke or transient ischemic attack, acute kidney injury, or mortality.
Length of stay in the intensive care unit and hospital were also
comparable between groups. Conclusion(s): PCC demonstrates superior
hemostatic efficacy compared to FFP in adult cardiac surgery patients,
while maintaining a comparable safety profile. These findings support its
use as a more effective and practical alternative for managing
postoperative coagulopathy in this population. Copyright © The
Author(s) 2025

<19>
Accession Number
2041283516
Title
Improvements in cardiac geometry following bariatric surgery in
adolescents help to address important knowledge gaps.
Source
Cardiology in the Young. (no pagination), 2025. Date of Publication:
2025.
Author
Michalsky M.
Institution
(Michalsky) Nationwide Children's Hospital, The Ohio State University,
College of Medicine, Columbus, United States
Publisher
Cambridge University Press
Abstract
US data from the National Health and Nutrition Examination Survey
estimates that the prevalence of obesity among US adolescents (ages 12-19)
has reached 22.9% of the paediatric population, with nearly 9% meeting
criteria for severe obesity (body mass index >=120% of the 95th percentile
or >=35 kg/m2). These alarming figures underscore the
cumulative impact of paediatric obesity, including established
associations with impaired cardiometabolic health. The study "Cardiac
Geometry Alterations Following Bariatric Surgery in Severely Obese
Adolescents: A One-Year Follow-Up Study of a Randomized Controlled Trial"
advances this understanding by comparing lifestyle intervention alone
versus lifestyle therapy in combination with the application of bariatric
surgery (e.g. laparoscopic adjustable gastric banding). As the first
prospective randomised trial to assess cardiac geometric and following
adolescent metabolic and bariatric surgical intervention, the findings
demonstrate significant improvements in cardiac geometry among surgical
participants, suggesting partial reversal of obesity-related cardiac
remodelling. While these short-term results are encouraging, durability
remains uncertain given the study's small sample size and previous reports
of significant weight regain and higher-than-expected complication rates
following gastric banding. Considerations for future investigational
designs should incorporate an expanded age range with regards to overall
eligibility as well as bariatric procedures other than the gastric band,
that offer long-term weight loss (i.e., vertical sleeve gastrectomy and
gastric bypass). Longer-term and comprehensive follow-up will be critical
to delineate the longitudinal cardiometabolic outcomes of surgical versus
medical interventions for severe adolescent obesity. Copyright ©
The Author(s), 2025. Published by Cambridge University Press.

<20>
Accession Number
2040773683
Title
Perioperative plasma lidocaine concentrations and their impact on pain
control. A systematic review and meta-analysis.
Source
Pain Management. (no pagination), 2025. Date of Publication: 2025.
Author
Foong K.W.; Lo Y.L.; Chaw S.H.; Loh P.S.
Institution
(Foong, Chaw, Loh) Department of Anaesthesiology, Faculty of Medicine,
Universiti Malaya, Kuala Lumpur, Malaysia
(Lo) Department of Pharmacy Practice, School of Pharmacy, IMU University,
Kuala Lumpur, Malaysia
Publisher
Taylor and Francis Ltd.
Abstract
Aim: To review the relationship between drug concentrations of
perioperative intravenous lidocaine and their analgesic effects.
 Method(s): We systematically searched SCOPUS, Medline, EMBASE,
CENTRAL, and Web of Science (inception to March 2024) for randomized
controlled trials comparing intraoperative lidocaine to placebo or control
in adults undergoing non-cardiac surgery. Studies reported pain outcomes
and plasma lidocaine concentrations. Bias was assessed using the Cochrane
risk-of-bias tool, and data was analyzed with a random-effects model to
determine mean difference (MD) and 95% confidence intervals (CI).
 Result(s): Fifteen studies (445 lidocaine, 453 control patients) were
included. Lidocaine lowered post-anesthetic care unit (PACU) opioid use (8
studies, MD: -3.00, 95% CI [-5.00, -1.01], p = 0.0092, I2 =
57%), with meta-regression indicating greater reduction at higher plasma
concentrations (regression coefficient: -3.05, 95% CI [-4.48, -1.61], p =
0.002). However, 11 studies found no significant difference in 24-hour
postoperative opioid consumption or pain scores. Nausea and vomiting
incidence were similar between groups, and a few patients experienced
lidocaine-related adverse events. Conclusion(s): Perioperative
lidocaine infusion reduces PACU opioid consumption, with greater effects
at higher concentrations, although significant heterogeneity was noted.
Further research is needed to identify optimal concentrations for
clinically significant analgesic benefits. Protocol Registration:
International Platform of Registered Systematic Review and Meta-analysis
Protocols (INPLASY) ID: INPLASY202180046, DOI:
10.37766/inplasy2021.8.0046. Copyright © 2025 Informa UK Limited,
trading as Taylor & Francis Group.

<21>
Accession Number
2040742794
Title
Effect of combined dexmedetomidine with ropivacaine in transversus
thoracis plane block on surgical stress response during cardiopulmonary
bypass surgery: a randomized controlled trial.
Source
Frontiers in Cardiovascular Medicine. 12 (no pagination), 2025. Article
Number: 1638373. Date of Publication: 2025.
Author
Huang L.; Chen Y.; Xu X.; Zeng F.; Li C.; Fu H.
Institution
(Huang, Chen, Zeng, Li, Fu) Department of Anaesthesiology, Longyan First
Affiliated Hospital of Fujian Medical University, Longyan, China
(Xu) Department of Laboratory Medicine, Longyan First Affiliated Hospital
of Fujian Medical University, Longyan, China
Publisher
Frontiers Media SA
Abstract
Objective: To examine how patients having open heart surgery under
cardiopulmonary bypass (CPB) react to surgical stress following bilateral
transversus thoracis plane (TTP) block with ropivacaine improved by
dexmedetomidine (DEX). Method(s): Three groups of sixty patients
(26M/34F, ASA II-III, 18-65 years old) slated for elective CPB heart
surgery were randomly assigned: general anesthesia alone (Group C), TTP
(ropivacaine) combined with general anesthesia group (Group R), or TTP
(ropivacaine + DEX) combined with general anesthesia group (Group RD).
Primary outcomes measured serum cortisol levels at five perioperative
phases, while the secondary outcomes included glucose/C-reactive protein
(CRP) levels, Numeric Rating Scale (NRS) pain scores postextubation, 48-hr
sufentanil consumption, patient-controlled analgesia (PCA) demand
frequency, rescue analgesia rates, mechanical ventilation duration, ICU
stay, and complications. Result(s): At 24 h postoperatively, RD and R
groups exhibited statistical lower serum cortisol levels compared to
controls (p < 0.05), with parallel glucose reductions. However, the CRP
level increased significantly. NRS scores in RD/R groups were
significantly lower than controls at 0 h, 6 h, and 12 h postextubation (p
< 0.05), and the RD group maintained superior analgesia vs. both groups at
24 h. RD and R groups demonstrated significant reductions for 48-h
sufentanil consumption vs. controls, and RD group showed less total
sufentanil consumption vs. R group. Besides, both mechanical ventilation
duration and ICU stay were shortened by serval hours compared to control.
Significant reductions in the count of effective analgesic pump
compressions were observed in groups R and RD compared to the control
group. Moreover, rescue analgesia rates were 55%, and 15% lower in RD vs.
R and Control groups, respectively (p = 0.031). However, no intergroup
differences occurred pulmonary complications. Conclusion(s):
DEX-enhanced TTP blockade may contribute to attenuating the stress
response, optimizing analgesia, and improving early postoperative recovery
parameters in CPB cardiac surgery through opioid-sparing mechanisms and
sympatholytic effects, demonstrating clinical viability within Enhanced
Recovery After Surgery (ERAS) protocols. Clinical Trial Registration:
https://www.chictr.org.cn/index.html, identifier
ChiCTR2400085899. Copyright 2025 Huang, Chen, Xu, Zeng, Li and Fu.

<22>
Accession Number
2040637085
Title
Prognostic Value of Myocardial T1 Mapping and Extracellular Volume
Fraction in Heart Failure: A Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 18(11) (pp 1203-1217), 2025. Date of
Publication: 01 Nov 2025.
Author
Zhang H.; Yang W.; Zhou D.; Wang Y.; Zhu L.; Jiang M.; Zhang Q.;
Sirajuddin A.; Arai A.E.; Zhao S.; Lu M.
Institution
(Zhang, Yang, Zhou, Wang, Zhu, Jiang, Zhao, Lu) Department of Magnetic
Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular
Disease, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Zhang) Oxford Centre for Clinical Magnetic Resonance Research, John
Radcliffe Hospital, National Institute for Health Research Oxford
Biomedical Research Centre, Oxford British Heart Foundation Centre of
Research Excellence, University of Oxford, Oxford, United Kingdom
(Sirajuddin) Department of Health and Human Services, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, MD,
United States
(Arai) Division of Cardiovascular Medicine and Department of Radiology,
University of Utah School of Medicine, Salt Lake City, UT, United States
(Lu) Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: Heart failure (HF) is a global health burden. Myocardial
fibrosis is a crucial promotor in HF progression which can be
characterized noninvasively by cardiac magnetic resonance T1 mapping.
 Objective(s): This study aims to systemically evaluate the prognostic
value of myocardial T1 mapping and extracellular volume fraction (ECV)
covering the entire spectrum of HF through a meta-analysis.
 Method(s): We searched PubMed, Web of Science, and SCOPUS for studies
examining the prognostic value of T1 mapping in HF with reduced and
preserved ejection fraction. Baseline level, mean difference, and HRs were
pooled for meta-analysis. Subgroup analyses were conducted according to HF
subtypes and clinical characteristics. Result(s): Nineteen studies
with 5,384 patients (56.2% male) were included in the analysis. Patients
with adverse outcomes (mortality, HF-related event, or composite outcome)
had higher native T1 and ECV values than those without (weighted mean
difference: 41.17 ms and 4.73%, respectively). Both native T1 and ECV were
positively associated with endpoints for the entire HF group (HR of 1%
increase in ECV: 1.20 [95% CI: 1.13-1.28]; HR of >1% increase: 1.56 [95%
CI: 1.40-1.75]; HR binary: 2.62 [95% CI: 2.07-3.32]; HR of 1-ms increase
in native T1: 1.02 [95% CI: 1.01-1.03]; HR of >=10-ms increase: 1.08 [95%
CI: 1.05-1.11]; HR binary: 2.93 [95% CI: 2.03-4.23], all P < 0.05). For
subgroup cohorts, native T1 had no significant prognostic value in HF with
preserved ejection fraction (P > 0.05). Younger patients with HF with
severe cardiac insufficiency (NYHA functional class III-IV), persistently
increasing ECV, or negative late enhancement who exhibited abnormal T1
mapping were at higher risk of adverse outcomes. Conclusion(s): ECV
has consistent prognostic implications across HF spectrum, regardless of
HF types, clinical characteristics, and various etiology. Native T1 is
less predictive than ECV, particularly in HF with preserved ejection
fraction. Copyright © 2025 American College of Cardiology
Foundation

<23>
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.

<24>
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.

<25>
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).

<26>
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.

<27>
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).

<28>
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.

<29>
Accession Number
2040703738
Title
Impact of left ventricular unloading timing on clinical outcomes in
venoarterial extracorporeal membrane oxygenation: an updated systematic
review and meta-analysis.
Source
BMC Cardiovascular Disorders. 25(1) (no pagination), 2025. Article Number:
759. Date of Publication: 01 Dec 2025.
Author
Peng S.; Li Z.; Wang S.; Lu Z.; Huang H.; Chang S.; Meng Y.; Zhang Y.
Institution
(Peng, Li, Huang, Chang, Meng, Zhang) Surgery ICU, Cardiac surgery, Fuwai
Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China
(Wang, Lu) Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
Publisher
BioMed Central Ltd
Abstract
Background: The optimal timing of left ventricular unloading in patients
with cardiogenic shock receiving venoarterial extracorporeal membrane
oxygenation therapy remains controversial. This systematic review
evaluated the latest evidence on the impact of left ventricular unloading
timing in patients with cardiogenic shock receiving venoarterial
extracorporeal membrane oxygenation. Method(s): The PubMed, Embase
and Cochrane Library databases were searched from inception to February
2025. The identified studies were screened based on predefined inclusion
and exclusion criteria, and eligible studies were subjected to quality
assessment and data extraction. Heterogeneity testing and meta-analysis
were performed using Review Manager software version 5.4. Result(s):
Eight studies involving 2,117 patients (proactive unloading, 1,338;
passive unloading, 779) were included in the meta-analysis, which revealed
no statistically significant differences in extracorporeal membrane
oxygenation weaning rates (relative risk = 1.06, 95% confidence interval:
0.87-1.28; P = 0.59), in-hospital mortality (relative risk = 0.95, 95%
confidence interval: 0.86-1.04; P = 0.28), or 30-day all-cause mortality
(relative risk = 0.75, 95% confidence interval: 0.52-1.10; P = 0.14)
between the proactive and passive unloading groups. However, the risks of
sepsis (relative risk = 0.79, 95% confidence interval: 0.64-0.96; P =
0.02) and abdominal complications (relative risk = 0.67, 95% confidence
interval: 0.46-0.96; P = 0.03) were lower following proactive unloading
than following passive unloading. Conclusion(s): Compared to passive
left ventricular unloading, proactive left ventricular unloading did not
confer significant benefits in terms of extracorporeal membrane
oxygenation weaning success or short-term survival outcomes, but was
associated with reduced risks of sepsis and abdominal complications.
Registration: The review protocol was registered in PROSPERO (ID:
CRD42024499028). Copyright © The Author(s) 2025.

<30>
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.

<31>
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.

<32>
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.

<33>
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.

<34>
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.

<35>
Accession Number
2032189518
Title
Sodium-glucose co-transporter 2 inhibitors in left ventricular assist
device and heart transplant recipients: a mini-review.
Source
Heart Failure Reviews. 30(2) (pp 327-335), 2025. Date of Publication: 01
Mar 2025.
Author
Alyaydin E.; Parianos D.; Hermes-Laufer J.; Nagele M.P.; Castro L.;
Papathanasiou M.; Reinecke H.; Flammer A.J.
Institution
(Alyaydin, Parianos, Hermes-Laufer, Nagele, Flammer) Department of
Cardiology, University Hospital Zurich, Zurich, Switzerland
(Castro) Department of Cardiovascular Surgery, University Heart and
Vascular Center Hamburg, Hamburg, Germany
(Papathanasiou) Department of Cardiology, Angiology and Intensive Care
Medicine, Goethe University Hospital, Frankfurt, Germany
(Reinecke) Department of Cardiology I-Coronary and Peripheral Vascular
Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
Publisher
Springer
Abstract
In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i)
emerged as promising therapeutic agents in managing heart failure (HF).
They demonstrated a significant impact on reducing HF hospitalizations and
related mortality in patients with reduced and preserved ejection
fraction. However, evidence supporting their use in patients with left
ventricular assist device (LVAD) and heart transplant (HT) recipients is
still limited. We identified six key studies investigating the safety and
efficacy of SGLT2i in LVAD and HT recipients. In patients with LVAD,
prescription of SGLT2i was predominantly associated with improved fluid
management and reduced pulmonary artery pressures. However, the results
regarding their effects on body weight, hemoglobin A1c, diuretic use, and
right ventricular function were contradictory. In terms of safety, SGLT2i
were generally well-tolerated in the LVAD population, and the reported
incidence of adverse events was low. In HT recipients, SGLT2i were
associated with better glycemic control and weight reduction. No relevant
adverse events were reported. Despite these encouraging results, the
long-term safety and efficacy of SGLT2i in these vulnerable patient
populations are yet to be investigated. Future randomized controlled
trials are needed to address existing gaps in evidence and help integrate
SGLT2i into clinical practice for LVAD and HT recipients. Copyright
© The Author(s) 2024.

<36>
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.

<37>
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

<38>
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.

<39>
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.

<40>
Accession Number
648992149
Title
Initial placement of TEE probe by observing the position of esophageal
opening in advance on improving the success rate of initial placement of
TEE probe by observing the position of esophageal opening: a randomized
controlled study.
Source
Journal of cardiothoracic surgery. 20(1) (pp 399), 2025. Date of
Publication: 28 Oct 2025.
Author
Liu G.-J.; Xiao L.; Yang H.; Liang J.; Yang X.-P.; Liu Z.-H.; Chen Y.;
Wang X.-E.
Institution
(Liu, Yang, Yang, Liu) Department of Anesthesiology, Shenzhen Second
People's Hospital, Shenzhen, China
(Xiao, Chen, Wang) Department of Anesthesiology, First Affiliated Hospital
of Sun Yat-sen University, Yuexiu District, 58 Second Zhongshan Road,
Guangzhou, China
(Liang) Department of Orthopedic Center, People's Hospital of Baoan,
Shenzhen, China
Abstract
OBJECTIVE: The objective of this study is to examine the success rate of
transesophageal echocardiography (TEE) probe placement and the incidence
of postoperative odynophagia based on pre-assessing the exposed position
of the esophageal opening within the pharyngeal cavity. METHOD(S):
Sixty-four patients scheduled for elective cardiac surgery under general
anesthesia, with a requirement for transesophageal echocardiography (TEE)
monitoring, were enrolled in this study. The patients were randomly
assigned to either a pre-observation group or a conventional group. In the
pre-observation group, the pharyngeal cavity was examined using a video
laryngoscope during endotracheal intubation, and the TEE probe was
inserted along the pre-observed esophageal opening. In the conventional
group, the probe was inserted using the standard blind insertion
technique. The number of insertion attempts and the time required for
probe placement were recorded, with three unsuccessful attempts defined as
a placement failure. Postoperative odynophagia was assessed in patients on
postoperative days 1, 3, 5, and 7, with both the severity and duration of
the condition being monitored. RESULT(S): All 64 patients
successfully completed the study, with no statistically significant
differences observed between the two groups in terms of basic demographic
data, risk classification, or oropharyngeal grading. The pre-observation
group demonstrated a significantly higher first-attempt success rate
compared to the conventional group (78% vs. 22%; Odds Ratio [OR], 17.54;
95% CI, 3.86 to 83.33; P < 0.001). Additionally, the numeric rating scale
(NRS) scores for odynophagia on postoperative days 1, 3, 5, and 7, as well
as the duration of odynophagia, were significantly lower in the
pre-observation group than in the conventional group (P < 0.05). The
incidence of postoperative odynophagia was also significantly reduced in
the pre-observation group compared to the conventional group (P < 0.001).
 CONCLUSION(S): The pre-observation group achieved a higher
first-attempt success rate for probe placement compared to the
conventional group, with patients experiencing less severe and
shorter-lasting postoperative odynophagia, indicating significant
advantages over the conventional blind insertion technique. Copyright
© 2025. The Author(s).

<41>
[Use Link to view the full text]
Accession Number
648978914
Title
Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at
7 Years.
Source
The New England journal of medicine. (no pagination), 2025. Date of
Publication: 27 Oct 2025.
Author
Leon M.B.; Mack M.J.; Pibarot P.; Hahn R.T.; Thourani V.H.; Kodali S.H.;
Genereux P.; Kapadia S.R.; Cohen D.J.; Pocock S.J.; Zhang Y.; Szerlip M.;
Ternacle J.; Malaisrie S.C.; Herrmann H.C.; Szeto W.Y.; Russo M.J.;
Babaliaros V.; Nazif T.; Webb J.G.; Makkar R.R.
Institution
(Leon, Hahn, Kodali, Nazif) Columbia University Irving Medical Center, New
York-Presbyterian Hospital, NY, United States
(Leon, Hahn, Kodali, Cohen, Pocock, Nazif) Cardiovascular Research
Foundation, NY, United States
(Mack, Szerlip) Baylor Scott and White the Heart Hospital Plano, Plano,
TX, United States
(Pibarot) Laval University, Quebec, QC, Canada
(Thourani) Piedmont Heart Institute, Atlanta, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Kapadia) Cleveland Clinic, Cleveland, United States
(Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Zhang) Edwards Lifesciences, Irvine, CA, United States
(Ternacle) Unite Medico-Chirurgicale des Valvulopathies, Hopital
Haut-Leveque, CHU Bordeaux, Pessac, France
(Malaisrie) Northwestern University, Chicago, Mexico
(Herrmann, Szeto) University of Pennsylvania, Philadelphia, United States
(Russo) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Babaliaros) Emory University, Atlanta, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
Canada
(Makkar) Cedars-Sinai Medical Center, Los Angeles, Mexico
Abstract
BACKGROUND: Five-year data from the PARTNER 3 trial showed that among
low-risk patients with severe, symptomatic aortic stenosis, outcomes were
similar among patients who had undergone transcatheter aortic-valve
replacement (TAVR) and those who had undergone surgical aortic-valve
replacement. Longer-term assessments of clinical outcomes and valve
durability are needed. METHOD(S): Patients were randomly assigned in
a 1:1 ratio to undergo transfemoral TAVR or surgery. The first primary end
point was a nonhierarchical composite of death, stroke, or
rehospitalization related to the procedure, the valve, or heart failure.
The second primary end point was a hierarchical composite of death,
disabling stroke, nondisabling stroke, and the number of rehospitalization
days related to the procedure, the valve, or heart failure, analyzed with
the use of a win ratio analysis. Clinical, echocardiographic,
valve-durability, and health-status end points were assessed through 7
years. RESULT(S): A total of 1000 patients underwent randomization.
In the analysis of the first primary end point, the Kaplan-Meier estimate
of the incidence of an end-point event was 34.6% with TAVR and 37.2% with
surgery (difference, -2.6 percentage points; 95% confidence interval [CI],
-9.0 to 3.7). The win ratio for the second primary end point was 1.04 (95%
CI, 0.84 to 1.30). In the TAVR and surgery groups, respectively, the
Kaplan-Meier estimates for the incidence of components of the first
primary end point were as follows: death, 19.5% and 16.8%; stroke, 8.5%
and 8.1%; and rehospitalization, 20.6% and 23.5%. The mean (+/-SD)
aortic-valve gradients assessed by echocardiography at 7 years were
13.1+/-8.5 mm Hg after TAVR and 12.1+/-6.3 mm Hg after surgery. The
percentage of bioprosthetic valves that failed was 6.9% in the TAVR group
and 7.3% in the surgery group. Patient-reported outcomes were similar in
the two groups. CONCLUSION(S): Among low-risk patients with severe,
symptomatic aortic stenosis, no significant differences with respect to
two primary composite end points involving death, stroke, and
rehospitalization were observed at 7 years between those who had undergone
TAVR and those who had undergone surgery. (Funded by Edwards Lifesciences;
PARTNER 3 ClinicalTrials.gov number, NCT02675114.). Copyright ©
2025 Massachusetts Medical Society.

<42>
Accession Number
2041320606
Title
Scoping review of early mobility in the intensive care unit following
cardiac surgery.
Source
Anaesthesia Critical Care and Pain Medicine. 44(6) (no pagination), 2025.
Article Number: 101603. Date of Publication: 01 Nov 2025.
Author
Phillips E.K.; Hay J.L.; Monnin C.; Gregora A.; Smith K.; Shaski C.; Bozek
G.; Gilchrist S.; Fagan A.; Ashe M.C.; Chudyk A.M.; Schultz A.S.H.;
O'Keefe-McCarthy S.; Arora R.C.; Duhamel T.A.
Institution
(Phillips, Hay) Applied Health Sciences, Faculty of Graduate Studies,
University of Manitoba, Winnipeg, MB, Canada
(Hay, Duhamel) Faculty of Kinesiology and Recreation Management,
University of Manitoba, Winnipeg, MB, Canada
(Hay, Schultz, Duhamel) Institute of Cardiovascular Sciences, St. Boniface
Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
(Monnin) Neil John Maclean Health Sciences Library, University of
Manitoba, Winnipeg, MB, Canada
(Gregora, Smith) WinnipegMBCanada
(Shaski, Bozek, Gilchrist, Fagan) St Boniface Hospital, Winnipeg, MB,
Canada
(Ashe) Department of Family Practice, The University of British Columbia,
Vancouver, Canada
(Chudyk) College of Pharmacy, Rady Faculty of Health Sciences, University
of Manitoba, Winnipeg, MB, Canada
(Schultz) College of Nursing, Rady Faculty of Health Sciences, University
of Manitoba, Winnipeg, MB, Canada
(O'Keefe-McCarthy) Department of Nursing, Faculty of Applied Health
Sciences, Brock University, St. Catharines, ON, Canada
(Arora) Harrington Heart and Vascular Institute University Hospitals -
Cleveland Medical Center/Case Western Reserve University, Cleveland, OH,
United States
Publisher
Elsevier Masson s.r.l.
Abstract
Introduction: Early mobility in the intensive care unit (ICU) within 24 h
following cardiac surgery (CS) is guideline-recommended, safe, and
supports improved patient outcomes. The evolution of early mobility
following CS research has not been explored. Prior reviews have not
included non-randomized controlled trials nor assessed the quality of
intervention reporting using standard guidelines. Objective(s): This
scoping review addresses these gaps and maps CS ICU early mobility
literature to understand the extent, range, and nature of the extant
literature. Design(s): The databases Medline, Embase, PsycINFO,
Scopus, CINAHL, ClinicalTrials.org, and CS association websites were
searched from inception to January 2025. Extracted details included early
mobility definitions and modes, outcome measures, alignment of
intervention reporting with the Consensus of Exercise Reporting Template
(CERT), and the inclusion of sex/gender in results/discussions.
 Result(s): A total of 109 studies were included. 43 studies defined
early mobility, ranging from the day of surgery to within 2 weeks
post-operatively. Many early mobility modes were noted, most commonly
ambulation. Primary outcomes varied, with hospital length of stay and
pulmonary function the most often studied. There was a consistent lack of
reporting of CERT items. Only two studies presented findings disaggregated
by sex/gender, and only 13 studies considered sex/gender in the
discussion. Conclusion(s): There is heterogeniety in the extant CS
ICU early mobility literature, specifically in early mobility definitions
and modes, outcome measures, quality of intervention reporting, and
consideration of sex/gender. Improvements to research design and reporting
should be encouraged to support the advancement of the
science. Copyright © 2025 The Author(s). Published by Elsevier
Masson SAS on behalf of Societe Francaise d'Anesthesie et de Reanimation
(SFAR). This is an open access article under the CC BY-NC-ND license.
http://creativecommons.org/licenses/by-nc-nd/4.0/

<43>
Accession Number
2040819198
Title
Beyond Conventional Meta-Analysis: A Meta-Learning Model to Predict
Cohort-Level Mortality After Transcatheter Aortic Valve Replacement
(TAVR).
Source
Journal of Cardiovascular Development and Disease. 12(10) (no pagination),
2025. Article Number: 376. Date of Publication: 01 Oct 2025.
Author
Liscano Y.; Martinez Guevara D.; Urriago-Osorio G.A.; Quintana J.
Institution
(Liscano, Martinez Guevara) Grupo de Investigacion en Salud Integral
(GISI), Department of Health, Universidad Santiago de Cali, Cali, Colombia
(Urriago-Osorio, Quintana) Internal Medicine Specialization Program,
Department of Health, Universidad Santiago de Cali, Cali, Colombia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Context and Objective: Post-Transcatheter Aortic Valve Replacement (TAVR)
mortality exhibits extreme heterogeneity that conventional meta-analyses
fail to explain, limiting the clinical utility of evidence synthesis and
hindering accurate prognostic assessment. This study evaluated whether
meta-learning, using aggregate data from the literature, can predict
cohort-level mortality and identify its determinants, overcoming the
limitations of traditional methods to provide a clearer understanding of
the factors driving TAVR outcomes. Method(s): A systematic review
following PRISMA guidelines was conducted across five databases.
Methodological quality was assessed with standardized tools (Risk of Bias
2, Newcastle-Ottawa Scale, Risk of Bias in Non-randomized Studies of
Exposure). After performing conventional meta-analyses and
meta-regressions, multiple machine learning models were trained using
study-level characteristics as predictors. Advanced optimization with
regularization and ensemble techniques was applied to develop a final,
optimized model. Result(s): Fifty-eight studies, encompassing over
533,000 patients, were included. Traditional meta-analysis confirmed
extreme heterogeneity (I2 = 76.7% in Random Clinical Trials,
96.8% in observational studies), with no explanatory power via
meta-regression. The initial AdaBoost model achieved R2 =
0.191, outperforming 17 alternative algorithms. Advanced optimization
developed a Blend_Optimized model that explained 65.3% of the variability
(R2 = 0.653), marking a substantial 46 percentage-point
increase. Interpretability analysis identified four dominant predictors:
Society of Thoracic Surgeons Predicted Risk of Operative Mortality
(R2 = 0.300), Recruitment Year (R2 = 0.212), %
Transfemoral (R2 = 0.201), and % Diabetes (R2 =
0.175), revealing a potent temporal gradient reflecting the evolution of
medical practice. Conclusion(s): Meta-learning significantly
surpasses traditional methods in extracting systematic signals from
heterogeneous evidence. This study demonstrates that, in addition to
patient risk factors, a significant temporal gradient models technological
evolution and learning curves. The methodology transforms seemingly
unexplained heterogeneity into clinically interpretable patterns,
demonstrating the potential of meta-learning as a complementary tool for
evidence synthesis in interventional cardiology and opening avenues for
applications in other complex cardiovascular fields. Important Limitation:
This model predicts cohort-level outcomes and should not be used for
individual risk assessment. Copyright © 2025 by the authors.

<44>
Accession Number
648979057
Title
Transcatheter mitral valve repair and replacement. A critical review of
current real-world practice.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 28 Oct 2025.
Author
Fiocco A.; Besola L.; De Carlo M.; Whitlock R.P.; Colli A.
Institution
(Fiocco, Besola, Colli) Cardiac Surgery Unit, Department of Surgical,
Medical and Molecular Pathology and Critical Care Medicine, University of
Pisa, Pisa, Italy
(Fiocco, Whitlock) Cardiac Surgery Unit, Department of Surgery, McMaster
University, Hamilton, Canada
(De Carlo) Interventional Cardiology Unit, Department of Surgical, Medical
and Molecular Pathology and Critical Care Medicine, University of Pisa,
Pisa, Italy
Abstract
OBJECTIVES: Transcatheter mitral valve interventions (TMVI) provide less
invasive alternatives for patients deemed ineligible for surgery. This
manuscript reviews the evolving landscape of TMVI, limited to a
comparative analysis of Transcatheter Edge-to-Edge Repair (TEER) and
Transcatheter Mitral Valve Replacement (TMVR) in terms of safety and
efficacy outcomes. METHOD(S): A comprehensive review of the existing
literature was conducted, encompassing data from initial device trials to
the most recent real-world studies, ranging from 2009 through 2025. A
narrative synthesis was conducted to integrate findings and evaluate the
current state of TMVI. RESULT(S): Initially approved based on trials
with stringent anatomical and clinical inclusion criteria, TEER has been
increasingly applied to broader patient populations in real-world
settings. Despite its expanded use, there remains a lack of randomized
trial evidence for TEER in complex anatomies. TEER remains the preferred
option for patients with suitable anatomy, given its well-established
safety and efficacy, with over 200,000 patients treated.TMVR demonstrates
promise in reducing mitral regurgitation (MR) but is associated with
higher peri-procedural risks, demands careful patient selection, and is
supported by a more limited clinical experience, with just over 1,400
patients treated. Emerging technological advancements are anticipated to
reduce reliance on transapical access, aiming to improve procedural safety
and outcomes. CONCLUSION(S): TEER and TMVR represent significant
advancements in the management of MR. However, the field requires
additional high-quality studies to clarify the efficacy and long-term
outcomes of these interventions. Further technological developments in
TMVR may enhance its safety profile and expand its
applicability. Copyright © The Author(s) 2025. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved. For commercial re-use,
please contact reprints@oup.com for reprints and translation rights for
reprints. All other permissions can be obtained through our RightsLink
service via the Permissions link on the article page on our site-for
further informat

<45>
Accession Number
648979354
Title
Dedicated Versus Conventional Devices in Patients With Pure Native Aortic
Regurgitation: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. (pp e038659), 2025. Date of
Publication: 28 Oct 2025.
Author
Bacigalupi E.; Scorpiglione L.; Prendergast B.D.; Radico F.; Gallinoro E.;
Bartorelli A.L.; Amat-Santos I.; Barbanti M.; De Backer O.; Latib A.;
Pizzicannella J.; Chiusolo S.; Van Mieghem N.M.; Perfetti M.; Testa L.;
Waksman R.; Pelliccia F.; Miraldi F.; Dangas G.; Zimarino M.
Institution
(Bacigalupi, Scorpiglione, Pizzicannella, Zimarino) Department of
Neuroscience, Imaging and Clinical Sciences "G. D'Annunzio" University of
Chieti-Pescara Chieti Italy, Italy
(Bacigalupi, Scorpiglione, Radico, Pizzicannella, Perfetti, Zimarino)
Cardiology Department SS. Annunziata Hospital Chieti Italy, Italy
(Prendergast) Department of Cardiology St Thomas' Hospital and Cleveland
Clinic London London United Kingdom, United Kingdom
(Gallinoro) Division of University Cardiology IRCCS Ospedale
Galeazzi-Sant'Ambrogio Milan Italy, Italy
(Bartorelli) IRCCS Ospedale Galeazzi-Sant'Ambrogio Milan Italy, Italy
(Bartorelli) Department of Biomedical and Clinical Sciences University of
Milan Italy, Italy
(Amat-Santos) Departamento de Cardiologia Hospital Clinico Universitario
de Valladolid Valladolid Spain, Spain
(Amat-Santos) Instituto de Ciencias Del Corazon Hospital Clinico
Universitario de Valladolid Valladolid Spain, Spain
(Barbanti) Universita degli Studi di Enna "Kore, Italy
(De Backer) Rigshospitalet Copenhagen University Hospital Copenhagen
Denmark, Denmark
(Latib) Montefiore-Einstein Center for Heart and Vascular Care, Montefiore
Medical Center Albert Einstein College of Medicine Bronx New York USA
(Chiusolo) Cardio-Thoracic and Vascular Department Pisa University
Hospital Pisa Italy, Italy
(Van Mieghem) Department of Cardiology, Thoraxcenter Erasmus University
Medical Center Rotterdam The Netherlands, Netherlands
(Testa) Department of Cardiology IRCCS Policlinico San Donato Milan Italy,
Italy
(Testa) "Vita e Salute" University Milan Italy, Italy
(Waksman) MedStar Washington Hospital Center Washington DC USA
(Pelliccia, Miraldi) Department of Cardiovascular Sciences University
Sapienza Rome Italy, Italy
(Dangas) Zena and Michael A. Wiener Cardiovascular Institute Icahn School
of Medicine at Mount Sinai New York New York USA
Abstract
BACKGROUND: Surgical aortic valve replacement is the gold standard for
treating pure native aortic regurgitation. However, many patients have
unacceptable surgical risk. Increasing evidence supports the use of
transcatheter aortic valve replacement in this subset. This metanalysis
aims to evaluate transcatheter aortic valve replacement efficacy in pure
native aortic regurgitation. METHOD(S): We systematically searched
MEDLINE/PubMed, Embase, the Cochrane Database, Google Scholar,
ClinicalTrials.gov, and major cardiology conference abstracts from
inception to April 1, 2024, and included 19 observational studies with
>=20 patients with pure native aortic regurgitation undergoing
transcatheter aortic valve replacement. The primary end point was 30-day
all-cause mortality; secondary end points were device success, valve
migration, and 1-year all-cause mortality. Pooled estimates were
calculated using random-effects meta-analysis. Risk of bias was assessed
using the Newcastle-Ottawa Scale and publication bias with funnel plots
and Egger's test. The study protocol was registered in International
Prospective Register of Systematic Reviews (CRD42024534117).
 RESULT(S): The pooled 30-day mortality was 8.7% (95% CI, 5.8%-10.7%),
and decreased from first (16.9% [95% CI, 13.2%-18.9%]) to second
generation (7.2% [95% CI, 6.1%-9.2%]) and dedicated devices (4.7% [95% CI,
1.8%-8.9%; P<0.0001]). Overall device success was 84.1% (95% CI,
78.0%-88.9%), improving from first (63.1% [95% CI, 52.0%-72.5%]) to second
generation (86.3% [95% CI, 80.1%-90.4%]) and dedicated devices (93.0% [95%
CI, 86.2%-97.3%]; P<0.00001). Valve migration occurred in 7.8% (95% CI,
5.0%-11.7%) of cases, decreasing from first (19.0% [95% CI, 15.2%-24.7%])
to second generation (6.9% [95% CI, 3.7%-10.0%]) and dedicated devices
(3.0% [95% CI, 1.3%-5.6%]; P<0.00001). Overall 1-year mortality was 14.0%
(95% CI, 10.1%-19.9%) and decreased from first (27.2% [95% CI,
15.4%-43.2%]) to second generation (12.7% [95% CI, 8.8%-18.9%]) and
dedicated devices (8.7% [95% CI, 3.5%-16.7%]; P<0.0001).
 CONCLUSION(S): Although the observational design, lack of
patient-level data, device heterogeneity, and potential publication bias
limit definitive conclusions, transcatheter aortic valve replacement using
dedicated devices may be considered a safe and effective therapeutic
option for patients with pure native aortic regurgitation and unacceptable
risk for surgery. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/;
Unique identifier: CRD42024534117.

<46>
Accession Number
2040854829
Title
The Influence of Anesthetics on the Functions of the Endothelium and
Oxidative Stress: A Critical Review.
Source
Biomedicines. 13(10) (no pagination), 2025. Article Number: 2357. Date of
Publication: 01 Oct 2025.
Author
Djuric M.; Nenadic I.; Radisavljevic N.; Todorovic D.; Stojanovic M.;
Dimic N.; Bobos M.; Bojic S.; Stevanovic P.; Savic P.; Stojakov D.;
Palibrk I.; Djuric D.
Institution
(Djuric, Dimic, Bobos, Bojic, Stevanovic) Clinic for Anesthesiology and
Intensive Care, University Clinical Hospital Center, "Dr Dragisa
Misovic-Dedinje", Belgrade, Serbia
(Djuric, Nenadic, Dimic, Bobos, Bojic, Stevanovic, Palibrk) Department of
Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine,
University of Belgrade, Belgrade, Serbia
(Radisavljevic, Todorovic, Djuric) Institute of Medical Physiology
"Richard Burian", Faculty of Medicine, University of Belgrade, Belgrade,
Serbia
(Stojanovic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Savic, Stojakov) Clinic for Surgery, University Clinical Hospital Center,
"Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
(Savic, Stojakov) Department of Surgery, Faculty of Medicine, University
of Belgrade, Belgrade, Serbia
(Palibrk) Department of Anesthesia and ICU, Clinic for Digestive Surgery,
University Clinical Center of Serbia, Belgrade, Serbia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Endothelial dysfunction (characterized by reduced vasodilation or
vasoconstriction, oxidative stress, inflammation, and pro-thrombotic
condition) is a critical factor in the pathophysiology of various
cardiovascular conditions, and the application of anesthetics can affect
this dysfunction. Patients undergoing major surgery, especially
cardiovascular surgery, are at increased risk of endothelial dysfunction.
The impact of anesthetics on endothelial function can vary depending on
the specific agent, dosage, duration of exposure, comorbidities, etc.
Certain anesthetics, especially at higher doses, may increase the
production of reactive oxygen species (ROS), leading to oxidative stress
and endothelial dysfunction through reduced nitric oxid (NO) availability.
Some anesthetics can modulate inflammatory responses, either by
suppressing or exacerbating inflammation, or may affect the permeability
of the endothelium, potentially leading to pulmonary edema and disruption
of the blood-brain barrier. Anesthetics can influence endothelial
glycocalyx. Understanding anesthetics effects is crucial for optimizing
anesthetic management, particularly in patients with pre-existing
cardiovascular issues. Therefore, the aim of this review is to critically
evaluate the effects of different classes of anesthetics on endothelial
function and oxidative stress. Specifically, we address how anesthetics
influence NO bioavailability, endothelial glycocalyx integrity,
inflammatory and oxidative pathways, and clinical outcomes in surgical
patients. By summarizing current evidence, we aim to highlight mechanistic
insights and identify potential perioperative strategies to minimize
endothelial dysfunction. Copyright © 2025 by the authors.

<47>
Accession Number
2040850093
Title
Effects of Empagliflozin and Dapagliflozin on Lipid Profiles and
Atherogenic Risk Indices in Patients with Heart Failure and a History of
CABG: First Evidence in the Literature.
Source
Journal of Clinical Medicine. 14(20) (no pagination), 2025. Article
Number: 7395. Date of Publication: 01 Oct 2025.
Author
Ozgol I.; Yigit Gencer E.; Yildiz C.; Karabulut D.; Turhan Caglar F.N.;
Bicakhan B.; Yucel C.; Ketenciler S.; Ay A.; Yigit Z.
Institution
(Ozgol, Yucel, Ketenciler) Department of Cardiovascular Surgery, Prof. Dr.
Cemil Tascioglu City Hospital, Istanbul, Turkey
(Yigit Gencer) Department of Internal Medicine, Pendik Medipol University
Hospital, Faculty of Medicine, Istanbul Medipol University, Istanbul,
Turkey
(Yildiz, Karabulut, Turhan Caglar) Department of Cardiology, Bakirkoy Dr.
Sadi Konuk Training and Research Hospital, Istanbul, Turkey
(Bicakhan) Department of Cardiovascular Surgery, Gaziosmanpasa Training
and Research Hospital, Istanbul, Turkey
(Ay) Department of Anesthesia and Reanimation, Prof. Dr. Cemil Tascioglu
City Hospital, Istanbul, Turkey
(Yigit) Department of Cardiology, Faculty of Medicine, Istanbul University
Cerrahpasa, Istanbul, Turkey
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objective: This study aimed to compare the effects of empagliflozin and
dapagliflozin on classical lipid parameters-including total cholesterol
(TC), low-density lipoprotein cholesterol (LDL-C), high-density
lipoprotein cholesterol (HDL-C), and triglycerides (TG)-as well as on
atherogenic risk indices, including the atherogenic index of plasma (AIP),
Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II),
atherogenic coefficient (AC), and triglyceride-glucose index (TyG), in
patients with heart failure and a history of coronary artery bypass
grafting (CABG). To our knowledge, this is the first study to
comprehensively evaluate these parameters in this high-risk population.
 Method(s): This single-center, retrospective study included 484
patients with preserved ejection fraction heart failure and prior CABG who
were treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.
Patients were allocated to empagliflozin (n = 201) or dapagliflozin (n =
283) groups. All patients were receiving statin therapy. Lipid parameters
and atherogenic indices were evaluated at baseline and after 12 weeks of
treatment. Result(s): Both empagliflozin and dapagliflozin
significantly reduced TC and LDL-C at 12 weeks (p < 0.001). No significant
changes were observed in HDL-C or TG. Both agents produced significant
improvements in CRI-I, CRI-II, AC, and TyG index (all p < 0.001), while
AIP remained unchanged. Dapagliflozin achieved a greater reduction in TC
(p = 0.044). Conclusion(s): This study represents the first direct
comparison of empagliflozin and dapagliflozin on lipid profiles and
atherogenic indices in patients with heart failure and prior CABG. Both
agents significantly improved TC, LDL-C, and atherogenic indices.
Dapagliflozin achieved a greater reduction in TC compared with
empagliflozin, but overall both drugs demonstrated favorable and largely
comparable effects. Beyond improvements in absolute values, both agents
also contributed to favorable shifts in risk categories of lipid-derived
indices. These findings suggest that clinical decision-making between
empagliflozin and dapagliflozin may rely on factors other than lipid
modulation. Larger multicenter prospective trials are warranted to confirm
these results and clarify their long-term cardiovascular
implications. Copyright © 2025 by the authors.

<48>
Accession Number
2041189524
Title
Prehabilitation of frail elderly PAtients undergoing majoR surgEry at HOME
(PREPARE-HOME): a superiority parallel-group randomised controlled trial
protocol evaluating smart wearable enhanced prehabilitation versus usual
care.
Source
BMJ Open. 15(10) (no pagination), 2025. Article Number: e094986. Date of
Publication: 23 Oct 2025.
Author
Leong Y.H.; Tay V.Y.J.; Yang X.; Tan C.J.; Au-Yong P.-S.; Sim J.L.X.; Ng
R.R.G.; Ong M.E.H.; Tan B.P.Y.; Abdullah H.R.; Ke Y.
Institution
(Leong, Tay, Yang, Au-Yong, Sim, Ng, Tan, Ke) Singapore General Hospital,
Singapore
(Tan) Department of Physiotherapy, Singapore General Hospital, Singapore
(Ong) Duke-NUS, Singapore
(Abdullah) Department of Anesthesiology, Singapore General Hospital,
Singapore
Publisher
BMJ Publishing Group
Abstract
Introduction Frailty is a key predictor of adverse surgical outcomes in
older adults, contributing to increased postoperative complications,
prolonged hospitalisation and delayed recovery. Prehabilitation-targeting
improvements in physical function before surgery-can mitigate these risks.
However, traditional programmes often face low adherence due to logistical
barriers. Integrating smart wearable devices into tele-supervised,
home-based prehabilitation may enhance adherence, engagement and clinical
outcomes. This trial protocol describes the PREhabilitation of frail
elderly PAtients undergoing majoR surgEry at HOME study with the objective
to evaluate the effectiveness of a wearable-enhanced, tele-supervised
prehabilitation programme (swSEP) versus standard care (unsupervised
prehabilitation, uSEP) on improving preoperative functional capacity and
postoperative outcomes in frail older adults undergoing major elective
surgery. Methods and analysis This single-centre, prospective, randomised
controlled trial will enrol 190 patients aged >=65 years scheduled for
major elective, non-cardiac surgery at Singapore General Hospital.
Participants with frailty (Edmonton Frail Scale >=6) will be randomised
1:1 to either the swSEP group (tele-supervised exercise with Fitbit
Inspire 3 monitoring) or the uSEP group (standard physiotherapy education,
exercise booklet and inspiratory muscle training if maximal inspiratory
pressure <100 cm H2O). The primary outcome is change in 6min walk test
distance from baseline to 1-3days presurgery. Secondary outcomes include
30s sit-to-stand test, handgrip strength, postoperative complications (per
American College of Surgeons National Surgical Quality Improvement
Program), hospital length of stay, readmissions, five-level version of the
EuroQol five-dimensional questionnaire (EQ-5D-5L) and adherence. Data will
be analysed using t-tests, analysis of covariance, logistic regression and
Cox models, with stratification by baseline nutritional status. Ethics and
dissemination Approved by the SingHealth Institutional Review Board (CIRB
Ref: 2024/2242). Trial registered on ClinicalTrials.gov (NCT06633614).
Results will be disseminated via peer-reviewed publications and academic
conferences. Contact: irb@singhealth.com.sg 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.

<49>
Accession Number
2041269848
Title
Left atrial appendage occlusion in patients with end-stage renal disease:
an individual patient-level meta-analysis.
Source
Europace. 27(10) (no pagination), 2025. Article Number: euaf198. Date of
Publication: 01 Oct 2025.
Author
Rodriguez-Riascos J.F.; Vemulapalli H.S.; Akin I.; Areiza L.A.; Della
Rocca D.G.; Eitel I.; Fink T.; Genovesi S.; Kefer J.; Zweiker D.;
Prajapati P.; Srivathsan K.
Institution
(Rodriguez-Riascos, Vemulapalli, Prajapati, Srivathsan) Division of
Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix,
AZ, United States
(Akin) Department of Invasive Cardiology and Electrophysiology, University
Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University,
First Department of Medicine, Cardiovascular Research, Mannheim, Germany
(Areiza) Department of Invasive Cardiology, Hospital Universitario Mayor,
Mederi, Bogota, Colombia
(Della Rocca) Texas Cardiac Arrhythmia Institute, St.David's Medical
Center, Austin, TX, United States
(Della Rocca) Heart Rhythm Management Centre, Universitair Ziekenhuis
Brussel-Vrije Universiteit Brussel, European Reference Network
Guard-Heart, Jette, Brussels, Belgium
(Eitel) Department of Cardiology, Angiology and Intensive Care
Medicine-Division of Electrophysiology, University Heart Center Lubeck,
Lubeck, Germany
(Fink) Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr
University Bochum, Bad Oeynhausen, Germany
(Genovesi) School of Medicine and Surgery, Nephrology Clinic, University
of Milano-Bicocca, Milan, Italy
(Genovesi) Istituto Auxologico Italiano, IRCCS, Milan, Italy
(Kefer) Division of Cardiology, Cliniques Universitaires Saint-Luc et Pole
de Recherche Cardiovasculaire, Universite Catholique de Louvain
(UCLouvain), Institut de Recherche Experimentale et Clinique, (IREC),
Brussels, Belgium
(Zweiker) Department of Cardiology, Medical University of Graz, Graz,
Austria
(Zweiker) Third Medical Department for Cardiology and Intensive Care,
Clinic Ottakring, Vienna, Austria
Publisher
Oxford University Press
Abstract
Aims Patients with end-stage renal disease (ESRD) and atrial fibrillation
present a challenge for thromboembolic prevention, given their elevated
risks of both thromboembolism and bleeding. Anticoagulants carry a higher
bleeding risk in this population without clear evidence of thromboembolic
benefit. This study aims to define the role of left atrial appendage
occlusion (LAAO) as a preventive strategy for patients with ESRD. Methods
and results A systematic literature review was conducted to identify
studies reporting outcomes in patients with ESRD who underwent LAAO.
Meta-analyses of aggregate and individual patient data were performed to
evaluate acute and long-term outcomes and compare them with those of
patients without ESRD. Seventeen studies reporting data from 24 127
patients, including 1047 with ESRD, were included. Procedural
complications were more common in patients with ESRD (RR 2.23; P = 0.02),
with a pooled rate of 4% (95% CI, 1-9%). There was no significant
difference in thromboembolic event rates during follow-up between the
groups (IRR 1.44; P = 0.16), but major bleeding incidence was higher among
patients with ESRD (IRR 1.84; P < 0.01). Individual patient-level data
from seven studies comprising 4745 patients (268 with ESRD) were obtained
and analysed. Similarly, there was no significant association between ESRD
and stroke/TIA incidence (HR, 1.22; 95% CI, 0.66-2.26), but major bleeding
was higher on patients with ESRD (HR, 1.65; 95% CI, 1.01-2.69). Conclusion
LAAO represents a feasible option for thromboembolic prevention in
patients with ESRD, although these patients have an increased risk of
complications and bleeding. Copyright © The Author(s) 2025.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<50>
Accession Number
2041268652
Title
Left Ventricular Health and TAVR Timing in Asymptomatic Severe Aortic
Stenosis: Analysis From the EARLY TAVR Trial.
Source
Journal of the American College of Cardiology. (no pagination), 2025.
Date of Publication: 2025.
Author
Lindman B.R.; Pibarot P.; Schwartz A.; Cohen D.J.; Giustino G.; Oldemeyer
J.B.; Strote J.A.; Babaliaros V.; Devireddy C.M.; Fearon W.F.; Fischbein
M.P.; Daniels D.; Spies C.; Chhatriwalla A.K.; Kavinsky C.J.; Shah P.;
Szerlip M.; Dahle T.; Stegman B.; O'Leary J.M.; O'Neill W.W.; Makkar R.R.;
Davidson C.J.; Sheth T.; DeVries J.T.; Southard J.; Depta J.P.; Pop A.;
Leipsic J.; Blanke P.; Li Y.; Hahn R.T.; Leon M.B.; Genereux P.
Institution
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Lindman, O'Leary) Division of Cardiovascular Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
(Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval
University, Quebec, QC, Canada
(Schwartz, Hahn, Leon) Columbia University Medical
Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Cohen) St Francis Hospital, Roslyn, NY, United States
(Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United
States
(Giustino, Genereux) Gagnon Cardiovascular Institute, Morristown Medical
Center, Morristown, NJ, United States
(Oldemeyer, Strote) University of Colorado Health, Loveland, CO, United
States
(Babaliaros, Devireddy) Structural Heart and Valve Center, Emory
University School of Medicine, Atlanta, GA, United States
(Fearon, Fischbein) Stanford Department of Cardiothoracic Surgery,
Stanford University School of Medicine, Stanford, CA, United States
(Daniels, Spies) Division of Cardiology, California Pacific Medical
Center, San Francisco, CA, United States
(Chhatriwalla) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Kavinsky) Beth Israel Deaconess Medical Center/Harvard Medical School,
Boston, MA, United States
(Shah) Division of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, United States
(Szerlip) Baylor Scott and White The Heart Hospital Plano, Plano, TX,
United States
(Dahle, Stegman) CentraCare Heart & Vascular Center, St Cloud, MN, United
States
(O'Neill) Henry Ford Health System, Detroit, MI, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Davidson) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Sheth) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, Hamilton, ON, Canada
(DeVries) Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
(Southard) UC Davis Health System, University of California-Davis,
Sacramento, CA, United States
(Depta) Sands-Constellation Heart Institute, Rochester Regional Health,
Rochester, NY, United States
(Pop) Alexian Brothers Medical Center, Elk Grove Village, IL, United
States
(Leipsic, Blanke) St Paul's Hospital and University of British Columbia,
Vancouver, BC, Canada
(Li) Edwards Lifesciences, Irvine, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: For patients with asymptomatic severe aortic stenosis (AS),
the EARLY TAVR trial demonstrated that early transcatheter aortic valve
replacement (TAVR) was superior to clinical surveillance (CS).
 Objective(s): In this study, the authors sought to evaluate whether
baseline left ventricular (LV) health altered the treatment effect of
early intervention and to examine longitudinal LV health under different
treatment strategies. Method(s): At 75 centers in the United States
and Canada, 901 patients underwent randomization to TAVR (n = 455) or CS
(n = 446). Echocardiographic measurements were made in a core laboratory.
The protocol defined integrated LV health as the composite of absolute LV
global longitudinal strain (GLS) >=15%, LV mass index (LVMi) <115
g/m2 (men) or <95 g/m2 (women), and left atrial
volume index (LAVi) <=34 mL/m2. Integrated LV health was a
prespecified secondary endpoint and the protocol outlined longitudinal
measurements to be made in the intention-to-treat (ITT) and valve implant
populations. As a stratification variable for effect-modification testing,
LV health was not prespecified, so those analyses are exploratory. The
trial's primary endpoint and 2 secondary composites were examined.
 Result(s): At randomization, in the ITT population, 27% had normal
integrated LV health (64% normal LVMi, 42% normal LAVi, 88% normal GLS).
Abnormal integrated LV health and each component were generally associated
with higher event rates across several composite endpoints. Benefit of
early TAVR, compared with CS, was consistently observed regardless of
whether LV health (evaluated as an integrated measure and as individual
components) was normal or not. In the ITT population, the CS group
exhibited normal LV health less frequently at 2 years than those treated
early according to the integrated LV health measure (35.9% vs 48.1%; P <
0.001) and component measures. Among CS patients undergoing delayed AVR,
LV health tended to decline from randomization to preprocedure (P < 0.10
for all measures except GLS), but baseline LV health did not predict
timing of conversion to AVR nor severity of presentation.
 Conclusion(s): For patients with asymptomatic severe AS, the benefit
of early TAVR, compared with CS, is consistent regardless of baseline LV
health according to integrated or individual measures. These exploratory
findings suggest limited value for measures of LV health to guide the
timing of TAVR in asymptomatic patients. Whether the worsening of LV
health associated with CS and delayed aortic valve replacement underlies
increased clinical events in that treatment arm requires further study.
(Evaluation of TAVR Compared to Surveillance for Patients With
Asymptomatic Severe Aortic Stenosis [EARLY TAVR];
NCT03042104) Copyright © 2025 American College of Cardiology
Foundation

<51>
Accession Number
648954142
Title
Transcatheter Aortic Valve Replacement for Mixed Aortic Valve Disease
versus Predominant Aortic Stenosis.
Source
The American journal of cardiology. (no pagination), 2025. Date of
Publication: 23 Oct 2025.
Author
Warraich N.; Ahmad D.; Brown J.A.; Serna-Gallegos D.; Kliner D.; Toma C.;
Makani A.; Hasan I.; Ogami T.; Bonatti J.; West D.; Sultan I.
Institution
(Warraich, Ahmad, Brown) Division of Cardiac Surgery, Department of
Cardiothoracic Surgery, University of Pittsburgh
(Serna-Gallegos, Hasan, Ogami, Bonatti, West, Sultan) Division of Cardiac
Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh;
Heart and Vascular Institute, University of Pittsburgh Medical Center
(Kliner, Toma, Makani) Heart and Vascular Institute, University of
Pittsburgh Medical Center; Division of Cardiology, Department of Medicine,
University of Pittsburgh
Abstract
We sought to evaluate survival of patients with mixed aortic valve disease
(MAVD) versus predominant aortic stenosis (AS) undergoing transcatheter
aortic valve replacement (TAVR). This was a study-level meta-analysis of
reconstructed time-to-event data from non-randomized studies published by
October 2024. Electronic databases were searched for studies with
Kaplan-Meier data for overall survival. Individual patient data were
reconstructed from published graphs and merged for analysis. Conventional
random-effects meta-analysis was conducted for secondary post-TAVR
outcomes. Ten studies (5 propensity-matched, 5 unmatched) met inclusion
criteria with a total of 7340 patients (4263 AS, 3077 MAVD). MAVD was
defined as severe AS with >= mild or >= moderate concomitant aortic
regurgitation in the included studies. At 5 years, there was no difference
in survival between patients in the AS group and MAVD group ([hazard ratio
(HR) 1.03, 95% confidence interval (CI) 0.94-1.14, p=0.51]). Sensitivity
analysis restricted to studies defining MAVD as >= moderate concomitant
aortic regurgitation (62% of population) also determined no difference
between groups (HR 0.97, 95% CI 0.84-1.12, p=0.67). When including only
propensity-matched studies (35% of population), we observed a significant
survival benefit in patients with MAVD (HR 0.79, 95% CI 0.65-0.94,
p=0.01). Patients with MAVD had higher post-TAVR paravalvular leak (RR
1.64, 95% CI 1.15-2.33, p<0.01). In conclusion, transcatheter aortic valve
replacement appears to be safe in patients with MAVD, with similar
survival as patients with predominant AS despite higher post-TAVR
paravalvular leak. A survival benefit of MAVD is observed after 1 year in
propensity-matched studies. Copyright © 2025. Published by
Elsevier Inc.

<52>
Accession Number
648956006
Title
Short-Term Anticoagulation versus Dual Antiplatelet Therapy for Preventing
Device Thrombosis Following Left Atrial Appendage Closure: The ANDES
Randomized Clinical Trial.
Source
Circulation. (no pagination), 2025. Date of Publication: 26 Oct 2025.
Author
Rodes-Cabau J.; Nombela-Franco L.; Cruz-Gonzalez I.; Hibbert B.; Freixa
X.; Masson J.-B.; Ibrahim R.; Estevez-Loureiro R.; Millan X.; Kass M.;
Paradis J.-M.; Champagne J.; Salinas P.; Laffond A.; Abdel-Razek O.;
Labinaz M.; Cepas-Guillen P.; Arzamendi D.; Vidal-Cales P.; Pavesi M.;
Cote M.; O'Hara G.; Salaun E.
Institution
(Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec
City, QC, Canada; Clinic Barcelona, Barcelona, Spain; Barcelona Clinical
Coordinating Center, Mon Clinic Foundation, Barcelona, Spain
(Nombela-Franco, Salinas) Hospital Clinico San Carlos, Instituto de
Investigacion Sanitaria Hospital Clonico San Carlos (IdISSC), Madrid,
Spain
(Cruz-Gonzalez, Laffond) Hospital Universitario de Salamanca, Salamanca,
Spain
(Hibbert, Abdel-Razek, Labinaz) Ottawa Heart Institute, Ottawa, ON, Canada
(Freixa, Cepas-Guillen) BarcelonaSpain
(Masson) Centre Hospitalier Universitaire de Montreal, Montreal, QC,
Canada
(Ibrahim) Montreal Heart Institute, Montreal, QC, Canada
(Estevez-Loureiro) Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
(Millan, Arzamendi) Hospital Santa Creu i Sant Pau, Barcelona, Spain
(Kass) Saint Boniface Hospital, Winnipeg, MB, Canada
(Paradis, Champagne, Vidal-Cales, Cote, O'Hara, Salaun) Quebec Heart &
Lung Institute, Laval University, Quebec City, QC, Canada
(Pavesi) Barcelona Clinical Coordinating Center, Mon Clinic Foundation,
Barcelona, Spain
Abstract
BACKGROUND: The optimal antithrombotic treatment following transcatheter
left atrial appendage closure (LAAC) remains to be determined. The
objective of this trial was to compare anticoagulation and antiplatelet
therapy for preventing device-related thrombosis (DRT) following LAAC.
 METHOD(S): Prospective multicenter international randomized trial
comparing 2 different antithrombotic strategies for preventing DRT
following LAAC in patients with non-valvular atrial fibrillation. Patients
were randomized (1:1) to receive direct oral anticoagulants (DOAC) or dual
antiplatelet therapy (DAPT, aspirin + clopidogrel) for 60 days. Patients
had a transesophageal echocardiography (TEE) at 60 days, and the images
were analyzed in a central echocardiography laboratory by experienced
echocardiographers blinded to the allocated treatment. The primary outcome
was DRT as determined by TEE at 60 days after LAAC in those patients
receiving the allocated treatment at the time of TEE (per-protocol
analysis). The safety outcome included all-cause mortality, stroke,
bleeding, or DRT (site-reported and leading to a treatment change) within
60 days after LAAC in all randomized patients (intention-to-treat
analysis). RESULT(S): A total of 510 patients (mean age 77+/-9 years,
35% of women) were included between October 2018 and May 2025, and 253 and
257 patients were randomized to the DOAC and DAPT groups, respectively. Of
these, 399 patients underwent TEE and were receiving the allocated
treatment at 60 days post-LAAC. The primary outcome occurred in 3 patients
(1.5%) in the DOAC group compared to 8 patients (4.1%) in the DAPT group
(difference, -2.7% [95%CI, -6.0% to 0.6% ], p=0.110). The safety outcome
occurred in 52 patients (22.5%) in the DOAC group compared to 82 patients
(34.9%) in the DAPT group (difference, -12.4% [95% CI: -20.6% to -4.2%],
p=0.003), and differences were mainly driven by a lower rate of bleeding
events in the DOAC group (44 patients [17.4%] vs 64 patients [24.9%],
difference, -7.5% [95% CI, -14.6% to -0.4%], p=0.038). CONCLUSION(S):
The use of DOAC after LAAC failed to reduce DRT compared to DAPT but it
was associated with an improved safety profile. The results of this study
should be interpreted with caution due to statistical power issues related
the narrowed than expected between-group differences, and will need
confirmation in future larger studies.

<53>
Accession Number
648949576
Title
All-Venous Grafting and Very-Long-Term Survival after Coronary Artery
Bypass Grafting.
Source
The Annals of thoracic surgery. (no pagination), 2025. Date of
Publication: 22 Oct 2025.
Author
Squiers J.J.; Shih E.; DiMaio J.M.; Banwait J.K.; Hale S.; Mack M.J.;
Schaffer J.M.
Institution
(Squiers, Shih, Schaffer) Department of Cardiothoracic Surgery, Baylor
Scott & White, The Heart Hospital; Plano, TX
(DiMaio, Mack) Department of Cardiothoracic Surgery, Baylor Scott & White,
The Heart Hospital; Plano, TX; Baylor Scott & White Research Institute;
Plano, TX
(Banwait, Hale) Baylor Scott & White Research Institute; Plano, TX
Abstract
BACKGROUND: Observational studies of coronary artery bypass grafting
(CABG) associate single-arterial grafting with superior outcomes compared
to all-venous grafting. Current guidelines assign single-arterial grafting
a Class I recommendation. However, no adequately powered randomized
controlled trials were undertaken to confirm this benefit, and
very-long-term data on outcomes of various conduit strategies from more
contemporary eras remain lacking. METHOD(S): We retrospectively
analyzed Medicare beneficiaries undergoing CABG from 1999-2004, the period
immediately preceding the first publication of guidelines affording
single-arterial grafting a Class I indication. We compared survival
between beneficiaries receiving all-venous grafting compared to
single-arterial grafting using restricted mean survival times (RMST).
Risk-adjustment was performed for all available covariates using overlap
propensity score weighting. RESULT(S): Among 640,116 beneficiaries,
101,120 (15.8%) underwent all-venous grafting and 538,996 (84.2%)
underwent single-arterial grafting. Beneficiaries undergoing all-venous
grafting, versus single-arterial grafting, were noted to have worse
risk-adjusted operative survival (30-day RMST: 28.6 [28.6,28.7] versus
29.3 [29.2,29.3] days, difference 0.73 [0.73,0.73] days, P<0.001),
short-term survival (1-year RMST: 324 [324,325] versus 339 [338,339] days,
difference 14 [13,15] days, P<0.001), and very long-term survival (20-year
RMST: 9.55 [9.51,9.59] versus 8.34 [8.30,8.38] years, difference: 1.21
years, P<0.001). CONCLUSION(S): Medicare beneficiaries undergoing
CABG with all-venous grafting had inferior risk-adjusted survival compared
to those receiving single-arterial grafting. These findings support
current multidisciplinary guideline recommendations offering a class I
indication for use of at least one arterial graft during
CABG. Copyright © 2025. Published by Elsevier Inc.

<54>
Accession Number
648951629
Title
The effects of a light and musicial toy on pain, anxiety, and
physiological parameters during venous blood sampling in children aged 3-6
years: A randomized controlled trial.
Source
Journal of pediatric nursing. 85 (pp 742-753), 2025. Date of Publication:
23 Oct 2025.
Author
Kalkan D.; Sezer T.A.
Institution
(Kalkan) Ankara University, Institute of Health Sciences, Department of
Nursing, Ankara, Turkey
(Sezer) Ankara University, Faculty of Nursing, Department of Pediatric
Nursing, Ankara, Turkey
Abstract
PURPOSE: The aim of this study is to evaluate the effect of a light-up toy
with music played during venous blood sampling on pain, anxiety, and
physiological parameters in children aged 3-6 years. METHOD(S): This
study was conducted as a randomized controlled trial in parallel groups.
It included children aged 3-6 years (n = 56) who visited the blood
collection clinic of the Children's Hospital at a university hospital in
Ankara between July 2024-April 2025. Children in the intervention group (n
= 28) were given light and music toys before, during the procedure, while
children in the control group (n = 28) underwent the hospital's routine
blood collection procedure. The following forms were used to collect data:
"Child and Parent Identification Form," "Child Emotional Expression
Assessment Scale," "Face, Leg Mobility, Activity, Crying, Consolability
Scale" and "Physiological Parameters Form" were used in data collection.
Data evaluation in the study, video recordings were made during the
procedure, and the videos were evaluated by two independent observers
using scales. RESULT(S): There was no statistically significant
difference between the intervention group and the control group in terms
of pain and anxiety levels before and during the procedure (p > 0.05).
However, when physiological parameters were examined, there was a
significant difference in heart rate between the two groups during the
procedure, with heart rate being lower in the intervention group(p <
0.05). Oxygen saturation remained stable during the procedure in the
intervention group and did not show a significant decrease, whereas it
decreased significantly in the control group. CONCLUSION(S): The
study found that light and music toys affect physiological conditions such
as heart rate and oxygen saturation but have limited effects on
psychological responses such as pain and anxiety. PRACTICE IMPLICATION:
The light and music toy can be used in clinics and any environment where
venous blood sampling is performed to maintain and improve physiological
parameters. Copyright © 2025 Elsevier Inc. All rights reserved.

<55>
[Use Link to view the full text]
Accession Number
648942518
Title
Five-Year Clinical Outcomes and Durability of a Self-Expanding
Transcatheter Heart Valve With Intra-Annular Leaflets.
Source
Circulation. Cardiovascular interventions. (pp e015430), 2025. Date of
Publication: 24 Oct 2025.
Author
Puri R.; Thiele H.; Fichtlscherer S.; Westermann D.; Makkar R.; Waksman
R.; Hakmi S.; Sondergaard L.; Groh M.; Montarello J.K.; Kempfert J.; Yong
G.; Bedogni F.; Maisano F.; Worthley S.G.; Rodes-Cabau J.; Fontana G.P.;
Mollmann H.
Institution
(Puri) Cleveland Clinic
(Thiele) Heart Center Leipzig at Leipzig University, Germany (H.T.),
Germany
(Fichtlscherer) University Heart and Vascular Center Frankfurt and Bad
Segeberg, Germany (S.F.), Germany
(Westermann) University Heart Center, University of Freiburg, Germany
(D.W.), Germany
(Makkar) Cedars-Sinai Medical Center, Los Angeles, Mexico
(Waksman) MedStar Washington Hospital Center (R.W.)
(Hakmi) Germany (S.H.), Asklepios Klinik St. Georg
(Sondergaard) Abbott Structural Heart, Santa Clara, Mexico
(Groh) Asheville Heart, NC (M.G.)
(Montarello) Royal Adelaide Hospital, Australia
(Kempfert) German Heart Institute Berlin, Germany (J.K.), Germany
(Yong) Hollywood Medical Centre, Australia
(Bedogni) IRCCS Policlinico San Donato
(Maisano) IRCCS Ospedale San Raffaele, Italy
(Worthley) St. Andrew's Hospital, Australia
(Rodes-Cabau) Quebec Heart & Lung Institute, Canada
(Fontana) Cardiovascular Institute of the HCA Los Robles Health System,
Thousand Oaks
(Mollmann) St.-Johannes-Hospital Dortmund, Germany (H.M.), Germany
Abstract
BACKGROUND: There is a paucity of data regarding the longer-term
durability of transcatheter heart valves. This analysis aimed to describe
the 5-year clinical outcomes and valve durability for patients treated
with the Portico transcatheter heart valves across 3 studies harmonized in
their prospective enrollment, inclusion/exclusion criteria, centralized
independent core laboratory echocardiographic analysis, and independent
clinical events committee adjudication. METHOD(S): Patient-level data
from the PORTICO IDE randomized controlled trial, the PORTICO I postmarket
study, and the PORTICO continued access protocol were pooled using a
random-effects meta-analysis model. All 3 studies collected follow-up data
at discharge, 30 days, and annually through 5 years. Adverse events and
pooled echocardiographic data were assessed using Valve Academic Research
Consortium-2 definitions. Durability definitions were adapted from Valve
Academic Research Consortium-3 and European Association of Percutaneous
Cardiovascular Interventions/European Society of Cardiology/European
Association for Cardio-Thoracic Surgery consensus guidelines.
 RESULT(S): A total of 1464 patients with severe symptomatic aortic
stenosis and high or extreme surgical risk were included. Median age was
83 years, 61.7% were women, and the median Society of Thoracic Surgeons
score was 4.9%. At 5 years, all-cause mortality and stroke rates were
49.4% and 12.3%, respectively. Transvalvular gradient and effective
orifice area at 5 years were 6.2 mm Hg and 1.83 cm2, respectively, with
paravalvular leak >=moderate severity occurring in 1.9%. The 5-year
bioprosthetic valve failure rate was 2.7%, including a 0.7% valve-related
death rate and a 2.0% valve reintervention rate, but no patients with
severe hemodynamic structural valve deterioration. Moderate hemodynamic
structural valve deterioration occurred in 0.9% of the patients at 5
years. Hemodynamic performance and transcatheter heart valve durability
remained stable irrespective of annular size. CONCLUSION(S): The use
of the Portico transcatheter heart valve system in patients at high or
extreme surgical risk demonstrated favorable clinical outcomes and
hemodynamic performance with low transvalvular gradients and greater than
mild paravalvular leak. Furthermore, bioprosthetic valve failure rates
were low with no incidence of severe hemodynamic structural valve
deterioration at 5 years, irrespective of annular size. REGISTRATION: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT02000115 and
NCT01802788.

<56>
Accession Number
648945273
Title
Efficacy and Safety of Protamine Use Following Transcatheter Aortic Valve
Implantation for Minimizing Post-Procedural Bleeding Risk: A Systematic
Review and Meta-Analysis.
Source
Cardiology. (pp 1-13), 2025. Date of Publication: 23 Oct 2025.
Author
Kara A.O.; Beshr M.S.; Abdelaziz A.M.; Alzubi A.S.; Alansari A.H.A.;
Arhaym E.; Aburawi D.M.M.; El Awami M.; Farag A.; Almezghwi H.; Abdulsalam
A.A.; Shahin H.N.; Elhadi M.; Mamas M.
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) may be
complicated by postoperative bleeding due to heparin use. Heparin
antagonists, such as protamine, have shown potential in reducing bleeding
risks. This meta-analysis assesses the efficacy and safety of protamine in
reducing bleeding complications after TAVI. METHOD(S): A systematic
search was conducted up to March 2025. Inclusion criteria encompassed
studies reporting the use of protamine post-TAVI with a control group.
Primary outcomes included major bleeding events as the efficacy endpoint,
30-day mortality, and ischemic events (stroke and transient ischemic
attack, or TIA) as safety endpoints. Secondary outcomes included
life-threatening bleeding events and the need for blood transfusion. A
random-effects model was used to calculate odds ratios (ORs).
 RESULT(S): Four studies involving 1,569 patients were included. As
compared to the control group, protamine was not associated with a
statistically significant difference in major bleeding events (OR = 0.59,
95% CI = 0.26 to 1.34, p = 0.21), life-threatening bleeding events (OR =
0.3, 95% CI = 0.06 to 1.62, p = 0.16), need for blood transfusions (OR =
0.75, 95% CI = 0.46 to 1.24, p = 0.27), 30-day mortality (OR = 1.07, 95%
CI = 0.54 to 2.11, p = 0.85), or rate of stroke and TIA (OR = 0.86, 95% CI
= 0.05 to 13.58, p = 0.91). CONCLUSION(S): Protamine use after TAVI
appeared to be safe with no increase in 30-day mortality or stroke and TIA
rates, but there was no observed statistically significant benefit in the
reduction of major or life-threatening bleeding events and the need for
blood transfusions. These findings are based on a limited number of
studies, and larger randomized controlled trials are warranted to confirm
them. Copyright The Author(s). Published by S. Karger AG, Basel.

<57>
Accession Number
648940979
Title
Effects of Psychosocial Nursing Interventions on Sleep, Anxiety and
Delirium in Patients Undergoing Open Heart Surgery: A Randomised
Controlled Trial.
Source
Nursing in critical care. 30(6) (pp e70216), 2025. Date of Publication: 01
Nov 2025.
Author
Ozdemir F.E.; Yilmaz M.
Institution
(Ozdemir) Cardiovascular Surgery Intensive Care Unit, Mersin University
Hospital, Mersin, Turkey
(Yilmaz) Psychiatric Nursing Department, Mersin University Faculty of
Nursing, Mersin, Turkey
Abstract
BACKGROUND: Postoperative delirium remains a frequent and serious
complication following open heart surgery, often linked with prolonged
hospital stays and increased morbidity. Since the causes are
multifactorial, non-pharmacological strategies such as psychosocial
nursing interventions are being explored for their preventive potential.
AIM: This randomised controlled trial aimed to evaluate the effectiveness
of psychosocial nursing interventions on sleep quality, anxiety levels and
the occurrence of delirium in patients undergoing open heart surgery.
STUDY DESIGN: A prospective, two-arm randomised controlled trial. Sixty
patients scheduled for elective open heart surgery at a university
hospital in southern Turkiye were randomly assigned to the intervention
group (n = 30) or the control group (n = 30). The control group received
standard nursing care. The intervention group received structured
psychosocial care including eye masks, earplugs and brief 45-min cognitive
behavioural therapy (CBT) sessions before and after surgery. Anxiety was
assessed before surgery and on day 2 after surgery, while sleep quality
was assessed before surgery and on days 1 and 2 after surgery. Patients'
anxiety and sleep quality were assessed before and after surgery using the
Richard Campbell Sleep Questionnaire and the State Anxiety Inventory. The
Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used
to assess delirium after surgery. Adherence to sensory aids was monitored
via nursing checklists. Outcome assessors for delirium were blinded to
group assignment. RESULT(S): Groups were demographically and
clinically comparable at baseline (p > 0.05). Post-intervention, anxiety
and pain levels significantly declined in the intervention group, with
improved sleep scores (p < 0.001). Delirium incidence was 0% in the
intervention group versus 30% in controls (p < 0.05). Duration of
mechanical ventilation and hospital stay was significantly reduced in the
intervention group. Effect sizes (Cohen's d) and 95% confidence intervals
were reported for major outcomes. CONCLUSION(S): Psychosocial nursing
interventions combining cognitive and sensory strategies effectively
enhance postoperative outcomes by reducing anxiety, improving sleep
quality and preventing delirium. These findings support integrating such
non-invasive, low-cost strategies into routine nursing care for patients
undergoing cardiac surgery. RELEVANCE TO CLINICAL PRACTICE: Delirium is a
critical postoperative complication after open heart surgery. Psychosocial
interventions can be incorporated into nursing care to prevent delirium in
intensive care units. Copyright © 2025 British Association of
Critical Care Nurses.

<58>
Accession Number
648933213
Title
The organ protective effects of penehyclidine hydrochloride (PHC) in
patients undergoing cardiac surgery: a systematic review and
meta-analysis.
Source
BMC anesthesiology. 25(1) (pp 516), 2025. Date of Publication: 22 Oct
2025.
Author
Tian L.; Guo J.; Yao Y.
Institution
(Tian, Guo, Yao) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Yao) Center of Outcomes Research, Department of Anesthesiology, Critical
Care and Pain Medicine, University of Texas, Houston, TX, United States
(Yao) Outcomes research Consortium, Houston, TX, United States
Abstract
BACKGROUND: As a novel selective anticholinergic drug, penehyclidine
hydrochloride (PHC) provided the potential to protect organs by inhibiting
the inflammatory response, attenuating oxidative stress, and alleviating
ischemia / reperfusion injury. This study aimed to evaluate the organ
protective effects of PHC in patients undergoing cardiac surgery.
 METHOD(S): Six electronic databases were searched systematically for
randomized-controlled trials (RCTs) published April 30th 2025 that
explored the application of PHC on cardiac surgical patients. Primary
outcomes of interest included the biomarkers and variables of major organs
(e.g. heart, lung, gastrointestinal tract and immune system) injury.
Secondary outcomes of interest included the mechanical ventilation
duration and hospital length of stay (LOS). Mean difference (MD) with 95%
confidence interval (CI) or odds ratios (OR) with 95% CI were employed to
analyze the data. RESULT(S): A total of 37 RCTs with 1929 cardiac
surgical patients (PHC group, 1043 patients; Control group, 886 patients)
were included. The current study demonstrated that the adult patients in
PHC group had lower cardiac troponin I (cTnI) [MD: -1.70, 95%CI: -2.63 to
-0.77, P = 0.0003, with heterogeneity (P < 0.00001)] and creatine kinase
(CK)-MB levels on post-operative day (POD)-1 after cardiac surgery, while
the pediatric patients had lower cardiac troponin T (cTnT) (MD: -0.10,
95%CI: -0.12 to -0.09, P < 0.00001, without heterogeneity) in PHC group on
POD-1. The levels of interleukin (IL)-6 and tumor necrosis factor
(TNF)-alpha were significantly lower in both adult and pediatric patients
of PHC group on POD-1. The incidence of postoperative pulmonary infection
was significantly reduced in the PHC group, and the duration of mechanical
ventilation and hospital LOS were shortened in adult patients.
 CONCLUSION(S): This meta-analysis demonstrated that PHC could provide
myocardial protection and suppress the inflammatory response in patients
undergoing cardiac surgery, thereby potentially facilitating rapid
recovery. CLINICAL TRIAL NUMBER: PROSPERO registration number
CRD42020183260. Copyright © 2025. The Author(s).

<59>
Accession Number
648933916
Title
Towards a more standardized bicuspid aortic valve repair: rationale and
design of the CONTOUR trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2025.
Date of Publication: 22 Oct 2025.
Author
Girdauskas E.; Stock S.; Hofbauer D.; Petersen J.; Reichenspurner H.;
Holubec T.; Walther T.; Vogl T.; Borger M.; Gutberlet M.; Kroncke T.;
Decker J.; Zapf A.; Lezius S.; Lenz A.; Lansac E.; Bannas P.
Institution
(Girdauskas, Stock, Hofbauer) Department of Cardiovascular and Thoracic
Surgery, University Hospital Augsburg, Germany
(Girdauskas, Petersen, Reichenspurner) Department of Cardiovascular
Surgery, University Heart and Vascular Center Hamburg, Germany
(Holubec, Walther) Department of Cardiovascular Surgery, University
Hospital, Frankfurt, Germany
(Vogl) Department of Diagnostic and Interventional Radiology, University
Hospital, Frankfurt, Germany
(Borger) Department Cardiac Surgery, Leipzig Heart Center, Germany
(Gutberlet) Department of Diagnostic and Interventional Radiology, Leipzig
Heart Center, Germany
(Kroncke, Decker) Department of Diagnostic and Interventional Radiology,
University Hospital Augsburg, Germany
(Zapf, Lezius) Institute of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Germany
(Lenz, Bannas) Department of Diagnostic and Interventional Radiology and
Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
(Lansac) Hopital de La Pitie-Salpetriere, AP-HP. Sorbonne Universite,
Paris, France
Abstract
OBJECTIVES: Aortic valve repair is an evolving and still underused
strategy in young BAV patients with aortic regurgitation (AR). The lack of
standardization remains the main limitation of current repair techniques,
resulting in an increased risk of AR recurrence and reoperation. The most
controversial issue is the stabilization of the BAV annulus.
 METHOD(S): The CONTOUR trial is a multicentre RCT designed to compare
two aortic valve annuloplasty concepts in 100 consecutive BAV patients.
BAV AR patients with an asymmetric configuration and without aortopathy
will be randomized 1:1 to undergo aortic valve repair using an internal
HAART 200 annuloplasty device (INTERNAL group) or double external
annuloplasty using Extra Aortic ring (EXTERNAL group). 4 D flow MRI will
be performed preoperatively (t1), postoperatively at discharge (t2), and
at 1-year follow-up (t3) for rater-blinded assessment of haemodynamic
profiles (ie, flow eccentricity) and regurgitation fraction at the MRI
core-lab. Two hierarchically ordered primary end-points will be
considered: (1) postoperative reduction of flow eccentricity at hospital
discharge and (2) regurgitation fraction (%) at 1-year follow-up.
 RESULT(S): The CONTOUR trial is the first RCT designed to compare two
different annuloplasty techniques in their effectivity to create a
completely symmetric post-repair BAV geometry and to achieve superior
aortic valve repair outcomes. CONCLUSION(S): The study findings are
expected to significantly influence aortic valve repair practice and
contribute to the refinement of guideline recommendations in the
management of BAV patients with AR. TRIAL REGISTRATION:
NCT06869954. Copyright © The Author(s) 2025. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved. For commercial re-use, please contact
reprints@oup.com for reprints and translation rights for reprints. All
other permissions can be obtained through our RightsLink service via the
Permissions link on the article page on our site-for further informat

<60>
Accession Number
648924733
Title
Contemporary Review of Outcomes in Patients Undergoing Transcatheter
Aortic Valve Replacement with Concomitant Mitral Stenosis.
Source
Current cardiology reviews. (no pagination), 2025. Date of Publication:
20 Oct 2025.
Author
Butt A.; Echefu G.; Geeslin D.; Ahmad L.; Craig D.; Ndubisi O.; Nayyar M.;
Ibebuogu U.N.
Institution
(Butt, Echefu, Nayyar, Ibebuogu) Division of Cardiovascular Diseases,
University of Tennessee Health Sciences Center, College of Medicine,
Memphis, TN, United States
(Geeslin, Ahmad, Craig) Department of Internal Medicine, University of
Tennessee Health Sciences Center, College of Medicine, Memphis, TN, United
States
(Ndubisi) Department of Internal Medicine, University of Galway, Ireland
Abstract
INTRODUCTION: Multivalvular cardiac disease has been associated with
increased mortality and morbidity as compared to isolated valve disease.
The treatment of choice for combined degenerative aortic and mitral
stenotic disease is considered to be double valve surgery, but it is
associated with poorer outcomes when compared to isolated valve surgical
correction, especially in high-risk populations. There is considerable
interest in utilizing transcatheter therapies in multivalvular disease.
The prevalence and outcomes of patients undergoing transcatheter aortic
valve replacement (TAVR) for aortic stenosis (AS) with concomitant mitral
stenosis (MS) have not been studied extensively. Currently, there are no
specific recommendations or guidelines for managing these patients.
 METHOD(S): A search of PubMed and Cochrane databases was performed
for studies and metaanalyses of patients undergoing TAVR for severe AS
with concomitant MS. RESULT(S): Our research demonstrates that most
patients undergoing TAVR for severe AS with concomitant mitral valve
stenosis tend to be elderly with degenerative valve disease. Short-term
outcomes, such as postoperative hospital stay, as well as long-term
outcomes, such as 1-year mortality, are worse in TAVR with severe MS. TAVR
in mild to moderate MS shows no significant differences in outcomes
compared with TAVR for isolated severe AS. DISCUSSION(S): Most
studies have shown that in subjects undergoing TAVR with concomitant MS,
severe MS is associated with worse outcomes, while mild to moderate MS
shows no significant difference compared with the absence of MS.
Limitations of our study are mainly related to the small number of
high-quality clinical trials examining TAVR in patients with combined AS
and MS. CONCLUSION(S): With the aging population, TAVR has been a
more attractive option for the treatment of severe symptomatic AS. The
optimal treatment of patients with AS along with MS is not clear. Thus,
further research is needed in this field. Copyright© Bentham
Science Publishers; For any queries, please email at
epub@benthamscience.net.

<61>
Accession Number
648931302
Title
Effects of Early Oral Hydration on Postextubation Thirst, Nausea, and
Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. (no pagination), 2025. Date of
Publication: 23 Oct 2025.
Author
Kim S.; Song Y.
Institution
(Kim) Department of Nursing, Kyungpook National University Chilgok
Hospital, Daegu, South Korea
(Song) Research Institute of Nursing Science, College of Nursing,
Kyungpook National University, Daegu, South Korea
Abstract
PURPOSE: A fasting period of 6 hours is generally maintained after
endotracheal tube extubation to reduce the risk of postoperative nausea
and vomiting in cardiac surgery patients. However, cardiac surgery
patients experience oral discomfort related to thirst, nausea, and
vomiting for a longer duration than patients undergoing other surgeries.
The purpose of this study was to determine the effects of early oral
hydration (EOH) on thirst, nausea, and vomiting in cardiac surgery
patients. DESIGN: Randomized controlled trial design as adopted and guided
by CONSORT. METHOD(S): Seventy-seven cardiac surgery patients were
randomly assigned to either the experimental (EOH; 2-hour fasting; n = 39)
or control group (delayed oral hydration; 6-hour fasting, n = 38). Thirst
was assessed using the Perioperative Thirst Discomfort Scale. Nausea and
vomiting were assessed using the Index of Nausea, Vomiting, and Retching.
Thirst, nausea, and vomiting were assessed immediately after extubation
(T1), as well as at 6 hours (T2) and 12 hours (T3) postextubation.
FINDINGS: Compared with the delayed oral hydration group, the EOH group
showed a significantly greater reduction in thirst over time (P < .001).
Nausea and vomiting were not significantly different between the two
groups (P = .327). CONCLUSION(S): EOH helped reduce thirst. Although
EOH did not aggravate nausea and vomiting relative to conservative oral
hydration, it may help alleviate postextubation discomfort in cardiac
surgery patients. Copyright © 2025 The American Society of
PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

<62>
Accession Number
648927620
Title
RADIOLOGIC RISK ASSESSMENT IN MULTIPLE MYCOTIC ANEURYSMS SECONDARY TO
INFECTIVE ENDOCARDITIS.
Source
Neuroradiology. Conference: 48th ESNR Annual Meeting and 15th
Asian-Oceanian Congress of Neuroradiology and Head and Neck Radiology and
34th Annual Meeting of the Turkish Society of Neuroradiology. Instanbul
Turkey. 67(Supplement_1) (pp S196-S197), 2025. Date of Publication: 01 Sep
2025.
Author
Anugrha H.W.; Pinuji D.A.; Lukman A.R.; Yunus R.E.
Institution
(Anugrha, Pinuji, Yunus) Department of Radiology, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
(Lukman) Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: Mycotic aneurysm (MA) is a rare, life-threatening
complication of infective endocarditis (IE) with high rupture risk if
untreated. In Indonesia, insurance limits prevent simultaneous treatment
of multiple MAs, requiring prioritization by rupture risk. This case
report identifies imaging features predictive of rupture in multiple MAs.
 Method(s): We report a 19-year-old female with IE who developed
seizures during hospitalization. Brain CT angiography revealed multiple
abscesses, saccular aneurysms (left A4 ACA, right M1 MCA, right M3 ACA),
and complete occlusion of the left M1 MCA due to vasculitis. After
multidisciplinary consultation, treatment prioritized the mycotic aneurysm
with the highest rupture risk before valve replacement surgery. Insurance
limitations precluded simultaneous intervention on all aneurysms; risk
stratification used imaging features and a systematic literature review
(PubMed, Cochrane Library, Proquest) to identify prognostic rupture
factors. Result(s): Two systematic reviews and two cohort studies met
PICO criteria. Key imaging risk factors identified were location,
diameter, aspect ratio (AR), and morphology. Three studies reported
increased diameter as a risk factor, two reported higher AR, two reported
irregular morphology, and two noted PCA, PCOM, and ACA aneurysms as higher
risk. Combining these factors for absolute risk estimation was not
feasible due to limited patient-level data and variability across studies.
 Discussion(s): The baseline risk of MA rupture is approximately
45.9%. The patient' s young age, absence of hypertension, and absence of
SAH did not increase risk. The patient' s aneurysms are: Risk assessment
indicates the first (location, morphology) and third aneurysms (higher AR,
morphology) have higher rupture risk. A systematic review reported a
pooled OR (95%CI) of 10.22 (4.25-24.58) for high AR and a hazard ratio
(95%CI) of 1.6 (1.1-2.5) for ACA location. Thus, the third aneurysm has
the highest rupture risk, followed by the first and second.
 Conclusion(s): This case highlights the critical role of radiology in
assessing rupture risk in patients with multiple MAs secondary to IE.
Further research is needed to improve risk stratification and clinical
decision-making.

<63>
Accession Number
648929824
Title
Effects of mannitol on cardiac function and postoperative arrhythmias
after coronary artery bypass grafting: a randomized controlled trial.
Source
Journal of cardiothoracic surgery. 20(1) (pp 376), 2025. Date of
Publication: 22 Oct 2025.
Author
Maslakpak M.H.; Negargar S.; Farbod A.; Fakhari S.; Khalili A.; Bilejani
E.; Alinejad V.; Faravan A.
Institution
(Maslakpak) Nursing and Midwifery School, Maternal and Childhood Obesity
Research Center, Urmia University of Medical, Iran, Islamic Republic of
(Negargar, Fakhari, Bilejani) Department of Anesthesia, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Farbod, Khalili) Cardiovascular Research Center, Madani Heart Center,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Alinejad) Department of Biostatistics, Urmia University of Medical
Sciences, Iran, Islamic Republic of
(Faravan) Student Research Committee, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Abstract
OBJECTIVE: Postoperative cardiac dysfunction and arrhythmias are
significant complications following cardiac surgery, frequently resulting
in increased mortality, longer hospital stays, higher healthcare costs,
and diminished patient quality of life. This study investigates the
effects of mannitol on cardiac function and the incidence of postoperative
arrhythmias after coronary artery bypass grafting (CABG). METHOD(S):
In a single-center, double-blind, randomized controlled trial, ninety
patients undergoing elective on-pump CABG were randomly assigned (1:1) to
receive either 200 mL of mannitol 20% (n = 45) or 200 mL of lactated
Ringer's solution (n = 45) during cardiopulmonary bypass priming.
Postoperative assessments included cardiac enzyme levels (creatine
phosphokinase, creatine kinase-MB isoenzyme, and cardiac troponin I),
incidence of arrhythmias (atrial fibrillation, ventricular fibrillation,
ventricular tachycardia), and left ventricular ejection fraction.
Statistical significance was defined as a p-value < 0.05. RESULT(S):
No significant differences were observed between the mannitol and control
groups in baseline demographics or clinical risk factors (p > 0.05). Left
ventricular ejection fraction was similar between the groups (45.22 +/-
9.82 in the mannitol group vs. 42.66 +/- 7.94 in the control group; p =
0.178). Atrial fibrillation occurred in 9 of 45 patients (20%) in the
mannitol group and 12 of 45 (26.7%) in the control group (p = 0.309).
Ventricular tachycardia was observed in 2 of 45 (4.4%) vs. 4 of 45 (8.9%)
patients, respectively (p = 0.338). Thirty-day mortality was 2 of 45
(4.4%) in the mannitol group and 1 of 45 (2.2%) in the control group (p =
0.50). Cardiac enzyme levels (CPK, CK-MB, and cTnI) showed no significant
differences between groups (p > 0.05). However, ventricular fibrillation
occurred in 2 of 45 patients (4.4%) in the mannitol group versus 8 of 45
(17.8%) in the control group, a statistically significant difference (p =
0.045). CONCLUSION(S): In conclusion, while mannitol was associated
with a lower incidence of ventricular fibrillation, this is a
single-center study with limited power to detect differences in other
outcomes. Further studies with larger sample sizes are needed to confirm
these findings. Copyright © 2025. The Author(s).

<64>
Accession Number
648929527
Title
Sex Differences in Transcatheter Aortic Valve Implantation Outcomes in
Patients on Oral Anticoagulants: A Popular PAUSE TAVI SubAnalysis.
Source
Journal of the American Heart Association. (pp e043448), 2025. Date of
Publication: 23 Oct 2025.
Author
van Bergeijk K.H.; Overduin D.C.; Venema C.S.; van Ginkel D.J.; van der
Werf H.W.; van den Heuvel A.F.M.; Voors A.A.; Wykrzykowska J.J.; Ten Berg
J.M.
Institution
(van Bergeijk, Venema, van der Werf, van den Heuvel, Voors, Wykrzykowska)
Department of Cardiology University of Groningen, University Medical
Center Groningen the Netherlands, Netherlands
(Overduin, van Ginkel, Ten Berg) Department of Cardiology St. Antonius
Hospital Nieuwegein the Netherlands, Netherlands
(Ten Berg) Cardiovascular Research Institute Maastricht (CARIM) the
Netherlands, Netherlands
Abstract
BACKGROUND: Many patients undergoing transcatheter aortic valve
implantation (TAVI) have an indication for oral anticoagulation (OAC). Our
aim was to study sex differences in outcomes after TAVI, depending on the
type and regimen of vitamin K antagonist versus direct OAC.
 METHOD(S): The Popular PAUSE TAVI (Periprocedural Continuation Versus
Interruption of Oral Anticoagulant Drugs During Transcatheter Aortic Valve
Implantation) was a randomized clinical trial to compare outcomes between
patients who continued or interrupted OAC during TAVI. The outcomes of
interest in this subanalysis were a combination of cardiovascular
mortality, stroke, myocardial infarction, major vascular complications or
major bleeding at 30 days, stratified by OAC regimen and type, and sex.
 RESULT(S): After 30 days of follow-up, 44/296 (14.9%) women reached
the combined end point, compared with 90/562 men (16.0%), P=0.732. There
were no statistically significant differences between sexes in outcomes,
irrespective of the continued or interrupted OAC regimen. Women on vitamin
K antagonist had a numerically higher combined event rate (21.7%) compared
with women using direct OAC (13.1%), although not statistically
significant (P=0.146), similarly for major vascular complications (15%
versus 7.2% in women on vitamin K antagonist and direct OAC respectively
[P=0.255]). The interaction between sex and type of OAC for the combined
end point lost significance after correcting for OAC indication and
randomization, among others (unadjusted: P=0.037, adjusted=0.090).
 CONCLUSION(S): After a 30-day follow-up of patients undergoing TAVI
on OAC, there were no statistically significant differences in outcomes
between sexes, independent of interrupted or continued management.
Although women treated with vitamin K antagonist had numerically more
events than those with direct OAC and an interaction between sex and type
of OAC was present, this interaction lost significance after adjustment
for other factors. REGISTRATION:
https://clinicaltrials.gov/study/NCT04437303; Unique Identifier:
NCT044373030.

<65>
Accession Number
2041239597
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. 54 (pp 220-232), 2025. Date of Publication: 01 Nov
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, Bertoni Maluf, Pabion, Moullet, 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, Carouge, Switzerland
(Jotterand Chaparro, Kiszio, Ramelet) Bureau d'Echange des Savoirs pour
des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence,
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) La Source, School of Nursing Sciences, HES-SO University of
Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
(Ramelet) University Institute of Higher Education and Research in
Healthcare, Faculty of Biology and Medicine, University of Lausanne,
Switzerland
(Ramelet) Lausanne University Hospital, Lausanne, Switzerland
(Morice) Geneva University Hospital, Geneva, Switzerland
(Valla) Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, Lyon,
France
(Tume) Faculty of Health, Social Care & Medicine, Edge Hill University, St
Helens Road, Ormskirk, United Kingdom
Publisher
Churchill Livingstone
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. This is an open access article under the CC BY license.
http://creativecommons.org/licenses/by/4.0/

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