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<1>
Accession Number
2038239093
Title
Serial quantitative optical coherence tomography for luminal volume
changes following either paclitaxel or sirolimus coated balloon in de novo
small coronary artery lesions.
Source
Cardiovascular Revascularization Medicine. 81 (pp 62-67), 2025. Date of
Publication: 01 Dec 2025.
Author
Tobe A.; Serruys P.; Miyashita K.; Oshima A.; Revaiah P.C.; Tsai T.-Y.;
Jouke D.; Garg S.; McInerney A.; Onuma Y.; Sharif F.
Institution
(Tobe, Serruys, Miyashita, Oshima, Revaiah, Tsai, Onuma, Sharif)
Department of Cardiology, School of Medicine, University of Galway,
Galway, Ireland
(Jouke) Leiden University Medical Center (LUMC), Leiden, Netherlands
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Garg) School of Medicine, University of Central Lancashire, Preston,
United Kingdom
(McInerney, Onuma, Sharif) Cardiology Department, Galway University
Hospital, Galway, Ireland
(Sharif) Department of Cardiology, Saolta Group, Galway University
Hospital Health Service Executive and University of Galway, Galway,
Ireland
(Sharif) CURAM Research Ireland Centre for Medical Devices, Ireland
Publisher
Elsevier Inc.
Abstract
Background Drug coated balloons (DCB) are a treatment option for lesions
in small coronary arteries, with treatment using paclitaxel coated
balloons (PCB) associated with less angiographic late lumen loss than
sirolimus coated balloons (SCB). Methods This single-center sub-study of
the TRANSFORM-I study compared quantitative optical coherence tomography
(OCT) data in patients with de novo lesions in small coronary arteries
treated with the MagicTouch (SCB) or SeQuent Please Neo (PCB). The
relationship between the lumen volume of the treated segment immediately
post procedure and at 6-month follow-up was evaluated. Late lumen volume
loss (LLVL, mm³) was defined as the post-procedural lumen
volume - lumen volume at 6 months. Results Serial OCT analysis was
performed in 19 patients with 21 lesions (SCB: 9 patients/11 lesions; PCB:
10 patients/10 lesions). There was a significant decrease in lumen volume
between post-procedure and 6 months in the SCB group (97.35 +/- 71.09
mm³ vs 87.96 +/- 61.48 mm³, p = 0.03), but not in
the PCB group (69.67 +/- 38.24 mm3 vs 71.64 +/- 42.22 mm3, p = 0.64). The
LLVL was 9.39 +/- 12.76 mm³ and - 1.97 +/- 12.90 mm³
in the SCB and PCB group, respectively (SCB vs PCB, p = 0.06). A trend for
interaction between SCB and PCB was observed in the relationship between
dissection volume and LLVL (SCB: LLVL = 1.28 * dissection volume + 7.42, p
= 0.37; PCB: LLVL = -2.84 * dissection volume + 4.51, p = 0.12; p for
interaction = 0.07). Conclusion In de novo lesions of small coronary
arteries, treatment with an SCB lead to a significant decrease in lumen
volume at 6-months compared to post-procedure, with no significant change
observed after treatment with a PCB.<br/>Copyright &#xa9; 2025 The
Authors.

<2>
Accession Number
2041694505
Title
Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation
in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE
Randomized Clinical Trial.
Source
JAMA Cardiology. 10(10) (pp 990-999), 2025. Date of Publication: 08 Oct
2025.
Author
Yamaguchi J.; Arashi H.; Hagiwara N.; Yasuda S.; Kaikita K.; Akao M.; Ako
J.; Matoba T.; Nakamura M.; Miyauchi K.; Matsui K.; Nakamura A.; Tamiya
E.; Yamamoto T.; Suetake S.; Noguchi T.; Nakamura S.; Kojima J.; Yamaguchi
H.; Suwa S.; Yasu T.; Nakajima A.; Yamada T.; Arai H.; Hata Y.; Sakanashi
T.; Tateishi H.; Nakayama T.; Nozaki Y.; Okumura Y.; Tokue M.; Kuroki N.;
Maruyama Y.; Suzuki H.; Nishida Y.; Ajioka M.; Yumoto K.; Shimizu S.;
Shimomura H.; Takeda T.; Oshiro K.; Sugishita N.; Shibata Y.; Otonari T.;
Shimizu M.; Kihara H.; Ogawa H.; Ono A.; Hazama M.; Tsukahara K.; Haruta
S.; Haruna T.; Ito M.; Fujii K.; Atsuchi N.; Sata M.; Wakeyama T.; Hasebe
N.; Kobayasi Y.; Osato K.; Hironaga K.; Naganuma Y.; Anzaki K.; Okazaki
S.; Nakagawa Y.; Tokuhiro K.; Tanaka K.; Momose T.; Fukushima Y.; Kametani
R.; Kawamitsu K.; Saito Y.; Akashi S.; Kumagai K.; Eshima K.; Tobaru T.;
Seo T.; Okuhara K.; Kozuma K.; Ikari Y.; Takahashi T.; Oiwa K.; Michishita
I.; Fujikura H.; Momomura S.; Yamamoto Y.; Otomo K.; Matsubara T.; Tashiro
H.; Inoue T.; Ishihara M.; Shiojima I.; Tachibana E.; Sumii K.; Yamamoto
N.; Omura N.; Takahashi N.; Morita Y.; Watanabe K.; Fujinaga H.; Maruyama
M.; Oka T.; Shirayama T.; Amano T.; Fukui K.; Ando K.; Oshima S.; Kagiyama
S.; Teragawa H.; Yuge M.; Ono S.; Koga T.; Fujiu K.; Kuwabara M.; Oya Y.;
Yumoto Y.; Kuji N.; Ikemura M.; Kario K.; Chatani K.; Sato K.; Miyagi H.;
Murakami M.; Saito K.; Hoshiga M.; Sato S.; Kubo N.; Sakamoto Y.; Ashida
K.; Sakamoto H.; Murasaki S.; Uehara H.; Akasaka T.; Oba Y.; Nakahara S.;
Hanaoka Y.; Nishimiya T.; Tsunoda R.; Onuma Y.; Higuchi S.; Tani A.; Wada
A.; Kato M.; Obata H.; Higuchi Y.; Endo T.; Kato R.; Matsunaga T.;
Matsuoka T.; Noguchi H.; Usui M.; Hayashi T.; Otsuji Y.; Osaki T.; Zaizen
H.; Yoshihara H.; Kadota K.; Hirose T.; Miyazawa T.; Mori A.; Takano M.;
Shimizu W.; Wake M.; Oriso S.; Yoshiyama M.; Kakinoki S.; Nishioka T.;
Ozaki T.; Nomoto K.; Seki K.; Kawai K.; Ozaki Y.; Miura S.; Kawasaki M.;
Funada R.; Dote K.; Okamoto S.; Owada T.; Doke T.; Matsumura T.; Kubo T.;
Horiuchi M.; Nagano T.; Takaishi A.; Yamamoto M.; Nakashima H.; Murozono
Y.; Munemasa M.; Sakata Y.; Inoue N.; Ota T.; Hamano Y.; Abe N.; Tsubokura
T.; Goto M.; Kubota I.; Yano M.; Umetani K.; Date T.; Morimoto H.; Noda
T.; Goto S.; Hibi K.; Nakano A.; Hiramitsu S.; Kihara Y.; Sugi M.; Shiba
N.; Izumi D.; Sato T.; Ajiki K.; Oishi M.; Kiryu M.; Ko T.; Ando H.;
Miyazaki S.; Kinugawa T.; Otake H.; Kitaoka H.; Tayama S.; Hirata Y.;
Honda S.; Manita M.; Ishii Y.; Oka H.; Nanba Y.; Nishino M.; Sakamoto T.;
Saito T.; Sakai H.; Ichikawa M.; Namiuchi S.; Matsui T.; Inoue K.;
Komiyama N.; Akashi Y.; Matsumura A.; Nakamura Y.; Komaru T.; Hosokawa T.;
Chikamori T.; Tanaka H.; Suzuki A.; Arasaki O.; Aonuma K.; Wakasa Y.;
Yoshizawa T.; Sugano T.; Yokota N.; Kakutani A.; Suzuki T.; Abe Y.;
Kataoka T.; Okayama H.; Yokoi H.; Chin K.; Hasegawa K.; Tomita H.; Honzyo
H.; Kawai H.; Morino Y.; Tsujiyama S.; Yoshimura M.; Hamasaki S.; Niijima
Y.; Aoyama T.; Mizuno Y.; Maki A.; Tanabe K.; Murohara T.; Nakamura T.;
Naomi S.; Matsumoto N.; Minamino T.; Sairenji H.; Miyamoto N.; Arikawa M.;
Ito H.; Matsuura Y.; Hata S.; Nakatsu Y.; Onodera T.; Kato T.; Amano H.;
Tokutake E.; Kasao M.; Moriguchi M.; Yamamoto K.; Tsuji M.; Yamamoto H.;
Yanbe Y.; Iwasawa T.; Suzuki M.; Mori H.; Shibahashi E.; Takita M.; Kimura
K.
Institution
(Yamaguchi, Arashi, Hagiwara) Department of Cardiology, Tokyo Women's
Medical University, Tokyo, Japan
(Yasuda) Department of Cardiovascular Medicine, Tohoku University,
Graduate School of Medicine, Miyagi, Japan
(Yasuda) National Cerebral and Cardiovascular Center, Osaka, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Kaikita) Division of Cardiovascular Medicine and Nephrology, Department
of Internal Medicine, Faculty of Medicine, University of Miyazaki,
Miyazaki, Japan
(Akao) Department of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University, School
of Medicine, Kanagawa, Japan
(Matoba) Department of Cardiovascular Medicine, Faculty of Medical
Sciences, Kyushu University, Fukuoka, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University, Ohashi
Medical Center, Tokyo, Japan
(Miyauchi) Department of Cardiovascular Medicine, Juntendo Tokyo Koto
Geriatric Medical Center, Tokyo, Japan
(Matsui) Department of General Medicine and Primary Care, Kumamoto
University Hospital, Kumamoto, Japan
(Ogawa) Kumamoto University, Kumamoto, Japan
(Nakamura) Iwate Prefectural Central Hospital, Japan
(Tamiya) Koto Hospital, Japan
(Yamamoto) Hokkaido Cardiovascular Hospital, Japan
(Suetake) Kaetsu Hospital, Japan
(Noguchi) National Cerebral and Cardiovascular Center, Japan
(Nakamura) Hitoyoshi Medhical Center, Japan
(Matsumura) Kameda Medical Center, Japan
(Kojima) Kojima Clinic, Japan
(Yamaguchi) Hiroshi YamaguchI Clinic, Japan
(Suwa) Juntendo University Shizuoka Hospital, Japan
(Yasu) Dokkyo Medhical University Nikko Medical Center, Japan
(Nakajima) New Tokyo Hospital, Japan
(Yamada) Osaka General Medical Center, Japan
(Arai) Kanoya Heart Center, Japan
(Hata) Minamino Cardiovascular Hospital, Japan
(Sakanashi) Sakanashi Heart Clinic, Japan
(Tateishi) Koyo Newtown Hospital, Japan
(Nakayama) Nakayama Clinic, Japan
(Nozaki) Hokkokinen Hospital, Japan
(Okumura) Nihon University Itabashi Hospital, Japan
(Tokue) Toho University Medical Center Ohashi Hospital, Japan
(Kuroki) Tokyo Metropolitan Bokutoh Hospital, Japan
(Maruyama) Iwatsuki-minami Hospital, Japan
(Suzuki) Showa University Fujigaoka Hospital, Japan
(Nishida) Kouseikai Takai Hospital, Japan
(Ajioka) Tosei General Hospital, Japan
(Yumoto) Yokohama Rosai Hospital, Japan
(Shimizu) Mashiko Hospital, Japan
(Aoyama) Fukui Prefectural Hospital, Japan
(Shimomura) Fukuoka Tokushukai Hospital, Japan
(Takeda) Koto Memorial Hospital, Japan
(Oshiro) Ohama Dai-ichi Hospital, Japan
(Sugishita) Sugishita Clinic, Japan
(Shibata) Miyazaki Medical Association Hospital, Japan
(Otonari) Otonari Clinic, Japan
(Shimizu) International Goodwill Hospital, Japan
(Kihara) Kihara Cardiovascular Clinic, Japan
(Ogawa) Kitaakita Municipal Hospital, Japan
(Ono) Medical Corporation Shoikai Kasai Shoikai Hospital, Japan
(Hazama) Nijigaoka Hospital, Japan
(Tsukahara) Fujisawa City Hospital, Japan
(Haruta) Fukuyama Cardiovascular Hospital, Japan
(Haruna) Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
(Ito) Mie University Hospital, Japan
(Fujii) Sakurabashi Watanabe Hospital, Japan
(Atsuchi) Tenyokai Central Clinic, Japan
(Sata) Tokushima University Hospital, Japan
(Wakeyama) Tokuyama Central Hospital, Japan
(Hasebe) Asahikawa Medical University Hospital, Japan
(Kobayasi) Chiba University Hospita, Japan
(Osato) Fukui CardioVascular Center, Japan
(Hironaga) Fukuoka City Hospital, Japan
(Naganuma) Hachinohe Red Cross Hospital, Japan
(Anzaki) Izumi Regional Medical Center, Japan
(Okazaki) Juntendo University Hospital, Japan
(Nakagawa) Kawanishi City Hospital, Japan
(Tokuhiro) Misato Central General Hospital, Japan
(Tanaka) Miyoshi Central Hospital, Japan
(Momose) Nagano Matsushiro General Hospital, Japan
(Fukushima) Nagatsuda Kosei General Hospital, Japan
(Kametani) Nagoya Tokushukai General Hospital, Japan
(Kawamitsu) Nanbu Tokushukai Hospital, Japan
(Saito) Nara Medical University, Japan
(Akashi) National Hospital Organization Hamada Medical Center, Japan
(Kumagai) Odawara Cardiovascular Hospital, Japan
(Eshima) Saga-Ken Medical Centre Koseikan, Japan
(Tobaru) Sakakibara Heart Institute, Japan
(Seo) Seo Heart Clinic, Japan
(Okuhara) Shobara Red Cross Hospital, Japan
(Kozuma) Teikyo University Hospital, Japan
(Ikari) Tokai University Hospital, Japan
(Takahashi) Tokyo Saiseikai Central Hospital, Japan
(Oiwa) Yokohama Chuo Hospital, Japan
(Michishita) Yokohama Sakae Kyosai Hospital, Japan
(Fujikura) Fujikura Clnic, Japan
(Momomura) Jichi Medical University Saitama Medical Center, Japan
(Yamamoto) Kansai Medical University Medical Center, Japan
(Otomo) Ome Municipal Hospital, Japan
(Matsubara) Shinrakuen Hospital, Japan
(Tashiro) St.Mary's Hospital, Japan
(Inoue) Dokkyo Medical University Hospital, Japan
(Ishihara) Hyogo College of Medicine College Hospital, Japan
(Shiojima) Kansai Medical University Hospital, Japan
(Tachibana) Kawaguchi Municipal Medical Center, Japan
(Sumii) MAZDA Hospital, Japan
(Yamamoto) Miyazaki Prefectural Nobeoka Hospita, Japan
(Omura) Nakata Clinic, Japan
(Nakamura) National Hospital Organization Kyushu Medical Center, Japan
(Takahashi) Oita University Hospital, Japan
(Morita) SAGAMIHARA NATIONAL HOSPITAL, Japan
(Watanabe) Saiseikai Matsuyama Hospital, Japan
(Fujinaga) Tokushima Prefectural Central Hospital, Japan
(Maruyama) Toyama Prefectural Central Hospital, Japan
(Oka) Tsuyama Chuo Hospital, Japan
(Shirayama) University Hospital, Kyoto Prefectural University of Medicine,
Japan
(Amano) Aichi Medical University Hospital, Japan
(Fukui) Kanagawa Cardiovascular and Respiratory Center, Japan
(Ando) Kokura Memorial Hospital, Japan
(Oshima) Kumamoto Chuo Hospital, Japan
(Kagiyama) Kyushu Central Hospital of the Mutual Aid Association of
Public, Japan
(Teragawa) Medical Corporation JR Hiroshima Hospital, Japan
(Yuge) Odawara Municipal Hospital, Japan
(Ono) Saiseikai Yamaguchi Hospita, Japan
(Koga) Steel Memorial Yawata Hospital, Japan
(Fujiu) The University of Tokyo Hospital, Japan
(Kuwabara) Toranomon Hospital, Japan
(Oya) University of the Ryukyus Hospital, Japan
(Yumoto) Fuji Hospital, Japan
(Kuji) Good Heart Clinic, Japan
(Ikemura) Ikemura Medical Clinic, Japan
(Kario) Jichi Medical University Hospital, Japan
(Chatani) Kawasaki Municipal Tama Hospital, Japan
(Sato) Kumamoto City Hospital, Japan
(Miyagi) Miyagi Clinic, Japan
(Murakami) Murakami Clinic, Japan
(Saito) Nishiarai Heart Center Hospital, Japan
(Hoshiga) Osaka Medical College Hospital, Japan
(Sato) Saiseikai Imabari Hospital, Japan
(Kubo) Saitama Medhical Center, Japan
(Sakamoto) Sakamoto Cardiovascular Clinic, Japan
(Ashida) Seirei Yokohama Hospital, Japan
(Sakamoto) Shizuoka Prefectural Hospital, Japan
(Murasaki) Tama-Hokubu Medical Center, Japan
(Uehara) Urasoe General Hospital, Japan
(Akasaka) Wakayama Medical University Hospital, Japan
(Oba) Chihaya Hospital, Japan
(Nakahara) Dokkyo Medical University Saitama Medical Center, Japan
(Hanaoka) Hanaoka Cardiovascular Clinic, Japan
(Nishimiya) Japanese Red Cross Asahikawa Hospital, Japan
(Tsunoda) Japanese Red Cross Kumamoto Hospital, Japan
(Onuma) JR Sapporo Hospital, Japan
(Higuchi) Kamiamakusa General Hospital, Japan
(Tani) Kano General Hospital, Japan
(Wada) Kusatsu General Hospital, Japan
(Kato) Mie Heart Center, Japan
(Obata) National Hospital Organization Obihiro Hospital, Japan
(Higuchi) Osaka Police Hospital, Japan
(Endo) Saiseikai Yokohamashi Nanbu Hospital, Japan
(Kato) Saitama Medical University International Medical Center, Japan
(Matsunaga) Suizenji Tohya Hospital, Japan
(Matsuoka) Uji Tokushukai Medical Center, Japan
(Noguchi) Fukuoka Wajiro Hospital, Japan
(Usui) Hamanomachi Hospital, Japan
(Hayashi) Hayashi Medical Clinic, Japan
(Otsuji) Hospital of the University of Occupational and Environmental
Health, Japan
(Osaki) Iwate Prefectual Kuji Hospital, Japan
(Zaizen) JA Oita Koseiren TsurumiI Hospital, Japan
(Yoshihara) JA Toride Medical Center, Japan
(Kadota) Kurashiki Central Hospital, Japan
(Hirose) Minamata City Hospital & Medical Center, Japan
(Miyazawa) Miyazawa Heart Clinic, Japan
(Mori) National Hospital Organization Iwakuni Clinical Center, Japan
(Takano) Nippon Medical School Chiba Hokusoh Hospital, Japan
(Shimizu) Nippon Medical School Hospital, Japan
(Wake) Okinawa Prefectural Chubu Hospital, Japan
(Oriso) Oriso Internal Medicine & Cardiology Clinic, Japan
(Yoshiyama) Osaka City University Hospital, Japan
(Kakinoki) Otaru Kyokai Hospital, Japan
(Nishioka) Saitama-Medhical Center, Japan
(Ozaki) Sapporo Orthopaedics and Cardiovascular Hospital, Japan
(Nomoto) Tokyo Rinkai Hospital, Japan
(Seki) Yamaguchi Rosai Hospital, Japan
(Kawai) Chikamori Hospital, Japan
(Ozaki) Fujita Health University Hospital, Japan
(Miura) Fukuoka University Hospital, Japan
(Kawasaki) Gifu University Hospital, Japan
(Funada) Gunma University Hospital, Japan
(Dote) Hiroshima City Asa Citizens Hospital, Japan
(Okamoto) Iwasaki Hospital, Japan
(Owada) Japanese Red Cross Society Fukushima Hospital, Japan
(Doke) Kohka Public Hospital, Japan
(Matsumura) Kumamoto Rosai Hospital, Japan
(Kubo) Japanese Red Cross Matsuyama Hospital, Japan
(Horiuchi) Medical Association Sugimura Hospital, Japan
(Nagano) Iwasa Hospital Iwasa Maternity, Japan
(Takaishi) Mitoyo General Hospital, Japan
(Yamamoto) National Center for Global Health and Medicine, Japan
(Nakashima) National Hospital Organization Kagoshima Medical Center, Japan
(Murozono) Japanese Red Cross Oita Hospital, Japan
(Munemasa) National Hospital Organization Okayama Medical Center, Japan
(Sakata) Osaka University Hospital, Japan
(Inoue) Sendai Kousei Hospital, Japan
(Ota) Takanohara Central Hospital, Japan
(Hamano) Tawaramachi Hamano Hospital, Japan
(Abe) Tokyo Medical University Ibaraki Medical Center, Japan
(Tsubokura) Tsubokura Cardiovascular Clinic, Japan
(Goto) Watanabe Hospital, Japan
(Kubota) Yamagata University Hospital, Japan
(Yano) Yamaguchi University Hospital, Japan
(Umetani) Yamanashi Prefectural Central Hospital, Japan
(Date) Date Naika Clinic, Japan
(Morimoto) Fukagawa Municipal Hospital, Japan
(Noda) Gifu Prefectural General Medical Center, Japan
(Goto) Goto Clinic, Japan
(Hibi) Gumyoji Eye Heart Clinic, Japan
(Nakano) Hikone Municipal Hospital, Japan
(Hiramitsu) Hiramitsu Heart Clinic, Japan
(Kihara) Hiroshima University Hospital, Japan
(Sugi) Imaki City Medical Center, Japan
(Shiba) International University of Health and Welfare Hospital, Japan
(Izumi) Japanese Red Cross Ise Hospital, Japan
(Sato) Japanese Red Cross Okayama Hospital, Japan
(Ajiki) JR Tokyo General Hospital, Japan
(Oishi) Kagoshima University Hospital, Japan
(Kiryu) Kanagawa Cardiovascular Medicine, Japan
(Ko) Kashima Heart Clinic, Japan
(Ando) Keiai Hospital, Japan
(Miyazaki) Kindai University Hospital, Japan
(Kinugawa) Kinugawa Cardiology Clinic, Japan
(Otake) Kobe University Hospital, Japan
(Kitaoka) Kochi Medical School Hospital, Japan
(Tayama) JCHO Kumamoto General Hospital, Japan
(Hirata) Kumamoto Regional Medical Center, Japan
(Honda) Minami Municipal National Insurance Hospital, Japan
(Manita) Naha City Hospital, Japan
(Ishii) Ogikubo Hospital, Japan
(Oka) Oka Clinic, Japan
(Nanba) Okayama Rosai Hospital, Japan
(Nishino) Osaka Rosai Hospital, Japan
(Sakamoto) Saiseikai Kumamoto Hospital, Japan
(Saito) Saito Clinic, Japan
(Sakai) Sakai Clinic, Japan
(Ichikawa) Sekishindo Hospital, Japan
(Namiuchi) Sendai Open Hospital, Japan
(Matsui) JCHO Shiga Hospital, Japan
(Inoue) South Miyagi Medical Center, Japan
(Komiyama) St. Luke's International Hospital, Japan
(Akashi) St. Marianna University School of Medicine Hospital, Japan
(Matsumura) Awa Regional Medical Center, Japan
(Nakamura) Takeda General Hospital, Japan
(Komaru) Tohoku Medical and Pharmaceutical University Hospital, Japan
(Hosokawa) Tokyo Haert Center, Japan
(Chikamori) Tokyo Medical University Hospital, Japan
(Tanaka) Tokyo Metropolitan Tama Medical Center, Japan
(Suzuki) JCHO Tokyo Yamate Medical Center, Japan
(Arasaki) Tomishiro Central Hospital, Japan
(Aonuma) University of Tsukuba Hospital, Japan
(Wakasa) Wakasa Medical Clinic, Japan
(Yoshizawa) Yamato Municipal Hospital, Japan
(Sugano) Yokohama City University Hospital, Japan
(Yokota) Yokota Naika, Japan
(Kakutani) Yoshinoawa Medical Center, Japan
(Suzuki) Aizawa Hospital, Japan
(Abe) Akeno Clinic, Japan
(Kataoka) Bellland General Hospital, Japan
(Okayama) Ehime Prefectural Central Hospital, Japan
(Yokoi) Fukuoka Sanno Hospital, Japan
(Chin) Hakuai Clinic, Japan
(Hasegawa) Hasegawa Outpatients Clinic for Cardiovascular Disease, Japan
(Tomita) Hirosaki University Hospital, Japan
(Honzyo) Honzyo Medical Hospital, Japan
(Kawai) Hyogo Brain and Heart CenterAt Himeji, Japan
(Yamamoto) Iida Municipal Hospital, Japan
(Morino) Iwate Medical University Hospital, Japan
(Tsujiyama) JA Hiroshima General Hospital, Japan
(Yoshimura) The Jikei University Hospital, Japan
(Hamasaki) Kagoshima City Hospital, Japan
(Niijima) Kan-etsu Chu-oh Hospital, Japan
(Aoyama) Kizawa Memorial Hospital, Japan
(Mizuno) Kumamoto Kinoh Hospital, Japan
(Maki) Maki Clinic, Japan
(Tanabe) Mitsui Memorial Hospital, Japan
(Murohara) Nagoya University Hospital, Japan
(Nakamura) Nakamura Clinic, Japan
(Naomi) Naomi Medicinal Clinic, Japan
(Matsumoto) Nihon University Hospital, Japan
(Minamino) Niigata University Medical & Dental Hospital, Japan
(Sairenji) Nishiyama Ichou Jyunkanki Geka Clinic, Japan
(Miyamoto) NTT-East Sapporo Hospital, Japan
(Arikawa) National Hospital Organization Oita Medical Center, Japan
(Ito) Okayama University Hospital, Japan
(Matsuura) Sakaemachi Clinic, Japan
(Hata) Sasebo City General Hospital, Japan
(Nakatsu) Shioda Memorial Hospital, Japan
(Onodera) Shizuoka City Shizuoka Hospital, Japan
(Kato) National Hospital Organization Tochigi Medical Center, Japan
(Amano) Toho University Omori Medical Center, Japan
(Tokutake) Tokutake Clinic, Japan
(Kasao) Tokyo Metropolitan Police Hospital, Japan
(Moriguchi) Toshiba Rinkan Hospital, Japan
(Yamamoto) Tottori University Hospital, Japan
(Tsuji) Tsuji Internal Medicine and Cardiology and Dental Clinic, Japan
(Yamamoto) Yamamoto Clinic, Japan
(Yanbe) Yokohama General Hospital, Japan
(Iwasawa) Yokohama General Hospital Uwamachi, Japan
(Suzuki) Yokohama Minami Kyousai Hospital, Japan
(Mori) Yokohama Sotetsu Building Clinic, Japan
(Shibahashi) Tokyo Women's Medical University, Japan
(Takita) Mebix, Japan
(Kimura) Yokohama City University Medical Center, Japan
Publisher
American Medical Association
Abstract
Importance: Antithrombotic therapy is crucial for older patients with
coronary artery disease (CAD) and atrial fibrillation (AF) who are at a
high risk of bleeding and thrombotic events. <br/>Objective(s): To examine
the age-stratified effects of rivaroxaban monotherapy compared with those
of rivaroxaban plus antiplatelet agent combination therapy. <br/>Design,
Setting, and Participant(s): This was a post hoc secondary analysis of the
Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With
Stable Coronary Artery Disease (AFIRE) open-label randomized clinical
trial. This was a multicenter study conducted in Japan from February 23,
2015, to July 31, 2018. Patients with AF and stable CAD who had undergone
percutaneous coronary intervention or coronary artery bypass grafting 1 or
more years earlier or who had angiographically confirmed CAD that did not
require revascularization were enrolled. Participants were stratified into
4 groups by age (<70 years, 70-74 years, 75-79 years, and >=80 years).
Study data were analyzed from August 2024 to July 2025.
<br/>Intervention(s): Rivaroxaban monotherapy or rivaroxaban plus
antiplatelet agent therapy. <br/>Main Outcomes and Measures: The primary
efficacy end point was a major adverse cardiovascular event, defined as a
composite of stroke, systemic embolism, myocardial infarction, unstable
angina requiring revascularization, or death from any cause. The primary
safety end point was major bleeding. <br/>Result(s): This study included a
total of 2215 participants (mean [SD] age, 74.3 [8.2] years; 1751 male
[79.1%]). The incidence of primary efficacy end points per patient-year
for rivaroxaban monotherapy vs rivaroxaban plus antiplatelet agent therapy
was 3.2% vs 4.3% (<70 years), 3.2% vs 2.8% (70-74 years), 3.8% vs 5.3%
(75-79 years), and 6.2% vs 10.3% (>=80 years). The hazard ratios were 0.74
(95% CI, 0.40-1.37) for those younger than 70 years, 1.16 (95% CI,
0.55-2.45) for those aged 70 to 74 years, 0.72 (95% CI, 0.41-1.26) for
those aged 75 to 79 years, and 0.61 (95% CI, 0.40-0.93) for those 80 years
and older (P for interaction =.51). For the primary safety end points, the
incidence was 0.5% vs 2.3% (<70 years), 2.2% vs 2.4% (70-74 years), 1.1%
vs 2.1% (75-79 years), and 2.9% vs 4.3% (>=80 years). The hazard ratios
were 0.23 (95% CI, 0.06-0.79) for those younger than 70 years, 0.91 (95%
CI, 0.39-2.15) for those aged 70 to 74 years, 0.52 (95% CI, 0.19-1.42) for
those aged 75 to 79 years, and 0.67 (95% CI, 0.35-1.27) for those 80 years
and older (P for interaction =.33). <br/>Conclusions and Relevance:
Results of this post hoc analysis of the AFIRE randomized clinical trial
reveal that rivaroxaban monotherapy reduced the risk of major
cardiovascular events and major bleeding across the broad range of age in
patients with AF and stable CAD. Possible age-related differences in
trends, with more pronounced efficacy in older patients and more
pronounced safety in younger patients, should be considered as hypothesis
generating and require further research.<br/>Copyright &#xa9; 2025
American Medical Association.

<3>
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Accession Number
2042429965
Title
Comparison of the Efficacy and Safety of Tranexamic Acid Versus
Aminocaproic Acid for Bleeding Prevention in Adult Surgical Patients
Undergoing Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis.
Source
Cardiology in Review. Publish Ahead of Print (no pagination), 2025. Date
of Publication: 01 Jan 2025.
Author
Behrendt H.A.; Reinert J.P.
Institution
(Behrendt, Reinert) Department of Pharmacy Practice, The University of
Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH
Publisher
Lippincott Williams and Wilkins
Abstract
The objective of this endeavor was to analyze current evidence comparing
tranexamic acid (TXA) with aminocaproic acid (EACA) to determine their
relative efficacy and safety in adult patients undergoing cardiopulmonary
bypass (CPB). A systematic review and meta-analysis were conducted
utilizing the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses methodology to assess randomized controlled trials comparing
TXA with EACA in adult CPB. Studies were excluded if not randomized, did
not directly compare TXA with EACA, or did not involve the adult CPB
population. The primary efficacy endpoint was total blood loss in 24 hours
(mL). Safety endpoints included the most commonly reported adverse events.
The secondary efficacy endpoint was total units of packed red blood cells
transfused (units). Nine randomized controlled trials were included. TXA
had a statistically significant reduction in 24-hour blood loss compared
with EACA [-0.21 (CI, -0.36 to -0.06), P = 0.0070]. TXA also had a
statistically significant reduction in total packed red blood cells
infused [-0.30 (CI -0.50 to -0.11), P = 0.0025]. There was no significant
difference in neurological [1.48 (0.92-2.38), P = 0.9843], renal [0.99
(0.85-1.15), P = 0.2274], cardiac [1.08 (0.88-1.32), P = 0.2068], or
thrombotic [1.00 (0.39-2.58), P = 0.4450] events. With synthesized
evidence supporting TXA, this review can help guide practitioners to make
informed recommendations regarding periprocedural care to minimize blood
loss and maximize resource use. This analysis and review supports the
preferential use of TXA over EACA in adults undergoing CPB.<br/>Copyright
&#xa9; 2025

<4>
Accession Number
2042229178
Title
Efficacy and safety of letermovir for cytomegalovirus prophylaxis in
thoracic organ transplantation: a systematic review and meta-analysis.
Source
BMC Infectious Diseases. 25(1) (no pagination), 2025. Article Number:
1766. Date of Publication: 01 Dec 2025.
Author
Aldalati A.Y.; Hussein A.M.; Aldalati K.; Hammadeh B.M.; Alrabadi B.;
Al-dabagh A.; Albliwi M.; Abuassi M.; Rawashdeh B.
Institution
(Aldalati, Aldalati, Alrabadi) Faculty of Medicine, Jordan University of
Science and Technology, Irbid, Jordan
(Hussein, Hammadeh) Faculty of Medicine, Al- Balqa' Applied University,
Salt, Jordan
(Al-dabagh) Faculty of Medicine, Sana'a University, P.O. Box 13078, Wadi
Dhaher Road, Sana'a, Yemen
(Albliwi) Department of Internal Medicine, Cleveland Clinic, Cleveland,
OH, United States
(Abuassi) Internal Medicine Department, College of Medicine, University of
Central Florida, Gainesville, FL, United States
(Rawashdeh) Department of Transplant Surgery, Medical College of
Wisconsin, Milwaukee, WI, United States
Publisher
BioMed Central Ltd
Abstract
Objective: Letermovir (LTV) is a novel antiviral agent approved for
cytomegalovirus (CMV) prophylaxis in high risk allogeneic hematopoietic
stem cell transplantation. However, its efficacy and safety in thoracic
organ transplant (TOT) recipients remain underexplored. This study
systematically evaluates the efficacy and safety of LTV prophylaxis for
CMV infection in TOT recipients. <br/>Method(s): A systematic search of
PubMed, Scopus, Web of Science, Embase, and Cochrane Library was conducted
up to February 2025. Studies assessing LTV prophylaxis in adult TOT were
included. We performed a single-arm meta-analysis using Open Meta Analyst
software and a double-arm meta-analysis with Review Manager. Dichotomous
outcomes were pooled as event rates using the fixed-effects model.
<br/>Result(s): Eleven studies with 380 patients were included. The
single-arm meta-analysis showed that LTV prophylaxis was associated with a
3.7% (95% CI: 0.006, 0.069) breakthrough CMV infection rate. The incidence
of low-level CMV viremia was 15.8% (95% CI: 0.070, 0.245). The percentage
of patients who discontinued LTV due to adverse effects was only 1.7% (95%
CI: -0.002, 0.035), while 79.9% (95% CI: 0.610, 0.988) experienced
improvement in leukopenia. The double-arm meta-analysis showed no
statistically significant difference in breakthrough CMV infection rates
between LTV and valganciclovir (VGC) (RR: 0.40; 95% CI: 0.09, 1.68; P =
0.21). <br/>Conclusion(s): LTV prophylaxis demonstrates promising efficacy
and safety in reducing breakthrough CMV infection, low-level viremia, and
adverse events in TOT recipients. Its favorable safety profile,
particularly in mitigating leukopenia, highlights its potential as an
effective alternative to VGC.<br/>Copyright &#xa9; The Author(s) 2025.

<5>
Accession Number
2042168523
Title
Cost-Effectiveness of Cryopreserved vs Liquid-Stored Platelets for
Managing Surgical Bleeding.
Source
JAMA Network Open. 8(12) (no pagination), 2025. Article Number: e2554363.
Date of Publication: 2025.
Author
Orman Z.; Reade M.C.; Marks D.C.; Howe B.D.; Bailey M.; Carrandi A.;
McQuilten Z.K.; Higgins A.M.
Institution
(Orman, Howe, Bailey, Carrandi, McQuilten, Higgins) Australian and New
Zealand Intensive Care Research Centre, School of Public Health and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Reade) Medical School, University of Queensland, Brisbane, QLD, Australia
(Reade) Joint Health Command, Australian Defence Force, Australian Capital
Territory, Canberra, Australia
(Marks) Australian Red Cross Lifeblood, Sydney, NSW, Australia
(McQuilten) Transfusion Research Unit, School of Public Health and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
IMPORTANCE Platelet transfusion is critical in managing major bleeding,
but access to liquid-stored platelets is limited by their 5- to 7-day
shelf life. Cryopreserved platelets last up to 2 years and may improve
availability, although their cost-effectiveness remains uncertain.
OBJECTIVE To evaluate the cost-effectiveness of cryopreserved platelets vs
liquid-stored platelets for managing surgical bleeding. DESIGN, SETTING,
AND PARTICIPANTS An economic evaluation was conducted from the Australian
government funder perspective alongside the CLIP-II randomized clinical
trial, following intention-to-treat principles. Adult patients (age >=18
years) undergoing cardiac surgery at 11 Australian tertiary hospitals
between August 2021 and April 2024 were screened for eligibility. Eligible
patients were those at high risk for platelet transfusion, identified by
risk prediction score or clinician judgment, excluding female patients
aged 18 to 55 years who were rhesus D (RhD) negative or with unknown RhD
status and patients with coagulopathy or prior thromboembolism. Data were
analyzed between January and April 2025. INTERVENTIONS Participants
received at least 3 units of either cryopreserved or liquid-stored
platelets intraoperatively or within 24 hours postsurgery. MAIN OUTCOMES
AND MEASURES Costs were estimated in 2023 Australian dollars (A$) by
assigning unit costs to patient-level resource use in each trial group,
including intensive care unit (ICU) admissions, hospitalizations, and
blood products. Effectiveness measures included postoperative bleeding
volume (first 24 hours post-ICU admission and total), 90-day mortality,
type 4 bleeding (based on the Bleeding Academic Research Consortium
criteria), and serious adverse events. Given the 90-day follow-up period,
discounting was not applied. RESULTS Among 202 participants (median [IQR]
age, 66 [57-74] years, 153 [75.7%] male), 104 received cryopreserved
platelets and 98 received liquid-stored platelets. The mean difference in
per-patient cost was A$15 035 (95% CI, -A$1878 to A$31 949) with
cryopreserved platelets vs liquid-stored platelets. Mean blood loss within
24 hours following ICU admission was 121 (95% CI, 5 to 237) mL higher,
total postoperative blood loss was 504 (95% CI, 145 to 862) mL higher, and
type 4 bleeding was 12.3% (95% CI, 1% to 23.6%) higher with cryopreserved
platelets compared with liquid-stored platelets. The difference in 90-day
mortality between cryopreserved platelet and liquid-stored platelet groups
was not statistically significant (7.4% [95% CI, -0.3% to 15.1%]). Only 1
serious adverse event was observed in each group. CONCLUSIONS AND
RELEVANCE In this economic evaluation, cryopreserved platelets were
dominated by liquid-stored platelets for managing bleeding in cardiac
surgery. Further research is needed to assess the potential economic
benefits of cryopreserved platelets in broader populations, particularly
in regional and remote hospitals where platelet availability is
limited.<br/>Copyright &#xa9; 2025 Orman Z et al.

<6>
Accession Number
2042330306
Title
Robotic-assisted thoracic surgery in children: A systematic review and
meta-analysis.
Source
Journal of Pediatric Surgery. 61(3) (no pagination), 2026. Article Number:
162840. Date of Publication: 01 Mar 2026.
Author
Delgado-Miguel C.; Camps J.; Garavis Montagut I.; Diez R.;
Arredondo-Montero J.; Hernandez-Oliveros F.
Institution
(Delgado-Miguel, Diez) Department of Pediatric Surgery, Fundacion Jimenez
Diaz University Hospital, Madrid, Spain
(Delgado-Miguel, Hernandez-Oliveros) Institute for Health Research IdiPAZ,
La Paz University Hospital, Madrid, Spain
(Camps) Department of Pediatric Surgery, Prisma Health Children's
Hospital, Columbia, SC, United States
(Garavis Montagut) Faculty of Medicine, El Bosque University, Bogota,
Colombia
(Arredondo-Montero) Department of Pediatric Surgery, Complejo Asistencial
Universitario de Leon, Castilla y Leon, Spain
Publisher
W.B. Saunders
Abstract
Introduction: Robot-assisted thoracic surgery (RATS) has emerged as an
innovative alternative to conventional video-assisted thoracoscopic
surgery (VATS) in pediatric patients. Although individual case series have
described its feasibility and safety, no systematic synthesis has
previously addressed its role in children. <br/>Method(s): We conducted a
systematic review and meta-analysis in accordance with PRISMA guidelines,
registered in PROSPERO (CRD420251091235). A comprehensive search of
PubMed, CINAHL, Web of Science, and EMBASE was performed to identify
studies reporting pediatric RATS. For the quantitative synthesis,
random-effects meta-analyses were applied with restricted maximum
likelihood (REML) estimation, and confidence intervals were adjusted using
either the Knapp-Hartung (HKSJ) or modified Knapp-Hartung (mKH) methods to
account for small-sample uncertainty. <br/>Result(s): Thirty-six studies
encompassing 936 patients were included; 638 underwent RATS. Indications
included tracheobronchial procedures, pulmonary resections, diaphragmatic
anomalies, mediastinal tumors, and thymic disorders. Qualitative synthesis
demonstrated high feasibility, versatility, and favorable safety, with a
1.8 % conversion rate and complication rates of 5.6 %. Quantitative
synthesis included 4 studies comparing pulmonary resections, and revealed
longer operative times for RATS compared to VATS (mean difference 26.4
min, 95 % CI: 3.26 to 49.47; p = 0.04). However, RATS significantly
reduced hospital stay (-0.70 days, 95 % CI: -1.22 to -0.17; p = 0.02) and
showed a nonsignificant trend toward shorter chest tube duration.
Complication rates did not differ significantly between groups (RR 1.16;
95 % CI: 0.83 to 1.63; p = 0.39). <br/>Conclusion(s): RATS may be
considered a safe and effective minimally invasive technique for selected
pediatric thoracic conditions, offering enhanced precision and
versatility. Current evidence, although limited by the small number of
studies, suggests a potentially beneficial profile for RATS. Larger
prospective multicenter studies are needed to confirm long-term results
and optimize patient selection.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<7>
Accession Number
2040341509
Title
Is There a Place for Intravascular Ultrasound in Guiding Endovascular
Treatment of the Femoropopliteal Arteries?.
Source
European Journal of Vascular and Endovascular Surgery. 70(6) (pp 818-819),
2025. Date of Publication: 01 Dec 2025.
Author
Golledge J.
Institution
(Golledge) Queensland Research Centre for Peripheral Vascular Disease,
College of Medicine and Dentistry, James Cook University, Townsville, QLD,
Australia
(Golledge) The Department of Vascular and Endovascular Surgery, Townsville
University Hospital, Townsville, QLD, Australia
(Golledge) The Australian Institute of Tropical Health and Medicine,
Townsville, QLD, Australia
Publisher
W.B. Saunders Ltd

<8>
Accession Number
2037646331
Title
Hybrid coronary revascularization versus traditional coronary artery
bypass grafting for left main coronary artery disease.
Source
Cardiovascular Revascularization Medicine. 81 (pp 11-15), 2025. Date of
Publication: 01 Dec 2025.
Author
Hebbo E.; Barker M.; Gold D.A.; Hassan M.E.; Sawan M.; Rab T.; Nicholson
W.J.; Halkos M.E.; Jaber W.A.; Sandesara P.B.
Institution
(Hebbo, Barker, Gold, Hassan, Sawan, Rab, Nicholson, Jaber, Sandesara)
Emory Clinical Cardiovascular Research Institute, Division of Cardiology,
Department of Medicine, Emory University School of Medicine, Atlanta, GA,
United States
(Halkos) Division of Cardiothoracic Surgery, Emory University, Atlanta,
GA, United States
Publisher
Elsevier Inc.
Abstract
Background The current recommended intervention for significant left main
(LM) stenosis, especially in patients with complex and high SYNTAX score
disease, is coronary artery bypass grafting (CABG). Hybrid coronary
revascularization (HCR) combines robotic coronary artery bypass and
percutaneous coronary intervention, offering a less invasive approach for
patients with LM disease. Objectives We compare clinical outcomes between
HCR and CABG in patients with LM disease. Methods We retrospectively
screened all patients treated for LM disease between 2019 and 2023 at a
single institution. Propensity matching was used for baseline
characteristics. The primary outcome was major adverse cardiovascular
events (MACE) at 30 days, 6 months and 1 year. Secondary outcomes included
death, myocardial infarction, repeat revascularization and stroke. Results
Out of a total of 761 patients treated for LM disease, 59 HCR patients
were propensity matched to 59 CABG patients and were included in the final
analysis. SYNTAX score was >33 for 49.1 % of HCR patients and 67.3 % of
CABG patients (p = 0.15). Hospital length of stay was significantly
shorter for HCR patients compared to CABG (4.07 days vs. 7.58 days, p <
0.001). MACE were significantly lower in the HCR group at 30 days (0 % vs
10.2 %; p = 0.01), 6 months (0 % vs 17 %; p = 0.002) and 1 year (2.4 % vs
20.5 %; p = 0.01) compared to CABG group. Additionally, there was a lower
rate of repeat revascularization at 6 months in the HCR group (0 % vs 10.9
%; p = 0.02). Conclusions This retrospective study demonstrates that HCR
is a safe and viable alternative to CABG in patients with LM disease.
Randomized clinical trials comparing the two treatment modalities are
needed to confirm these findings.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<9>
Accession Number
2038208579
Title
Comparison of drug-coated versus conventional balloons for the side branch
of the bifurcation lesion - multicenter randomized controlled study -
(OCVC-BIF): Design and rationale.
Source
Cardiovascular Revascularization Medicine. 81 (pp 57-61), 2025. Date of
Publication: 01 Dec 2025.
Author
Dohi T.; Ishihara T.; Kida H.; Nakamura D.; Kikuchi A.; Kawai T.; Mori N.;
Okamoto N.; Ueda Y.; Shutta R.; Ichikawa M.; Mano T.; Watanabe T.; Higuchi
Y.; Nishino M.; Hida E.; Sato T.; Hikoso S.; Nakatani D.; Sotomi Y.;
Sakata Y.
Institution
(Dohi, Kida, Nakamura, Hikoso, Nakatani, Sotomi, Sakata) Department of
Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2
Yamadaoka, Suita, Japan
(Ishihara, Mano) Kansai Rosai Hospital Cardiovascular Center, 3-1-69
Inabasou, Amagasaki, Japan
(Kikuchi, Kawai, Watanabe) Division of Cardiology, Osaka General Medical
Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, Japan
(Mori, Higuchi) Cardiovascular Division, Osaka Keisatsu Hospital, 10-31
Kitayamacho, Tennojiku, Osaka, Japan
(Okamoto, Nishino) Division of Cardiology, Osaka Rosai Hospital, 3-1179
Nagasonecho, Kita-ku, Sakai, Japan
(Ueda) Cardiovascular Division, National Hospital Organization Osaka
National Hospital, 2-1-14 Hoenzaka, Chuou-ku, Osaka, Japan
(Shutta) Department of Cardiology, Rinku General Medical Center, 2-23
Ourai-kita, Rinku, Izumisano, Japan
(Ichikawa) Department of Cardiology, Higashiosaka City Medical Center,
3-4-5 Nishi-Iwata, Higashiosaka, Japan
(Watanabe) Department of Cardiovascular Medicine, Yao Municipal Hospital,
1-3-1 Ryuge-cho, Yao, Japan
(Hida) Department of biostatics and data science, Osaka University
Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan
(Sato) Department of Intelligent Systems, Hiroshima City University
Graduate School of Information Sciences, 3-4-1 Ozuka-Higashi,
Asaminami-ku, Hiroshima, Japan
(Hikoso) Department of Cardiovascular Medicine, Nara Medical University,
840 Shijo-cho, Kashihara, Japan
Publisher
Elsevier Inc.
Abstract
Background Although several clinical trials have suggested the usefulness
of drug-coated balloons (DCB) for side-branch lesions, their efficacy and
safety have not yet been established. Methods and study design The Osaka
Cardiovascular Conference (OCVC) will conduct a multicenter, randomized,
open-label, controlled trial aiming to examine whether additional DCB
treatment for the side branch after main vessel stenting followed by
kissing balloon inflation (KBI) is superior to only KBI by conventional
balloons in PCI patients with coronary bifurcation lesions. The primary
endpoint is restenosis of side branches documented by scheduled or
symptom-driven coronary angiography during 9-month follow-up period after
the index PCI. The key secondary endpoints include major adverse cardiac
event which consists of cardiac death, myocardial infarction, target
lesion revascularization, and stent thrombosis, and optical coherence
tomography findings. A total of 300 patients will be enrolled and followed
up to 1 year. Summary The OCVC-BIF trial is a randomized controlled trial
designed to assess whether additional DCB treatment for side branch is
superior to only KBI by conventional balloons in patients with coronary
bifurcation lesions undergoing PCI with main vessel
stenting.<br/>Copyright &#xa9; 2025 The Authors.

<10>
Accession Number
2042189764
Title
GV effects of diabetes mellitus on clinical outcomes of patients with
acute heart failure: A systematic review and meta-analysis.
Source
PLOS ONE. 20(12 December) (no pagination), 2025. Article Number: e0338653.
Date of Publication: 01 Dec 2025.
Author
Zhao L.; Zhang J.; Liu W.; Dai C.; Li A.
Institution
(Zhao, Liu, Dai, Li) Department of Biochemistry and Molecular Biology,
College of Basic Medicine, Hebei University of Chinese Medicine, Hebei,
Shijiazhuang, China
(Zhang, Li) Hebei Key Laboratory of Chinese Medicine Research on
Cardio-Cerebrovascular Disease, Hebei, Shijiazhuang, China
(Li) Hebei Higher Education Institute Applied Technology Research Center
on TCM Formula Preparation, Hebei, Shijiazhuang, China
Publisher
Public Library of Science
Abstract
Diabetes mellitus (DM) is identified as a potential modifier of clinical
outcomes in acute heart failure (AHF), yet its prognostic impact is not
fully determined. This systematic review and meta-analysis aimed to assess
the prognostic impact of DM on survival outcomes in AHF patients by
synthesizing evidence from 26 studies involving 326,928 subjects collected
from Cochrane Library, PubMed, Web of Science, and Embase databases up to
1 June 2024. Both prospective/retrospective cohort and case-control
studies published since 2000 were included, with outcomes evaluated
through multivariate, univariate, and binary analyses using the
Newcastle-Ottawa Scale for quality assessment. Multivariate analysis
indicated that DM significantly increased the risk of all-cause mortality
in AHF patients (cohort studies: HR = 1.21, 95%CI (1.13, 1.29), OR=1.15,
95%CI (1.05, 1.26); case-control studies: HR = 1.39, 95%CI (1.26, 1.53),
OR=1.43, 95%CI (1.10, 1.84)]. Univariate analysis confirmed this finding
in case-control studies [HR = 1.30, 95%CI (1.01, 1.67)], but not in cohort
studies. In both cohort [RR = 1.27, 95%CI (1.12, 1.43)] and case-control
[OR=1.21, 95%CI (1.08, 1.35)] studies, DM increased the risk of all-cause
mortality. AHF patients with DM had a higher risk of cardiovascular
mortality [cohort studies: HR = 1.85, 95%CI (1.46, 2.33); case-control:
OR=1.70, 95%CI (1.17, 2.47)]. While multivariate analysis showed no
association between DM and in-hospital mortality, case-control studies
indicated an increased risk [OR=1.21, 95%CI (1.03, 1.42)]. DM also
increased the risk of readmission [cohort studies: HR = 1.32, 95%CI (1.14,
1.53); case-control studies: HR = 1.44, 95%CI (1.23, 1.69); binary data:
OR=1.19, 95%CI (1.07, 1.31)]. This updated meta-analysis demonstrates that
DM imposes significant adverse effects on all-cause mortality,
cardiovascular-related mortality, and readmission risk in AHF patients.
However, no significant connection was found between diabetes and survival
outcomes with respect to the co-endpoint of death or readmission and the
endpoint of in-hospital mortality. These findings underscore the necessity
for implementing targeted diabetes management within AHF care protocols to
enhance clinical outcomes, an essential consideration for future
practice.<br/>Copyright &#xa9; 2025 Zhao 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.

<11>
Accession Number
2035796594
Title
Long-term Survival in Elderly Patients after Coronary Artery Bypass
Grafting Compared to the Age-matched General Population: A Meta-analysis
of Reconstructed Time-to-Event Data.
Source
Thoracic and Cardiovascular Surgeon. 74(1) (pp 1-7), 2026. Date of
Publication: 01 Jan 2026.
Author
Kirov H.; Caldonazo T.; Toshmatov S.; Tasoudis P.; Mukharyamov M.; Diab
M.; Doenst T.
Institution
(Kirov, Caldonazo, Toshmatov, Mukharyamov, Diab, Doenst) Department of
Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
(Tasoudis) Division of Cardiothoracic Surgery, University of North
Carolina, Chapel Hill, NC, United States
Publisher
Georg Thieme Verlag
Abstract
Background Coronary artery disease (CAD) limits life expectancy compared
to the general population. Myocardial infarctions (MIs) are the primary
cause of death. The incidence of MI increases progressively with age and
most MI deaths occur in the population older than 70 years. Coronary
artery bypass grafting (CABG) may prevent the occurrence of new MIs by
bypassing most CAD lesions, providing downstream collateralization to the
diseased vessel, and consequently prolonging survival. We systematically
assessed the survival-improving potential of CABG by comparing elderly
CABG patients to the age-matched general population. Methods Three
databases were assessed. The primary and single outcome was long-term
all-cause mortality. Time-to-event data of the individual studies were
extracted and reconstructed in an overall survival curve. As a sensitivity
analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs)
for all individual studies were pooled and meta-analytically addressed.
The control group was based on the age-matched general population of each
individual study. Results From 1,352 records, 4 studies (4,045 patients)
were included in the analysis. Elderly patients (>70 years) who underwent
CABG had a significantly lower risk of death in the follow-up compared to
the general age-matched population in the overall survival analysis (HR:
0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years).
Conclusion Elderly patients who undergo CABG appear to have significantly
better long-term survival compared to the age-matched general population.
This advantage becomes visible after the first year and underscores the
life-prolonging effect of bypass surgery, which may eliminate the expected
reduction in life expectancy through CAD.<br/>Copyright &#xa9; 2024.
Thieme. All rights reserved.

<12>
Accession Number
2042176932
Title
Randomized clinical trial between two sedation protocols during
transcatheter aortic valve replacement procedures: Ketamine and Propofol
versus Remifentanil and Dexmedetomidine.
Source
Journal of Clinical Anesthesia. 109 (no pagination), 2026. Article Number:
112116. Date of Publication: 01 Feb 2026.
Author
Castellari A.; Lucchelli M.; Gomarasca M.; Salice V.; Orsenigo F.; Moro
Salihovic B.; Mondin F.; Castiglioni C.; Calzolari A.; Mistraletti G.
Institution
(Castellari, Lucchelli, Gomarasca, Salice, Orsenigo, Moro Salihovic,
Mondin, Castiglioni, Calzolari, Mistraletti) S.C. Rianimazione e Anestesia
Legnano, ASST Ovest Milanese, Legnano, Italy
(Mistraletti) Dipartimento di Fisiopatologia Medico-chirurgica e dei
Trapianti, Universita degli Studi di Milano, Italy
Publisher
Elsevier Inc.
Abstract
Objectives To compare efficacy and safety of two different sedation
protocols during Transcatheter Aortic Valve Replacement (TAVR); Ketamine
and Propofol (KETOFOL) versus Remifentanil and Dexmedetomidine (REMIDEX).
Design Monocentric, prospective, randomized and controlled trial. Setting
University hospital. Participants 231 patients were enrolled in the trial.
198 patients were included in the final analysis. Interventions Patients
enrolled underwent procedural sedation according to one of the two
possible drug combinations, KETOFOL vs REMIDEX, assigned through
randomization. During the procedure intervention times and clinical
parameters were recorded. After the procedure incidence of postoperative
adverse events were recorded. Measurements and main results REMIDEX group
showed a higher trend in the raw incidence of respiratory acidosis (67.7 %
vs 54.3 %). The correlation was confirmed in the multivariate logistic
regression analysis, with an increased risk of developing respiratory
acidosis in the REMIDEX group (OR 1.864 %, 95 % CI 1.014-3.427). Patients
in the REMIDEX group showed significantly longer induction times. REMIDEX
group required a greater number of pharmacological adjustments, had a
higher incidence of intraoperative agitation, and more episodes of
desaturation. No other differences were observed in any of the other
intraoperative or postoperative safety indicators. Conclusions Both
protocols showed a low and comparable incidence of cardiovascular adverse
events and postoperative complications such as POD and POCD. KETOFOL
protocol appears to offer greater sedative stability and seems to be more
protective regarding the incidence of respiratory adverse
events.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<13>
Accession Number
2040475548
Title
The Impact of Perioperative Hemodynamic and Blood Pressure Variability in
Outcomes and Mortality: A Comprehensive Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 347-354),
2026. Date of Publication: 01 Jan 2026.
Author
Saputra P.B.T.; Widiarti W.; Siahaan P.P.; Putra R.M.; Kriswidyatomo P.;
Faizah N.N.; Alkaff F.F.
Institution
(Saputra) Specialist Study Program of Cardiology and Vascular Medicine,
Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
(Saputra) Department of Cardiology and Vascular Medicine, Dr. Soetomo
General Academic Hospital, East Java, Surabaya, Indonesia
(Widiarti, Siahaan) Faculty of Medicine, Universitas Airlangga, East Java,
Surabaya, Indonesia
(Putra) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Airlangga, East Java, Surabaya, Indonesia
(Putra) Universitas Airlangga Hospital, East Java, Surabaya, Indonesia
(Kriswidyatomo) Department of Anesthesiology and Reanimation, Faculty of
Medicine, Universitas Airlangga - Universitas Airlangga Hospital, East
Java, Surabaya, Indonesia
(Faizah) Division of Cardiovascular Medicine, of Medicine, Kobe
University, Kobe, Japan
(Alkaff) Division of Nephrology, Department of Internal Medicine,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(Alkaff) Division of Pharmacology and Therapy, Department of Anatomy,
Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga,
East Java, Surabaya, Indonesia
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate the impact of perioperative blood pressure
variability (BPV) on cardiovascular outcomes and mortality in cardiac
surgery patients. <br/>Method(s): Literature searches were performed
across scientific databases up to December 31, 2024. Studies reporting
perioperative BPV in patients undergoing cardiac surgery and its
association with mortality and clinical outcomes were included.
<br/>Result(s): Fifteen studies with 16,407 patients were included.
Increased BPV was significantly associated with higher rates of 30-day
mortality, acute kidney injury (AKI), prolonged intensive care unit stay,
and cognitive dysfunction. Among patients with fewer comorbidities and
perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in
patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001).
Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in
blood pressure (BP) standard deviation (SD) and a 15% increased incidence
of postoperative delirium. The findings emphasize the critical need for
precise perioperative BP control, with advanced metrics like BP
fragmentation providing valuable insights into patient risk.
<br/>Conclusion(s): Perioperative BPV appears to be a crucial factor
influencing postoperative outcomes in cardiac surgery patients. Effective
management of BPV may help reduce complications and improve patient
outcomes, highlighting the potential benefits of tailored hemodynamic
strategies. However, further research is needed to establish standardized
BPV thresholds and optimal management approaches.<br/>Copyright &#xa9;
2025 The Authors

<14>
Accession Number
2035833154
Title
Intravenous methadone for pain management in cardiac surgery: a randomised
controlled trial with plasma concentration analysis*.
Source
Anaesthesia. 81(1) (pp 51-61), 2026. Date of Publication: 01 Jan 2026.
Author
Wong H.M.K.; Lai V.K.W.; Chiu S.L.C.; Wong W.T.; Wo S.K.; Zuo J.Z.; Liu
X.; Wong R.H.L.; Ho K.M.
Institution
(Wong, Chiu, Wong, Liu, Ho) Department of Anaesthesia and Intensive Care,
The Chinese University of Hong Kong, Hong Kong
(Lai) Child Health Evaluative Sciences, The Hospital for Sick Children
Research Institute, Toronto, ON, Canada
(Wo, Zuo) School of Pharmacy, Faculty of Medicine, The Chinese University
of Hong Kong, Hong Kong
(Wong) Division of Cardiothoracic Surgery, Department of Surgery, Prince
of Wales Hospital, New Territories, Hong Kong
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Postoperative pain after cardiac surgery remains significant
despite the administration of opioids. Methadone may improve pain control
and decrease the need for postoperative opioids. Randomised controlled
trials, however, are limited and the effects of cardiopulmonary bypass on
methadone pharmacokinetics are unclear. The aims of this study were to
compare methadone and morphine in cardiac surgery, measuring methadone
concentrations and correlating them with pain control. <br/>Method(s):
Patients undergoing cardiac surgery that required cardiopulmonary bypass
were allocated randomly to receive either 0.2 mg.kg^-1 methadone
or 0.2 mg.kg^-1 morphine (based on actual body weight, maximum
20 mg for both drugs). Postoperative pain was assessed at 15 min and 8 h,
12 h, 24 h, 48 h and 72 h after tracheal extubation, by analysis of
morphine consumption and pain scores. Opioid-related adverse events were
evaluated. Postoperative blood samples were collected for 96 h to measure
plasma methadone concentrations. <br/>Result(s): In total, 80 patients
were analysed (40 allocated to the methadone group, 40 allocated to the
morphine group). Patients allocated to the methadone group had
significantly reduced 24-h and total postoperative morphine requirements
compared to those allocated to the morphine group (median (IQR [range]) 9
(5-16 [0-40]) mg vs. 24 (17-43 [4-54]) mg (p < 0.001) at 24 h and 35
(23-52 [5-66]) mg vs. 11 (7-20 [0-44]) mg (p < 0.001) total). Patients
allocated to the methadone group had lower pain scores at rest (beta
-2.24, standard error 0.49, p < 0.001) and on coughing (beta -2.16,
standard error 0.50, p < 0.001). There was no difference in the incidence
of opioid-related adverse effects between the two groups. Plasma methadone
concentration decreased during cardiopulmonary bypass but remained above
the minimum effective analgesic concentration for approximately 24 h after
administration (mean (SD) 51 (24.7) ng.ml^-1 at baseline to 30
(10.7) ng.ml^-1 at 24 h). <br/>Discussion(s): Intra-operative
methadone reduces postoperative analgesia requirements without increasing
the incidence of opioid-related adverse events.<br/>Copyright &#xa9; 2025
The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of
Association of Anaesthetists.

<15>
Accession Number
2041514868
Title
Impact of Flow Status on Effective Orifice Area in Transcatheter Heart
Valves: A COMPARE-TAVI 1 Substudy.
Source
Journal of the American Society of Echocardiography. 39(1) (pp 80-88),
2026. Date of Publication: 01 Jan 2026.
Author
Krasniqi L.; Terkelsen C.J.; Nissen H.; Freeman P.; Frederiksen C.A.; Vase
H.; Hejlesen K.; Fur C.B.; Thim T.; Eftekhari A.; Uttenthal F.; Ellert J.;
Borg Mogensen N.S.; Haujir A.; Christiansen E.H.; Dahl J.S.
Institution
(Krasniqi) Department of Cardiothoracic Surgery, Odense University
Hospital, Odense, Denmark
(Krasniqi, Dahl) Department of Clinical Research, University of Southern
Denmark, Odense, Denmark
(Terkelsen, Frederiksen, Vase, Hejlesen, Fur, Thim, Christiansen)
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Terkelsen, Thim, Christiansen) Department of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
(Nissen, Ellert, Borg Mogensen, Haujir, Dahl) Department of Cardiology,
Odense University Hospital, Odense, Denmark
(Freeman, Eftekhari, Uttenthal) Department of Cardiology, Aalborg
University Hospital, Aalborg, Denmark
(Dahl) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
Minnesota, United States
Publisher
Elsevier Inc.
Abstract
Objective: The aim of this study was to study the impact of flow status on
effective orifice area (EOA) in patients treated with the
balloon-expandable Myval and Sapien transcatheter heart valves (THVs).
<br/>Method(s): We collected the core laboratory-measured EOA, mean and
peak gradients, Doppler velocity index (DVI), and stroke volume index
(SVi) from the 30-day echocardiograms in patients treated with the
balloon-expandable Myval and Sapien THVs in the COMPARE-TAVI 1 trial.
Patients were stratified according to flow into low flow (SVi <35
mL/m²), normal flow (SVi 35-50 mL/m²), and high flow
(SVi >50 mL/m²). <br/>Result(s): A total of 1,031 patients were
included in COMPARE-TAVI 1. Myval THVs (20.0-32.0 mm) exhibited overall
higher mean EOA and lower mean gradients (1.99 +/- 0.55 cm²,
9.46 +/- 3.84 mm Hg) compared to Sapien THVs (20-29 mm; 1.81 +/- 0.56
cm², 11.47 +/- 4.47 mm Hg). Compared to normal-flow patients,
low-flow patients exhibited smaller EOA (P < .001) and lower DVI (P <
.001) in all valve sizes irrespective of THV platform, while high-flow
patients had larger EOA (P < .001) and higher DVI (P < .001). Female sex
was associated with lower stroke volume, resulting in lower mean and peak
gradients independent of valve size and platform (P < .001).
<br/>Conclusion(s): The study indicates that EOA may be underestimated
after TAVI in patients with low-flow status, which can impact the
assessment of prosthesis-patient mismatch.<br/>Copyright &#xa9; 2025
American Society of Echocardiography

<16>
Accession Number
2041584664
Title
Center-mediated Differences in Postoperative Acute Kidney Injury Rates: A
Post Hoc Analysis of the PROTECTION Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 179-186),
2026. Date of Publication: 01 Jan 2026.
Author
Ranucci M.; Monaco F.; Bradic N.; Venditto M.; Neri G.; Barucco G.; Ti
L.K.; Porta S.; Baryshnikova E.; Pontillo D.; Silvetti S.; Federici F.;
Crescenzi G.; Cortegiani A.; Guarracino F.; Bove T.; Paternoster G.;
Anguissola M.
Institution
(Ranucci, Baryshnikova, Anguissola) Department of Cardiovascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, San
Donato Milanese, Italy
(Monaco) Division of Cardiacthoracic and Vascular Anesthesia, IRCCS
Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital,
University of Bologna, Bologna, Italy
(Monaco) Department of Medical and Surgical Sciences, DIMEC, University of
Bologna, Bologna, Italy
(Bradic, Barucco, Pontillo) Clinic of Anesthesiology, Resuscitation and
Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia
(Bradic) University North, Department of Nursing, Varazdin, Croatia
(Venditto) Cardiac Anesthesia and ICU, AORN "Dei Colli," Monaldi Hospital,
Naples, Italy
(Neri) Anesthesia and Intensive care, Department of Medical and Surgical
Sciences, Magna Graecia University, Catanzaro, Italy
(Ti) Department of Anaesthesia, National University Hospital, Singapore
(Porta) S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine
Maurizio Umberto I di Torino, Turin, Italy
(Silvetti) Department of Cardiac Anesthesia and Intensive Care, Ospedale
Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova,
Italy
(Federici) UOC Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria
Sant'Andrea, Rome, Italy
(Crescenzi) IRCCS Humanitas Research Hospital, Anestesia e Terapia
Intensiva Cardiochirurgica (TIC), Milan, Rozzano, Italy
(Cortegiani) Department of Precision Medicine in Medical, Surgical and
Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy
(Cortegiani) Department of Anesthesia Analgesia Intensive Care and
Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo,
Italy
(Guarracino) Azienda Ospedaliero Universitaria Pisana, Department of
Cardiothoracic Anaesthesia and Intensive Care, Pisa, Italy
(Bove) Department of Medicine, University of Udine, Udine, Italy
(Bove) Azienda Sanitaria Universitaria Friuli Centrale, Department of
Emergency "Santa Maria Della Misericordia", University Hospital of Udine,
Italy
(Paternoster) Department of Health Science School of Medicine, University
of Basilicata, Italy
(Paternoster) Anesthesia and ICU San Carlo Hospital, Potenza, Italy
Publisher
W.B. Saunders
Abstract
Objectives: The recently published PROTECTION trial (Intravenous Amino
Acid Therapy for Kidney Protection in Cardiac Surgery) demonstrated that,
in adult cardiac surgery patients, preoperative amino acid (AA)
administration has a protective effect on renal function. However, large
differences were observed within the participating centers. We aimed to
investigate whether such center effects would remove the impact of AA on
the prevention of cardiac surgery-associated acute kidney injury
(CSA-AKI). <br/>Design(s): A post hoc analysis of data from the PROTECTION
trial was performed. <br/>Setting(s): Multi-institutional data from
centers that participated in the PROTECTION trial. <br/>Participant(s):
Adult patients undergoing cardiac surgery enrolled in the PROTECTION
trial. <br/>Intervention(s): Two centers showed a significantly lower rate
of CSA-AKI with respect to the pooled rate in all centers (low-rate
centers) and 3 centers had a significantly higher rate (high-rate centers
[HR-C]). These centers were compared for preoperative and intraoperative
variables. <br/>Result(s): Patients in the HR-C were significantly (p =
0.001) older, with lower left ventricular ejection fraction and hemoglobin
values, a higher rate of class III and IV New York Heart Association
functional class, arterial hypertension, previous myocardial infarction,
diabetes, peripheral vascular disease, and more frequently received
myocardial revascularization. During surgery, patients in the HR-C group
had a longer aortic cross-clamp time, higher temperature on
cardiopulmonary bypass, and received diuretics and hemofiltration at a
lower rate. Additionally, a greater number of patients in the HR-C group
required norepinephrine. However, once corrected for such a center effect,
AA remained significantly independently associated with a reduction in
CSA-AKI (relative risk, 0.79). <br/>Conclusion(s): HR-Cs treated patients
with greater severity (unmodifiable risk factors) and received different
operative and perioperative management. Taking into account such center
effects, however, AA therapy remained independently associated with
CSA-AKI prevention.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<17>
Accession Number
2041808848
Title
Efficacy and safety of transcatheter aortic valves in patients with aortic
stenosis: a network meta-analysis.
Source
Future Cardiology. 21(12) (pp 1081-1090), 2025. Date of Publication: 2025.
Author
Adnan M.; Ahmed Usman M.; Akhtar M.; Hameed H.; Hussain Bakhtiari M.I.;
Hamza M.; Zaheer W.; Shoaib I.; Saleem A.; Basit J.; Alraies M.C.
Institution
(Adnan, Ahmed Usman, Akhtar, Hameed, Hussain Bakhtiari, Zaheer, Shoaib,
Saleem) Department of Medicine, Gujranwala Medical College, Gujranwala,
Pakistan
(Hamza) Department of Hospital Medicine, Guthrie Medical Group, Cortland,
NY, United States
(Basit) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Alraies) Detroit Medical Center, Wayne State University, Detroit, MI,
United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: Patients with aortic stenosis have a high mortality risk
treatable by transcatheter aortic valve replacement (TAVR). We conducted a
network meta-analysis to compare the efficacy and safety of transcatheter
aortic valves in aortic stenosis patients. <br/>Method(s): A systematic
search of PubMed, Embase, and Cochrane was conducted. Randomized
controlled trials (RCTs) that included adult patients with aortic stenosis
undergoing TAVR, which compared clinical efficacy and safety between any
of the transcatheter aortic valves, were included. Random effects
meta-analysis was employed. <br/>Result(s): A total of 4687 patients from
9 RCTs were included. Sapien XT had a significantly higher risk of stroke
compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, p = 0.043), while
other devices showed no significant differences. Evolut had a
significantly increased risk of permanent pacemaker placement compared to
Sapien 3 RR = 1.36 (95% CI: 1.07-1.74, p = 0.013). No significant
differences were observed between valves for any of the other analyzed
outcomes. <br/>Conclusion(s): While most TAVR devices showed comparable
safety profiles, Evolut was associated with increased pacemaker
implantation risk. The higher stroke risk with Sapien XT should be
interpreted with caution. <br/>Protocol Registration: This review was
registered with PROSPERO (CRD42024563628). Plain Language Summary: Aortic
stenosis is a common heart condition in which the main heart valve becomes
narrow and stiff, reducing blood flow from the heart to the rest of the
body. In recent years, a less invasive treatment called transcatheter
aortic valve replacement (TAVR) has become an important alternative to
open-heart surgery, especially for older adults or patients at higher
surgical risk. Several transcatheter valves are available, each with
distinct structural and technical features. Selecting the most appropriate
valve for each patient is therefore a key clinical decision. To compare
their safety and effectiveness, we combined results from major randomized
clinical trials using a method called network meta-analysis, which allows
comparisons between multiple valves even when they have not been directly
compared in a single study. Our study evaluated key outcomes at one year
after TAVR, including survival, stroke, bleeding, heart-failure
rehospitalization, and the need for a permanent pacemaker. Overall, most
modern valves demonstrated comparable safety and survival outcomes.
However, the Evolut valve was associated with a higher likelihood of
requiring a pacemaker, while the Sapien XT valve showed an uncertain but
possible higher risk of stroke. The Sapien 3, a newer-generation valve,
showed favorable safety results. These findings suggest that while
contemporary TAVR devices generally perform well, the choice of valve
should be guided by each patient's anatomy, coexisting medical conditions,
and the experience of the treating team. Further long-term research is
needed to clarify device durability and patient outcomes over
time.<br/>Copyright &#xa9; 2025 Informa UK Limited, trading as Taylor &
Francis Group.

<18>
Accession Number
2042560529
Title
Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery:
Systematic Review and Meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Salles M.M.M.; Massoud R.O.; de Carvalho P.L.; Correia J.S.; Melo R.H.
Institution
(Salles) Department of Medicine, University of Oeste Paulista, Jau, Brazil
(Massoud) Department of Medicine, State University of Para, Belem, Brazil
(de Carvalho) Department of Medicine, Federal University of Juiz de Fora,
Juiz de Fora, Brazil
(Correia) Department of Arts and Science, University of South Florida,
Tampa, FL, United States
(Melo) Hospital Municipal Gilson de Cassia Marques de Carvalho, Sao Paulo,
Brazil
(Melo) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Publisher
W.B. Saunders
Abstract
Cardiovascular surgery with cardiopulmonary bypass (CPB) is associated
with several potential complications, including the activation of
inflammatory and coagulation pathways, which may lead to acute kidney
injury (AKI). In this context, the intraoperative use of extracorporeal
cytokine adsorbers has been studied for their potential benefits; however,
their association with renal outcomes remains unclear. The authors aimed
to perform a systematic review and meta-analysis comparing the AKI
incidence and the need for renal replacement therapy in patients
undergoing cardiovascular surgery with and without intraoperative
hemoadsorption (HA). A comprehensive search of the PubMed, Embase, and
Cochrane Library databases was conducted to identify observational studies
and randomized controlled trials (RCTs) comparing the use of cytokine
adsorbers incorporated into the CPB circuit (eg, CytoSorb and Jafron HA
series) with standard surgical treatment during cardiac surgery.
Statistical analysis was performed using Review Manager, version 5.4. Risk
ratios (RRs) with 95% confidence intervals (CIs) were pooled using a
random-effects model. The authors included 17 studies-7 of which were
RCTs-comprising a total of 1,797 patients, 826 of whom underwent HA during
CPB. The incidence of AKI was lower with HA in the overall analysis,
driven by observational data, whereas RCTs did not show a statistically
significant reduction (overall RR, 0.66; 95% CI, 0.49-0.87; p = 0.008).
The need for renal replacement therapy did not differ significantly
between groups (RR, 0.83; 95% CI, 0.63-1.11; p = 0.19). Intraoperative HA
may be associated with a lower AKI incidence in observational studies, but
randomized data do not confirm a causal benefit. Larger, standardized
trials are required to determine the effect on renal
outcomes.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<19>
Accession Number
2037498070
Title
Serial cerebral magnetic resonance imaging before and after birth in
patients with complex congenital heart disease - a prospective,
multicentre observational study.
Source
Swiss Medical Weekly. 155(12) (no pagination), 2025. Article Number: 4466.
Date of Publication: 01 Dec 2025.
Author
Knirsch W.; De Silvestro A.; Steger C.; Rathke V.; Weber R.; von Rhein M.;
Schneider J.; Hutter D.; Reich B.; Held U.; Hackenberg A.; O'gorman R.T.;
Kottke R.; Jakab A.
Institution
(Knirsch, De Silvestro, Steger, Rathke, Weber) Paediatric Cardiology,
Paediatric Heart Centre, University Children's Hospital, Zurich,
Switzerland
(Knirsch, De Silvestro, Steger, Rathke, Weber, von Rhein, Hackenberg,
O'gorman, Kottke, Jakab) Children's Research Centre, University Children's
Hospital, Zurich, Switzerland
(Knirsch, De Silvestro, Rathke, Weber, von Rhein, Held, Hackenberg,
O'gorman, Kottke, Jakab) University of Zurich, Zurich, Switzerland
(De Silvestro, O'gorman, Kottke, Jakab) Department of Diagnostic Imaging,
MR Centre, University Children's Hospital, Zurich, Switzerland
(von Rhein) Child Development Centre, University Children's Hospital,
Zurich, Switzerland
(Schneider) Clinic of Neonatology, Woman-Mother-Child Department, Lausanne
University Hospital and University of Lausanne, Lausanne, Switzerland
(Hutter) Paediatric Cardiology, Centre for Congenital Heart Disease,
Department of Cardiology and Cardiac Surgery, University Children's
Hospital, University of Bern, Bern, Switzerland
(Reich) German Heart Centre, Department of Congenital Heart Defects and
Paediatric Cardiology, Technical University Munich, Munich, Germany
(Held) Biostatistic and Prevention Institute, Biostatistics Department,
Zurich, Switzerland
(Hackenberg) Paediatric Neurology, University Children's Hospital, Zurich,
Switzerland
Publisher
SMW supporting association
Abstract
STUDY AIMS: Our objective was to establish a multicentre
foetal-to-neonatal magnetic resonance (MR) neuroimaging programme for
neonates undergoing surgery for complex congenital heart disease (CHD). We
assessed structural and volumetric MRI findings at different timepoints in
various types of CHD and evaluated neurodevelopmental outcomes at one year
of age. Additionally, we analysed the feasibility, challenges and
limitations of implementing this MR neuroimaging programme.
<br/>METHOD(S): In this prospective, multicentre observational study, we
examined brain development and growth in infants with complex CHD
requiring neonatal cardiac surgery. Brain MRI was performed at multiple
timepoints: at the 32^nd week of gestation, after birth (both
before and after stage I surgery), and before stage II surgery in
single-ventricle CHD. We analysed and compared cardiac diagnoses,
treatment approaches, structural and volumetric brain MRI findings and
neurodevelopmental outcomes at one year of age (assessed using the Bayley
III scale) with those of healthy controls. <br/>RESULT(S): Between April
2020 and September 2023, 81 patients and 15 healthy controls underwent at
least one MRI. Cardiac diagnoses were biventricular CHD (66.7%),
single-ventricle CHD (25.9%) and borderline left ventricle CHD (7.4%). New
structural cerebral lesions were found before stage I or after stage I
including white matter injury in 3.8% and 8.7%, respectively, ischaemic
cerebral lesions in 11.5 and 11.6%, intraventricular haemorrhages in 7.7%
and 7.2%, and subdural haemorrhages in 33.6% and 26.1%. Total brain volume
at 32.6 (interquartile range [IQR]: 31.3-33.3) gestational weeks was 228.9
ml (213.1-241.2) in biventricular CHD, 194.4 ml (165.3-223.6) in
single-ventricle CHD and 196.4 ml (186.4-235.2) in normal healthy
controls. After birth, at 6 days (3-16) of life total brain volume was
337.1 ml (310.3-350.2) in biventricular CHD, 331.6 ml (305.9-350.7) in
single-ventricle CHD and 406.8 ml (389.9-438.7) in normal healthy
controls. After stage I, at 26.5 days (18.3-40.8) total brain volume was
367.7 ml (341.8-385.5) in biventricular CHD, 353.6 ml (338.2-375.7) in
single-ventricle CHD and 514.1 ml (482.9-554.6) at 116 days (94.5-118.5)
in patients with single-ventricle CHD. At 12.1 months of age,
neurodevelopmental performance determined by the Bayley III scale (mean
+/- SD [standard deviation]) was lower for patients with single-ventricle
CHD (cognitive composite score [CCS]: 92.9 +/- 13.1; language composite
score [LCS]: 88.5 +/- 12.0; motor composite score [MCS]: 85.6 +/- 14.5)
than in patients with biventricular CHD (CCS: 101.2 +/- 11.1; LCS: 95.7
+/- 13.1; MCS: 87.6 +/- 18.0) or in healthy controls (CCS: 113.3 +/- 5.6;
LCS: 102.3 +/- 7.9; MCS: 100.7 +/- 8.2). Feasibility for performing
cerebral MRI was limited due to maternal/patient safety reasons and
further logistical infrastructural reasons. <br/>CONCLUSION(S): Structural
cerebral lesions were found at various timepoints in both biventricular
and single-ventricle CHD during foetal-to-neonatal serial cerebral MRI.
Compared to healthy controls, total brain volume was reduced in patients
with complex CHD, and neurodevelopmental outcomes at one year of age were
mildly to moder ately impaired. Several patient-related and
infrastructural challenges limit the feasibility of a routine magnetic
resonance neuroimaging programme, necessitating further efforts to
optimise its implementation into routine clinical practice in the future.
Trial registration: ClinicalTrials.gov NCT04233775.<br/>Copyright &#xa9;
2025, SMW supporting association. All rights reserved.

<20>
Accession Number
2039641610
Title
Global Research Trends and Hotspots in Anesthesia for Coronary Artery
Bypass Graft Surgery: A Bibliometric Analysis from 2004 to 2024.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 40(1) (pp 114-126),
2026. Date of Publication: 01 Jan 2026.
Author
Liu Y.; Li C.
Institution
(Liu, Li) Department of Anesthesiology, Second Hospital, Hebei Medical
University, Shijiazhuang, China
Publisher
W.B. Saunders
Abstract
Objectives: This study aimed to analyze global research trends and
hotspots in anesthesia for coronary artery bypass grafting (CABG) surgery
through a comprehensive bibliometric analysis. <br/>Design(s):
Observational bibliometric analysis. <br/>Setting(s): Data was collected
from the Web of Science Core Collection database, which encompasses a
broad array of international research publications. <br/>Participant(s):
There were 740 publications related to anesthesia for CABG surgery
published between 2004 and 2024. <br/>Intervention(s): No direct
interventions were performed. The study involved the collection and
analysis of published research data. <br/>Measurements and Main Results:
Key findings revealed that the United States, Turkey, and China are
leading in anesthesia for CABG surgery research output, with an average
international collaboration rate of 12.57%. The Cleveland Clinic
Foundation was the top contributor with 48 publications. The Journal of
Cardiothoracic and Vascular Anesthesia was noted for its high impact
(H-index of 33). Influential authors identified include Landoni Giovanni
and Zangrillo Alberto. Keyword analysis showed a shift in research focus
from ischemia and morphine to myocardial protection, complications, and
cardiac anesthesia from 2019 to 2024. <br/>Conclusion(s): This
bibliometric study provides a comprehensive overview of the evolving
research landscape in anesthesia for CABG surgery, highlighting trends,
collaborative efforts, and emerging research areas that may guide future
investigations and clinical practices in cardiac anesthesia
management.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<21>
Accession Number
2042097944
Title
Peri-Operative Dosage and Therapeutic Concentrations of Cefazolin
Administered for Surgical Site Infection Prophylaxis in Elective Surgery-A
Systematic Review.
Source
Antibiotics. 14(12) (no pagination), 2025. Article Number: 1227. Date of
Publication: 01 Dec 2025.
Author
Ryan R.; Bosnak C.; Bright M.; Cheng V.; Velli G.; van Zundert A.; Lipman
J.; Roberts J.A.
Institution
(Ryan) Department of Anaesthesia and Peri-Operative Medicine, Sunshine
Coast Health, Birtinya, QLD, Australia
(Ryan, van Zundert) School of Medicine, The University of Queensland,
Herston, QLD, Australia
(Bosnak) Department of Infectious Diseases and Clinical Microbiology,
Hacettepe University Hospital, Ankara, Turkey
(Bright) Department of Anaesthesia, Princess Alexandra Hospital,
Woolloongabba, QLD, Australia
(Cheng, Lipman, Roberts) UQ Centre for Clinical Research, Faculty of
Medicine, The University of Queensland, Herston, QLD, Australia
(Cheng) Medical Education Unit, Princess Alexandra Hospital,
Woolloongabba, QLD, Australia
(Cheng) Department of Anaesthesia and Intensive Care, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Velli) Library and Information Management, Princess Alexandra Hospital,
Woolloongabba, QLD, Australia
(van Zundert) Department of Anaesthesia and Peri-Operative Medicine, The
Royal Brisbane and Women's Hospital, Herston, QLD, Australia
(Lipman, Roberts) UR UM 103, Division of Anesthesia, Critical Care and
Emergency and Pain Medicine, Nimes University Hospital, University of
Montpellier, Nimes, France
(Lipman, Roberts) Herston Infectious Disease Institute (HeIDI), Metro
North Health, Herston, QLD, Australia
(Roberts) Departments of Intensive Care Medicine and Pharmacy, The Royal
Brisbane and Women's Hospital, Herston, QLD, Australia
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Cefazolin is commonly administered for surgical
antibiotic prophylaxis. This review aims to examine whether target unbound
plasma and tissue cefazolin concentrations are reached following
prophylactic administration across multiple surgical subtypes. The primary
outcome was a lower limit of cefazolin concentration variability (mean-SD,
lower quartile, or lower range) in unbound plasma and/or tissue > 2
mg.L^-1, the epidemiological cut-off (ECOFF) value for
Staphylococcus aureus at skin incision and/or closure. <br/>Method(s):
Prisma 2020 guidelines were followed, and the protocol is registered in
PROSPERO (CRD42021080289). A literature search using MEDLINE (PubMed),
Embase, CENTRAL, CINAHL, and further databases was performed to identify
studies in which prophylactic cefazolin was administered to adult surgical
patients (>=18 years old) undergoing elective surgery, and unbound plasma
and tissue concentrations were measured at skin incision and closure.
Exclusion criteria included languages other than English, emergency
surgery, cefazolin being administered for any reason other than surgical
site prophylaxis, and whether patients received any cefazolin within the
48 h prior to the prophylactic dose. The search was repeated in August
2025 to ensure currency. A narrative assessment of the methodological
quality was performed. The data were synthesised in a narrative and
tabular form, and the certainty of the evidence was assessed using the
GRADE approach. <br/>Result(s): A total of 37 studies with 1102 patients
met the inclusion criteria. Twelve bariatric studies and 378 patients, 9
cardiac studies and 197 patients, 8 obstetric studies and 277 patients, 6
orthopaedic studies and 176 patients, 3 abdominal surgery studies and 62
patients, and 1 vascular study and 12 patients were included. Two studies
met the inclusion criteria for both bariatric and abdominal surgery. The
lower limit of variability of the unbound plasma concentration was
consistently >2 mg.L^-1. The reported lower limits of
variability in tissue concentrations of bariatric surgery were
conflicting. Only one study in cardiac surgery assessed the current dosing
regimens. The lower range of variability of tissue concentrations was
consistently >2 mg.L^-1 in the orthopaedic, obstetric,
abdominal, and vascular surgery subtypes. <br/>Conclusion(s): The current
dosing approaches in the obstetric, orthopaedic, abdominal, and vascular
surgery groups are reassuring for achieving effective concentrations,
although the overall data are sparse. It is unclear if increased dosing is
warranted in bariatric surgery patients, and further investigations in
cardiac surgery with current dosing regimens are required.<br/>Copyright
&#xa9; 2025 by the authors.

<22>
Accession Number
2042446385
Title
Transcatheter Aortic Valve Replacement in the Immunocompromised: A
Systematic Review and Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 71-79), 2026. Date of Publication:
01 Feb 2026.
Author
Meeus R.; Dhondt P.; Meeus N.; Ashraf H.; Minten L.; Hariyanto J.; Dubois
C.
Institution
(Meeus, Dhondt, Meeus, Minten, Dubois) Department of Cardiovascular
Medicine, University Hospitals Leuven, Leuven, Belgium
(Ashraf) Rawalpindi Medical University, Rawalpindi, Pakistan
(Hariyanto) Gedung Fakultas Kedokteran UPH, Tangerang, Indonesia
(Dubois) Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
Publisher
Elsevier Inc.
Abstract
Data on the safety and efficacy of transcatheter aortic valve replacement
(TAVR) for the treatment of aortic valve stenosis in immunocompromised
(IC) patients is scarce, while it represents a valid alternative to
surgical AVR in this vulnerable population. This meta-analysis aims to
compare the clinical outcomes of TAVR in IC versus non-IC patients. A
comprehensive search was conducted across PubMed, EMBASE, and Cochrane
Central for randomized controlled trials and observational studies that
compared outcomes between IC and non-IC patients undergoing TAVR. Primary
outcomes included 1-year all-cause, cardiovascular (CV) and non-CV
mortality. Secondary outcomes included new permanent pacemaker
implantation (PPI) and major periprocedural complications. 4,478 patients
in 7 studies (mean age 80.5 years, 7.64% IC) were included in the
analysis. As compared with non-IC patients, IC patients exhibited a
similar 30-day death rate (Odds Ratio [OR] 1.62; 95% Confidence Interval
[CI] 0.68 to 3.98; p = 0.297), but significantly higher 1-year all-cause
mortality (OR 2.39; 95% CI 1.55 to 3.70; p <0.001). Notably, IC patients
demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 to 0.59; p =
0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 to 10.18; p
= 0.002). There was no difference in the rate of new PPI or major
periprocedural complications. In conclusion, TAVR is a safe and effective
treatment strategy in IC patients, with similar short-term mortality and
increased medium-term mortality risk as compared with non-IC patients.
(PROSPERO: CRD42024623229)<br/>Copyright &#xa9; 2025 Elsevier Inc.

<23>
Accession Number
2034662763
Title
Does the venous cannulation method affect gaseous embolic load to the
patient during extracorporeal circulation?.
Source
Perfusion (United Kingdom). 41(1) (pp 102-109), 2026. Date of Publication:
01 Jan 2026.
Author
Torild P.; Corderfeldt Keiller A.; Damen T.
Institution
(Torild, Corderfeldt Keiller) Department of Perfusion, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Corderfeldt Keiller, Damen) Department of Anesthesiology and Intensive
Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Damen) Department of Cardiothoracic Anaesthesia and Intensive Care,
Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
SAGE Publications Ltd
Abstract
Introduction: Cardiopulmonary bypass (CPB) is essential for cardiac
surgery but poses risks, including gaseous micro emboli (GME). While the
incidence of stroke-a common clinical consequence of embolism-ranges from
1-5% in cardiac surgery, prevalence of GME during CPB remain poorly
understood. <br/>Objective(s): To quantitatively compare GME incidence in
the arterial line between cavoatrial and bicaval cannulation during
open-heart surgery. Secondary exploratory objectives include evaluating
the impact of venous reservoir volume on GME, and the correlation between
GME in the venous and arterial lines. <br/>Method(s): This single center
randomized controlled trial was conducted at Sahlgrenska University
Hospital, Sweden. Patients >=18 years undergoing planned aortic valve
repair/replacement with cavoatrial cannulation, or mitral valve
repair/replacement with bicaval cannulation, with or without coronary
artery revascularization, were screened for eligibility. Patients were
further randomized to either venous reservoir volume of >=300 mL (control)
or 200-300mL (intervention). GME detection was performed using GAMPT
BCC300 with probes positioned at multiple locations within the CPB
circuit. <br/>Result(s): 39 patients were included. No significant
differences in GME quantity in the arterial line were observed between the
cannulation methods (count p=.444; volume p=967). Similarly, no
significant differences were found based on venous reservoir volume (count
p=.074; volume p=.166). Furthermore, no significant correlation was
observed between GME in venous line entering the arterial line (count
p-value=492; volume p-value=.750). The CPB circuit effectively removed
99.14% of GME, with no adverse events reported. <br/>Conclusion(s): No
significant differences were found in arterial GME count or volume between
cavoatrial and bicaval cannulation during CPB. These findings underscore
the importance of the bypass circuit's air-handling capacity, as well as
the role of modern oxygenators and arterial line filters in effectively
minimizing the passage of GME. Trial Registration:ClinicalTrials.gov
Identifier: NCT05820828URL:
https://clinicaltrials.gov/ct2/show/NCT05820828<br/>Copyright &#xa9; The
Author(s) 2025

<24>
Accession Number
2042499984
Title
Transcatheter or Surgical Strategy for Aortic Stenosis and Coronary Artery
Disease: A Kaplan-Meier-Derived Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 80-88), 2026. Date of Publication:
01 Feb 2026.
Author
Baudo M.; Leone P.P.; Sicouri S.; Magouliotis D.E.; Yamashita Y.; Cabrucci
F.; Sturla M.; Latib A.; Ramlawi B.
Institution
(Baudo, Sicouri, Magouliotis, Yamashita, Cabrucci, Ramlawi) Department of
Cardiac Surgery Research, Lankenau Institute for Medical Research, Main
Line Health, Wynnewood, PA, United States
(Leone, Sturla, Latib) Division of Cardiology, Montefiore Medical Center,
Bronx, NY, United States
(Yamashita, Ramlawi) Department of Cardiac Surgery, Lankenau Heart
Institute, Main Line Health, Wynnewood, PA, United States
Publisher
Elsevier Inc.
Abstract
Coronary artery disease (CAD) is commonly found in patients with severe
aortic stenosis (AS) and combined surgical aortic valve replacement (SAVR)
and coronary artery bypass grafting (CABG) is currently recommended as the
preferred treatment in this setting. Transcatheter aortic valve
replacement (TAVR) and percutaneous coronary intervention (PCI) represent
a valid alternative. This study sought to investigate clinical outcomes
after TAVR+PCI versus SAVR+CABG in patients with severe AS and CAD. A
systematic review was conducted from inception until December 2024 for
randomized controlled and propensity score-matched studies comparing
TAVR+PCI and SAVR+CABG for patients with severe AS and CAD.
Kaplan-Meier-derived individual patient data was retrieved when available.
Primary endpoint was all-cause mortality. The study was registered with
PROSPERO (CRD42025642206). Six studies met our inclusion criteria with a
total of 1,998 patients: 1,007 in the TAVR+PCI group and 991 in the
SAVR+CABG group. The hazard ratio of all-cause mortality varied over time
between groups: TAVR+PCI showed a lower incidence of all-cause mortality
in the first 19 days, with a reversal at 73 days favoring SAVR+CABG.
Patients undergoing TAVR+PCI group experienced lower rates of stroke-free
survival (p = 0.039), postoperative reintervention (p = 0.020), atrial
fibrillation (p <0.001), and acute kidney injury (p = 0.001) rates, while
they were at higher risk of postoperative moderate/severe aortic
regurgitation (p <0.001), permanent pacemaker implantation (p = 0.005) and
major vascular complication (p <0.001). Major bleeding didn't differ (p =
0.358). A percutaneous treatment approach offered an early survival
benefit over a surgical approach in patients with severe AS and CAD but
was associated with worse survival at mid-term follow-up.<br/>Copyright
&#xa9; 2025 Elsevier Inc.

<25>
Accession Number
2042470815
Title
Post-operative atrial fibrillation and stroke after non-cardiac surgery: a
systematic review and meta-analysis.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 11(8) (pp
682-697), 2025. Date of Publication: 01 Dec 2025.
Author
Donati J.; Morrone D.; Verheugt F.W.A.; De Caterina R.
Institution
(Donati, Morrone, De Caterina) University of Pisa, Cardiovascular
Division, Pisa University Hospital, Via Paradisa, 2, Pisa, Italy
(Verheugt) AmsterdamNetherlands
Publisher
Oxford University Press
Abstract
Post-operative atrial fibrillation (POAF) is common after non-cardiac
surgery. Because often transient, there are uncertainties on the
associated risk of stroke, possibly driving the need for long-term
anticoagulation. We performed a systematic PubMed search until 16 January
2025, related to the incidence of stroke in patients with POAF after
non-cardiac surgery. We included papers reporting outcomes, excluding
studies only dealing with epidemiology, mechanisms, management, and
treatment. We excluded studies reporting on POAF after cardiac surgery.
Risk of bias was assessed for each study, and the certainty of evidence
was evaluated using the GRADE methodology. We retrieved and included 40
studies (including review papers) for the systematic review. These were
then further selected to create a final list of 19 studies included in the
meta-analysis. The reported incidence of stroke after POAF was found to be
widely variable, ranging between 0.4% and 16.7% at 1 year. Stroke
incidence also varies widely according to the type of surgery and patient
characteristics. With only three exceptions, all studies, however,
reported a risk of stroke higher in the POAF group than in the no-POAF
group, with a mean odds ratio of 3.02. POAF on average triples the risk of
stroke, with variations related to patient characteristics and type of
surgery. Patients after non-cardiac surgery should be monitored at least
during hospitalisation to detect POAF. Future studies are necessary to
evaluate optimal duration and modalities of monitoring, as well as to
assess the relevance of symptomatic vs asymptomatic AF
episodes.<br/>Copyright &#xa9; The Author(s) 2025. Published by Oxford
University Press on behalf of European Society of Cardiology.

<26>
Accession Number
2041999638
Title
Cardiac Rehabilitation After Thoracic Aortic Surgery.
Source
Canadian Journal of Cardiology. 41(12 Supplement) (pp S86-S94), 2025. Date
of Publication: 01 Dec 2025.
Author
McMurtry M.S.; Skow R.J.; Foulkes S.J.; Moulson N.; McKinney J.; Thompson
R.B.; Haykowsky M.J.
Institution
(McMurtry) Department of Medicine, University of Alberta Walter Mackenzie
Health Sciences Centre, Edmonton, AB, Canada
(Skow, Haykowsky) Faculty of Nursing, University of Alberta, Edmonton,
Canada
(Foulkes) Baker Heart and Diabetes Institute, Melbourne, Australia
(Moulson, McKinney) Division of Cardiology, University of British
Columbia, Vancouver, Canada
(Thompson) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, Canada
Publisher
Elsevier Inc.
Abstract
Thoracic aortic diseases, including aortic aneurysm and aortic dissection,
are disorders that frequently require cardiac surgical intervention.
Current clinical practice guidelines recommend cardiac rehabilitation for
patients after thoracic aortic surgery. However, the evidence to support
these recommendations remains limited, and there is a notable absence of
individualized approaches for resuming regular exercise. In this narrative
review the literature on cardiovascular rehabilitation after thoracic
aortic surgery for inherited and acquired thoracic aortic disease is
examined, a clinical case to illustrate limitations in the current
approach is presented, and how exercise-based magnetic resonance imaging
to assess aortic wall stress might support a more personalized and precise
exercise prescription is explored. Further research on the safety and
efficacy of exercise training in patients after thoracic aortic
surgery-particularly randomized controlled trials-are
needed.<br/>Copyright &#xa9; 2025 The Authors.

<27>
Accession Number
2033036350
Title
Biomarkers predicting postoperative adverse outcomes in children with
congenital heart disease: a systematic review and meta-analysis.
Source
Frontiers in Pediatrics. 13 (no pagination), 2025. Article Number:
1508329. Date of Publication: 2025.
Author
Zhou S.; Liu L.; Jin X.; Dorikun D.; Ma S.
Institution
(Zhou, Jin, Dorikun, Ma) Pediatric Cardiothoracic Surgery, First
Affiliated Hospital of Xinjiang Medical University, Urumqi, China
(Zhou) College of Pediatrics, Xinjiang Medical University, Urumqi, China
(Liu) Hematology Department, First Affiliated Hospital of Xinjiang Medical
University, Urumqi, China
Publisher
Frontiers Media SA
Abstract
Objective: To statistically analyze biomarkers predicting postoperative
outcomes in children with congenital heart disease (CHD). <br/>Method(s):
PubMed, Embase, Cochrane Library, and Web of Science were performed to
search up to February 2024. The measured outcomes were biomarkers,
mortality, length of hospital stay, complication rates, and infection
rates. Adults with CHD were excluded. Standard deviation or odds ratio
(OR) with 95% confidence interval (95% CI) were extracted. A
random-effects model synthesized SMDs or ORs with 95% CIs. Sensitivity
analysis investigated heterogeneity, and Egger's test assessed publication
bias. <br/>Result(s): Seventeen eligible articles were included, the
biomarkers involved include serum lactate, NT-Pro BNP, PaO2, serum
creatinine, C1-INH activity, ST2, serum chloride concentration, GH,
glycemia, cTOI, NLR, serum albumin, and glucose levels, with 2,888
patients who underwent surgery(modified Norwood procedure, arterial switch
procedure, biventricular repair etc.). Serum lactate was higher in the
postoperative death group (SMD: 1.18, 95% CI: 0.59-1.77). Lower
postoperative N-terminal pro-B-type natriuretic peptide (NT-pro BNP)
levels were associated with lower mortality (OR: 0.23, 95% CI: 0.08-0.68)
and shorter mechanical ventilation time (OR: 0.40, 95% CI: 0.18-0.90).
Higher serum albumin levels were associated with longer hospital stays
(OR: 3.12, 95% CI: 1.66-5.84). Significant heterogeneity was found in
serum creatinine, B-type natriuretic peptide (BNP), serum lactate, and
NT-Pro BNP. Publication bias was detected in some studies.
<br/>Conclusion(s): Serum lactate, NT-Pro BNP, and serum albumin are
reliable biomarkers for predicting adverse outcomes in children with CHD
after surgery. Systematic Review Registration: PROSPERO
[CRD42024512753].<br/>Copyright 2025 Zhou, Liu, Jin, Dorikun and Ma.

<28>
Accession Number
2042484647
Title
Differential effects of pre-procedural atorvastatin versus rosuvastatin on
hematologic and inflammatory markers in patients with ST-elevation
myocardial infarction undergoing primary percutaneous coronary
intervention: A randomized controlled trial.
Source
American Heart Journal Plus: Cardiology Research and Practice. 61 (no
pagination), 2026. Article Number: 100701. Date of Publication: 01 Jan
2026.
Author
Khameneh Bagheri R.; Eshraghi A.; Amirsoleimani H.; Keihanian F.
Institution
(Khameneh Bagheri, Eshraghi) Interventional Cardiologist, Department of
Cardiovascular Diseases, Faculty of Medicine, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic of
(Amirsoleimani) Department of Cardiovasular diseases, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Keihanian) Fellowship of Echocardiography, Department of Cardiovasular
diseases, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Background: The pleiotropic effects of statins may benefit patients with
acute coronary syndromes. This study compared the impact of pre-procedural
atorvastatin versus rosuvastatin on hematologic and inflammatory indexes
in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).
<br/>Method(s): In this pre-specified, multi-centric, triple-blind trial,
STEMI patients were randomized to receive either 80-mg atorvastatin (n =
98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary
intervention (PPCI). Key hematologic indexes-neutrophil-to-lymphocyte
ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution
width (PDW)-were measured at baseline, 24, and 48 h post-PPCI.
Contrast-induced nephropathy (CIN) incidence was also assessed.
<br/>Result(s): The incidence of CIN was similarly low in both groups
(atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However,
hematologic markers showed significant differences. The atorvastatin group
had a significantly lower NLR at 48 h compared to the rosuvastatin group
(Median [IQR]: 5.1 [3.2-8.1] vs. 7.8 [4.9-10.2], p = 0.003). Conversely,
the rosuvastatin group demonstrated a significantly higher PDW at 24 h
(15.6 +/- 1.5 vs. 14.7 +/- 1.5, p < 0.001). No significant inter-group
difference was found in the 48-h PLR. <br/>Conclusion(s): While both
high-intensity statins provided similar nephroprotection, they exhibited
distinct modulatory effects. Atorvastatin was associated with a more
pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was
linked to increased platelet activity (higher PDW). These findings suggest
differential pleiotropic properties that warrant further investigation for
their impact on clinical outcomes. Registry Accessibility:
http://irct.ir/trial/27377 Trial registration code:
IRCT2017101236737N1.<br/>Copyright &#xa9; 2025 The Authors

<29>
[Use Link to view the full text]
Accession Number
2041776567
Title
Triglyceride-glucose index and the risk of major adverse cardiovascular
events in patients with coronary artery disease: A systematic review and
meta-analysis.
Source
Medicine (United States). 104(42) (pp e42562), 2025. Date of Publication:
17 Oct 2025.
Author
Lai J.; Zhang X.; He Y.; Liang S.
Institution
(Lai, Zhang, He, Liang) Department of Cardiology, The Affiliated Guangdong
Second Provincial General Hospital of Jinan University, Guangdong
Province, Guangzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background: - The triglyceride-glucose (TyG) index has been shown to
correlate with cardiovascular risk. This meta-analysis aims to evaluate
the incidence of the TyG index on the occurrence of major adverse
cardiovascular events (MACEs) in patients with coronary artery disease
(CAD). <br/>Method(s): - A systematic literature search was conducted in
the Web of Science, PubMed, and Embase databases from their inception
until December 18, 2024. Studies that examined the association between the
TyG index and the risk of MACEs in patients with CAD were included.
Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were
aggregated using a random-effects model. Statistical analysis was
performed using STATA 14.0. <br/>Result(s): - A total of 23 studies
encompassing 50, 793 subjects were ultimately incorporated into this
meta-analysis. The findings indicated that an elevated TyG index
correlates with an increased risk of MACEs (HR = 1.66, 95% CI [1.47-1.88],
P < .0001), all-cause mortality (HR = 1.36, 95% CI [1.12-1.66], P = .002),
cardiovascular mortality (HR = 1.44, 95% CI [1.00-2.06], P = .049),
myocardial infarction (HR = 1.72, 95% CI [1.33-2.23], P < .0001), stroke
(HR = 1.60, 95% CI [1.23-2.07], P < .0001), and revascularization
procedures (HR = 1.82, 95% CI [1.41-2.36], P < .0001) among CAD patients.
<br/>Conclusion(s): - This meta-analysis underscores the association
between the TyG index and an elevated risk of MACEs in CAD
patients.<br/>Copyright &#xa9; 2025 the Author(s). Published by Wolters
Kluwer Health, Inc.

<30>
Accession Number
2037470525
Title
Relationship Between the Current Definitions of Periprocedural Myocardial
Infarction and Clinical Outcomes Following Percutaneous Coronary
Revascularization.
Source
Reviews in Cardiovascular Medicine. 26(11) (no pagination), 2025. Article
Number: 43839. Date of Publication: 01 Nov 2025.
Author
Paolucci L.; Nardi G.; Lombardi M.; Occhipinti G.; Mangiacapra F.;
Vergallo R.; Musto C.; Colaiori I.; Briguori C.; Gabrielli D.; Felice F.D.
Institution
(Paolucci, Gabrielli, Felice) Interventional Cardiology Unit, San Camillo
Forlanini Hospital, Rome, Italy
(Nardi) Structural Interventional Cardiology, Careggi University Hospital,
Florence, Italy
(Lombardi, Vergallo) Department of Internal Medicine and Medical
Specialties (DIMI), Universita di Genova, Genova, Italy
(Occhipinti) Cardiovascular Clinic Institute, Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona,
Hospital Clinic de Barcelona, Catalunya, Barcelona, Spain
(Mangiacapra) Interventional Cardiology Unit, Campus Biomedico University,
Rome, Italy
(Vergallo) Cardiothoracic and Vascular Department (DICATOV), IRCCS
Ospedale Policlinico San Martino, Genova, Italy
(Musto) Cardiology Unit, PO San Giovanni Evangelista, Tivoli, Italy
(Colaiori) Interventional Cardiology Unit, Santa Maria Goretti Hospital,
Latina, Italy
(Briguori) Interventional Cardiology Unit, Clinica Mediterranea, Naples,
Italy
Publisher
IMR Press Limited
Abstract
Since the beginning of the percutaneous coronary intervention (PCI) era,
periprocedural myocardial infarction (PMI) has been recognized as a
potential source of impaired outcomes in patients undergoing
revascularization. Subsequently, several different definitions of PMI have
been provided, coming from trial research groups or international
consensus. Despite these efforts, the debate over the prognostic value or
PMI in terms of mortality risk, as well as its role in defining composite
ischemic endpoints in clinical investigations, has been extremely active.
Currently, three international definitions of PMI are available: the
Universal Definition of Myocardial Infarction (UDMI), the Academic
Research Consortium (ARC)-2 definition, and the definition by the Society
for Cardiovascular Angiography and Interventions (SCAI). These definitions
differ significantly in terms of sensitivity and prognostic relevance,
which has led to heterogeneous findings in clinical studies investigating
this topic. Thus, this review aims to provide an overview of the main
features of these definitions, their association with the risk of
mortality, and how different definitions can influence the results of
major investigations in the research setting.<br/>Copyright &#xa9; 2025
The Author(s). Published by IMR Press.

<31>
Accession Number
2037469669
Title
Lipoprotein A and the Association With Peripheral Arterial Disease: A
Review of the Risk in Peripheral Arterial Disease.
Source
Reviews in Cardiovascular Medicine. 26(11) (no pagination), 2025. Article
Number: 41551. Date of Publication: 01 Nov 2025.
Author
Kar S.
Institution
(Kar) Division of Cardiology, Virginia Commonwealth University Veterans
Affairs Medical Center, Richmond, VA, United States
Publisher
IMR Press Limited
Abstract
Peripheral arterial disease (PAD) is a global atherosclerotic disease
which can lead to acute limb ischemia, chronic limb-threatening ischemia,
and limb amputation. It has similar risk factors to coronary artery
disease (CAD). Elevated lipoprotein A (Lp[a]) is associated with CAD,
myocardial infarction, and PAD. Patients with PAD can have CAD and
polyvascular disease. An extensive PubMed and Cochrane library search was
performed in April 2025 using the words "Lipoprotein A and PAD", "Elevated
lipoprotein A and PAD", and "High Lipoprotein A and PAD" to obtain
relevant English articles for this systematic review. An elevated Lp(a)
may enhance the risk of PAD. Elevated Lp(a) can amplify the risk of CAD,
PAD, and polyvascular disease. It may portend worse outcomes in patients
with CAD and PAD. It can increase the risk of acute limb ischemia,
coronary revascularization, peripheral revascularization, cardiovascular
death, and all-cause mortality. Hence, elevated Lp(a) may serve as a risk
factor for patients with CAD who could potentially develop PAD. No
currently approved medical therapy aimed at Lp(a) reduction exists only
lipoprotein apheresis is approved to lower Lp(a) levels in these patients.
This systematic review discusses the role of an elevated Lp(a) in PAD,
clinical research in PAD with elevated Lp(a), and the current treatment
for PAD and elevated Lp(a).<br/>Copyright &#xa9; 2025 The Author(s).
Published by IMR Press.

<32>
Accession Number
2042031902
Title
Reversal of neuromuscular blockade after coronary artery bypass grafting:
a randomized control trial.
Source
BMC Anesthesiology. 25(1) (no pagination), 2025. Article Number: 612. Date
of Publication: 01 Dec 2025.
Author
Ellison M.B.; Statler A.; Grose B.; Sloyer D.; Hayanga H.; Ellison P.R.;
Funke C.
Institution
(Ellison, Statler, Grose, Sloyer, Hayanga, Ellison, Funke) West Virginia
University School of Medicine, Morgantown, WV, United States
(Ellison, Statler, Grose, Sloyer, Hayanga, Ellison) Department of
Anesthesiology, West Virginia University School of Medicine, Morgantown,
WV, United States
(Ellison, Hayanga) Division of Cardiovascular and Thoracic Anesthesiology,
West Virginia University, Morgantown, United States
(Ellison) Division of Pediatric Anesthesiology, West Virginia University,
Morgantown, United States
Publisher
BioMed Central Ltd
Abstract
Background: Early extubation in cardiac surgery improves recovery and
outcomes. Extubation of the airway after cardiac surgery in the operating
room or in the immediate postoperative period is a key component of the
optimization of outcomes in cardiac surgical patients. Specific objectives
of this study included measuring time to extubation with secondary
outcomes of post-extubation vital signs, lung function, and esophageal
motility. Exploratory parameters included ICU stay and re-intubation in 24
h. <br/>Method(s): In this study, we compare two groups of patients
undergoing coronary bypass grafting surgery (CABG) under general
anesthesia with muscle relaxation. Reversal of neuromuscular blockade
randomized to group 1: neostigmine and group 2: sugammadex. A standard
anesthetic protocol was followed throughout the perioperative period in
each of these patients with the goal of in-operating room extubation. A
two-sample t-test and/or linear model was used in the data analysis.
<br/>Result(s): 4 subjects were not extubated in the neostigmine group
versus 1 subject in the sugammadex group. The average time to extubation
in the neostigmine group was 10.4 min, (STDEV: 5.9 min) and sugammadex was
6 min, (STDEV: 4.7 min). p = 0.001 (ANOVA). Significant secondary outcome
measures included patients who received sugammadex had higher heart rates
at the second measurement (85.0) vs. neostigmine (79.5) p = 0.047 and
higher systolic blood pressures at the second measurement point for
sugammadex (111.7) vs. neostigmine (103.9) p = 0.023. 11/36 (30%) failed
the Functional Dysphasia Screen in the neostigmine group versus 5/35 (14%)
in the sugammadex. Subjects in the neostigmine group had an average ICU
stay of 40.1 +/- 32.4 h versus 35.6 +/- 15.8 in the sugammadex group. 2
patients in the neostigmine group were re-intubated and 1 patient was
placed on non-invasive positive pressure ventilation vs. no airway
interventions in the sugammadex group. <br/>Conclusion(s): Based on the
results of this study, utilizing sugammadex for reversal of neuromuscular
blockade after CABG may increase early extubation in the operating room,
decrease the re-intubation rates, provide a very consistent level of
muscle strength for lung function, and may improve postoperative
esophageal dysmotility. Trial registration: ClinicalTrials.gov
NCT03939923, Registration date of Feb 2, 2019.<br/>Copyright &#xa9; The
Author(s) 2025.

<33>
Accession Number
2042440670
Title
Balloon Postdilation After Transcatheter Aortic Valve Implantation (TAVI)
Among Self- and Balloon-Expandable Valves: A Systematic Review and
Meta-Analysis.
Source
American Journal of Cardiology. 260 (pp 61-70), 2026. Date of Publication:
01 Feb 2026.
Author
Cheikh-Ibrahim M.; de Pontes V.B.; Alachkar N.; Jaramillo S.; Esteves
I.M.; Lauten A.
Institution
(Cheikh-Ibrahim, Lauten) Department of Cardiology, Helios Klinikum Erfurt,
Health and Medical University Erfurt, Germany
(de Pontes) Division of Medicine, University Centre of Associated Colleges
for Education, Sao Joao da Boa Vista, Brazil
(Alachkar) Heart Center Brandenburg, University Hospital of the Medical
School Brandenburg, Berlin, Germany
(Jaramillo) Division of Medicine, Universidad Austral, Pilar, Argentina
(Esteves) School of Medicine and Biomedical Sciences, University of Porto,
Porto, Portugal
Publisher
Elsevier Inc.
Abstract
Balloon postdilation (BPD) is used to optimize valve expansion after
transcatheter aortic valve implantation (TAVI). However, the clinical
impact, particularly between balloon-expandable (BE) and self-expanding
(SE) valves, remains unclear. We conducted a systematic search of PubMed,
Embase, and Cochrane Library to compare patients undergoing TAVI with and
without BPD. We pooled the risk ratios (RR) and mean differences (MD) for
binary and continuous outcomes, respectively. All statistical analyses
were performed using a random effects model. Sixteen observational studies
comprising 15,508 patients were included, of which 3,397 (22%) underwent
TAVI with BPD. BPD was associated with a significantly higher risk of
in-hospital stroke (RR, 1.66; 95% CI 1.15 to 2.40; p <0.01) and 30-day
mortality (RR, 1.28; 95% CI 1.05 to 1.56; p = 0.01). No significant
differences were observed in terms of 30-day, 1-year, or overall stroke;
pacemaker implantation; myocardial infarction; or cardiovascular or
all-cause mortality. Regarding echocardiographic outcomes, BPD resulted in
a larger effective orifice area (EOA) (MD 0.06; 95% CI 0.01 to 0.11; p =
0.01), with no differences in the mean transvalvular gradient and
paravalvular regurgitation. In prespecified subgroup analyses, BPD was
associated with an increased risk of 1-year stroke in patients receiving
BE valves (RR, 1.57; 95% CI, 1.11 to 2.24; p = 0.01) and a higher 30-day
mortality with SE valves (RR, 1.28; 95% CI 1.01 to 1.62; p = 0.04)
compared with non-BPD. BPD is associated with an increased risk of early
mortality and periprocedural stroke, albeit with a slightly larger EOA.
Further randomized trials are needed to confirm our
findings.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<34>
Accession Number
2041956323
Title
Ketone bodies for hemodynamic support in acute pulmonary embolism: a
randomized, blinded, controlled animal study.
Source
Intensive Care Medicine Experimental. 13(1) (no pagination), 2025. Article
Number: 133. Date of Publication: 01 Dec 2025.
Author
Lyhne M.D.; Gopalasingam N.; Berg-Hansen K.; Dragsbaek S.J.; Homilius C.;
Seefeldt J.; Hansen J.V.; Kramer A.D.; Christensen L.J.; Ellegaard M.S.;
Horsdal O.K.; Overgaard A.; Larsen A.M.; Boedtkjer E.; Andersen A.;
Nielsen R.
Institution
(Lyhne, Gopalasingam, Berg-Hansen, Dragsbaek, Seefeldt, Hansen, Kramer,
Christensen, Ellegaard, Horsdal, Overgaard, Larsen, Andersen, Nielsen)
Department of Clinical Medicine, Aarhus University, Palle Juul Jensens
Boulevard 82, Aarhus N, Denmark
(Lyhne, Ellegaard) Department of Anaesthesiology and Intensive Care,
Aarhus University Hospital, Aarhus, Denmark
(Gopalasingam, Berg-Hansen, Dragsbaek, Seefeldt, Hansen, Kramer,
Christensen, Horsdal, Overgaard, Larsen, Andersen, Nielsen) Department of
Cardiology, Aarhus University Hospital, Aarhus, Denmark
(Homilius, Boedtkjer) Department of Biomedicine, Aarhus University,
Aarhus, Denmark
Publisher
Springer Nature
Abstract
Background: Acute pulmonary embolism (PE) is a leading cause of
cardiovascular death, primarily due to abrupt increased pulmonary vascular
resistance (PVR) leading to acute right ventricular (RV) failure. Ketone
bodies, especially 3-hydroxybutyrate (3-OHB), have shown potential to
increase cardiac output (CO) and reduce PVR in pulmonary hypertension,
suggesting possible benefits in PE. We hypothesized that 3-OHB would
induce pulmonary vasorelaxation and increase CO in a porcine model of
acute PE. <br/>Method(s): We conducted a randomized, controlled,
assessor-blinded study in a porcine model of acute PE. Acute PE was
induced, followed by a 3-h infusion of 3-OHB (0.22 g/kg/h, n = 8) or
control (isovolumic saline of equimolar tonicity) (n = 8). Hemodynamic
parameters were monitored hourly including right heart catheterization and
RV pressure-volume loop acquisition. Primary outcome was the difference in
CO during 3 h. Ex vivo effects on isolated pulmonary arteries were tested
using wire myography. <br/>Result(s): Compared with control infusion,
3-OHB did not increase CO significantly (between-group difference: 0.7
[-0.2 to 1.6] L/min, p = 0.131). However, 3-OHB treatment lowered the
PVR/systemic vascular resistance (SVR) ratio (-0.05 [-0.09; -0.01], p =
0.046) and increased pulmonary artery pulsatility index (5 [2-8], p =
0.006). Ex vivo, 3-OHB caused vasorelaxation in pre-contracted pulmonary
arteries (p < 0.0001). <br/>Conclusion(s): 3-OHB reduced PVR/SVR ratio,
while CO was not significantly increased in a porcine model of acute PE.
The present findings demonstrated potential hemodynamic effects in PE.
Further studies are needed to explore the translational potential of
ketone body therapy in humans with PE.<br/>Copyright &#xa9; The Author(s)
2025.

<35>
Accession Number
2040525275
Title
Prognostic impact of SCAI shock severity classes in AMI-related
cardiogenic shock: A sub-study of the ECLS-SHOCK Trial.
Source
ESC Heart Failure. 12(6) (pp 4359-4368), 2025. Date of Publication: 01 Dec
2025.
Author
Poss J.; Jentzer J.; Desch S.; Feistritzer H.-J.; Freund A.; Rossberg M.;
Jung C.; Ouarrak T.; Schneider S.; Akin I.; Rassaf T.; Thevathasan T.;
Zeymer U.; Thiele H.
Institution
(Poss, Desch, Feistritzer, Freund, Rosberg, Thiele) Heart Center Leipzig,
Leipzig University and Leipzig Heart Science, Leipzig, Germany
(Jentzer) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
(Jung) University Hospital Dusseldorf, Dusseldorf, Germany
(Ouarrak, Schneider, Zeymer) Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Akin, Zeymer) University Clinic Mannheim, Mannheim, Germany
(Rassaf) West German Heart and Vascular Center, University Hospital Essen,
Essen, Germany
(Thevathasan) DZHK (German Center for Cardiovascular Research), Berlin,
Germany
(Thevathasan) Deutsches Herzzentrum der Charite (DHZC), Campus Benjamin
Franklin, Berlin, Germany
(Thevathasan) Berlin Institute of Health, Berlin, Germany
(Zeymer) Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg,
Freiburg, Germany
Publisher
John Wiley and Sons Inc
Abstract
Aims: The Society for Cardiovascular Angiography and Interventions (SCAI)
Classification provides risk stratification of patients with acute
myocardial infarction complicated by cardiogenic shock (AMI-CS). This
sub-study of the ECLS-SHOCK trial investigates the prognostic impact of
SCAI stages in AMI-CS and the influence of SCAI stages on the effect of
extracorporeal life support (ECLS) therapy in AMI-CS patients.
<br/>Method(s): Patients with AMI-CS enrolled in the multicentre,
randomized ECLS-SHOCK trial were included. The outcomes, treatment effect
and safety of ECLS were stratified according to SCAI stage at admission
using a post-hoc classification. <br/>Result(s): From a total of 417
patients enrolled in the ECLS-SHOCK trial between June 2019 and November
2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in
SCAI Stages C, D and E, respectively. SCAI stages were associated with the
risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs.
64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C
vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor
neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P <
0.001). No interaction was observed between SCAI stage and the treatment
effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C:
32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for
interaction = 0.65). <br/>Conclusion(s): In AMI-CS patients included in
the ECLS-SHOCK trial, SCAI stages at admission were predictive for
mortality and for the incidence of safety events. The efficacy of ECLS
treatment was not affected by SCAI stage.<br/>Copyright &#xa9; 2025 The
Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf
of European Society of Cardiology.

<36>
Accession Number
2041860854
Title
Preoperative cannabinoid exposure and postoperative pain: A narrative
review.
Source
Journal of Clinical Anesthesia. 109 (no pagination), 2026. Article Number:
112097. Date of Publication: 01 Feb 2026.
Author
King D.D.; Temmermand R.; Greenwood J.E.
Institution
(King, Greenwood) Department of Nurse Anesthesia, Rosalind Franklin
University of Medicine and Science, North Chicago, IL, United States
(Temmermand) College of Nursing and Health Professions, Drexel University,
Philadelphia, PA, United States
Publisher
Elsevier Inc.
Abstract
Background Cannabis use is increasingly common, yet its effects on
postoperative pain and opioid requirements remain unclear. While
cannabinoids are used in chronic pain, their role in acute perioperative
recovery is less defined. Methods A systematic search of PubMed, CINAHL,
and Embase identified studies published within the past ten years that
examined preoperative cannabis use and its relationship with postoperative
pain and opioid consumption. Forty-two studies met the inclusion criteria.
Data were extracted and summarized using a narrative synthesis
methodology. Results Exposure definitions, surgical specialties, and
outcome metrics were heterogeneous, limiting cross-study comparability;
therefore, effects were reported in their native form without pooling. Of
the 42 included studies, 14 (33.3 %) found that cannabis users reported
higher postoperative pain, 10 (23.8 %) reported no difference, 2 (4.8 %)
suggested reduced pain, and 16 (38.1 %) did not report pain outcomes.
Regarding opioids, 18 studies (42.9 %) indicated greater postoperative
requirements, 17 (40.5 %) found no difference, 3 (7.1 %) suggested reduced
use, and 4 (9.5 %) did not report opioid outcomes. Specialty-specific
patterns emerged: mixed cohorts (90 %) and spine populations (55 %) more
frequently reported increased opioid use, whereas arthroplasty studies
more often reported no difference (62 %). Limited, low-certainty evidence
suggested that resuming cannabis after discharge was associated with lower
persistent opioid use. Conclusions Preoperative cannabis exposure is
associated with increased postoperative pain and opioid requirements in
some, but not all, surgical contexts. Outcomes vary by specialty, and
residual confounding and nonstandardized exposure measurement constrain
inference, underscoring the need for standardized exposure definitions,
prospective designs, and individualized perioperative pain
strategies.<br/>Copyright &#xa9; 2025 Elsevier Inc.

<37>
Accession Number
2040504843
Title
Right ventricle to pulmonary artery coupling as a prognostic factor in
tricuspid regurgitation: A systematic review.
Source
ESC Heart Failure. 12(6) (pp 4033-4040), 2025. Date of Publication: 01 Dec
2025.
Author
Piasecki A.; Rdzanek A.; Scislo P.; Pedzich E.; Kaplon-Cieslicka A.;
Tomaniak M.
Institution
(Piasecki, Rdzanek, Scislo, Pedzich, Kaplon-Cieslicka, Tomaniak) First
Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Publisher
John Wiley and Sons Inc
Abstract
Severe tricuspid regurgitation is a prevalent condition with a poor
prognosis. Recent advances in transcatheter techniques resulted in a
growing population of patients who are qualified for transcatheter
edge-to-edge repair of tricuspid regurgitation. There is evidence that
these procedures result in an improvement in heart failure symptoms and
patient-reported quality of life; however, the data guiding the
qualification process are scarce. The increasing volume of patients that
undergo qualification for interventional TR treatment creates the need to
improve the tools for risk stratification and outcome prediction.
TAPSE/SPAP ratio is an echocardiographic parameter that has been recently
proposed as a predictive factor for adverse outcome in various clinical
settings including patients undergoing transcatheter procedures. In this
systematic review, we gathered the data on the utility of this parameter
in patients with significant tricuspid regurgitation. We identified five
studies fulfilling the search criteria. In all of the studies, a low
TAPSE/SPAP ratio was associated with worse prognosis, but the exact cutoff
value remains difficult to define. In available studies, it ranged from
0.26 to 0.49 mm/mmHg. Moreover, greater severity of tricuspid
regurgitation results in an underestimation of SPAP potentially reducing
the usefulness of TAPSE/SPAP ratio in patients with massive and torrential
TR.<br/>Copyright &#xa9; 2025 The Author(s). ESC Heart Failure published
by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

<38>
Accession Number
2041866618
Title
Efficacy and safety of postoperative autologous blood transfusion in
cardiac surgery (RESCUE): Rationale, design, and study protocol of a
multicenter randomized controlled trial.
Source
American Heart Journal. 293 (no pagination), 2026. Article Number: 107313.
Date of Publication: 01 Mar 2026.
Author
Shan J.; Gao J.; Chen Y.; Ji H.
Institution
(Shan, Gao, Chen, Ji) Department of Anesthesiology, Fuwai Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Ji) Department of Anesthesiology, Chinese Academy of Medical Sciences
Fuwai Hospital Shenzhen Hospital, Guangdong, China
Publisher
Elsevier Inc.
Abstract
Background Postoperative bleeding is a major concern in cardiac surgery,
often leading to significant transfusion requirements. Despite this high
transfusion demand, the use of postoperative autologous blood transfusion
(PABT) remains underexplored. Methods and Results This large-scale,
single-blind randomized controlled trial with a 30-day follow-up enrolls
patients undergoing elective on- or off-pump coronary artery bypass
grafting. Patients with shed mediastinal blood volumes over 500 mL within
the first 6 hours postoperatively are randomly assigned 1:1 to either the
PABT group or the standard care group. The PABT group receives
postoperative autotransfusion and additional allogeneic RBC transfusions
if needed, while the standard care group receives allogeneic RBC
transfusions only when clinically necessary, without postoperative
autotransfusion. The primary efficacy endpoint is the postoperative
allogeneic RBC transfusion volume, defined as the cumulative amount
transfused from the day of surgery to discharge. Secondary efficacy
endpoints include postoperative allogeneic RBC and non-RBC transfusion
rates, perioperative hematologic recovery, drainage volume, mechanical
ventilation duration, ICU and hospital length of stay. The primary safety
endpoint is the incidence of a composite of postoperative infections
(pneumonia, bloodstream infections, and surgical site infections).
Secondary safety endpoints include a composite of other postoperative
complications (renal dysfunction, myocardial infarction, stroke, deep vein
thrombosis, and all-cause mortality), individual components of these
composites, and 30-day mortality and morbidity. The estimated sample size
is 1,232 participants. Patient recruitment is planned from January 2026 to
December 2029 and is currently in the preparatory phase. The study is
registered at the Chinese Clinical Trial Registry (ChiCTR2500103269,
https://www.chictr.org.cn/ ) and was registered on May 27, 2025.
Conclusions The study is designed to identify the efficacy and safety of
PABT after cardiac surgery. We hypothesize that PABT has superior efficacy
and noninferior safety to the standard care.<br/>Copyright &#xa9; 2025 The
Author(s).

<39>
Accession Number
2036240928
Title
Simultaneous vaccination against influenza and respiratory syncytial virus
in high-risk heart failure patients.
Source
ESC Heart Failure. 12(6) (pp 3869-3877), 2025. Date of Publication: 01 Dec
2025.
Author
Biegus J.; Szenborn L.; Tkaczyszyn M.; Zymlinski R.; Cotter G.;
Zakliczynski M.; Reczuch K.; Guzik M.; Urban S.; Rosiek-Biegus M.;
Jankowiak B.; Iwanek G.; Wleklik M.; Fudim M.; Ponikowski P.
Institution
(Biegus, Tkaczyszyn, Zymlinski, Zakliczynski, Reczuch, Guzik, Jankowiak,
Iwanek, Ponikowski) Institute of Heart Diseases, Wroclaw Medical
University, Wroclaw, Poland
(Biegus, Tkaczyszyn, Zymlinski, Zakliczynski, Reczuch, Guzik, Jankowiak,
Iwanek, Ponikowski) Institute of Heart Diseases, Jan Mikulicz Radecki
University Hospital in Wroclaw, Wroclaw, Poland
(Szenborn) Department of Paediatrics and Infectious Diseases, Wroclaw
Medical University, Wroclaw, Poland
(Cotter) Universite Paris Cite, Paris, France
(Cotter) Momentum Research Inc, Durham, NC, United States
(Urban) Department of Cardiology, Copper Health Centre, Lubin, Poland
(Rosiek-Biegus) Department and Clinic of Internal Medicine, Pneumology and
Allergology, Wroclaw Medical University, Wroclaw, Poland
(Wleklik) Department of Nursing and Obstetrics, Faculty of Health
Sciences, Wroclaw Medical University, Wroclaw, Poland
(Fudim) Duke University Medical Center, Durham, NC, United States
(Fudim) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: There is a scarcity of prospective data on the impact of
available vaccinations against respiratory viruses on hard clinical
endpoints in patients with heart failure (HF). <br/>Aim(s): We
investigated whether, in the population of high-risk HF patients,
simultaneous vaccination against influenza and respiratory syncytial virus
(RSV) improves outcomes during the subsequent infection season.
<br/>Method(s): We conducted a prospective, randomized, single-centre,
open-label study in which patients with high-risk HF were randomized 1:1
to simultaneous influenza and RSV vaccination or standard of care (SOC).
The primary composite endpoint comprised all-cause death, HF
hospitalization (HFH) or clinical signs/symptoms of infection within a 6
month follow-up period (regular structured telephone interview). Secondary
endpoints were components of the composite primary endpoint.
<br/>Result(s): Two hundred twenty patients were randomized. During the
follow-up period, the primary endpoint occurred in 59% of patients in the
vaccination group versus 75% in the SOC group [hazard ratio (HR) 0.66, 95%
confidence interval (CI) 0.48-0.92, P = 0.01]. Regarding the secondary
endpoint analyses, during 6 month follow-up, 3% in the vaccination group
died compared with 5% of patients in the SOC arm (HR 0.50, 95% CI 0.12
1.99, P = 0.32), and 18% versus 16% of study participants were
hospitalized for HF in the two study arms, respectively (HR 0.86, 95% CI
0.45-1.62, P = 0.64). Infection occurred in 53% of vaccinated patients
compared with 68% in SOC (HR 0.68, 95% CI 0.48-0.96, P = 0.03).
<br/>Conclusion(s): In the population of high-risk HF, simultaneous
vaccination against influenza and RSV reduced the incidence of the primary
outcome. The effect was driven by a significant reduction in
infections.<br/>Copyright &#xa9; 2025 The Author(s). ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of European Society of
Cardiology.

<40>
Accession Number
2042407441
Title
History and challenges of multi-organ allocation in the United States: A
systematic review.
Source
Transplantation Reviews. 40(1) (no pagination), 2026. Article Number:
100988. Date of Publication: 01 Jan 2026.
Author
Cheng M.; Huynh S.C.T.; Dale R.; Currie M.E.
Institution
(Cheng) Geisel School of Medicine, Dartmouth College, Hanover, NH, United
States
(Huynh, Dale, Currie) Department of Cardiothoracic Surgery, Stanford
University School of Medicine, Stanford, CA, United States
Publisher
Elsevier Inc.
Abstract
Current multi-organ candidates are prioritized primarily based on
single-organ risk scores. Once the primary organ is allocated, the
secondary organ follows to the same recipient, resulting in waitlisted
single-organ candidates being skipped in allocation. Our previous work
examined the ethical and statistical alignment of single-organ risk
scores. Here, we aim to extend our analysis to multi-organ transplantation
policies in the United States, surveying the current state of multi-organ
candidate prioritization and the challenges of conducting high-quality
research in multi-organ transplantation. We systematically searched PubMed
for published literature on the allocation of all multi-organ pairs
involving the liver, kidney, lungs, and heart. After screening based on
our inclusion and exclusion criteria, we identified 126 articles to
include in this review. These include 31 articles for Heart-Lung, 24 for
Heart-Kidney, 52 for Liver-Kidney, and 19 for Liver-Heart transplantation.
We did not discuss the remaining organ pairs due to insufficient
literature to provide a balanced analysis. Provider-, center-, and
region-dependent variations exist in multi-organ practices due to evolving
national guidelines and a lack of standardized institutional protocols for
candidate evaluation and listing. The use of single-organ risk scores in
multi-organ allocation has not been statistically validated, therefore
raising concerns about applicability. Multi-organ transplant research
relies heavily on single-center reports, case studies, and registry-based
analyses. The frequent re-use of national registry data limits the novelty
and reliability of multi-organ research. We encourage future efforts to
consider exploratory, prospective, and perhaps randomized-controlled
trials to advance understanding and strengthen the evidence base in
multi-organ transplantation.<br/>Copyright &#xa9; 2025

<41>
Accession Number
2036114864
Title
Empagliflozin after myocardial infarction with or without diabetes and
chronic kidney disease: Insights from EMPACT-MI.
Source
ESC Heart Failure. 12(6) (pp 3940-3952), 2025. Date of Publication: 01 Dec
2025.
Author
Fioretti F.; Butler J.; Udell J.A.; Schuyler Jones W.; Petrie M.C.;
Harrington J.; Mattheus M.; Bauersachs J.; Bayes-Genis A.; Goodman S.G.;
Gasior T.; Januzzi J.L.; Lopes R.D.; Ponikowski P.; Rossello X.; Schou M.;
van der Meer P.; Vinereanu D.; Zieroth S.; Brueckmann M.; Sumin M.; Bhatt
D.L.; Hernandez A.F.; Anker S.D.
Institution
(Fioretti, Butler) Baylor Scott & White Research Institute, Dallas, TX,
United States
(Fioretti) Cardiology Unit, ASST Spedali Civili Hospital and University of
Brescia, Brescia, Italy
(Udell) Women's College Hospital and Peter Munk Cardiac Centre, Toronto
General Hospital, University of Toronto, Toronto, Canada
(Schuyler Jones, Harrington, Lopes, Hernandez) Division of Cardiology,
Department of Medicine and Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Petrie) School of Cardiovascular and Medical Sciences, British Heart
Foundation Glasgow Cardiovascular Research Centre, University of Glasgow,
Glasgow, United Kingdom
(Mattheus) Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
(Bauersachs) Department of Cardiology and Angiology, Hannover Medical
School, Hanover, Germany
(Bayes-Genis) Heart Institute, Hospital Universitari Germans Trias i
Pujol, Barcelona, Spain
(Bayes-Genis) Department of Medicine, Universitat Autonoma de Barcelona,
Barcelona, Spain
(Goodman) Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
(Goodman) Division of Cardiology, Department of Medicine, St. Michael's
Hospital, Unity Health Toronto and Peter Munk Cardiac Centre, University
Health Network, University of Toronto, Toronto, Canada
(Gasior, Brueckmann, Sumin) Boehringer Ingelheim International GmbH,
Ingelheim, Germany
(Gasior) Collegium Medicum-Faculty of Medicine, WSB University, Dabrowa
Gornicza, Poland
(Januzzi) Division of Cardiology, Harvard Medical School and Massachusetts
General Hospital, Baim Institute for Clinical Research, Boston, MA, United
States
(Ponikowski) Institute for Heart Diseases, Wroclaw Medical University,
Wroclaw, Poland
(Rossello) Hospital Universitari Son Espases, Health Research Institute of
the Balearic Islands, University of the Balearic Islands, Palma de
Mallorca, Spain
(Schou) Department of Cardiology, Herlev and Gentofte University Hospital,
Copenhagen, Denmark
(van der Meer) Department of Cardiology, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital, Bucharest, Romania
(Zieroth) Section of Cardiology, Max Rady College of Medicine, University
of Manitoba, Winnipeg, Canada
(Brueckmann) First Department of Medicine, Medical Faculty Mannheim,
Heidelberg University, Mannheim, Germany
(Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Anker) Department of Cardiology (CVK), German Heart Center Charite,
German Centre for Cardiovascular Research (DZHK) Partner Site Berlin,
Charite-Universitatsmedizin Berlin, Berlin, Germany
Publisher
John Wiley and Sons Inc
Abstract
Background: In the EMPACT-MI trial, empagliflozin did not reduce the
primary endpoint of all-cause mortality or hospitalization for heart
failure (HHF) following acute myocardial infarction (AMI) but was
associated with a risk reduction for HF events. <br/>Objective(s): This
study aimed to evaluate whether the effect of empagliflozin on HF events
is consistent in patients with and without type 2 diabetes and/or chronic
kidney disease enrolled in the EMPACT-MI trial. <br/>Method(s): Post hoc
analysis assessing the effect of empagliflozin on the primary endpoint and
on HF events in AMI patients with and without an established
recommendation for a sodium-glucose cotransporter-2 inhibitor (SGLT2i)
(type 2 diabetes or chronic kidney disease). <br/>Result(s): Of 6522
participants, 3489 (53%) did not have type 2 diabetes and/or chronic
kidney disease. Those without these conditions were younger and with fewer
comorbidities. No differences were observed for the primary endpoint.
Empagliflozin reduced time to first HHF, total HHF, time to adverse event
(AE) of HF (including outpatient HF events) and total AEs of HF similarly
in patients with and without type 2 diabetes or chronic kidney disease.
Total HHFs were 50 and 63 [adjusted event rate 1.74 and 2.31 events per
100 patient-years; rate ratio (RR) 0.75; 95% confidence interval (CI)
0.48, 1.18] in patients without and 98 and 144 (adjusted event rate 3.91
and 6.04 events per 100 patient-years; RR 0.65; 95% CI 0.45, 0.94; P for
interaction = 0.61) in those with type 2 diabetes or chronic kidney
disease in the empagliflozin and placebo arms, respectively. Any AEs,
serious AEs and AEs leading to permanent study drug discontinuation were
similar between treatment groups in both subgroups. <br/>Conclusion(s):
Empagliflozin improved HF outcomes similarly in patients after AMI with or
without type 2 diabetes or chronic kidney disease.<br/>Copyright &#xa9;
2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd
on behalf of European Society of Cardiology.

<42>
Accession Number
2042265733
Title
Assessing the effectiveness of continuous glucose monitoring compared with
conventional monitoring in enhancing surgical outcomes for patients with
diabetes: protocol for a multicentre, parallel-arm, randomised, pragmatic
trial in China.
Source
BMJ Open. 15(2) (no pagination), 2025. Article Number: e090664. Date of
Publication: 01 Feb 2025.
Author
Duan Y.; Ding L.; Gao Z.; Wang Y.; Cao H.; Zhang H.; Yao L.
Institution
(Duan, Ding, Gao, Wang, Zhang) Department of Anesthesiology, Beijing
Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua
University, Beijing, China
(Ding, Yao) Department of Anaesthesiology, Peking University International
Hospital, Beijing, China
(Cao) Medical Data Science Center, Beijing Tsinghua Changgung Hospital,
School of Clinical Medicine, Tsinghua University, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction The Comprehensive Complication Index (CCI) is an
internationally recognised indicator of postoperative complications.
During the perioperative period, patients with diabetes mellitus (DM) or
impaired glucose tolerance (IGT) may experience a significant increase in
the CCI associated with glucose-related complications and increased
mortality. Continuous glucose monitoring (CGM) offers advantages such as
portability, accuracy, real-time monitoring and rich information. However,
few large-scale studies have investigated the effectiveness and safety of
CGM in reducing CCI during major surgeries. Methods and analysis This
study is a multicentre, parallel-arm, randomised pragmatic trial to
investigate whether CGM improves clinical outcomes in patients with type 1
or type 2 DM or IGT undergoing major surgery relative to conventional
monitoring. This study is planned to be conducted in 50 secondary or
tertiary hospitals in China. Eligible patients aged 18 years or older with
DM or IGT undergoing elective major surgery will be recruited during a
baseline screening period of 3 days before surgery. Eligible patients will
be randomly assigned to receive CGM or conventional monitoring in a 1:1
ratio. The primary endpoint measure is the CCI score within 30
postoperative days. The margin of superiority is -12.0. A total of 10 168
participants will achieve 90% power to detect a clinically important
difference of -13.0 between the means in the primary outcome. This trial
includes multiple statistical analysis steps. For the primary outcome, a
covariance model will be used to compare the difference in CCI within 30
days postoperatively between the two groups after adjusting for baseline
and centre effects. Ethics and dissemination This trial has been approved
by the Ethics Committee of Beijing Tsinghua Changgung Hospital (No.
23684-0-02) and its corresponding branch centres. Informed consent will be
obtained from all subjects involved in the study. The primary trial
results will be submitted for publication to a peer-reviewed
journal.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2025.

<43>
Accession Number
2035832909
Title
Phenotype characterization of heart failure with preserved ejection
fraction in medical device and surgical trials.
Source
ESC Heart Failure. 12(6) (pp 3878-3898), 2025. Date of Publication: 01 Dec
2025.
Author
Araz K.; Fioretti F.; Ladak S.; Obaidan M.; Butler J.; Hameed A.
Institution
(Araz, Ladak) School of Medicine, RCSI University of Medicine and Health
Sciences, Dublin, Ireland
(Fioretti, Butler) Baylor Scott & White Research Institute, Dallas, TX,
United States
(Obaidan) UCD School of Medicine, UCD Health Sciences Centre, University
College Dublin, Dublin, Ireland
(Butler) University of Mississippi, Jackson, MS, United States
(Hameed) Tissue Engineering Research Group (TERG), Department of Anatomy
and Regenerative Medicine, RCSI University of Medicine and Health
Sciences, Dublin, Ireland
(Hameed) Trinity Centre for Biomedical Engineering (TCBE), Trinity College
Dublin (TCD), Dublin, Ireland
Publisher
John Wiley and Sons Inc
Abstract
Aims: Heart failure with preserved ejection fraction (HFpEF) prevalence is
nearing 50% of all heart failure cases and is often associated with
advanced age, obesity, atrial fibrillation and hypertension, and medical
approaches are limited. This review aims to determine the potential of
medical devices or surgical interventions in treating HFpEF and to propose
specific phenotypes of HFpEF. <br/>Methods and Results: A systematic
review was conducted using various clinical trial databases and the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines followed by descriptive analysis and methodology
quality assessment. Inclusion criteria included a medical device or
surgical intervention involving HFpEF patients defined by a left
ventricular ejection fraction (LVEF) >=50% and signs of diastolic
dysfunction. Twenty-four novel trials were identified involving n = 1752
participants: 17 medical device trials [3 interatrial shunt device trials
(n = 1069), 1 atrial flow regulator trial (n = 41), 3 vagal nerve
stimulation trials (n = 112), 1 baroreflex activation therapy trial (n =
21), 1 cardiac contractility modulator trial (n = 47), 6 cardiac
resynchronization therapy trials (n = 178) and 2 functional electrical
stimulation therapy trials (n = 89)] and 7 surgical intervention trials [1
renal denervation trial (n = 25), 3 greater splanchnic nerve ablation
trials (n = 111), 2 catheter ablation trials (n = 55) and 1 pericardiotomy
procedure trial (n = 4)]. One trial completed phase 3 trials, 20 trials
completed phase 1 trials with further trials, and 5 trials completed phase
1 trials without further trials. <br/>Conclusion(s): Overall, 16 out of 24
trials have at least demonstrated safety and feasibility. However, despite
many trials of a medical device or surgical procedure showing proof of
concept to treat HFpEF phenotypes, they do not provide sufficient evidence
of long-term benefit. More robust and phenotype-based clinical trials are
needed to ensure evidence-based solutions are developed in
HFpEF.<br/>Copyright &#xa9; 2025 The Author(s). ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of European Society of
Cardiology.

<44>
[Use Link to view the full text]
Accession Number
2037376168
Title
Should We Intervene Early in Asymptomatic Aortic Stenosis? Evidence From a
Meta-Analysis.
Source
American Journal of Therapeutics. 32(6) (pp e581-e583), 2025. Date of
Publication: 21 Nov 2025.
Author
Waqas S.A.; Saad M.; Aamer H.; Sohail M.U.; Rashid M.; Ahmed R.
Institution
(Waqas, Saad, Aamer, Sohail) Department of Medicine, Dow University of
Health Sciences, Karachi, Pakistan
(Rashid) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Institute for Primary Care and Health Sciences, Keele
University, Keele, United Kingdom
(Rashid) Department of Cardiovascular Sciences, Glenfield Hospital,
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
(Rashid) NIHR Leicester Biomedical Research Centre, University of
Leicester, Leicester, United Kingdom
(Ahmed) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Publisher
Lippincott Williams and Wilkins

<45>
Accession Number
2034220147
Title
Sex-related outcomes during short-term mechanical circulatory support: A
systematic review and meta-analysis of propensity-score matched studies.
Source
Perfusion (United Kingdom). 41(1) (pp 5-14), 2026. Date of Publication: 01
Jan 2026.
Author
Luiz L.; Mesadri Gewehr D.; Picado-Loaiza S.; Ohashi L.; Goebel N.; Rylski
B.; Ayala R.
Institution
(Luiz) Department of Medicine, University of the Region of Joinville,
Joinville, Brazil
(Mesadri Gewehr) Curitiba Heart Institute, Curitiba, Brazil
(Picado-Loaiza) Department of Cardiovascular Surgery, Hospital Mexico, San
Jose, Costa Rica
(Ohashi) Department of Cardiovascular Surgery, Federal University Sao
Paulo, Sao Paulo, Brazil
(Goebel, Rylski, Ayala) Department of Cardiovascular Surgery, Robert Bosch
Hospital, Stuttgart, Germany
Publisher
SAGE Publications Ltd
Abstract
Background: The association between sex and cardiovascular risk and
different responses to heart failure therapies is well established.
However, sex related outcomes of different types of short-term mechanical
circulatory support (MCS) therapy remains controversial. <br/>Method(s):
We performed a systematic review and meta-analysis of studies comparing
outcomes of MCS between sexes. We restricted inclusion to propensity score
matched studies to minimize the risk of confounding. We pooled binary and
continuous outcomes with odds ratio (OR) and mean differences (MD),
respectively, under a random effects model. <br/>Result(s): We pooled 6
propensity score matched studies evaluating sex related outcomes during
short-term MCS, with 18,720 patients, of whom 9442 (50.5%) were male and
9278 (49.5%) were female. Subgroup analysis showed higher 30-day mortality
during ECMO (OR 1.11; 95% CI 1.01-1.22; p = .038; I² = 0%) in
males, but lower 30-day mortality during Impella therapy than females (OR
0.87; 95% CI 0.80-0.94; p = .001; I² = 0%). Males had a higher
need of myocardial revascularization (OR 3.09; 95% CI 1.56-5.99; p = .001;
I² = 0%), but a higher risk of acute kidney injury (OR 1.20;
95% CI 1.09-1.31; p < .001; I² = 18%). <br/>Conclusion(s):
In-hospital and 30-day mortality were similar between females and
males.<br/>Copyright &#xa9; The Author(s) 2025

<46>
Accession Number
2042285744
Title
Quality of early recovery after ultrasound-guided serratus plane block for
transapical transcatheter aortic valve implantation surgery under general
anesthesia: a single-center randomized controlled trial.
Source
BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 1. Date
of Publication: 01 Dec 2026.
Author
Xiao C.; Jing S.; Yang G.; Chen F.; Yang M.; Cao L.; Tan Y.; Lin G.; Li H.
Institution
(Xiao, Jing, Yang, Chen, Yang, Cao, Tan, Lin, Li) Department of
Anesthesiology, Second Affiliated Hospital of Army Medical University,
PLA, No. 83 Xinqiao Road, Chongqing, Shapingba, China
Publisher
BioMed Central Ltd
Abstract
Background: Regional anesthesia techniques, including the serratus
anterior plane block (SAPB), reduce postoperative pain after minimally
invasive cardiac surgery. However, the evidence regarding its impact on
transapical transcatheter aortic valve replacement (TA-TAVR) is limited,
and data specifically exploring its effectiveness on patient-centric
outcomes are lacking. <br/>Method(s): We conducted a single-center
randomized controlled trial comparing the efficacy of ultrasound-guided
SAPB with ropivacaine 0.5% (40 ml) with no block for patients undergoing
TA-TAVR. The primary outcome was 24-hour Quality of Recovery-40 (QoR-40)
score. Secondary outcomes included QoR-40 at 48 h, pain scores, opioid
consumption, and complications. <br/>Result(s): A total of 66 participants
were included in the analysis. The median QoR-40 [IQR] at 24 h was higher
in SAPB group (n = 32) compared with the no block group (n = 34): 180.5
(171.25-183) VS 172 (165.25-179), p = 0.006. At 48 h, scores were 185.5
(182-189) vs. 183.5 (178.5-187), p = 0.048. Although these differences
were statistically significant, they did not reach the minimum clinically
important difference (MCID) of 6.3. Early postoperative analgesia was
superior in the SAPB group, with lower resting/coughing NRS scores at 6
and 12 h (median difference 1, P < 0.001). However, there were no
intergroup differences in opioid consumption or the need for rescue
analgesia. <br/>Conclusion(s): As part of multimodal analgesia for
TA-TAVR, SAPB improved early postoperative analgesia but did not enhance
the multidimensional quality of early recovery, as measured by the QoR-40
score. Further studies are warranted. Trial registration:
ChiCTR2300068584. Registered 24 February 2023.
https://www.chictr.org.cn/bin/project/edit? pid=184719.<br/>Copyright
&#xa9; The Author(s) 2025.

<47>
Accession Number
2042285746
Title
Effect of dexmedetomidine on postoperative mortality and prognosis: a
systematic review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 4. Date
of Publication: 01 Dec 2026.
Author
Xu Z.; Wang D.; Sun H.; Zhang W.; Li S.; Su N.; Chen Y.; Jiang C.; Bi C.
Institution
(Xu, Wang, Sun, Li, Su, Chen, Jiang, Bi) Department of Anesthesiology,
Central Hospital of Dalian University of Technology, Liaoning, Dalian,
China
(Zhang) Department of Anesthesiology, Zhoukou Central Hospital, Henan,
Zhoukou, China
Publisher
BioMed Central Ltd
Abstract
Objective: This meta-analysis aimed to systematically evaluate the impact
of intraoperative dexmedetomidine (DEX) on postoperative mortality and
clinical outcomes in surgical patients, addressing existing controversies
in the literature. <br/>Method(s): We conducted a systematic review of
randomized controlled trials (RCTs) from PubMed, Embase and Cochrane
Library (inception to October 8, 2024; PROSPERO: CRD42024583524). Included
studies compared intraoperative DEX against controls (placebo/active
comparators) in adults undergoing general anesthesia. Primary outcome was
mortality; secondary outcomes included postoperative delirium (POD),
ICU/hospital stay, mechanical ventilation duration, and safety endpoints.
Risk ratios (RR) or mean differences (MD) with 95% confidence intervals
(CI) were pooled using fixed/random-effects models. <br/>Result(s): This
meta-analysis included 17 randomized controlled trials (RCTs). In cardiac
surgery patients, DEX significantly reduced all-cause mortality (RR 0.39,
95% CI 0.18-0.85; P = 0.02) and in-hospital mortality (RR 0.23, 95% CI
0.08-0.70; P = 0.01), but not 30-day mortality. In non-cardiac surgery
patients, DEX did not significantly reduce all-cause, 30-day, or
in-hospital mortality. DEX decreased the incidence of POD in both cardiac
(RR 0.61, 95% CI 0.46-0.82; P = 0.001) and non-cardiac surgery patients
(RR 0.56, 95% CI 0.36-0.87; P = 0.01). For other outcomes, significant
reductions in hospital stay, ICU stay, and mechanical ventilation duration
were primarily observed in the cardiac surgery subgroup. Safety analysis
indicated there was no significant difference in intraoperative
bradycardia or hypotension between groups. <br/>Conclusion(s):
Dexmedetomidine use in cardiac surgery significantly reduces all-cause and
in-hospital mortality, shortens hospital length of stay, decreases ICU
stay duration, and reduces mechanical ventilation requirements. However,
its impact on 30-day mortality is not significant. Additionally, the drug
consistently demonstrates a preventive effect on postoperative delirium
across different surgical types.Clinicians must carefully weigh the
benefits of this medication against the potential risk of transient
hemodynamic instability.<br/>Copyright &#xa9; The Author(s) 2025.

<48>
Accession Number
2042275821
Title
Safety and Efficacy of Cerebral Embolic Protection Device During
Transcatheter Aortic Valve Implantation: An Updated Systematic Review and
Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2026.
Date of Publication: 2026.
Author
de Pontes V.B.; Jaramillo S.; Trevisan T.; Huntermann R.; de Sousa
P.A.M.G.; Silva L.D.D.; Clemente M.R.C.; Garot P.; Gomes W.F.
Institution
(de Pontes, Trevisan) University Centre of Associated Colleges for
Education, Sao Joao da, Boa Vista, Brazil
(Jaramillo) Universidad Austral, Pilar, Argentina
(Huntermann) University Center for the Development of Alto Vale, Rio do
Sul, Brazil
(de Sousa) University of Sao Paulo Medical School, Sao Paulo, Brazil
(Silva) Federal University of Uberlandia, Uberlandia, Brazil
(Clemente) Faculdade de Medicina de Petropolis, Petropolis, Brazil
(Garot) Institut Cardiovasculaire Paris-Sud, Hopital Jacques Cartier,
Ramsay-Sante, Massy, France
(Gomes) Hospital INC, Curitiba, Brazil
(Gomes) Faculdades Pequeno Principe, Curitiba, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Background: Cerebral embolic protection (CEP) devices may mitigate the
risk of embolization and stroke during transcatheter aortic-valve
implantation (TAVI), yet their safety and efficacy remain debated.
<br/>Aim(s): To evaluate the safety and efficacy of CEP during TAVI.
<br/>Method(s): We conducted a systematic search of PubMed, Embase, and
the Cochrane Library from inception through April 2025 for randomized
controlled trials (RCTs) and observational studies comparing TAVI
performed with versus without the Sentinel CEP device. Pooled risk ratios
(RRs), odds ratios (ORs), and 95% confidence intervals (CIs) were
calculated using a random-effects model. <br/>Result(s): Seventeen studies
(4 RCTs and 13 observational cohorts) involving 752,164 patients were
included; among them, 86,916 (11.5%) received the Sentinel device. CEP use
was associated with significantly lower rates of early stroke (within 72
h; RR 0.61; 95% CI 0.40-0.94), any stroke (RR 0.78; 95% CI 0.65-0.94),
30-day stroke (RR 0.47; 95% CI 0.26-0.85), disabling stroke (RR 0.49; 95%
CI 0.29-0.84), and all-cause mortality (RR 0.66; 95% CI 0.49-0.89). No
significant differences were observed in transient major vascular
complications, bleeding events, or acute kidney injury (AKI). In the
analysis restricted to RCTs, stroke and mortality outcomes were similar
between groups, with no significant differences across safety endpoints.
In prespecified subgroup analyses, patients with bicuspid aortic valves
derived no significant benefit from CEP (OR O.80; 95% CI 0.40-1.61),
whereas those with prior stroke experienced a reduced risk of recurrent
stroke (RR 0.61; 95% CI 0.45-0.82). <br/>Conclusion(s): This meta-analysis
suggests that the Sentinel CEP device is associated with lower risks of
stroke and mortality following TAVI, without increasing the incidence of
vascular complications, bleeding, or AKI.<br/>Copyright &#xa9; 2026 Wiley
Periodicals LLC.

<49>
Accession Number
2042623472
Title
Comparative Evaluation of Epidural Dexmedetomidine Versus Fentanyl as
Adjuvants to Bupivacaine in Thoracic Surgery: A Randomized Controlled
Trial.
Source
Bali Journal of Anesthesiology. 9(4) (pp 224-229), 2025. Date of
Publication: 01 Oct 2025.
Author
Mohamed M.A.; Soliman M.G.; El Ashmawi H.S.E.D.; Muhareb R.S.; Tawadros
P.Z.
Institution
(Mohamed, Soliman, El Ashmawi, Muhareb, Tawadros) Department of
Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of
Medicine, Cairo University, Cairo, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Thoracic surgery is associated with significant postoperative
pain, often managed with epidural analgesia. This study compared the
analgesic efficacy, sedation profile, opioid-sparing effect, and patient
satisfaction of epidural dexmedetomidine versus fentanyl when used as
adjuvants to bupivacaine. <br/>Method(s): In this prospective, randomised,
double-blind trial, 50 patients undergoing elective thoracotomy were
allocated equally into two groups. Group A received epidural
dexmedetomidine (50 mug) with 0.125% bupivacaine, while Group B received
fentanyl (50 mug) with 0.125% bupivacaine. Primary outcomes included
postoperative analgesic requirements and sedation scores. Secondary
outcomes included haemodynamic parameters, numeric rating scale (NRS) for
pain, and patient satisfaction over 24 h postoperatively. <br/>Result(s):
Baseline characteristics were comparable between groups. Mean arterial
pressure and heart rate decreased significantly from baseline in both
groups; however, the heart rate remained lower in the dexmedetomidine
group throughout the intraoperative period (P < 0.05). Postoperatively,
the dexmedetomidine group required significantly less morphine (0.08 +/-
0.4 mg vs 0.88 +/- 1.8 mg, P = 0.047) and exhibited lower NRS scores (P =
0.001). Sedation scores were significantly higher with dexmedetomidine (P
= 0.001), and patient satisfaction was markedly improved (P = 0.001). Side
effect incidence was comparable, with no significant increase in
hypotension, nausea, or vomiting. <br/>Conclusion(s): Dexmedetomidine,
when used as an epidural adjuvant to bupivacaine in thoracic surgery,
provides superior sedation and analgesia with reduced opioid use and
improved patient satisfaction, without increasing adverse effects. It
represents a valuable alternative to fentanyl in thoracic epidural
analgesia.<br/>Copyright &#xa9; 2025 Bali Journal of Anesthesiology.

<50>
Accession Number
2042661739
Title
Efficacy of rhomboid intercostal block for postoperative analgesia in
patients undergoing breast surgery: A systematic review and meta-analysis.
Source
Indian Journal of Anaesthesia. 70(1) (pp 53-67), 2026. Date of
Publication: 01 Jan 2026.
Author
Sandhya M.K.; Desai T.; Podder S.; Shetty S.R.; Siva M.
Institution
(Sandhya) Department of Anaesthesiology, Dayananda Sagar University,
Chandramma Dayananda Sagar Institute of Medical Education and Research,
Bangalore South, Karnataka, Harohalli, India
(Desai) Department of Anaesthesiology, Belagavi Institute of Medical
Sciences, Karnataka, Belagavi, India
(Podder) Department of Anaesthesiology, Kasturba Medical College, Manipal
Academy of Higher Education, Karnataka, Manipal, India
(Shetty) Department of Anaesthesiology, Kanachur Institute of Medical
Sciences, Karnataka, Mangalore, India
(Siva) Department of Community Medicine, Dayananda Sagar University,
Chandramma Dayananda Sagar Institute of Medical Education and Research,
Bangalore South, Karnataka, Harohalli, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: The rhomboid intercostal plane block (RIB) is a
regional anaesthesia technique that has shown promising results in breast
and thoracic surgeries. This systematic review and meta-analysis evaluated
the efficacy and safety of RIB in breast surgery. <br/>Method(s): The
study was conducted as per PRISMA guidelines and registered in PROSPERO
(CRD420251089477). Randomised controlled studies in which RIB was compared
with other regional blocks or a control group for postoperative analgesia
in breast surgeries were included in this study. Databases searched
included PubMed, EMBASE, the Cochrane Library, Web of Science, Directory
of Open Access Journals, and Google Scholar. The primary outcome was 24 h
opioid consumption; secondary outcomes were duration of analgesia, pain
scores, and complications. Data extraction and Risk of Bias assessment
were performed independently by two reviewers. Continuous data were pooled
as mean difference (MD) and dichotomous data as risk ratio with 95%
confidence intervals (CIs). Analyses were conducted using Python
(v3.11.13) and RevMan (v5.4). <br/>Result(s): Ten randomised controlled
trials (n = 777) were included in this meta-analysis. The risk of bias was
low in 70% of studies, and none were at high risk. RIB reduced 24 h opioid
consumption compared to control (no block) (SMD: -3.68; 95% CI: 5.13,
2.23; P < 0.00001) and serratus anterior plane block (SAPB) (SMD: -0.93;
95% CI: 1.65, -0.21; P = 0.01). There was no difference between RIB and
pectoral nerve block or erector spinae plane block in terms of
postoperative analgesic consumption. The duration of analgesia was
significantly longer with the rhomboid intercostal block (RIB) compared to
no block (MD: 8.84 h; 95% CI: 8.02, 9.66; P < 0.00001). The duration of
analgesia was comparable between RIB and SAPB. Meta-analysis of
postoperative pain scores was not feasible due to the limited number of
studies. No block-related complications were reported in any of the
studies. RIB reduced postoperative nausea and vomiting compared to control
(no block), but not significantly when compared to other blocks.
<br/>Conclusion(s): RIB, as part of multimodal analgesia, significantly
reduces opioid consumption compared with no block. RIB is a safe and
effective alternative to established regional anaesthesia techniques for
postoperative analgesia in breast surgeries.<br/>Copyright &#xa9; 2026
Indian Journal of Anaesthesia.

<51>
Accession Number
649780531
Title
Impact of early balance training on recovering following coronary artery
bypass grafting. A randomized trial.
Source
Clinical rehabilitation. (pp 2692155251407320), 2025. Date of
Publication: 30 Dec 2025.
Author
Atef H.; Marques-Sule E.; Moreno-Segura N.; Maged A.; ELSayed S.H.;
Pengelly J.; Ali H.F.; Ghaffar H.A.E.
Institution
(Atef) School of Allied Health Professions (SAHP), Keele University,
Keele, Newcastle, UK
(Atef, Maged, Ghaffar) Department of Physical Therapy for Internal
Medicine, Faculty of Physical Therapy, Cairo University, Al Giza, Egypt
(Marques-Sule) Multispeciality Research Group (PTinMOTION), Faculty of
Physiotherapy, Department of Physiotherapy, University of Valencia,
Valencia, Spain
(Marques-Sule, Moreno-Segura) Faculty of Physiotherapy, Department of
Physiotherapy, University of Valencia, Valencia, Spain
(ELSayed) Department of Rehabilitation Sciences, College of Health and
Rehabilitation Sciences, Princess Nourah bint Abdulrahman University,
Riyadh, Saudi Arabia
(Pengelly) School of Allied Health, Human Services and Sport, La Trobe
University, Bundoora, Australia
(Ali) Cardiothoracic Surgery Department, Faculty of Medicine, Cairo
University, Al Giza, Egypt
Abstract
ObjectiveTo investigate the effect of early balance training combined with
traditional Phase I cardiac rehabilitation (based on circulatory,
respiratory and progressive aerobic exercises) compared to Phase I cardiac
rehabilitation alone, on balance, functional capacity, quality of life,
length of hospital stay and adverse events in patients post coronary
artery bypass graft surgery.DesignRandomized controlled
trial.SettingCardiothoracic surgery departments from the Cairo University
Hospitals.ParticipantsAdults (>=55 years) undergoing coronary artery
bypass graft were randomly allocated to either an early balance training
plus Phase I cardiac rehabilitation group or a Phase I cardiac
rehabilitation alone group. Both groups commenced within 48 hours
postoperatively and performed 30 minutes of moderate-intensity Phase I
cardiac rehabilitation, thrice daily for 7 days. The cardiac
rehabilitation Balance group performed an additional 5 minutes of balance
training each session.Main measuresBalance (Berg Balance Scale),
functional capacity (5-Repetition-Sit-to-Stand test), quality of life
(Short Form-36 Health Survey Questionnaire), length of hospital stay
(number of days hospitalized) and adverse events were
evaluated.ResultsSixty coronary artery bypass graft patients completed the
study. When compared to cardiac rehabilitation Alone group, the cardiac
rehabilitation balance group significantly improved balance (39.77 +/-
4.73 vs 34.03 +/- 4.94, respectively, P < .001) functional capacity (11.93
+/- 1.70 vs 15.97 +/- 2.01, respectively, P < .001), quality of life
(71.87 +/- 3.21 vs 66.17 +/- 2.94, respectively, P < .001) and hospital
length stay (11.47 +/- 1.22 vs 14.93 +/- 1.36, respectively, P < .01).
Additionally, both groups showed significant improvements in balance,
functional capacity and quality of life. No adverse events were registered
in any of the groups.ConclusionsPhase I cardiac rehabilitation plus early
balance training improves balance, functional capacity, quality of life,
and decreases length of hospital stay beyond that of Phase I cardiac
rehabilitation alone, without an increase in adverse events.Institutional
Research CommitteeNo: P.T.REC/012/004372Registrationclinicaltrails.gov
NCT06490458).

<52>
Accession Number
649781275
Title
Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve
Replacement in Women With Severe Aortic Stenosis: The RHEIA Trial.
Source
Journal of the American Heart Association. (pp e047196), 2025. Date of
Publication: 30 Dec 2025.
Author
Silva I.; Alperi A.; Hecht S.; Zanuttini A.; Theron A.; Giuliani C.;
Camacho B.; Dahou A.; Mares J.; Bax J.; Bonaros N.; Windecker S.;
Messika-Zeitoun D.; Wesselink W.; Rakova R.; Bramlage P.; Tchetche D.;
Eltchaninoff H.; Pibarot P.
Institution
(Silva, Alperi, Rakova) Department of Cardiology, Hospital Universitario
Central de Asturias Instituto de Investigacion Sanitaria del Principado de
Asturias Oviedo Spain, Spain
(Silva, Alperi, Hecht, Zanuttini, Theron, Giuliani, Rakova, Pibarot)
Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada,
Canada
(Theron) Department of Cardiology, Assistance Publique Hopitaux de
Marseille Marseille France, France
(Camacho) Interventional Cardiology Hospital Arnau de Vilanova Lerida
Spain, Spain
(Dahou) Division of Cardiovascular Imaging, St. Francis Hospital and Heart
Center, Catholic Health New York NY
(Dahou) Division of Cardiology Massachusetts General Hospital/Harvard
Medical School Boston MA
(Mares) Department of Data Science Institute for Clinical and Experimental
Medicine Prague Czech Republic, Czechia
(Bax) Department of Cardiology Leiden University Medical Center Leiden The
Netherlands, Netherlands
(Bonaros) Department of Cardiac Surgery Medical University of Innsbruck
Innsbruck Austria, Austria
(Windecker) Department of Cardiology, Inselspital University Hospital of
Bern University of Bern Bern Switzerland, Switzerland
(Messika-Zeitoun) Division of Cardiology University of Ottawa Heart
Institute Ottawa ON Canada, Canada
(Wesselink) Edwards Lifesciences Prague Prague Czech Republic, Czechia
(Bramlage) Institute for Pharmacology and Preventive Medicine Cloppenburg
Cloppenburg Germany, Germany
(Tchetche) Clinique Pasteur Toulouse France
(Eltchaninoff) Department of Cardiology Univ Rouen Normandie, INSERM
U1096, France
Abstract
BACKGROUND: In the RHEIA (Randomized Research in Women All Comers With
Aortic Stenosis) trial, the incidence of the primary end point of death,
stroke, or rehospitalization at 1 year was lower with transcatheter aortic
valve implantation (TAVI) than with surgical aortic valve replacement. The
objective of this substudy was to compare echocardiographic findings in
women with severe aortic stenosis following surgical aortic valve
replacement or TAVI. <br/>METHOD(S): At 48 European centers, 443 women
underwent randomization 1:1, and 420 were treated as randomized.
Echocardiograms were available in 356 patients and were analyzed by a core
laboratory. <br/>RESULT(S): Rates of or greater moderate paravalvular
regurgitation was low (<1%) and similar between groups. At 30 days, TAVI
was associated with higher mean transprosthetic gradient and smaller
aortic valve area, but the rate of severe patient-prosthesis mismatch (3.0
versus 2.6%; P=1) was low and not different between groups. Valve
hemodynamics were stable at 1 year. The rate of residual left ventricular
hypertrophy (45.3 versus 28.6%; P=0.004) at 1 year was significantly
higher with TAVI, whereas the rate of right ventricular systolic
dysfunction (14.5 versus 40.7%; P<0.001) and evolution of cardiac damage
stage (improved in 21.8 versus 18.1%; worsened in 16.8 versus 47.0%;
P=0.001) were better with TAVI. <br/>CONCLUSION(S): Among women with
severe aortic stenosis, both TAVI and surgical aortic valve replacement
achieve excellent valve hemodynamic results with low and similar rates of
moderate or greater paravalvular regurgitation or severe
patient-prosthesis mismatch. Surgical aortic valve replacement was
associated with lower gradients and more pronounced regression of left
ventricular hypertrophy, whereas TAVI was associated with better right
ventricular systolic function and evolution of cardiac damage stage.
REGISTRATION: URL: https://clinicaltrials.gov/study/NCT04160130; Unique
Identifier: NCT04160130.

<53>
Accession Number
2042626685
Title
Minimally invasive coronary artery bypass grafting (MINI-CABG): Protocol
for a pilot randomized controlled trial comparing minimally invasive
versus conventional coronary surgery.
Source
PLOS ONE. 20(12 December) (no pagination), 2025. Article Number: e0337829.
Date of Publication: 01 Dec 2025.
Author
Dallan L.R.P.; Lisboa L.A.F.; Dallan L.A.O.; Mejia O.A.V.; Filho A.F.N.;
Doenst T.; Babliak O.; Sampedro G.A.O.; Jatene F.B.
Institution
(Dallan, Lisboa, Dallan, Mejia, Filho, Jatene) Instituto do Coracao,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo, Brazil
(Doenst) Cardiothoracic Surgery Department, University Hospital Jena,
Friedrich Schiller University, Jena, Germany
(Babliak) Cardiac Surgery Department, Cardiac Surgery Center, Dobrobut
Medical Network, Kyiv, Ukraine
(Sampedro) Department of Surgery, Grupo Hospitalario Kennedy, Guayaquil,
Ecuador
Publisher
Public Library of Science
Abstract
Introduction Coronary artery bypass grafting (CABG) via sternotomy remains
the standard of care for multivessel coronary disease. Minimally invasive
cardiac surgery for coronary artery bypass grafting (MICS-CABG) is an
evolving technique with the potential to reduce surgical trauma and
promote faster recovery without compromising outcomes. This protocol
describes a pilot randomized controlled trial comparing MICS-CABG and
conventional CABG in multivessel patients in a high-volume tertiary
center. Methods and analysis This is a single-center, prospective,
randomized controlled pilot trial. A total of 100 patients with
multivessel coronary artery disease will be randomized (1:1) to undergo
either conventional CABG via median sternotomy or MICS-CABG through a left
anterior thoracotomy. The sample size of 100 patients (50 per group) was
defined based on feasibility and statistical precision. This allows
estimation of an expected 8% major adverse cardiovascular and
cerebrovascular events (MACCE) rate with a 95% confidence interval
half-width of +/-5% in each group. These data will inform sample size
calculations for a future phase III trial. The primary outcomes are safety
and feasibility. Feasibility will be assessed by the successful completion
of the planned minimally invasive coronary revascularization strategy.
Safety will be evaluated through the occurrence of MACCE within 30 days
postoperatively. Secondary outcomes include operative time, mechanical
ventilation time, conversion rate to sternotomy, bleeding volume, atrial
fibrillation, postoperative ICU and hospital length of stay, and
patient-reported quality of life (EQ-5D-5L) 6 months postoperatively. The
trial is ongoing at this moment. Ethics and dissemination The protocol was
approved by the Institutional Research Ethics Committee under que number
CAAE: 54175921.8.0000.0068. Results will be disseminated through
peer-reviewed publications and scientific conferences.<br/>Copyright
&#xa9; 2025 Palma Dallan 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.

<54>
Accession Number
2042283295
Title
The Role of Colchicine in the Prevention of Postoperative Atrial
Fibrillation: Mechanisms, Efficacy, and Future Directions.
Source
SN Comprehensive Clinical Medicine. 8(1) (no pagination), 2026. Article
Number: 3. Date of Publication: 01 Dec 2026.
Author
Ogieuhi I.J.; Ajekiigbe V.O.; Anthony C.S.; Abiodun C.A.; Kolo-Manma K.;
Aghasili C.C.; Ayokunle F.T.; Ajayi J.O.; Akinmeji O.; Adeyemi B.A.;
Tetteh E.B.
Institution
(Ogieuhi, Adeyemi) Northwestern Medicine McHenry Hospital, McHenry, IL,
United States
(Ajekiigbe, Kolo-Manma) Ladoke Akintola University of Technology,
Ogbomosho, Nigeria
(Anthony) University of Calabar, Calabar, Nigeria
(Abiodun) Department of Global Health, African Cancer Institute,
Stellenbosch University, Cape Town, South Africa
(Aghasili) Geisinger Wyoming Valley Medical Centre, Wilkes Barre, PA,
United States
(Ayokunle) Bowen University Teaching Hospital, Ogbomosho, Nigeria
(Ajayi) Kharkiv National Medical University, Kharkiv, Ukraine
(Akinmeji) Olabisi Onabanjo University, Ogun State, Ago-Iwoye, Nigeria
(Tetteh) Sinai Hospital of Baltimore, Baltimore, MD, United States
Publisher
Springer Nature
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is a pathological
condition observed commonly among patients who underwent cardiac
surgeries. It has been associated with increased hospital stay length,
healthcare costs, morbidity, and mortality. Recent studies have evaluated
colchicine's innate role as an anti-inflammatory in preventing POAF. This
is due to its ability to reduce the remodeling of the atrial walls. In
this review, we focus on the proposed mechanisms, efficacy, and future
directions in preventing POAF with colchicine. Methodology: This study
incorporated six (6) randomized controlled trials and three (3) systematic
reviews and meta-analyses of randomized controlled trials of varying
sample sizes involving individuals with cardiovascular comorbidities such
as diabetes, coronary artery disease, and hypertension after carefully
searching the data available on colchicine's efficacy in POAF.
<br/>Result(s): The reviewed randomized controlled trials found the
following-three (3) studies found that colchicine significantly reduced
POAF compared to placebo; two (2) studies found that colchicine reduced
the occurrence of POAF, but the findings were not statistically
significant; and one study found no change between the treatment group and
placebo. Aside from reducing POAF incidence in patients treated with
colchicine, it was observed in the studies that patients noted improved
quality of life and reduced hospital stay. Additionally, patients reported
adverse effects such as increased rates of infections and gastrointestinal
side effects such as diarrhea. This review also conducted a comparative
analysis of colchicine with conventional therapies such as beta-blockers
and amiodarone, and it was noted that colchicine can serve as a
supplementary option. <br/>Conclusion(s): Large-scale studies with larger
sample sizes and more extensive clinical trials must be conducted to
prospectively scrutinize colchicine's definite role in POAF and its
application in a more diverse population of patients.<br/>Copyright &#xa9;
The Author(s), under exclusive licence to Springer Nature Switzerland AG
2026.

<55>
Accession Number
2042264034
Title
Transradial vs transfemoral secondary access outcomes in transcatheter
aortic valve replacement: an updated systematic review and meta-analysis.
Source
Egyptian Heart Journal. 77(1) (no pagination), 2025. Article Number: 113.
Date of Publication: 01 Dec 2025.
Author
Shaikh R.H.; Fatima E.; Jamshed M.M.; Ishfaq H.; Lukan A.; Inam H.;
Ibrahim M.B.; Shaka H.
Institution
(Ishfaq, Shaikh, Fatima, Jamshed) Medical College, Aga Khan University,
Karachi, Pakistan
(Ishfaq) Northwest Health-Porter, Valparaiso, United States
(Lukan) Advocate Illinois Masonic Medical Center, Chicago, United States
(Inam) Department of Cardiothoracic Surgery, Aga Khan University Hospital,
Karachi, Pakistan
(Ibrahim, Shaka) John H. Stroger, Jr. Hospital of Cook County, Chicago,
United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a minimally
invasive procedure with associated risks that are influenced by the choice
of secondary vascular access used. The impact of transradial secondary
access (TRSA) compared to transfemoral secondary access (TFSA) on adverse
events remains uncertain. Therefore, we conducted an updated meta-analysis
to compare procedural complications between TRSA and TFSA in TAVR.
<br/>Method(s): We systematically searched PubMed, Scopus, and the
Cochrane Library for studies comparing TRSA and TFSA in patients
undergoing TAVR. The primary endpoints were 30-day rates of each of the
following: access-related bleeding, access-related vascular complications,
stroke/transient ischemic attack (TIA), myocardial infarction (MI), acute
kidney injury (AKI stage III or higher), and all-cause mortality.
Leave-one-out sensitivity analyses and subgroup analyses stratified by
primary access route were performed to assess the consistency of the
findings. <br/>Result(s): Seven studies with 6327 patients were included,
comprising of six observational studies and one randomized controlled
trial TRSA was associated with significantly lower odds of mortality (OR
0.55, 95% CI [0.39, 0.78], p = 0.0007), stroke/TIA (OR 0.58, 95% CI [0.39,
0.87], p = 0.009), major/life-threatening bleeding (OR 0.50, 95% CI [0.30,
0.83], p = 0.008), and major vascular complications (OR 0.59, 95% CI
[0.41, 0.85], p = 0.004). Additionally, we stratified outcomes for
patients undergoing transfemoral primary access (TFPA) to determine
whether the primary access route influences results. The transradial group
demonstrated significantly lower odds of 30-day all-cause mortality (OR
0.49, 95% CI [0.28, 0.87], p = 0.01), and 30-day minor bleeding (OR 0.48,
95% CI [0.27, 0.86], p = 0.01). <br/>Conclusion(s): Key limitations
included predominance of non-randomized studies and high heterogeneity in
some outcomes. In patients undergoing TAVR, TRSA is associated with
significantly lower complications compared to TFSA, suggesting it may be a
superior alternative.<br/>Copyright &#xa9; The Author(s) 2025.

<56>
Accession Number
2042265217
Title
Clinical efficacy and mechanisms of transcutaneous auricular vagus nerve
stimulation targeting the gut-brain axis for postoperative complications
of aortic dissection: study protocol for a randomized controlled trial.
Source
Frontiers in Medicine. 12 (no pagination), 2025. Article Number: 1692356.
Date of Publication: 2025.
Author
Ning B.; Yang L.; Wei Y.; Luo C.; Zheng F.; Ge T.; Ou H.; Wang C.; Hu J.;
Zhao Q.; Bo J.; Wang K.; Zhang Z.; Chen H.; Zou R.; Fan X.; Peng J.
Institution
(Ning, Yang, Ge, Wang, Hu, Zhao, Bo, Zou, Fan) The Second Clinical Medical
College, Guangzhou University of Chinese Medicine, Guangzhou, China
(Wei) The Fourth Clinical Medical College, Guangzhou University of Chinese
Medicine, Shenzhen, China
(Luo) Clinical Medical College, Chengdu University of Traditional Chinese
Medicine, Chengdu, China
(Zheng, Ou, Wang, Zou, Fan, Peng) Guangdong Provincial Hospital of Chinese
Medicine, The Second Affiliated Hospital of Guangzhou University of
Chinese Medicine, Guangzhou, China
(Wang, Zhang, Chen) The First Clinical Medical College, Shaanxi University
of Chinese Medicine, Xianyang, China
(Zou, Fan) State Key Laboratory of Traditional Chinese Medicine Syndrome,
State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangdong
Provincial Key Laboratory of TCM Emergency Research, Guangzhou, China
Publisher
Frontiers Media SA
Abstract
Background: Aortic dissection (AD) is a life-threatening cardiovascular
emergency characterized by rapid onset and high mortality. While surgery
intervention, the primary treatment, improves short-term survival, it
frequently leads to postoperative complications including systemic
inflammatory response syndrome, gastrointestinal dysfunction, and
anxiety/depression. These complications may be exacerbated by
dysregulation of the gut-brain axis (GBA). Transcutaneous auricular vagus
nerve stimulation (taVNS) is a non-invasive neuromodulation technique
known to exert anti-inflammatory, prokinetic, and neuroregulatory effects
in various conditions; however, its application for managing postoperative
complications in AD remains unexplored. This study aims to evaluate the
efficacy and safety of taVNS in regulating the GBA among postoperative AD
patients through a randomized controlled trial. <br/>Method(s): This is a
single-center, randomized, investigator-blinded, sham-controlled
randomized controlled trial. A total of 50 patients aged 18-75 years with
postoperative Stanford Type A or B AD will be enrolled and randomly
assigned in a 1:1 ratio to either the active taVNS group or the sham
control group. Both groups will receive standard postoperative care. The
experimental group will additionally receive active taVNS targeting the
vagus nerve-innervated auricular area (15 Hz, 200 mus pulse width), while
the control group will receive sham stimulation at a non-vagus innervated
site without electrical current. The intervention will be administered for
30 min, twice daily, over 7 consecutive days, with follow-up assessments
continuing until 24 weeks post-surgery. Primary outcomes include changes
in gut microbiota diversity/abundance and brain function (assessed via
functional near-infrared spectroscopy). Secondary outcomes encompass
inflammatory markers, plasma neurotransmitter levels, intestinal function
recovery, and relevant psychometric scale scores. Safety will be monitored
through vital signs, laboratory tests, and recording of any adverse
events. <br/>Discussion(s): This study is the first to innovatively
integrate taVNS with the GBA theory, investigating its multi-target
mechanisms through a comprehensive set of biomarkers and clinical
endpoints. If proven effective, taVNS could offer a safe and
cost-effective non-pharmacological adjunctive therapy for managing
postoperative complications in AD. Furthermore, the findings have the
potential to elucidate the role of the GBA in the recovery trajectory of
patients following major cardiovascular surgery. Trial Registration:
Chinese Clinical Trial Registry (ChiCTR, http://www.chictr.org.cn), No.
ChiCTR2500102345, Date: May 13, 2025.<br/>Copyright &#xa9; 2025 Ning,
Yang, Wei, Luo, Zheng, Ge, Ou, Wang, Hu, Zhao, Bo, Wang, Zhang, Chen, Zou,
Fan and Peng.

<57>
Accession Number
2042260196
Title
Effects of RBT-1 on the Occurrence of Postoperative Complications in
Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiac Surgery. 2025(1) (no pagination), 2025. Article Number:
5324660. Date of Publication: 2025.
Author
Mack C.A.; Jessen M.E.; Shaw A.D.; Ruiz S.; Wang C.; Snapinn S.; Singh B.;
Lamy A.
Institution
(Mack) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Jessen) Department of Cardiovascular and Thoracic Surgery, University of
Texas Southwestern Medical Center, Dallas, TX, United States
(Shaw) Department of Intensive Care and Resuscitation, Cleveland Clinic,
Cleveland, OH, United States
(Ruiz, Singh) Renibus Therapeutics, Inc, Southlake, TX, United States
(Wang) Pharma Data Associates, LLC, Piscataway, NJ, United States
(Snapinn) Seattle-Quilcene Biostatistics, LLC, Seattle, WA, United States
(Lamy) Department of Perioperative Medicine and Surgery, Population Health
Research Institute, Hamilton, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Approximately two-thirds of patients undergoing cardiac
surgery experience postoperative complications, which may lead to
significant clinical consequences. RBT-1, an investigational drug with
anti-inflammatory and antioxidant properties, elicits a preconditioning
response and was shown to improve clinical outcomes when administered
within 24-48 hours prior to surgery (modified intention-to-treat
population). The current post hoc analysis evaluated the efficacy of RBT-1
in reducing postoperative complications in the entire study population
without excluding patients based on when surgery occurred relative to
study drug administration. <br/>Method(s): A total of 135 patients were
randomized to receive a single infusion of RBT-1 (n = 91) or placebo (n =
44) at least 1 day before undergoing nonemergent coronary artery bypass
graft (CABG) and/or heart valve surgery on cardiopulmonary bypass (CPB)
and were followed for 90 days postsurgery. Clinical outcomes assessed
included ventilator time, intensive care unit (ICU) and hospital length of
stay (LOS), cardiopulmonary readmission, and other clinical events of
interest. <br/>Result(s): In this analysis, RBT-1 reduced ventilator time,
ICU, and hospital LOS by 0.98 days (NS), 2.59 days (p = 0.026), and 1.35
days (NS), respectively, compared with placebo. The incidence of 30-day
cardiopulmonary readmission was significantly reduced by RBT-1 (4.6% vs.
17.5%, placebo; p = 0.035). Additionally, RBT-1 showed a trend in
reductions in several clinical events of interest, including anemia,
atrial fibrillation, and fluid overload. <br/>Conclusion(s): Trends in
improved clinical outcomes were seen with RBT-1 treatment in this post hoc
analysis that included all patients enrolled in a Phase 2 clinical study
regardless of surgery delay beyond 2 days posttreatment. A Phase 3 study
is underway to confirm these improved clinical outcomes in a larger study
population. Trial Registration: ClinicalTrials.gov identifier:
NCT06021457.<br/>Copyright &#xa9; 2025 Charles A. Mack et al. Journal of
Cardiac Surgery published by John Wiley & Sons Ltd.

<58>
Accession Number
2042477964
Title
UK multisociety consensus statement on the emergency management and
resuscitation of patients with left-sided Impella support.
Source
Heart. (no pagination), 2025. Date of Publication: 2025.
Author
Akhtar W.; Bowles C.T.; Costanzo P.; Deakin C.D.; Elliot P.; Eladawy M.;
Gardner R.S.; Govier M.; Handslip R.; Hill J.; Jain A.; Khan S.Q.; Lewis
I.; Lim H.S.; Mariathas M.; Mellis C.; Monteagudo-Vela M.; Naldrett I.;
Ostermann M.; Perera D.; Pinto S.; Richardson C.; Ranasinghe A.; Gil F.R.;
Rosenberg A.; Schueler S.; Sinclair A.; Swanson N.; Wilson S.; Webb I.;
Webb S.; Walker C.; Panoulas V.
Institution
(Akhtar, Perera) St Thomas' Hospital, Guy's and St Thomas' NHS Foundation
Trust, London, United Kingdom
(Akhtar, Bowles, Monteagudo-Vela, Pinto, Gil, Rosenberg, Panoulas)
Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London,
United Kingdom
(Akhtar, Elliot) Faculty of Intensive Care Medicine, London, United
Kingdom
(Costanzo) Royal Papworth Hospital, Cambridge, United Kingdom
(Deakin) Resuscitation Council UK, London, United Kingdom
(Eladawy, Schueler) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Gardner, Sinclair) Golden Jubilee National Hospital, Clydebank, United
Kingdom
(Gardner) British Society for Heart Failure, London, United Kingdom
(Govier, Mariathas) Bristol Royal Infirmary, University Hospitals Bristol,
Bristol, United Kingdom
(Handslip, Wilson) St Georges University Hospital, London, United Kingdom
(Hill) Royal Brompton Hospital, Guy's and St Thomas NHS Foundation Trust,
London, United Kingdom
(Jain, Mellis) Barts Health NHS Trust, London, United Kingdom
(Khan, Lim, Richardson) University Hospitals Birmingham NHS Foundation
Trust, Birmingham, United Kingdom
(Lewis) University Hospital of Wales, Cardiff, United Kingdom
(Naldrett) British Association of Critical Care Nurses, London, United
Kingdom
(Ostermann, Webb) Intensive Care Society, London, United Kingdom
(Ranasinghe) Society for Cardiothoracic Surgery in Great Britain and
Ireland, London, United Kingdom
(Swanson) British Cardiovascular Society, London, United Kingdom
(Webb) King's College Hospital NHS Foundation Trust, London, United
Kingdom
(Walker) Association of Cardiothoracic Anaesthesia and Critical Care,
London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
The use of left-sided Impella microaxial flow pumps has expanded rapidly
for the management of cardiogenic shock, left ventricular unloading and as
a bridge to heart transplantation. However, standard life support and
resuscitation algorithms are not directly applicable to patients receiving
this therapy due to fundamental alterations in circulatory physiology. To
address this gap, eleven UK Impella centres and eight national
professional societies collaborated to develop a unified national
consensus statement on the emergency management of patients with
left-sided Impella support. Using a systematic review of the literature
and a modified Delphi process guided by the European Society of Cardiology
framework for grading recommendations, expert representatives achieved
agreement on key priorities and structured actions to be undertaken in the
first few minutes of resuscitation. The consensus outlines early
recognition of circulatory inadequacy (mean arterial pressure <30mm Hg or
end-tidal CO2 <2kPa), prompt activation of multidisciplinary responders,
reduction of Impella power to P2 before initiating cardiopulmonary
resuscitation and structured division of patient-focused and
device-focused teams. Device-specific troubleshooting algorithms are
presented for suction, malposition, purge-system failure and mechanical
malfunction. This multisociety consensus represents the first national
standard for emergency management and resuscitation of patients supported
by a left-sided Impella device and is intended to inform structured
clinical training and improve patient outcomes through rapid, coordinated
and physiologically tailored interventions.<br/>Copyright &#xa9; Author(s)
(or their employer(s)) 2025. Re-use permitted under CC BY-NC. No
commercial re-use. See rights and permissions. Published by BMJ Group.

<59>
Accession Number
2042623465
Title
Dissecting the Albumin Assumption: Can Albumin Reduce Acute Kidney Injury
after Cardiac Surgery Compared with Crystalloids? A Systematic Review and
Meta-analysis.
Source
Bali Journal of Anesthesiology. 9(4) (pp 209-217), 2025. Date of
Publication: 01 Oct 2025.
Author
Gemawan T.; Setiawan P.; Erisadana R.N.
Institution
(Gemawan, Setiawan) Department of Anesthesiology and Reanimation,
Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya,
Indonesia
(Gemawan) Department of Anesthesiology and Intensive Care, Dr. Soebandi
General Academic Hospital, Jember, Indonesia
(Erisadana) University of Jember, Department of Faculty of Medicine,
Jember, Indonesia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Acute kidney injury (AKI) is a common and serious
complication after cardiac surgery. Albumin has been proposed as a
superior fluid for perioperative management compared to crystalloids. We
aimed to evaluate whether albumin reduces the incidence of AKI compared to
crystalloid solutions in patients undergoing cardiac surgery. The need for
renal replacement therapy (RRT) was assessed as a secondary outcome.
<br/>Material(s) and Method(s): A systematic search was performed on
PubMed, ScienceDirect, and Scopus. Eligible studies were randomized
controlled trials (RCTs) comparing albumin to crystalloids in adult or
pediatric cardiac surgery patients and reporting AKI based on standardized
criteria. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 tool.
Meta-analysis was performed, calculating risk ratios (RRs) with 95%
confidence intervals (CIs) and applying random- or fixed-effects models
depending on heterogeneity. <br/>Result(s): Six RCTs, including 2465
patients, were analyzed. No significant difference in AKI incidence was
found between albumin and crystalloid groups (RR: 0.97, 95% CI: 0.79-1.18,
P = 0.74). Subgroup analysis showed no benefit when albumin was used as a
priming solution (RR: 1.06, 95% CI: 0.79-1.43), while a benefit was
observed in off-pump surgery in a single study. No significant difference
in RRT requirement was observed (RR: 1.75, 95% CI: 0.52-5.97, P = 0.37).
<br/>Conclusion(s): This meta-analysis provides no evidence that albumin
reduces the incidence of AKI, compared to crystalloids in cardiac surgery.
Crystalloids remain an appropriate first-line choice, while future
large-scale RCTs are needed to clarify whether certain patient subgroups
may benefit from albumin.<br/>Copyright &#xa9; 2025 Bali Journal of
Anesthesiology.

<60>
Accession Number
2042276617
Title
Tricuspid valve disease: updates on diagnostic imaging and intervention.
Source
Nature Reviews Cardiology. (no pagination), 2026. Date of Publication:
2026.
Author
Grapsa J.; Zancanaro E.; Rommel K.P.; Weber L.; Coisne A.;
Estevez-Loureiro R.; Delgado V.; Sitges M.; Enriquez-Sarano M.; Praz F.;
Fam N.; Cristell N.; Latib A.; Piazza N.; Lurz P.; Modine T.; Hausleiter
J.; Hahn R.T.; Leon M.B.; Granada J.F.
Institution
(Grapsa, Zancanaro) Heart and Vascular Institute, Brigham and Women's
Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, United
States
(Zancanaro, Rommel) Department of Cardiac and Vascular Surgery, University
of Mainz, Faculty of Medicine and University Hospital Mainz, Mainz,
Germany
(Zancanaro) Department of Cardiac Surgery, San Raffaele Hospital, Milan,
Italy
(Weber, Modine) Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux,
Bordeaux, France
(Weber) Department of Cardiology, Kantonsspital St. Gallen, St. Gallen,
Switzerland
(Coisne) University of Lille, Inserm, CHU Lille, Institut Pasteur de
Lille, Lille, France
(Estevez-Loureiro) Department of Cardiology, University Hospital Alvaro
Cunqueiro, Vigo, Spain
(Delgado) Heart Institute, Department of Cardiology, Germans Trias i Pujol
University Hospital, Barcelona, Spain
(Sitges) Cardiovascular Institute, Hospital Clinic, Universitat de
Barcelona, Barcelona, Spain
(Enriquez-Sarano) Minneapolis Heart Institute, Minneapolis, MN, United
States
(Praz) Universitatsklinik Fur Kardiologie, Inselspital Bern, Bern,
Switzerland
(Fam) St. Micheal's Hospital, Toronto, ON, Canada
(Cristell, Hahn, Granada) Cardiovascular Research Foundation, New York,
NY, United States
(Latib) Montefiore-Einstein Center for Heart and Vascular Care, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, NY, United
States
(Piazza) McGill University Health Centre, Montreal, QC, Canada
(Lurz) Department of Cardiology, University Medical Center Mainz, Mainz,
Germany
(Hausleiter) Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU
Munchen, Munich, Germany
(Hausleiter) German Center for Cardiovascular Research (DZHK), Partner
Site Munich Heart Alliance, Munich, Germany
(Hahn, Leon) NewYork-Presbyterian/Columbia University Medical Center, New
York, NY, United States
Publisher
Nature Research
Abstract
Tricuspid regurgitation is associated with an increased risk of
hospitalization and death. Many patients with severe tricuspid
regurgitation are unable to undergo surgical intervention owing to
prohibitive technical or clinical risk. The past two decades has seen an
outburst of technological advances in the field of transcatheter tricuspid
technologies, with numerous randomized, controlled trials assessing the
safety and efficacy of various repair and replacement therapies for
tricuspid regurgitation. However, crucial knowledge gaps persist,
particularly in areas such as patient selection, anatomical eligibility
and the haemodynamic effects of device implantation. In this Review, we
outline the anatomical features of the tricuspid valve and the
haemodynamic consequences of tricuspid regurgitation, and we summarize the
imaging modalities used for diagnosis and management. Furthermore, we
detail the current guideline-directed medical therapy for tricuspid
regurgitation, as well as valve repair and replacement surgical procedures
being tested in clinical trials. Finally, we highlight future
technological innovations that promise to optimize diagnosis, patient
selection and the device development process.<br/>Copyright &#xa9;
Springer Nature Limited 2026.

<61>
Accession Number
2042519485
Title
Effects of hyperoxia in pediatric perfusion patients: a scoping review.
Source
Journal of Extra-Corporeal Technology. 57(4) (pp 263-269), 2025. Date of
Publication: 01 Dec 2025.
Author
Derenzo M.; Velazquez-Milton V.; Johnson S.
Institution
(Derenzo, Velazquez-Milton, Johnson) Emory University, Perfusion Program,
Atlanta, GA, United States
Publisher
EDP Sciences
Abstract
Hyperoxia in pediatric cardiopulmonary bypass patients is associated with
adverse effects, including reoxygenation injury, increased mortality,
heightened inflammatory response, and cerebral injury. Although prior
research has demonstrated a correlation between these adverse effects and
hyperoxia during cardiac surgery, definitions of "hyperoxia' vary across
the literature. This scoping review synthesizes findings from PubMed,
CINAHL, Embase, and Web of Science to categorize the adverse effects of
hyperoxia based on age range, presence of cyanosis, and PaO<inf>2</inf>
levels. The results highlight the need for standardized oxygenation
management protocols in pediatric bypass procedures and a consistent
definition of "hyperoxia" for cyanotic and acyanotic
patients.<br/>Copyright &#xa9; The Author(s), published by EDP Sciences,
2025.

<62>
Accession Number
2042612647
Title
Prognostic Value of Speckle-tracking Echocardiography in Assessing
Outcomes of Transcatheter Edge-to-edge Repair for Mitral Regurgitation.
Source
Journal of Cardiovascular Echography. 35(4) (pp 336-343), 2025. Date of
Publication: 01 Oct 2025.
Author
Taherkhani A.; Zarinfar Y.; Khaheshi I.
Institution
(Taherkhani, Zarinfar) School of Medicine, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Khaheshi) Cardiovascular Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Khaheshi) Echocardiography Fellowship Program, Division of Cardiology,
Vancouver General Hospital, University of British Columbia, Vancouver,
Canada
Publisher
Wolters Kluwer Medknow Publications
Abstract
Mitral regurgitation (MR) is a valvular heart disease with high morbidity
and mortality. Transcatheter edge-to-edge repair (TEER) presents a viable
treatment option for severe MR in high-risk surgical patients. This review
aims to assess the prognostic significance of speckle-tracking
echocardiography (STE) in predicting outcomes after TEER and its potential
role in patient management. A systematic literature review was done on
PubMed for studies until November 2024. The search incorporated keywords
of STE and TEER, including original research on STE's predictive value in
TEER patients. Studies concerning surgical mitral valve repair or
unrelated imaging techniques were excluded. Twenty-nine articles were
included, indicating that STE metrics, especially global longitudinal
strain (GLS), correlate with clinical outcomes like heart failure
progression and mortality. Baseline GLS was determined as predictive of
hospitalization and mortality, while post-TEER GLS improvements were
associated with better functional capacity. Furthermore, left atrial
function metrics were significant in predicting arrhythmia recurrence.
This study highlights the utility of STE in predicting outcomes for TEER
patients. While findings are encouraging, additional research is essential
to elucidate the long-term effects of TEER on cardiac function, thereby
enhancing patient selection and management approaches. This review
highlights the relevance of STE in prognosticating outcomes for patients
undergoing TEER. Further investigations are essential to clarify the
long-term repercussions of TEER on cardiac functionality, thereby refining
patient selection and management strategies.<br/>Copyright &#xa9; 2025
Journal of Cardiovascular Echography.

<63>
Accession Number
2042519464
Title
Continuous furosemide does not prevent cardiopulmonary bypass-related
acute kidney injury in minimally invasive cardiac surgery: the randomized
furosemide trial.
Source
Journal of Extra-Corporeal Technology. 57(4) (pp 209-217), 2025. Date of
Publication: 01 Dec 2025.
Author
Takeichi T.; Morimoto Y.; Yamada A.; Tanaka T.; Fujiwara K.; Sato M.; Toma
R.; Mitsui K.; Sugita T.; Yamada H.; Gan K.
Institution
(Takeichi, Tanaka, Fujiwara, Mitsui, Sugita, Yamada) Department of
Clinical Engineering, Kitaharima Medical Center, 926-250, Ichiba-cho, Ono,
Japan
(Morimoto, Yamada, Sato, Toma, Gan) Cardiovascular Surgery, Kitaharima
Medical Center, 926-250, Ichiba-cho, Hyogo, Ono-shi, Japan
Publisher
EDP Sciences
Abstract
Objectives: This study aimed to assess whether continuous furosemide
administration during cardiopulmonary bypass (CPB) in minimally invasive
cardiac surgery (MICS) reduces the incidence of cardiac surgery-associated
acute kidney injury (AKI). <br/>Method(s): A total of 100 patients
undergoing MICS with CPB were randomly assigned to receive either
continuous furosemide infusion or no continuous furosemide during CPB. The
primary endpoint was the incidence of AKI. Secondary endpoints included
the cardiac surgery-associated neutrophil gelatinase-associated lipocalin
(CSA-NGAL) score, urine output within 12 h postoperatively, postoperative
furosemide dose requirements, red blood cell transfusion volume,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, duration of mechanical ventilation,
length of stay in the intensive care unit (ICU) and hospital, and
in-hospital mortality. <br/>Result(s): AKI occurred in 8 patients (16%) in
the continuous furosemide group and in 6 patients (12%) in the
non-continuous group (relative risk, 0.72; 95% CI, 0.23-2.23). Among the
secondary endpoints, urine output within the first 3 h postoperatively and
the PaO<inf>2</inf>/FiO<inf>2</inf> ratio were significantly higher in the
continuous furosemide group. However, subgroup analyses revealed no
significant differences between the two groups. <br/>Conclusion(s):
Continuous furosemide administration during CPB did not effectively reduce
the incidence of AKI. However, it was associated with a significant
increase in postoperative urine output and an improvement in the
PaO<inf>2</inf>/FiO<inf>2</inf> ratio.<br/>Copyright &#xa9; The Author(s),
published by EDP Sciences, 2025.

<64>
Accession Number
649780659
Title
Ross Procedure Renaissance: A Contemporary Review of Patient Selection,
Technique, and Long-Term Outcomes in Adults.
Source
Journal of the American Heart Association. (pp e044454), 2025. Date of
Publication: 30 Dec 2025.
Author
Bloom J.P.; Nam L.; Sa M.P.; Williams E.; Ouzounian M.; El-Hamamsy I.;
Hopkins W.; Yeh D.D.
Institution
(Bloom, Nam, Sa) Division of Cardiac Surgery Massachusetts General
Hospital Boston MA USA
(Williams, El-Hamamsy) Division of Cardiovascular Surgery Mount Sinai
Hospital, Icahn School of Medicine at Mount Sinai New York NY USA
(Ouzounian) Division of Cardiovascular Surgery University of Toronto
Toronto Ontario Canada, Canada
(Hopkins) Division of Cardiology University of Vermont Medical Center
Burlington VT USA
(Yeh) Division of Cardiology Massachusetts General Hospital Boston MA USA
Abstract
Renewed interest in the Ross procedure, driven by compelling evidence of
superior long-term outcomes, has led to increased international use. This
review outlines a comprehensive framework for understanding the Ross
procedure within the broader context of aortic valve replacement. Topics
include procedural overview, patient selection and contraindications,
diagnostic imaging, technical modifications to promote durability,
clinical outcomes, postoperative management, and future directions. The
Ross procedure remains the only valve replacement strategy capable of
restoring life expectancy in selected young and middle-aged adults, making
it an imperative option for multidisciplinary consideration.

<65>
Accession Number
649779834
Title
CPAP Versus Conventional Oxygenation Postextubation in Children With
Congenital Heart Disease.
Source
Respiratory care. (no pagination), 2025. Date of Publication: 17 Dec
2025.
Author
Shi A.; Li M.; Zhou J.; Peng M.; Bian L.
Institution
(Shi, Li) Mr. Shi and Ms. Li are affiliated with Department of
Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University,
Nanjing City, Jiangsu Province, China
(Zhou, Peng, Bian) Ms. Zhou, Peng, Bian are affiliated with Department of
Nursing, Children's Hospital of Nanjing Medical University, Nanjing City,
Jiangsu Province, China
Abstract
Background: Congenital heart disease (CHD) is a leading contributor to
pediatric morbidity and mortality worldwide. Postoperative respiratory
complications, particularly reintubation, remain a critical concern
following cardiac surgery in children. This study evaluates the
effectiveness of early nasal CPAP in reducing reintubation rates and
respiratory complications in children with CHD after extubation.
<br/>Method(s): A single-center randomized controlled trial was conducted
from July 2022 to July 2024. A total of 264 children (<=3 years)
undergoing cardiac surgery for CHD were randomized to either an
intervention group (n = 132), receiving nasal CPAP (4 cm H2O pressure, 5
L/min oxygen flow) immediately postextubation, or a control group (n =
132), receiving standard nasal cannula oxygen therapy. The primary outcome
was reintubation within 48 h. Secondary outcomes included ventilation
parameters (PaO2, PaCO2, SpO2) and respiratory complications (eg,
bronchospasm, hypoxemia). <br/>Result(s): The reintubation rate within 48
h was significantly lower in the CPAP group compared with the control
group (12% vs 28%, risk ratio 0.41, 95% CI 0.22-0.76, P < .05). The CPAP
group demonstrated marked improvements in ventilation parameters (PaO2,
PaCO2, SpO2) at 4, 8, and 12 h postextubation (P < .05 for all).
Additionally, the incidence of respiratory complications was notably
reduced in the intervention group (P < .05). <br/>Conclusion(s): Early
application of nasal CPAP postextubation significantly reduces
reintubation rates and enhances respiratory outcomes in children with CHD.
This low-complexity CPAP shows promise for adoption in resource-limited
settings, with potential cost advantages meriting further investigation.

<66>
Accession Number
2042578392
Title
Heart Transplantation: Immunological Challenges Revisited.
Source
Current Cardiology Reviews. 22(2) (no pagination), 2026. Date of
Publication: 2026.
Author
Assadiasl S.; Safdel S.; Gheitasi M.; Nicknam M.H.
Institution
(Assadiasl, Safdel, Nicknam) Molecular Immunology Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Assadiasl) Iranian Tissue Bank and Research Center, Tehran University of
Medical Science, Tehran, Iran, Islamic Republic of
(Gheitasi) Department of Immunology, School of Medicine, Kerman University
of Medical Sciences, Kerman, Iran, Islamic Republic of
(Nicknam) Department of Immunology, School of Medicine, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Bentham Science Publishers
Abstract
Introduction: Immunologic responses to cardiac allografts initiate before
transplantation during brain-dead organ procurement and might persist for
years after transplantation, culminating in chronic allograft dysfunction.
Despite remarkable advances in post-transplant care and immunosuppressive
agents, acute cellular and antibody-mediated rejections as well as chronic
allograft vasculopathy significantly affect cardiac allograft and patient
survival. <br/>Method(s): Herein, recent findings of the molecular
mechanisms involved in the inflammatory responses before and after heart
transplantation, including brain death donor inflammation, acute cellular
rejection, antibody-mediated rejection, and chronic allograft dysfunction,
have been summarized, along with novel therapeutic approaches for their
treatment. Finally, recent developments in prognostic and diagnostic
biomarkers for immunological complications have been provided, with an
overview of the most promising biomarkers to date. Results and Discussion:
Due to the recent developments in the description of molecular mechanisms
involved in the immunopathogenesis of cardiac allograft rejection, some
immune cells, proinflammatory cytokines, and adhesion molecules have been
proposed as therapeutic targets for the prevention or treatment of
alloimmune responses. In addition, several molecules derived from graft
tissue or immune cells, e.g. natriuretic peptides, cardiac troponins,
exosomal products, microRNAs, and donor-derived cell-free DNA, have been
suggested as potential biomarkers for the prediction or diagnosis of
cardiac transplant rejection. <br/>Conclusion(s): Considering the need to
design non-invasive, low-cost tests for early diagnosis of post-transplant
complications and convenient follow-up of the cardiac transplant
recipients, peripheral blood biomarkers could be appropriate candidates
for this purpose.<br/>Copyright 2026, &#xa9; Bentham Science Publishers

<67>
Accession Number
2042593319
Title
Association between platelet-to-lymphocyte ratio and prognosis in patients
receiving coronary artery bypass grafting: a meta-analysis.
Source
Journal of Thoracic Disease. 17(12) (pp 10820-10834), 2025. Date of
Publication: 31 Dec 2025.
Author
Li Z.; Su H.; Li C.
Institution
(Li, Su, Li) College of Basic Medicine, Army Medical University,
Chongqing, China
(Li) College of Basic Medicine, Army Medical University, No. 30 Gaotan Yan
Zhengjie, Shapingba District, Chongqing, China
Publisher
AME Publishing Company
Abstract
Background: Emerging evidence indicates a possible relation of the
platelet-to-lymphocyte ratio (PLR) to clinical outcomes in the coronary
artery disease (CAD) population receiving coronary artery bypass grafting
(CABG). However, current findings remain inconclusive and inconsistent.
Our study examines the prognostic value of PLR in CAD patients undergoing
CABG. <br/>Method(s): PubMed, Embase, Web of Science, as well as Cochrane
Library, were thoroughly retrieved until April 15, 2025. Data for
categorical and continuous variables were merged separately using odds
ratio (OR), 95% confidence interval (CI), and standardized mean difference
(SMD). In addition, the result stability was rated, and possible sources
of heterogeneity were identified via sensitivity and subgroup analyses.
<br/>Result(s): Twenty-seven studies were encompassed, comprising nine
cohort studies and eighteen case-control studies, with an aggregate sample
size of 17,120 patients. Meta-analysis of categorical data revealed that
elevated PLR was notably linked to an elevated incidence of postoperative
atrial fibrillation (POAF) (OR =1.02, 95% CI: 1.01-1.02; P<0.001),
all-cause mortality (ACM) (OR =1.69, 95% CI: 1.04-2.74; P=0.03), and
delirium (OR =1.05, 95% CI: 1.03-1.07; P<0.001). Statistically significant
relations were noted between PLR and acute kidney injury (AKI) (OR =1.04,
95% CI: 0.97-1.11; P=0.30) or saphenous vein graft disease (SVGD) (OR
=1.34, 95% CI: 0.81-2.20; P=0.25). For continuous variables, elevated PLR
values were associated with a greater likelihood of POAF, AKI, ACM, and
SVGD; however, no significant correlations were found with delirium or
other adverse events. Subgroup analyses suggested that the predictive
value of PLR for POAF was influenced by study design, patient age,
geographic location, and PLR cutoff values, while region and time of PLR
measurement affected its prognostic significance for AKI.
<br/>Conclusion(s): An elevated PLR correlated with a potential risk of
POAF, AKI, ACM, delirium, and SVGD in the CAD population undergoing CABG.
PLR may be a valuable and accessible biomarker for prognostic assessment
in this patient population, thereby aiding clinical decision-making in the
context of surgical management of CAD.<br/>Copyright &#xa9; AME Publishing
Company.

<68>
Accession Number
2042578368
Title
Alirocumab versus Evolocumab on Cardiovascular Outcomes: A Systematic
Review and Meta-analysis.
Source
Current Cardiology Reviews. 22(1) (no pagination), 2026. Date of
Publication: 2026.
Author
Cleto A.S.; Schirlo J.M.; Machozeki J.; Martins C.M.
Institution
(Cleto, Schirlo, Machozeki, Martins) Department of Medicine, State
University of Ponta Grossa, Ponta Grossa, Brazil
Publisher
Bentham Science Publishers
Abstract
Introduction: The PCSK9 enzyme is present mainly in the liver and is
responsible for the degradation of LDL-C receptors. Currently, there are
some drugs that inhibit this enzyme, such as alirocumab and evolocumab.
Consequently, these drugs reduce serum LDL-C levels. Therefore, a
systematic review and a meta-analysis were carried out in order to compare
alirocumab against evolocumab in reducing cardiovascular outcomes.
<br/>Method(s): This systematic review was carried out in accordance with
PRISMA and was registered in PROSPERO (CRD42024573217). The following
databases were searched on July, 9, 2024: PubMed, Web of Science and
Scopus. Randomized clinical trials with a control group were included and
meta-analyses were performed to assess relative risk (RR). The random
effects model was used in heterogeneous samples. The articles were
distributed into 2 subgroups: use of alirocumab and evolocumab.
<br/>Result(s): Initially, 2,213 articles were found, of which 6 were
included. In total, 62,119 patients participated. The RR values were
significant for alirocumab in the following outcomes: myocardial
infarction (MI) 0.85 (95% CI 0.77-0.93), stroke 0.75 (95% CI 0.60-0.94)
and hospitalization for unstable angina 0.58 (95% CI 0.39-0.86), while for
evolocumab they were significant for MI 0.75 (95% CI 0.68-0.83) and
coronary revascularization 0.81 (95 CI % 0.75-0.88). There was a
statistically significant difference between the drugs for hospitalization
for unstable angina (p=0.02). <br/>Discussion(s): This study highlights
the benefits of PCSK9 inhibitors, especially alirocumab, in reducing major
cardiovascular events. Alirocumab significantly lowered hospitalizations
for unstable angina, with a 42% reduction, and showed favorable outcomes
in reducing myocardial infarction, coronary revascularization, and stroke.
These reductions are clinically meaningful, as they lower morbidity,
improve patient quality of life, and reduce healthcare costs. Both
alirocumab and evolocumab are effective and safe, offering important
therapeutic options for high-risk cardiovascular patients.
<br/>Conclusion(s): The use of alirocumab is preferable if the focus is to
avoid hospitalizations for unstable angina or stroke, while evolocumab may
be an option if one wants to avoid coronary revascularization. Both drugs
are effective in reducing cardiovascular outcomes, but alirocumab was
superior to evolocumab.<br/>Copyright 2026, Bentham Science Publishers

<69>
Accession Number
2042120723
Title
Open Heart Mitral Valve Replacement Using Transcatheter Heart Valves for
Severe Mitral Annular Calcification-A Literature Review.
Source
Journal of Cardiovascular Development and Disease. 12(12) (no pagination),
2025. Article Number: 491. Date of Publication: 01 Dec 2025.
Author
D'Alonzo M.; Baudo M.; Cabrucci F.; di Muro F.M.; Magouliotis D.E.; Bacchi
B.; Arjomandi Rad A.; Xanthopoulos A.; Caldonazo T.
Institution
(D'Alonzo) Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Via
Bissolati 57, Brescia, Italy
(Baudo, Cabrucci, Magouliotis) Department of Cardiac Surgery Research,
Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA,
United States
(Cabrucci) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,
Toronto General Hospital, University Health Network, Toronto, ON, Canada
(di Muro) Department of Medicine, Surgery and Dentistry, University of
Salerno, Via Giovanni Paolo II 132, Salerno, Italy
(Bacchi) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, ON, Canada
(Arjomandi Rad) Department of Cardiothoracic Surgery, John Radcliffe
Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United
Kingdom
(Xanthopoulos) Department of Cardiology, University Hospital of Larissa,
Larissa, Greece
(Caldonazo) Department of Cardiothoracic Surgery, Jena University
Hospital, Jena, Germany
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Mitral annular calcification makes conventional mitral valve surgery
extremely challenging and has led to growing interest in less invasive
alternatives such as transcatheter mitral valve replacement. Alongside
percutaneous approaches, some centers have explored open transatrial
implantation of transcatheter heart valves in patients with heavily
calcified annuli. This systematic review examines the current evidence on
this hybrid "valve-in-MAC" technique, tracing its clinical evolution,
technological refinements, patient outcomes, and ongoing debates. Key
themes emerging from the literature include the adaptation of existing
balloon-expandable and mitral-specific devices to the complex anatomy of
calcified mitral annuli, the open transatrial approach as a safer
alternative to extensive surgical debridement, and advances in imaging and
device design aimed at reducing left ventricular outflow tract obstruction
and paravalvular leak. Persistent uncertainties remain, particularly
regarding patient selection, long-term valve performance, and comparisons
with conventional surgical repair or replacement. Although open
transatrial implantation appears technically feasible and provides
favorable hemodynamic results compared with fully percutaneous procedures,
reported 30-day mortality remains high (approximately 19-27%). This
reflects the advanced age, frailty, and multiple comorbidities typical of
this patient group rather than procedural shortcomings. Current evidence
is limited, with few comparative studies and little data on valve
durability. Future work should prioritize multicenter prospective
registries and well-designed comparative studies to better define the role
of this emerging salvage strategy.<br/>Copyright &#xa9; 2025 by the
authors.

<70>
Accession Number
649758274
Title
Sutureless versus transcatheter aortic valve replacement in patients with
aortic stenosis: An updated meta-analysis of short- and mid-term outcomes
with trial sequential analysis.
Source
International journal of cardiology. (pp 134116), 2025. Date of
Publication: 24 Dec 2025.
Author
Obi O.; Ayesha A.; Lajczak P.; Hageen A.W.; Hamza M.; Erzinger G.; Khan
M.; Nweze U.; Eltawansy S.
Institution
(Obi) New York Institute of Technology College of Osteopathic Medicine,
Northern Blvd Old Westbury, United States
(Ayesha) Shifa College of Medicine, Islamabad, Pakistan
(Lajczak) Medical University of Silesia Katowice, Poland
(Hageen) Faculty of Medicine, Tanta University, Egypt
(Hamza) Saidu Medical College, Swat, Pakistan
(Erzinger) University of the Region of Joinville (Univille), Joinville,
Brazil
(Khan) Bacha Khan Medical College, Mardan, Pakistan
(Nweze) Fontana Medical Center, Kaiser Permanente, Fontana, United States
(Eltawansy) Jersey Shore University Medical Center, Neptune, United States
Abstract
BACKGROUND: The efficacy and safety of a novel aortic valve replacement
treatment (SAVR) technique, sutureless aortic valve replacement (SU-AVR),
compared to transcatheter aortic valve replacement (TAVR) in the treatment
of aortic stenosis, is unclear in short and mid-term outcomes due to
limited data. <br/>METHOD(S): PubMed, Scopus, Embase, Web of Science, and
the Cochrane Library were systematically searched for studies comparing
SU-AVR with TAVR. Risk ratios (RR) with 95 % confidence intervals (CIs)
were computed for binary outcomes. Trial sequential analysis (TSA) was
performed to assess whether the results in our meta-analysis were
conclusive. <br/>RESULT(S): This systematic review and meta-analysis
included 22 observational studies of symptomatic patients. When comparing
SU-AVR to TAVR, similar risk of in-hospital mortality (RR 0.67, 95 % CI
0.37-1.24, p = 0.20, I2 = 15.1 %) and two-year mortality (RR 0.73, 95 % CI
0.39-1.37, p = 0.32, I2 = 61.5 %) were noted. However, SU-AVR was
associated with significantly lower 30-day mortality (RR 0.46, 95 % CI
0.28-0.75, p = 0.002, I2 = 0.9 %), total number of valvular leakages (RR
0.13, 95 % CI 0.05-0.32, p < 0.00, I2 = 59.5 %), and one-year mortality
(RR 0.51, 95 % CI 0.32-0.80, p = 0.003, I2 = 0.0 %). In the TSA analysis,
30-day mortality, one-year mortality, and total leakage rate showed
true-positive results in the method. The two-year mortality rate yielded
false-negative results due to the too low required information size.
<br/>CONCLUSION(S): In patients with aortic stenosis, SU-AVR was
associated with similar in-hospital mortality and two-year mortality rates
compared with TAVR; however, it was associated with significantly lower
30-day mortality, total number of valvular leakages, and one-year
mortality rates.<br/>Copyright &#xa9; 2025 Elsevier B.V. All rights
reserved.

<71>
Accession Number
2042308555
Title
Exercise Prehabilitation and 90-Day Self-Rated Health Status in Cardiac
Surgery Patients with Poor Early Recovery: A Secondary Analysis of a
Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2025.
Date of Publication: 2025.
Author
Yau D.K.W.; Joynt G.M.; Ho K.M.; Lee A.
Institution
(Yau) Department of Rehabilitation Sciences, Hong Kong Polytechnic
University, Hung Hom, Hong Kong
(Yau, Joynt, Ho, Lee) Department of Anaesthesia and Intensive Care, The
Chinese University of Hong Kong, Hong Kong SAR, Shatin, China
Publisher
W.B. Saunders

<72>
Accession Number
649761840
Title
CARDIAC REHABILITATION in CONTEMPORARY CARDIOLOGY: A NARRATIVE REVIEW.
Source
Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom.
111(Supplement 5) (pp A7), 2025. Date of Publication: 01 Nov 2025.
Author
Aldeie A.; Salman A.
Institution
(Aldeie, Salman) Department of Public Health Practice, College of Public
Health, Kuwait University, P.O. Box 24923, Safat, Kuwait
Publisher
BMJ Publishing Group
Abstract
Background Cardiac rehabilitation (CR) is a cornerstone of secondary
prevention for patients with cardiovascular disease (CVD), including
ischaemic heart disease, heart failure, and post-cardiac surgery recovery.
While CR is a Class I recommendation by major cardiovascular societies,
its role is being reassessed in light of advancements in cardiology such
as revascularization techniques, modern pharmacotherapy, and digital
health integration. Aim To synthesize recent evidence evaluating the
effectiveness and relevance of CR in the era of contemporary cardiology.
Methods A narrative review was conducted of studies published between 1995
and 2025, focusing on systematic reviews, randomized trials, and large
cohort studies. Databases searched included PubMed, Scopus, and Cochrane
Library. Studies were selected if they evaluated clinical outcomes (e.g.,
mortality, functional capacity, quality of life) of CR in the context of
modern cardiology practice. Additional thematic focus was given to studies
on CR delivery during the COVID-19 pandemic and the integration of
artificial intelligence in CR services. Results Recent evidence confirms
that CR significantly reduces cardiovascular mortality, enhances
functional capacity, and improves quality of life. However, the effects on
all-cause mortality and hospital readmissions are less consistent.
Barriers such as low participation rates, variability in program models,
and lack of standardization persist across healthcare settings. Emerging
approaches during the COVID-19 era, including remote and hybrid models,
demonstrate feasibility and potential for wider access. Artificial
intelligence applications, though early in development, show promise in
personalized rehabilitation planning and outcome prediction. Conclusion
While CR retains a critical role in cardiovascular care, its effectiveness
and delivery must adapt to the evolving context of modern cardiology.
Enhanced standardization, increased uptake, and integration of digital
tools are needed to ensure CR continues to deliver optimal outcomes in the
coming decade.

<73>
Accession Number
2041290391
Title
Perioperative Administration of SGLT2 Inhibitors in Non-Diabetic Cardiac
Surgery Patients With Heart Failure: Friend or Foe?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 98-99), 2025. Date of Publication: 01 Dec 2025.
Author
Hassan M.
Institution
(Hassan) University Hospital of Wuerzburg, Wuerzburg, Germany
Publisher
W.B. Saunders
Abstract
Objective: Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i)
have demonstrated substantial benefit in patients with heart failure
regardless of diabetic status. However, perioperative discontinuation
remains common due to concerns over euglycemic diabetic ketoacidosis
(euDKA). Data are lacking on the clinical impact of discontinuing SGLT2i
therapy in non-diabetic patients undergoing cardiac surgery. Design and
method: Methods: We conducted a retrospective, single-center, propensity
score-matched cohort study including 258 non-diabetic patients with
chronic heart failure who underwent elective cardiac surgery and were
receiving SGLT2 inhibitors (empagliflozin or dapagliflozin)
preoperatively. Using 1:1 propensity score matching based on demographic,
clinical, and surgical variables, 98 patients who continued SGLT2i
postoperatively (Group A) were matched to 98 patients in whom the therapy
was discontinued (Group B). The primary endpoint was hospitalization for
heart failure within 90 days post-surgery. Secondary endpoints included
changes in NT-proBNP, incidence of euglycemic ketoacidosis, and 90-day
mortality. <br/>Result(s) and Conclusion(s): Results: Heart
failure-related rehospitalization was significantly more frequent in Group
B compared to Group A (24.5% vs. 10.2%). Median NT-proBNP levels on
postoperative day 5 were lower in Group A (2,850 [IQR 1,980-3,960] pg/mL)
than in Group B (4,330 [IQR 3,300-5,780] pg/mL). No cases of euglycemic
ketoacidosis occurred in either group. The 90-day mortality rate was
similar between groups (3.1% vs. 4.1%). <br/>Conclusion(s):
Discontinuation of SGLT2 inhibitors in non-diabetic patients with heart
failure undergoing cardiac surgery is associated with a significantly
higher rate of postoperative heart failure hospitalization. Continuation
of therapy was not linked to an increased risk of euglycemic ketoacidosis
and had no effect on short-term mortality. These findings support the
safety and potential benefit of maintaining SGLT2 inhibitor therapy in the
perioperative setting for this patient population. However, confirmation
of these results in large-scale, prospective randomized controlled trials
is warranted.<br/>Copyright &#xa9; 2025

<74>
Accession Number
649758061
Title
Triglyceride-glucose index as a novel predictor of major adverse
cardiovascular events in patients with coronary revascularization: a
meta-analysis of cohort studies.
Source
Annals of medicine. 58(1) (pp 2607796), 2026. Date of Publication: 01 Dec
2026.
Author
Zhang C.; Li M.; Liu L.; Zhong Y.; Xie Y.; Liao B.; Feng J.; Deng L.
Institution
(Zhang, Li, Liu, Zhong, Feng, Deng) Department of Cardiology, Affiliated
Hospital of Southwest Medical University, Stem Cell Immunity and
Regeneration Key Laboratory of Luzhou, China
(Xie) School of Rehabilitation, Capital Medical University, Beijing, China
(Xie) Department of Rehabilitation Medicine, Affiliated Hospital of North
Sichuan Medical College, Sichuan, China
(Liao) Department of Cardiovascular Surgery, Affiliated Hospital of
Southwest Medical University, Metabolic Vascular Diseases Key Laboratory
of Sichuan Province, China
(Deng) Department of Rheumatology, Affiliated Hospital of Southwest
Medical University, China
Abstract
BACKGROUND: The triglyceride-glucose index (TyG) has gained attention as
an alternative indicator for assessing insulin resistance (IR). The
purpose of this study was to comprehensively summarize the correlation
between the TyG index and cardiovascular events in patients with coronary
revascularization. <br/>METHOD(S): PubMed, Web of Science, Embase, and The
Cochrane Library databases were searched to find relevant literature on
the prognostic assessment of TyG index in patients undergoing coronary
artery revascularization. Utilize the risk ratio (RR) and its 95%
confidence interval (CI) as the standard for assessing the correlation
between TyG and major adverse cardiovascular events (MACEs) in patients
undergoing coronary artery revascularization. Conduct sensitivity analysis
and subgroup analysis to detect the sources of heterogeneity and assess
the stability of the results. <br/>RESULT(S): A total of 12 studies
involving 9,973 participants were included. The results of the study
indicate that a high TyG index was related to the major adverse
cardiovascular event in patients undergoing coronary artery
revascularization (RR:2.0,95%CI: 1.71-2.35, I2=76.2%, p < 0.0001).
Subgroup analysis reveals that the probability of MACEs occurring in
patients with high TyG index is higher than in those with low TyG index
after two different coronary artery revascularization procedures: CABG
group (RR:2.10, 95%CI:1.80-2.45, I2 = 20.9%, p = 0.0001). PCI group:
(RR:1.94, 95%CI:1.54-2.46, I2 = 84.2%, p < 0.00001). Additionally, we also
demonstrated the prognostic value of the TyG index in all-cause
mortality(p = 0.003), non-fatal myocardial infarction(p = 0.003),
non-fatal stroke(p < 0.0001) and repeat revascularization(p < 0.0001).
<br/>CONCLUSION(S): Higher TyG index may be independently associated with
higher incidence of MACEs in patients with coronary revascularization.

<75>
Accession Number
2041289758
Title
Plasma Pharmacokinetics of Prophylactic Cefazolin Administration for
Cardiac Surgery: Comparison of Cardiopulmonary Bypass Priming with
Additive Human Albumin 20% vs Pure Crystalloid Priming.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 34-35), 2025. Date of Publication: 01 Dec 2025.
Author
Wohlrab P.; Skhirtladze-Dworschak K.; Hutschala-Kinstner D.; Wisser W.;
Zeitlinger M.; Stimpfl T.; Zapletal B.; Tschernko E.
Institution
(Wohlrab, Skhirtladze-Dworschak, Hutschala-Kinstner, Zapletal, Tschernko)
Medical University of Vienna, Division of Cardiothoracic and Vascular
Anesthesia and Intensive Care Medicine, Vienna, Austria
(Wisser) Medical University of Vienna, Department of Cardiac and Thoracic
Aortic Surgery, Vienna, Austria
(Zeitlinger) Medical Universiry of Vienna, Department of Clinical
Pharmacology, Vienna, Austria
(Stimpfl) Medical University of Vienna, Department of Laboratory Medicine,
Vienna, Austria
Publisher
W.B. Saunders
Abstract
Objective: Surgical site infection after cardiac surgery is associated
with increased morbidity and mortality. Standard antimicrobial prophylaxis
is associated with reduced surgical site infections and improved surgical
outcomes. However, antimicrobial prophylaxis is not effective in all
patients. Antibiotic prophylaxis should lead to adequate serum and tissue
concentrations inhibiting possible pathogens contaminating the surgical
site. Multiple trials showed that these concentrations could not be
reached in many patients undergoing cardiopulmonary bypass.
Cardiopulmonary bypass may substantially change the pharmacokinetics of
protein-bound antibiotics due to dilution effects associated with
significant changes in plasma albumin. The unbound fraction of the
antibiotic is antimicrobially effective, whereas the protein-bound
fraction of the drug is ineffective. This study aimed to show that adding
albumin to the cardio-pulmonary bypass circuit's priming solution affects
cefazolin's plasma concentration. Design and method: This study was
designed as a prospective, single-center, randomized, controlled trial. We
included 19 patients meeting the inclusion criteria. Patients were
randomly assigned to two groups: the intervention and control group. In
patients assigned to the intervention group (n=9), 250 mL of crystalloid
priming solution was exchanged with 20% human albumin. In patients
assigned to the control group (n=10), standard crystalloid priming
solution was used. After induction of anesthesia, 4000 mg Cefazolin was
administered intravenously in all patients. A further cefazolin bolus of
2000 mg was administered immediately before skin closure. Blood samples
were then taken at close time intervals. Cefazolin (total and unbound
levels in plasma) was measured by a validated ultra-high-performance
liquid chromatography tandem mass spectrometry method on a Nexera2 UHPLC
system connected to an 8030 + triple quadrupole mass spectrometer.
<br/>Result(s) and Conclusion(s): Overall, the mean concentration of total
Cefazolin was higher in the intervention group (159 microg/mL, SD +/-
83.71) compared to the mean concentration in the control group (121.2
microg/mL, SD+/-75.84) (p>0.05). Total concentrations of Cefazolin dropped
by 19,9 % in the control group (176.7 microg/mL SD +/- 30.52 vs. 159.8
microg/mL SD +/- 29.25) and by 16,2% in the intervention group (p>0.05)
after CPB. Unbound Cefazolin concentrations dropped by 27.7 % and by 20.4%
after beginning CPB (intervention 118.6 microg/mL SD +/- 25 vs. control
149.9 microg/mL SD +/- 33.1) (p>0.05). Although not statistically
significant, the concentration of total Cefazolin was increased in the
intervention group. We could not show that there was a substantial
difference between the two groups in unbound Cefazolin concentrations.
Therefore, the higher total concentration might result from increased
albumin-bound cefazolin concentrations. Higher albumin-bound antibiotic
concentrations might be beneficial to prolong the time over the break
point concentrations for Cefazolin and ultimately decrease surgical site
infections. The insight that albumin may increase the bound concentration
fraction of Cefazolin paves the way for further pharmacokinetic
investigations.<br/>Copyright &#xa9; 2025

<76>
Accession Number
2041289811
Title
HIGH FLOW DURING CARDIOPULMONARY BYPASS REDUCES KIDNEY INJURY BIOMARKERS
AND NEED FOR POSTOPERATIVE VASOACTIVE SUPPORT- A RANDOMIZED CONTROLLED
TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 29-30), 2025. Date of Publication: 01 Dec 2025.
Author
Wijk J.; Corderfeldt-Keiller A.; Bragadottir G.; Redfors B.; Ricksten
S.-E.; Lannemyr L.
Institution
(Wijk, Bragadottir, Redfors, Ricksten, Lannemyr) Departement of
Anesthesiology and intensive care medicine, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Corderfeldt-Keiller) Departement of perfusion, Sahlgrenska University
hospital, Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: Acute kidney injury (AKI) affects up to 1/3 of the patients
after cardiac surgery and is associated with increased morbidity and
mortality. In particular, the renal medulla is sensitive to hypoxia and
reduced renal blood flow. Low systemic oxygen delivery during
cardiopulmonary bypass (CPB) may increase the risk for AKI, but there is a
lack of data on whether increased systemic blood flow may reduce renal
ischemia and improve outcomes. The aim of this study was to evaluate the
impact of a higher CPB-flow on kidney injury biomarkers, renal function
and early postoperative outcomes. Design and method: In a single center,
non-blinded randomized controlled trial, we enrolled adult elective
cardiac surgery patients with an expected CPB time >60 minutes. Major
exclusion criteria were body mass index >32 kg/m2, previous stroke and use
of intraoperative hypothermia. Participants were randomized to high-flow
(HF, 2.9 L/min/m2) or standard flow (SF, 2.4 L/min/m2) during CPB. Target
mean arterial pressure was kept within 60-80 mmHg during CPB using
norepinephrine or nitroprusside. The primary outcome was the postoperative
difference in biomarkers of renal injury; urine
N-acetyl-s-D-glucoseaminidase (NAG), measured at baseline, at 60 minutes
on CPB, at 60 minutes after CPB, and 4 hours after CPB. Secondary outcomes
were IGFBP7xTIMP2 (Nephrocheck) at 4 hours after CPB, the development of
s-creatinine, incidence of AKI, postoperative inotropic score, duration of
mechanical ventilation and length of stay in the ICU. Continuous variables
are presented as median with interquartile range. Mann-Whitney U-tests and
Fisher's exact tests were used for group comparisons, and a p-value <0.05
was considered statistically significant. <br/>Result(s) and
Conclusion(s): In total, 90 patients were analyzed (46 in the SF and 44 in
the HF group). Baseline renal function was lower in the HF group, with
eGFR 80 (62;86) vs. 86 (72;95) ml/min/1.73m2 in the SF group (p=0.020),
but otherwise the groups were comparable. Target CPB flow could be
maintained in both groups with short term deviations (e.g. during aortic
cross-clamp). There were no differences in perfusion-related adverse
events. Peak NAG excretion was 2.99 (1.39;7.92) and 1.52 (0.89;3.59)
Units/mmol creatinine (p=0.019), and Nephrocheck was 0.22 (0.09;0.32) and
0.13 (0.06;0.21), (p=0.038) in the SF and HF groups, respectively. Figure
shows s-creatinine development. AKI within 7 days was seen in 13/46 (28%)
vs. 9/44 (20%) in the SF and HF group (p=0.389). Inotropic score at ICU
arrival was 15 (8;20) vs. 9 (4;15) (p=0.018), and maximum inotropic score
during the first 24 hours was 16 (8;20) vs. 11 (5;15), (p=0.025) in the SF
and HF groups, respectively. There were no differences in time in
mechanical ventilator or time in the ICU between groups (p=0.977) and
(p=0.676). <br/>Conclusion(s): A 20% increased CPB-flow reduced biomarkers
of renal injury and the need for postoperative vasopressors. An adequately
powered study should be undertaken to assess the impact of high flow on
postoperative AKI, as well as identifying patient populations who might
benefit from this intervention.<br/>Copyright &#xa9; 2025

<77>
Accession Number
2041289752
Title
IMPACT OF CARDIOPULMONARY BYPASS FLOW ON HEMOLYSIS AND ENDOTHELIAL
DYSFUNCTION IN CARDIAC SURGERY PATIENTS.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 31-32), 2025. Date of Publication: 01 Dec 2025.
Author
Lannemyr L.; Hesse C.; Damen T.; Ricksten S.-E.; Wijk J.
Institution
(Lannemyr, Damen, Ricksten, Wijk) Department of Anesthesiology and
Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Hesse) Department of laboratory medicine, Institute of Biomedicine,
Gothenburg University, Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: The use of cardiopulmonary bypass (CPB) may lead to shear
stress with activation of monocytes and disruption of erythrocytes. The
resulting inflammation and hemolysis have been associated with acute
kidney injury, endothelial dysfunction and tissue edema. In a recently
finished randomized controlled trial, we compared the renal effects of
applying our standard flow or a 20% higher systemic blood flow during CPB
in cardiac surgery patients. We found that increased CPB flow had positive
effects on the kidneys, but there remains some concern that higher CPB
flow may lead to worsened shear stress with negative effects on the
erythrocytes and vascular endothelium. In this secondary analysis, our aim
was to investigate the impact of CPB flow on markers of endothelial
dysfunction and hemolysis. Design and method: In a single center,
non-blinded randomized controlled trial, we enrolled adult elective
cardiac surgery patients with expected CPB time >60 minutes. Exclusion
criteria were body mass index >32 kg/m2, previous stroke and use of
intraoperative hypothermia. Participants were randomized to high-flow (HF,
2.9 L/min/m2) or standard-flow (SF, 2.4 L/min/m2) during CPB. Target mean
arterial pressure was kept within 60-80 mmHg during CPB using
norepinephrine or nitroprusside. Arterial blood plasma samples were
collected before CPB, at 60 minutes during CPB and at 60 minutes and 4
hours after CPB. Markers of hemolysis; plasma-hemoglobin, and endothelial
dysfunction; plasma Syndecan-1 and Trombomodulin, were analyzed using the
ELISA technique. Linear mixed model analyses with time and group as fixed
factors were used for statistical analyses, and a p<0.05 was considered
statistically significant. <br/>Result(s) and Conclusion(s): In total, 90
patients were analyzed, 46 in the SF and 44 in the HF group. Target CPB
flow was maintained in both groups with short term deviations, e.g. during
aortic cross-clamp. There were no differences in perfusion-related adverse
events. The figures show the development over time in the studied
variables. Plasma-hemoglobin increased (3-5 fold) during and after CPB
compared to baseline in both groups, with higher levels in the SF group
(p=0.031). Syndecan-1 increased (2-3 fold) during and after CPB compared
to baseline, with no significant differences between the groups (p=0.227).
Thrombomodulin levels were unchanged during CPB but increased by 30-40%
after CPB in both groups, but without significant group difference
(p=0.639). <br/>Conclusion(s): Cardiac surgery with CPB lead to increased
markers of hemolysis and endothelial dysfunction, but we found no negative
impact of elevated blood flow during CPB.<br/>Copyright &#xa9; 2025

<78>
Accession Number
2041290409
Title
EVALUATION OF ERECTOR SPINAE BLOCK FOR PAIN RELIEF IN PATIENTS UNDERGOING
ROBOTIC- ASSISTED AND MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERIES:
A PROSPECTIVE, RANDOMIZED CONTROL STUDY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 125), 2025. Date of Publication: 01 Dec 2025.
Author
Rastogi A.; Srivastava S.; Tewari P.; Goyal P.
Institution
(Rastogi, Srivastava, Tewari, Goyal) Sanjay Gandhi Post Graduate Institute
of Medical Sciences, Lucknow, India
Publisher
W.B. Saunders
Abstract
Objective: primary objective is to assess Static and dynamic pain using
mean VAS score in in patients undergoing robotic- assisted and minimally
invasive coronary artery bypass surgeries. Design and method: This is a
prospective observational study, 70 patients were enrolled in the study,
finally 31 patients were analysed in each of the two groups, using a
computer-generated block randomization method. The sample size was
estimated using the software PASS-16.Adult patients (18 to 75 years) of
either sex ASA status II and III with New York Heart Association grading I
and II, scheduled for Robotic-assisted and minimally invasive coronary
artery bypass surgeries under general anaesthesia were included. Patients
were assigned to groups A and B in the survey via randomization. General
anaesthesia with endotracheal intubation was induced utilizing a uniform
protocol in all the patients. One-lung ventilation was achieved using a
Bronchial blocker or a double-lumen tube. At the end of surgery but before
the transfer of the patient to the ICU, one group of patients was
receiving an ESP catheter at vertebra T5 under ultrasound guidance. Group
A - Intravenous PCA with IV fentanyl via patient-controlled analgesia
device. Group B - Patients received a 20 mL mixture of 0.5% ropivacaine
with a bolus, followed by an infusion of 0.2% ropivacaine at the rate of 8
mL/h in the postoperative period along with Intravenous PCA with IV
fentanyl via patient-controlled analgesia device. <br/>Result(s) and
Conclusion(s): At 6 hours, the Group A reported significantly higher mean
VAS scores (2.81+/-0.65) compared to the Group B (2.45+/-0.72), with a
highly significant p value of 0.047. This significant reduction in static
pain persisted at 12 hours (Group A 2.03 +/- 0.55 vs Group B 1.74 +/-
0.58, p = 0.046) and 24 hours (Group A 1.94 +/- 0.51 vs Group B 1.61 +/-
0.56, p = 0.021). By 48 hours, both groups showed a reduction in pain with
mean VAS scores (2 +/- 0.63 in Group A vs 1.65 +/- 0.55 in Group B), and
the difference was statistically significant (p = 0.022). Dynamic pain
scores (during movement or deep inspiration) between both the groups at 6,
12, 24, and 48 hours were assessed postoperatively using the Visual
Analogue Scale (VAS). At 6 hours, the Group A had significantly higher
dynamic pain scores 3.42+/-0.56 compared to the Group B 2.73+/-1.46, with
a p value of 0.018. This trend of superior pain control in the Group B
continued at 12 hours- (Group A 2.97 +/- 0.55 vs Group B 2.48 +/- 0.89, p
= 0.012), at 24 hours (Group A 2.9 +/- 0.47 vs Group B 2.52 +/- 0.57, p =
0.005), and 48 hours, (Group A 2.23 +/- 0.67 vs Group B 1.84 +/- 0.64 ),
with significant difference (p = 0.013). This study highlights the
efficacy and safety of ESP block as an effective component of multimodal
analgesia in patients undergoing robotic-assisted and minimally invasive
direct coronary artery bypass surgeries.<br/>Copyright &#xa9; 2025

<79>
Accession Number
2041290010
Title
INTRAOPERATIVE USE OF ESMOLOL AS A CARDIAC PROTECTIVE STRATEGY TO REDUCE
TROPONIN RELEASE AND PHARMACOLOGICAL SUPPORT FOLLOWING CORONARY ARTERY
BYPASS SURGERY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 88-89), 2025. Date of Publication: 01 Dec 2025.
Author
Jordanoska B.K.; Nikolic A.; Stefanovski I.; Mustafa E.; Bedzeti F.;
Radoeshki A.; Bozinovski A.; Bislimovski D.
Institution
(Jordanoska, Nikolic, Stefanovski, Mustafa, Bedzeti, Radoeshki,
Bozinovski, Bislimovski) Acibadem Sistina Hospital - Department of Cardiac
Surgery, Skopje, North Macedonia
Publisher
W.B. Saunders
Abstract
Objective: Myocardial injury remains a major contributor to postoperative
morbidity in coronary artery bypass surgery. Despite advances in
cardioplegia and perfusion techniques, ischemia-reperfusion injury remains
a challenge. It is widely recognized that a short-acting beta-1 selective
blocker can lower myocardial metabolic demands and may help reduce
ischemia-reperfusion injury. This study aimed to evaluate whether
intraoperative administration of esmolol, a short-acting beta-1-adrenergic
antagonist, reduces myocardial injury and the need for pharmacological
cardiovascular support in patients undergoing coronary artery bypass
grafting (CABG). Design and method: This prospective, randomized,
double-blind, placebo-controlled study included 100 adult patients
undergoing elective isolated CABG with written informed consent. Patients
were randomized into two equal groups. The esmolol group received a bolus
dose of 1 mg/kg intravenously prior to aortic cross-clamping, and an
additional 2 mg/kg was added to the antegrade cold blood cardioplegia. The
control group received a volume-matched placebo at the same time points.
Myocardial injury was assessed by serial measurement of high-sensitivity
troponin T (hs-TnT) during the first 48 hours postoperatively. Secondary
endpoints included vasoactive-inotropic score (VIS) at 24 hours, duration
of inotropic and vasopressor therapy, serum lactate levels at 3 hours
postoperatively, and length of stay in the intensive care unit and total
hospitalization. All patients followed standardized surgical and
anesthetic protocols. Statistical significance was set at p < 0.05.
<br/>Result(s) and Conclusion(s): The esmolol group had significantly
lower peak hs-TnT levels (1.08 +/- 0.90 ng/ml) compared to the control
group (2.05 +/- 3.71 ng/ml, p = 0.02). VIS at 24 hours was also
significantly reduced in the esmolol group (7.39 +/- 5.62 vs. 11.94 +/-
8.44, p = 0.002). Only 18% of patients in the esmolol group required
prolonged inotropic support beyond 24 hours, compared to 66% in the
placebo group (p < 0.001). Maximum epinephrine dose was lower (0.02 +/-
0.01 vs. 0.03 +/- 0.02 mcg/kg/min, p = 0.001), as was norepinephrine
(0.095 +/- 0.27 vs. 0.088 +/- 0.07 mcg/kg/min, p = 0.025). Mean serum
lactate at 3 hours was significantly lower in the esmolol group (2.29 +/-
1.15 mmol/L vs. 3.41 +/- 3.69 mmol/L, p = 0.020). The duration of
intensive care unit stay was shorter in the esmolol group (2.1 vs. 3.4
days), while hospital stay showed a non-significant trend toward
reduction. Conclusion Intraoperative administration of esmolol, both
intravenously and as an additive to cardioplegia, significantly reduces
myocardial injury, the need for prolonged inotropic support, and metabolic
stress in coronary artery bypass surgery. Esmolol demonstrated excellent
tolerability and improved early recovery. These results support its
integration into routine myocardial protection strategies in surgical
coronary revascularization.<br/>Copyright &#xa9; 2025

<80>
Accession Number
649761846
Title
DOES INTEGRATING COGNITIVE BEHAVIOURAL THERAPY into CARDIAC REHABILITATION
IMPROVE DEPRESSION and QUALITY of LIFE? A SYSTEMATIC REVIEW.
Source
Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom.
111(Supplement 5) (pp A7-A8), 2025. Date of Publication: 01 Nov 2025.
Author
Alqahtani O.; Gale N.
Institution
(Alqahtani) Department of Physical Therapy, College of Applied Medical
Sciences, Najran University, P.O. Box 1988, Najran, Saudi Arabia
(Gale) School of Healthcare Sciences, Cardiff University, Heath Park,
Cardiff, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Depression is common after cardiovascular events, including
myocardial infarction, coronary artery bypass grafting or acute
heart-failure exacerbation, and independently predicts poorer outcomes
from cardiac rehabilitation (CR). CR is a structured, multidisciplinary
programme of supervised exercise, education and psychosocial support to
promote recovery and reduce recurrence. Although psychological support is
advocated in CR, the additional value of structured Cognitive Behavioural
Therapy (CBT) beyond routine CR counselling remains unclear. Aim To
systematically review whether integrating structured CBT into CR improves
depressive symptoms and healthrelated quality of life (HRQoL) in adults
with cardiovascular disease versus CR alone. Methods A systematic search
of MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane CENTRAL was conducted.
Randomised controlled trials comparing CR plus CBT with CR alone without
structured CBT were eligible. Adults with cardiovascular disease and
baseline depression were included; anxiety-only trials or those without a
CR component were excluded. PRISMA and JBI methods guided screening,
quality appraisal. Due to clinical heterogeneity, results were narratively
synthesised. Results The search identified 1,537 records; six RCTs,
including one follow-up (totalling 633 participants), met the criteria.
Face-to-face CBT delivered alongside exercise-based CR resulted in greater
reductions in depression scores (1.3-3.9 points on HADS-D/T within 6-12
weeks) and clinically meaningful improvements in HRQoL, with high
adherence rates (77-92%). In contrast, the single digital CBT trial showed
no significant benefit over usual care (HADS-D: b =-0.47, p = 0.53), a
result likely influenced by low participant engagement (15% completed >1
module). A key moderating factor was baseline depression, with patients
experiencing moderate-to-severe symptoms showing the greatest treatment
response. Conclusion Structured, face-to-face CBT integrated into CR
effectively reduces depression and improves HRQoL. The findings strongly
support policies for routine depression screening at CR entry to enable
targeted CBT allocation, thereby optimising recovery for patients with
higher symptom severity.

<81>
Accession Number
2041289770
Title
A COMPARISON OF EFFECTIVENESS OF TWO DOSES OF BUPIVACAINE FOR TRANSVERSUS
THORACIC MUSCLE PLANE BLOCK IN CARDIAC SURGERY PATIENTS: A PROSPECTIVE
DOUBLE-BLIND RANDOMISED CONTROLLED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 10-11), 2025. Date of Publication: 01 Dec 2025.
Author
Singh A.; Kapoor D.; Garg S.; Khanna S.
Institution
(Singh, Kapoor) Government Medical College and Hospital, Department of
Anaesthesia and Intensive Care, Chandigarh, India
(Garg) Neelam Hospital, Department of Cardiothoracic and Vascular Surgery,
Rajpura, India
(Khanna) Government Medical College and Hospital, Department of General
Surgery, Chandigarh, India
Publisher
W.B. Saunders
Abstract
Objective: The fascial plane blocks decrease post-operative opioid
requirements and are an integral component of early recovery after cardiac
surgery. The transversus thoracic muscle plane block (TTPM) improves pain
scores after sternotomy. The drug dosing regimens are variable, usually
15-20 ml in adults, bilaterally, or 0.2-0.5 ml/kg in children. It is
essential to use the minimum possible dose and standardise the volume of
local anaesthesia for this procedure. The authors hypothesised that a
volume of 0.2 ml/kg of 0.25% bupivacaine would be equi-analgesic to 20 ml
of 0.25 % bupivacaine, considering a variation of 10% in the fentanyl
requirement as non-significant. Design and method: This was a prospective
double-blind randomised controlled study in a teaching hospital. A total
of 24-adult patients, undergoing cardiac surgery via midline sternotomy
were randomised into two groups for ultrasound guided TTPM block at the
end of the surgery- group 1(n=12; bilateral TTPM block with 20 ml of 0.25%
bupivacaine on each side; defined- conventional) and group 2(n=12;
bilateral TTPM block with 0.2 ml/kg of 0.25% bupivacaine, on each side).
Additionally, 10 ml of 0.25% bupivacaine was infiltrated along the chest
drains. The post-operative analgesia was maintained by patient-controlled
intravenous analgesia (PCA) with fentanyl, background infusion of 20
mcg/hour with boluses of 10 mcg/bolus with a lockout interval of 10
minutes, maximum dose of 1 mcg/kg in an hour, in extubated patients. The
nurse provided an adjuvant intravenous fentanyl of 20 mcg if the visual
analogue score (VAS) was>4, when the upper limit of PCA was reached after
an hour. In the intubated patients, a behavioral pain score (BPS) < 4 was
maintained by 20 mcg/hr intravenous fentanyl and nurse-provided fentanyl
boluses of 20 mcg. This was supplemented with 15 mg/kg acetaminophen,
given every six hours. The BPS, VAS at rest and movement and hemodynamic
parameters were recorded at 6,12,18 and 24 hours after surgery, along with
the total fentanyl requirement for 24 hours. <br/>Result(s) and
Conclusion(s): The pre-operative and intra-operative parameters of both
groups were similar. The post-operative fentanyl requirement in 24 hours
was identical groups(590.00+/-37.65 mcg vs 558.33+/-41.30 mcg; p=0.062)
(Figure 1). An equivalence test, with a two-tailed t-test, displayed
equivalence of fentanyl requirement between the two groups (mean
difference = 31.66 mcg; SE = 16.13; df = 22, 90% confidence interval;
range 3.96 mcg to 59.37 mcg) (Figure 1). The VAS at rest, movement and
BPS, at individual time points and their maximum values were similar for
all time points. The SFMPQ2 scoring evaluated at 24 hours was lower in
group 1 ( 14.18+/-5.32 vs 19.92+/-5.29;p=0.026). The maximum VAS on
movement (VAS M) was a better correlator of fentanyl consumption (r=0.690;
r2=0.476; p=0.003) than maximum VAS on rest (VAS R) (r=0.480; r2=0.231;
p=0.020). The regression equation formulated for the 24-hour fentanyl
requirement was (447.48+17.65x VASM+4.77xVASR+12.88xBPS) mcg.
<br/>Conclusion(s): The 0.2 ml/kg of 0.25% bupivacaine is equivalent to 20
ml of 0.25% bupivacaine for bilateral TTPM block after cardiac surgery via
midline sternotomy, but provides lesser analgesia satisfaction measured
via SFMPQ2.<br/>Copyright &#xa9; 2025

<82>
Accession Number
2041289773
Title
A GLOBAL SURVEY OF POST-CARDIAC SURGERY SHOCK FOR THE EUROPEAN ASSOCIATION
OF CARDIOTHORACIC ANAESTHESIOLOGY & INTENSIVE CARE.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 72), 2025. Date of Publication: 01 Dec 2025.
Author
Milne B.; Corredor C.; Naganathar S.; Vives M.; Kunst G.
Institution
(Milne) Department of Anaesthesia, Guy's & St Thomas' NHS Foundation
Trust, London, United Kingdom
(Corredor, Naganathar) Department of Anaesthesia, Barts Health NHS Trust,
London, United Kingdom
(Vives) Intensive Care Unit, Clinica Universidad de Navarra, Pamplona,
Spain
(Kunst) Department of Anaesthesia, King's College Hospital NHS Foundation
Trust, London, United Kingdom
(Kunst) King's College London, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: Mortality after cardiac surgery is declining globally, but is
disproportionately represented in patients developing vasoplegic syndrome
(VPS), or cardiogenic shock (CS) severe enough to require temporary
mechanical circulatory support (tMCS). A global observational study is
required to better understand the incidence, aetiology and outcomes of
these shock states. We conducted an international survey to examine the
current management of post-cardiac surgery shock. Design and method: A 25
question survey was devised for EACTAIC members, endorsed by the EACTAIC
Scientific Committee & distributed via the Association from April - June
2025. Respondents were asked to use their most current (or estimated, if
not available) incidence data. <br/>Result(s) and Conclusion(s):
Sixty-three centres in 31 countries responded (76% Europe, 11% Asia, 8%
South America, 2% North America, 2% Australia/Oceania & 2% Africa). The
response rate was 11%, which should not confer bias given the sampling
frame of 670 (Fosnacht et al. RHE. 2017). Median reported incidence of
post-cardiac surgery CS was 5% [IQR: 3-10%]. Diagnosis and management is
primarily informed by transoesophageal echocardiography (TOE) in 98% of
centres in the Operating Room (OR), and in 87% by TOE and 75% by
transthoracic echocardiogram (TTE) in the Cardiac ICU (CICU). Pulmonary
artery catheters (PAC) are used in 70%<br/>79% (OR<br/>CICU, respectively)
and clinical signs in 70%<br/>73%. Most institutions, 62%, do not have a
protocol for CS management. For CS management, intra-aortic balloon pump
(IABP) (94%) and VA-ECMO (92%) were available in nearly all centres, with
median usage of 3% [IQR: 2-10%] and 2% [IQR: 1-5%], respectively.
Provision of microaxial flow pumps, such as Impella devices, was 57%, with
usage of 1% [IQR: 0.5-2.5%]), and ventricular assist devices (VAD) was
41%, with 1% usage [IQR: 0.5-2%]). In tMCS cases, median mortality was
lowest in those receiving IABP (20% [IQR: 10-35%]) and VAD (19% [IQR:
10-40%]), and highest with use of Impella devices (40% [IQR: 30-70%]) and
VA-ECMO (42% [20-50%]) support. Most institutions (56%) did not have a
standardised definition for VPS. Most (68%) agreed with a pragmatic
definition (based on ATHOS-3; Khanna et al. NEJM. 2017), which would
result in a median incidence of 9% [IQR: 5-20%]. Diagnosis & management of
VPS is driven by TOE in the OR in 94% of centres, and by TTE in 83% & TOE
in 79% in CICU. Clinical signs support diagnosis and management in
73%<br/>81% (in the OR<br/>CICU) of centres, as does PAC monitoring
(70%<br/>78%). Noradrenaline is used in all centres in the OR and CICU for
VPS, with high availability of of vasopressin (89%<br/>92% OR<br/>CICU,
respectively), 'shock dose' hydrocortisone (84%<br/>86%), adrenaline
(79%<br/>91%) and methylene blue (71%<br/>76.2%). There is more variable
use of cytokine absorbers, hydroxocobalamin, vitamin C (all available in
30-50% of centres), and terlipressin, angiotensin II and vitamin B/C
(Pabrinex) (in <30% of centres). These therapies were guided by a protocol
in only 33% of centres. These results confirm the requirement for a large
international observational study of post-cardiac surgery shock to guide
future RCTs, refine therapeutic indications & understand the health
economics of managing this high-risk cohort.<br/>Copyright &#xa9; 2025

<83>
Accession Number
2041289623
Title
Effect of intrathecal morphine on recovery following cardiac surgery: a
systematic review and meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 39), 2025. Date of Publication: 01 Dec 2025.
Author
Hoogma D.; Caeyers Y.; Rex S.; Coppens S.; Oosterlinck W.
Institution
(Hoogma, Rex, Coppens, Oosterlinck) KU Leuven, Department of
Cardiovascular Sciences, Leuven, Belgium
(Rex, Coppens) UZ Leuven, Department of Anesthesiology, Leuven, Belgium
(Oosterlinck) UZ Leuven, Department of Cardiac Surgery, Leuven, Belgium
(Caeyers) KU Leuven, Department of Biomedical Sciences, Leuven, Belgium
Publisher
W.B. Saunders
Abstract
Objective: Introduction: Cardiac anesthesia and surgery have witnessed a
transformative evolution, embracing minimally invasive techniques and
multimodal analgesic approaches. This paradigm shift reflects a broader
trend towards patient-centered healthcare, emphasizing safety,
satisfaction, and quality of recovery (QoR). Intrathecal morphine (ITM)
stands out as a promising analgesic strategy, however, its use entails
inherent risks. This systematic review aimed to investigate the effect of
ITM versus placebo regarding QoR in adult patients undergoing cardiac
surgery. Design and method: Methodology: Two researchers independently
performed a systematic search on MEDLINE (PubMed), Embase and Web of
Science for randomized controlled trials comparing ITM versus control
(placebo) from inception to November 7th, 2023. The primary outcome was
quality of recovery (QoR). Key secondary outcomes included hospital and
intensive care unit (ICU) length of stay (LOS). Statistical heterogeneity
was assessed using X2 and I2 tests, and pooled estimates were calculated
using random-effects models (inverse-variance and Mantel-Haenszel).
Continuous outcomes were analyzed as MD or SMD, binary outcomes as OR,
with data conversions based on Wan et al. for medians and estimated SDs
when missing. GRADE framework was used to assess the quality of the
evidence. <br/>Result(s) and Conclusion(s): Results: A total of 24
studies, published from 1985 to 2021, were identified and 23 studies,
including 1163 patients were included in the meta-analysis. None of the
included studies reported a QoR-score. Pooled results showed significantly
lower hospital (mean difference (MD) = -0.474 days; 95% confidence
interval (CI) = (-0.909; -0.040); p = 0.032; certainty of evidence =
moderate) and ICU LOS (MD = -1.878 hours; 95%CI = (-2.599; -1.158); p <
0.001; certainty of evidence = moderate) (Figure 1). <br/>Conclusion(s):
Although this systematic review could not retrieve any study reporting
QoR, we identified that ITM, compared to control, reduced hospital and ICU
LOS. Future research should incorporate patient reported endpoints as
outcome measure.<br/>Copyright &#xa9; 2025

<84>
Accession Number
2041290023
Title
IS THE HYPOTENSION PREDICTION INDEX WITH GOAL-DIRECTED HEMODYNAMIC
TREATMENT THE KEY TO OPTIMIZING OUTCOMES IN TRANSCATHETER AORTIC VALVE
REPLACEMENT?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 125-126), 2025. Date of Publication: 01 Dec 2025.
Author
Milionis O.; Falara A.; Gkantinas G.; Ftikos P.; Karageorgos V.; Koziakas
I.; Smirli A.; Balanika M.; Antoniou T.; Sidiropoulou T.
Institution
(Milionis, Sidiropoulou) Attikon University Hospital-Second Department of
Anesthesiology, Athens, Greece
(Falara, Gkantinas, Ftikos, Karageorgos, Koziakas, Smirli, Balanika,
Antoniou) Onassis Cardiac Surgery Center-Department of Anesthesiology,
Athens, Greece
Publisher
W.B. Saunders
Abstract
Objective: This study explores whether the Hypotension Prediction Index
(HPI), a machine learning-based tool, can reduce hypotension during
Transcatheter Aortic Valve Replacement (TAVR) and MitraClip procedures
when used with specific diagnostic and treatment protocols. Design and
method: We conducted a randomized study at two high-volume tertiary care
centers specializing in structural heart interventions from January to
December 2024. Adult patients undergoing elective TAVR or MitraClip,
either under general anesthesia or monitored anesthesia care (MAC), were
enrolled. The target mean arterial pressure (MAP) was set to 65 mmHg or
higher, with monitoring for at least one hour. Participants were divided
into two groups: the intervention group (n=50) used the AcumenIQ and
Hemosphere monitor with HPI for goal-directed hemodynamic treatment
(GDHT), while the control group (n=50) received standard invasive blood
pressure monitoring. <br/>Result(s) and Conclusion(s): One hundred
patients were enrolled. Baseline characteristics were similar between two
groups. Primary outcomes showed a significant reduction in the severity of
hypotension, measured as the time-weighted average (TWA) of MAP <65 mmHg
in the HPI group, which was 72.09% lower than the control group (median
difference: -0.46 mmHg; p=0.002). The HPI group experienced significantly
less time in hypotension (median total duration: 3.15 vs. 10.30 minutes; p
= 0.002), received a lower volume of crystalloids (median: 600 vs. 900 mL;
p = 0.014), and required a smaller dose of phenylephrine (median: 100 vs.
450 mcg; p = 0.002) compared to the control group. No significant
difference was observed in the rate of postoperative complications between
groups. These results suggest that the use of HPI-guided GDHT
significantly reduced the incidence, severity and duration of hypotension
during elective TAVR and MitraClip procedures. These findings support the
clinical utility of HPI as a predictive tool to enhance intraoperative
hemodynamic stability and reduce vasopressor and fluid
requirements.<br/>Copyright &#xa9; 2025

<85>
Accession Number
2041289597
Title
Enhancing Recovery after Cardiac Surgery and the Incidence of
Post-Operative Nausea and Vomiting - a Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 10), 2025. Date of Publication: 01 Dec 2025.
Author
Verbeek S.; Hoogma D.F.; Rex S.
Institution
(Verbeek, Hoogma, Rex) KU Leuven - Departement of Cardiovascular Sciences,
Leuven, Belgium
(Hoogma, Rex) University Hospitals Leuven - Departement of Anesthesiology,
Leuven, Belgium
Publisher
W.B. Saunders
Abstract
Objective: Post-operative nausea and vomiting (PONV) is a common adverse
effect after surgery, associated with an increased length of stay in the
post-anesthesia care unit and decreased patient satisfaction. The ERAS
society includes adequate treatment and prophylaxis for PONV in their
recommendations (enhanced recovery program, ERP). These guidelines were
developed to facilitate postoperative recovery through pre-, intra- and
postoperative interventions. In contrast, fast-track (FT) anesthesia
primarily focuses on speeding up recovery through intraoperative
interventions. We compared the incidence of cardiac anesthesia with ERP or
FT protocols to anesthesia using conventional care. Design and method: We
conducted a search through multiple databases using a search string
consisting of 'cardiac surgery' and 'enhanced recovery' or 'fast track',
along with synonyms of these terms. Randomized controlled trials,
nonrandomized controlled trials and prospective observational studies that
implemented an ERP or FT protocol and reported on PONV incidence were
included. Meta-analyses were performed for most outcome variables: PONV
incidence, time to extubation, length of stay in hospital and length of
stay in ICU. We also reviewed use of anti-emetic medication and PONV
prophylaxis. <br/>Result(s) and Conclusion(s): We identified 11 papers,
encompassing 1159 patients. The overall incidence of PONV was 18.53% in
patients in an ERP or FT group and 22.88% in the control group. Our
meta-analysis shows a significant reduction of PONV incidence in the ERP
or FT group. Only 45.45% of studies reported on using PONV prophylaxis,
and 9.09% on anti-emetic medication. Ondansetron was most used for both
indications. Time to extubation, length of stay in the intensive care unit
and length of hospitalization were reduced in the ERP or FT group when
compared to the control group, but this was not statistically significant.
Implementation of enhanced recovery or FT guidelines in cardiac surgery is
associated with a decreased incidence of PONV. This review also
illustrates an important lack of reporting and clinical awareness of PONV
in cardiac surgery.<br/>Copyright &#xa9; 2025

<86>
Accession Number
2041290387
Title
COMPARISON OF DIFFERENT TRANEXAMIC ACID DOSAGE REGIMENS IN PATIENTS
UNDERGOING CARDIAC SURGERY. A PRELIMINARY FEASIBILITY STUDY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 55-56), 2025. Date of Publication: 01 Dec 2025.
Author
Athanasopoulou E.; Samara E.; Karakosta A.; Micha G.; Alexiou C.; Pappas
P.; Tzimas P.
Institution
(Athanasopoulou, Samara, Karakosta, Micha, Tzimas) University Hospital of
Ioannina, Department of Anesthesiology and Postoperative Intensive Care,
Ioannina, Greece
(Alexiou) University Hospital of Ioannina, Department of Cardiac Surgery,
Ioannina, Greece
(Pappas) University of Ioannina, Faculty of Medicine, Department of
Pharmacology, Ioannina, Greece
Publisher
W.B. Saunders
Abstract
Objective: Excessive bleeding and blood transfusions are common in cardiac
surgery. Tranexamic acid is an antifibrinolytic agent widely used. The
present study aims to evaluate different dosages of tranexamic acid in
terms of fibrinolytic inhibition duration as tested via fibroelastic
essays. Design and method: Patients scheduled for elective cardiac surgery
using cardiopulmonary bypass were randomized to receive tranexamic acid
after induction of anesthesia at three different doses: 10 mg / kg
followed by 1 mg / kg / h until the end of the surgery (group 1), 20 mg /
kg (group 2) or 30 mg / kg (group 3). The point of care test TPA- test
(ClotPro ) was used to detect successful inhibition of fibrinolysis at
specified time points (during induction of anesthesia and before
administration of the drug, after the completion of the single dose
administration, after the end of the cardiopulmonary bypass, six and
twelve hours after the administration of the drug and then subsequently
every twelve hours). Fibrinolysis inhibition was defined as a maximum
lysis (ML) < 50% and a lysis time (LT) > 2100 seconds on the tissue
plasminogen activator (TPA) assay using the ClotPro system. <br/>Result(s)
and Conclusion(s): A total of 47 patients participated in the study, with
a mean age of 69.06 years (SD +/-8.1). The study groups were homogeneous
with respect to baseline characteristics. In addition, key aspects of
intraoperative management were comparable across groups. Intraoperative
transfusion requirements did vary between groups, specifically in the
number of packed red blood cells (pRBC) (p = 0.012, Table 1) and fresh
frozen plasma (FFP) units transfused (p = 0.038, Table 1). There were no
significant differences between groups in the transfusion of platelets,
fibrinogen, or administration of prothrombin complex concentrate (Table
1). Fibrinolysis inhibition per group and per timepoint are presented on
Table 2. Postoperative bleeding and transfusion requirements were
comparable across all groups. One patient in group 1 required reoperation
for bleeding control. All three tested dosage regimens are safe and
effective. Larger studies can determine the safety margins and the optimum
dosage of tranexamic acid in cardiac surgery regarding the duration of
fibrinolysis inhibition.<br/>Copyright &#xa9; 2025

<87>
Accession Number
2041289781
Title
Milrinone vs phentolamine after paediatric cardiac surgery: a randomized,
controlled trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 95), 2025. Date of Publication: 01 Dec 2025.
Author
Pernbro F.; Romlin B.; Wahlander H.; Svenne L.; Thorlacius E.; Hjarpe A.
Institution
(Pernbro, Romlin, Svenne, Thorlacius) Queen Silvia's Childrens' Hospital,
Department of Anaesthesia and Intensive Care, Gothenburg, Sweden
(Wahlander) Queen Silvia's Childrens' Hospital, Department of Paediatric
Cardiology, Gothenburg, Sweden
(Hjarpe) Sahlgrenska University Hospital, Department of Thoracic Surgery,
Gothenburg, Sweden
Publisher
W.B. Saunders
Abstract
Objective: BACKGROUND: Previous studies have suggested that a milrinone
infusion after paediatric cardiac surgery may decrease the risk of the
patient developing low cardiac output syndrome (LCOS). It is not clear,
however, whether this is due to the inotropic or vasodilator effects of
milrinone. This study randomized paediatric cardiac patients to a
postoperative infusion of either milrinone or phentolamine, a vasodilator
drug without inotropic effect. <br/>OBJECTIVE(S): The objectives were to
1) compare the haemodynamic response of milrinone and phentolamine after
paediatric cardiac surgery with cardiac index as the primary endpoint, and
2) analyze differences in markers for organ hypoperfusion. Design and
method: METHOD: Forty children under the age of one year, scheduled for
surgical correction of a ventricular or an atrio-ventricular septal defect
using cardiopulmonary bypass were randomized to an infusion of either
milrinone or phentolamine for the first 24 hours after surgery.
Haemodynamic parameters including cardiac index were recorded using a
transpulmonary dilution technique (PiCCO) at 8 and 18 hours after surgery,
and echocardiography 18 hours after surgery. In addition, parameters such
as serum lactate, urine output, and incidence of kidney failure (defined
using the KIDGO score) were recorded. <br/>Result(s) and Conclusion(s):
RESULTS: There were no statistically significant differences between the
groups in haemodynamic parameters, serum lactate levels, or the incidence
of acute kidney injury. No adverse events were recorded in either group.
<br/>CONCLUSION(S): No advantage or disadvantage for the patients could be
found when using either milrinone or phentolamine after paediatric cardiac
surgery.<br/>Copyright &#xa9; 2025

<88>
Accession Number
2041290171
Title
ANALGESIC EFFICACY OF LOCOREGIONAL TECHNIQUES IN CARDIAC SURGERY: A
SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 16-17), 2025. Date of Publication: 01 Dec 2025.
Author
Dejaegere M.; Vandepitte J.; Eynde J.V.D.; Rex S.; Coppens S.; Oosterlinck
W.; Hoogma D.F.
Institution
(Dejaegere, Vandepitte, Rex, Coppens, Hoogma) University Hospitals Leuven,
Department of Anesthesiology, KU Leuven, Leuven, Belgium
(Eynde, Rex, Coppens, Oosterlinck, Hoogma) University of Leuven,
Biomedical Sciences Group, Department of Cardiovascular Sciences, KU
Leuven, Leuven, Belgium
(Oosterlinck) University Hospitals Leuven, Department of Cardiac Surgery,
KU Leuven, Leuven, Belgium
Publisher
W.B. Saunders
Abstract
Objective: Postoperative pain following cardiac surgery remains a
significant clinical challenge, with nearly half of patients experiencing
moderate to severe discomfort. While opioids remain the cornerstone of
analgesia, their adverse effects underscore the need for effective
locoregional analgesic (LRA) alternatives. However, current guidelines
offer limited recommendations due to a lack of comparative data on
different LRA techniques. Design and method: This systematic review and
network meta-analysis evaluated and compared the analgesic efficacy and
safety of all relevant LRA techniques in adult patients undergoing cardiac
surgery, with primary outcomes focusing on opioid consumption, pain
scores, and time to first rescue analgesia within the first 24 hours
postoperatively. Secondary outcomes included intensive care unit (ICU) and
hospital length of stay (LOS), block-related complications, and side
effects. A comprehensive search of PubMed, Embase, and CENTRAL was
conducted up to October 13, 2023. One hundred six randomized controlled
trials involving 7,878 patients were included. A Bayesian random-effects
network meta-analysis was performed to compare LRA techniques across core
analgesic outcomes. Certainty of evidence was assessed using the GRADE
approach. <br/>Result(s) and Conclusion(s): Compared to placebo, five LRA
techniques significantly reduced 24h opioid consumption: erector spinae
plane block (ESPB) mean difference -41.7 mg OME; 95% CI: -70.1 to -15,
intrathecal opioids (IT) -38 mg; 95% CI: -56.1 to -21.2, local anesthetic
infiltration (LA) -35.8 mg; 95% CI: -62.9 to -7.4), parasternal
intercostal plane block (PIPB) -28 mg; 95% CI: -46 to -10.8, and thoracic
epidural analgesia (TEA) -26.9 mg; 95% CI: -51.4 to -2.8. IT opioids
yielded the most consistent reductions in pain scores at all time points,
with a mean difference of -1.2 cm on the visual analogue scale (VAS) at
24h (95% CI: -2.1 to -0.43). LA, ESPB, PIPB, and TEA provided intermittent
pain relief with varying degrees of evidence certainty. No significant
differences were observed in time to first rescue analgesia. ESPB (-11.3
hours; 95% CI: -19.2 to -2.6), PIPB (-8.1 hours; 95% CI: -15.3 to -1.1),
and TEA (-11.9 hours; 95% CI: -21.2 to -2) also reduced ICU LOS, while
only TEA reduced hospital LOS by 1.2 days (95% CI: -1.7 to -0.5). No major
block-related complications were reported. IT opioids offer the most
robust and clinically meaningful reductions in postoperative opioid
consumption and pain scores following cardiac surgery, supported by the
highest certainty of evidence. ESPB and LA are effective alternatives when
neuraxial approaches are contraindicated. Despite the overall positive
analgesic effects of several LRA techniques, heterogeneity in study
protocols, patient populations, and outcome reporting limits definitive
conclusions. Future high-quality trials are needed to optimize and
standardize LRA use in cardiac surgery and further elucidate their impact
on recovery outcomes and safety.<br/>Copyright &#xa9; 2025

<89>
Accession Number
2041289823
Title
EFFECT OF REMIMAZOLAM VS CONVENTIONAL ANESTHESIA (PROPOFOL OR DESFLURANE)
ON POSTOPERATIVE DELIRIUM IN PATIENTS WITH CARDIAC SURGERY: RANDOMIZED
CONTROLLED TRIAL (REDCARD TRIAL).
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 14-15), 2025. Date of Publication: 01 Dec 2025.
Author
Iguchi N.; Hayashi Y.; Takeyama E.; Akasaka H.; Yasunobe Y.; Okamura S.
Institution
(Iguchi, Hayashi, Takeyama) The University of Osaka Graduate School of
Medicine, Department of Anaesthesiology and Intensive Care Medicine,
Osaka, Japan
(Akasaka, Yasunobe) The University of Osaka Graduate School of Medicine,
Department of Geriatric and General Medicine, Osaka, Japan
(Okamura) The University of Osaka Hospital, Department of Medical
Innovation, Osaka, Japan
Publisher
W.B. Saunders
Abstract
Objective: Remimazolam is a new benzodiazepine-based anesthetic with an
ultra-short duration of action, and its use in cardiac surgery is
increasing due to its minimal impact on hemodynamics. Cardiac surgery is
associated with a high risk of postoperative delirium, and
benzodiazepine-based agents are considered risk factors for delirium;
however, the effects of remimazolam on postoperative delirium remain
unclear. To evaluate the incidence of postoperative delirium within 5 days
after surgery in patients undergoing scheduled cardiac surgery under
general anesthesia, comparing the use of remimazolam as a maintenance
anesthetic with conventional anesthetics (propofol and desflurane) in a
randomized, double-blind, controlled trial (jRCT1051210195). Design and
method: The target number of patients was set at 250, and anesthesia was
managed with a target bispectral index value of 40 to 60 and a target mean
arterial pressure range of 50 to 100 mmHg. The primary outcome was the
incidence of delirium within 5 days postoperatively, assessed using the
Intensive Care Delirium Screening Checklist (ICDSC) score. The incidence
rates between groups adjusted for age (age 75 and over / under) and their
95% confidence intervals (CI) will be calculated using a Poisson
regression model. Subgroup analyses were performed for cardiac function
(left ventricular ejection fraction 50% and over / under) and other
factors as secondary analyses of the primary outcome. Other intraoperative
and postoperative secondary outcomes were compared using chi-square tests
or Mann-Whitney U tests. <br/>Result(s) and Conclusion(s): The incidence
rate of delirium was 2.9 in the remimazolam group (n=123) and 3.0 in the
conventional anesthetics group (n=123), with an adjusted incidence rate
ratio of 0.964 (95% CI 0.607, 1.531). In patients with left ventricular
ejection fraction <50%, the remimazolam group tended to have a lower
incidence of postoperative delirium (adjusted incidence ratio 0.472; 95%
CI 0.200, 1.116). There was no significant difference in the
intraoperative use of circulatory agents, but the intraoperative use of
remifentanil was significantly higher in the remimazolam group (p=0.005).
There was no significant difference in the incidence of postoperative
acute kidney injury. In cardiac surgery patients, general anesthesia using
remimazolam did not increase the incidence of postoperative delirium
compared to conventional general anesthetics.<br/>Copyright &#xa9; 2025

<90>
Accession Number
2041290190
Title
Don't Bypass your preparation for surgery: Setting up a Surgery School for
patients undergoing cardiac surgery in a single centre.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 41), 2025. Date of Publication: 01 Dec 2025.
Author
Green S.; Pope L.; Dryden L.
Institution
(Green, Pope, Dryden) Royal Sussex County Hospital, University Hospitals
Sussex, Brighton, United Kingdom
Publisher
W.B. Saunders
Abstract
Objective: Surgery Schools have been proven to improve patient experience,
reduce complications and reduce length of stay within general surgical
populations (1). Our cardiac surgery school was developed to empower
patients to actively shape their surgical journey with a view to enhancing
both their recovery and experience of care. Design and method: A
multidisciplinary team involved across the continuum of patient care
developed a seminar-based programme for the pilot cardiac surgery school.
To inform its design, a survey of post-operative patients was conducted,
and expert patients were engaged in both the development and delivery of
content. Survey findings highlighted key areas where patients felt
underprepared-specifically recovery, physiotherapy, and psychological
readiness. Notably, all respondents (n=8) indicated that attending a
surgery school would likely have had a positive impact on their
perioperative experience. The team also conducted a site visit to an
established surgery school at another centre to gather insights and best
practices. An in-person surgery school was piloted in June 2025, with
attendance from 53 people, namely 28 patients with a support person. The
talks covered the entire patient journey, with time for questions and
patient participation. <br/>Result(s) and Conclusion(s): 14 patients (50%)
who attended the session filled out our feedback survey. The survey showed
excellent feedback for each individual talks with patients feeling more
prepared for their operation after the afternoon. Feedback showed 13/14
patients were happy to attend an in-person event rather than online.
Subsequently we will utilise a modified version of our ongoing enhanced
recovery survey and compare patient experience with and without surgery
school. We plan to offer the surgery school to all future elective
patients by way of an established programme running 3-4 times per year. We
recognise that challenges in the geography of our centre, and the region
we serve, impresses an obligation to develop a virtual surgery school
offering -which would have the additional benefit of serving out inpatient
population. 1) "Systematic review and narrative description of the
outcomes of group preoperative education before elective major surgery"
Fecher - Jones et al, BJA Open, June 2024<br/>Copyright &#xa9; 2025

<91>
Accession Number
2041290218
Title
INTRAOPERATIVE REMOVAL OF TICAGRELOR DURING URGENT CORONARY ARTERY BYPASS
GRAFTING REDUCES PERIOPERATIVE BLEEDING IN A POOLED ANALYSIS OF A
RANDOMIZED TRIAL AND AN INTERNATIONAL REGISTRY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 51-52), 2025. Date of Publication: 01 Dec 2025.
Author
Schmoeckel M.; Mack M.; Storey R.; Whitlock R.; Chu M.; Taylor B.; Zias
E.; Liu D.; Hassan K.; Thielmann M.; Meyer A.; De Neve N.; Sellke F.;
Schneider D.; Thourani V.; Douketis J.; Mazer D.; Wendt D.; Deliargyris
E.; Gibson M.
Institution
(Schmoeckel) LMU Grosshadern Clinic, Department of Cardiac Surgery,
Munich, Germany
(Mack) Baylor Scott & White Health, Department of Cardiovascular Surgery,
Plano, TX, United States
(Storey) NIHR Sheffield Biomedical Research Centre, Sheffield Teaching
Hospitals NHS Foundation Trust, Sheffield, United Kingdom
(Whitlock) McMaster University, Population Health Research Institute,
Department of Cardiac Surgery, Hamilton, Canada
(Chu) Western University, London Health Sciences Centre, London, Canada
(Taylor) University of Maryland Medical Center, Department of
Cardiothoracic Surgery, Baltimore, MD, United States
(Zias) NYU Langone Health, Department of Cardiothoracic Surgery, New York,
NY, United States
(Liu) Harvard University, Beth Israel Deaconess Medical Center, Department
of Cardiothoracic Surgery, Boston, MA, United States
(Hassan) Asklepios Clinic St. Georg, Department of Cardiac Surgery,
Hamburg, Germany
(Thielmann) University of Essen, Westgerman Heart and Vascular Center,
Department of Thoracic- and Cardiovascular Surgery, Essen, Germany
(Meyer) University Clinic Heidelberg, Department of Cardiac Surgery,
Heidelberg, Germany
(De Neve) AZORG Hospitals, Department of Anesthesiology and Intensive Care
Medicine, Aalst, Belgium
(Sellke) Brown Medical School, Lifespan Hospitals, Department of
Cardiothoracic Surgery, Providence, RI, United States
(Schneider) University of Vermont, Cardiovascular Research Institute of
Vermont, Burlington, VT, United States
(Thourani) Piedmont Heart Institute, Piedmont Healthcare, Department of
Cardiovascular Surgery, Atlanta, GA, United States
(Douketis) McMaster University, St. Joseph's Healthcare, Department of
General Internal Medicine and Clinical Thromboembolism, Hamilton, Canada
(Mazer) University of Toronto, St. Michael's Hospital, Department of
Anesthesia, Toronto, Canada
(Wendt) University of Essen Medical School, Department of Cardiac Surgery,
Essen, Germany
(Deliargyris) CytoSorbents Inc., Princeton, NJ, United States
(Gibson) Harvard University, BAIM Research Institute, Boston, MA, United
States
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the effectiveness of a polymer bead-based device
for intraoperative removal of ticagrelor in reducing perioperative
bleeding in patients undergoing urgent isolated coronary artery bypass
grafting (CABG) without completing the recommended washout period. Design
and method: This pooled analysis combined data from two sources: STAR-T, a
North American randomized, double-blind, sham-controlled trial, and the
STAR Registry, a European real-world registry. Both studies assessed the
intraoperative removal of ticagrelor using a polymer bead hemoadsorption
device incorporated into the cardiopulmonary bypass (CPB) circuit. In
STAR-T, patients were randomized 1:1 to either the device or sham control.
All STAR Registry patients were treated with the device. To ensure
comparability, inclusion and exclusion criteria from STAR-T were
retrospectively applied to STAR Registry data to identify patients
undergoing isolated CABG on ticagrelor without sufficient washout.
Device-treated patients from both studies were pooled and compared with
STAR-T sham-treated controls. The primary endpoint was a hierarchical
composite of fatal bleeding, severe or massive bleeding according to the
Universal Definition for Perioperative Bleeding (UDPB Class 3 & 4), and
24-hour chest tube drainage (CTD), analyzed using an unmatched win ratio
approach. Secondary endpoints included CTD at 12 and 24 hours and the
incidence of severe clinical bleeding events (SCBE), defined as delayed
sternal closure, re-exploration for bleeding, or cardiac tamponade.
<br/>Result(s) and Conclusion(s): The analysis included 153 device-treated
patients and 60 controls who underwent isolated CABG. The mean patient age
was 64.4 years, and 84% were male. Baseline clinical and procedural
characteristics were balanced between groups. However, the time from the
last ticagrelor dose to surgery was significantly shorter in
device-treated patients (28.8 +/- 16.4 hours) compared to controls (38.6
+/- 14.6 hours; p<0.001). There were no significant differences in
operative time (4.3 +/- 1.3 vs. 4.2 +/- 1.2 hours; p=0.710) or CPB
duration (95.3 +/- 35.9 vs. 94.0 +/- 34.4 minutes; p=0.801). The primary
endpoint significantly favored the device group with a win ratio of 1.72
(95% confidence interval 1.18 to 2.49; p=0.003). Median CTD was lower in
the device group at both 12 hours (354 mL vs. 487 mL; p=0.0008) and 24
hours (580 mL vs. 765 mL; p=0.003). The incidence of SCBE was numerically
lower in the device group (5.9% vs. 8.3%), although not statistically
significant (p=0.516). Intraoperative removal of ticagrelor using a
polymer bead device during urgent CABG significantly reduces the severity
of perioperative bleeding. These findings, derived from both controlled
and real-world settings, support the use of this technology when surgery
cannot be delayed to meet recommended antiplatelet washout
guidelines.<br/>Copyright &#xa9; 2025

<92>
Accession Number
2041290233
Title
Intraoperative Removal of Direct Oral Anticoagulants in Patients
Undergoing Urgent Cardiothoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 33-34), 2025. Date of Publication: 01 Dec 2025.
Author
Schmoeckel M.; Mack M.; Choi C.; Nicolato P.; Langer N.; Copeland H.;
Sellke F.; Schneider D.; Thourani V.; Douketis J.; Wendt D.; Fan W.;
Deliargyris E.; Gibson M.
Institution
(Schmoeckel) LMU, Cardiac Surgery, Munich, Germany
(Mack) Baylor Scott & White Health, Plano, UNITED STATES MINOR OUTLYING
ISLANDS, United States Minor Outlying Islands
(Choi) The Johns Hopkins Hospital, Baltimore, United States
(Nicolato) VCU School of Medicine, Richmond, United States
(Langer) Massachusetts General Hospital, Wellesley, UNITED STATES MINOR
OUTLYING ISLANDS, United States Minor Outlying Islands
(Copeland) Community Heart and Vascular Hospital, Fort Wayne, UNITED
STATES MINOR OUTLYING ISLANDS, United States Minor Outlying Islands
(Sellke) Brown Medical School, Providence, UNITED STATES MINOR OUTLYING
ISLANDS, United States Minor Outlying Islands
(Schneider) University of Vermont, Burlington, UNITED STATES MINOR
OUTLYING ISLANDS, United States Minor Outlying Islands
(Thourani) Piedmont Atlanta Hospital, Atlanta, UNITED STATES MINOR
OUTLYING ISLANDS, United States Minor Outlying Islands
(Douketis) McMaster University, Hamilton, Canada
(Wendt) CytoSorbents GmbH, Berlin, Germany
(Fan, Deliargyris) CytoSorbents Inc., Princeton, UNITED STATES MINOR
OUTLYING ISLANDS, United States Minor Outlying Islands
(Gibson) Baim Institute, Boston, UNITED STATES MINOR OUTLYING ISLANDS,
United States Minor Outlying Islands
Publisher
W.B. Saunders
Abstract
Objective: The aim of the STAR-D randomised, double-blind, sham-controlled
trial was to investigate whether the use of a polymer bead device to
remove DOACs intraoperatively reduced the severity of perioperative
bleeding in patients undergoing cardiac surgery before the recommended
washout period had been completed. Design and method: Patients undergoing
cardiac surgery on cardiopulmonary bypass (CPB) within 36 hours of their
last dose of apixaban or rivaroxaban were randomised 1:1 to receive the
device or a sham procedure. The device was used for the duration of CPB.
Blood samples for measuring drug concentrations were collected before CPB,
every 30 minutes during CPB, and within 30 minutes after CPB. The primary
endpoint was a composite of fatal bleeding, moderate/severe/massive
bleeding according to the Universal Definition for Perioperative Bleeding
(UDPB > or equal to 2) and 24-hour chest tube drainage (CTD), while the
key secondary endpoint was the percentage reduction in DOAC levels between
the pre- and post-CPB samples. The study was planned to enrol 120 subjects
at 30 U.S. sites, but was stopped early by the sponsor for business
reasons. <br/>Result(s) and Conclusion(s): A total of nine patients (mean
age 65+/-13 years; five female) were randomised to receive either the
device (n=4) or the sham device (n=5). Six patients were on apixaban and
three on rivaroxaban, with a mean time from the last dose to surgery of
29.5+/-10.4 hours and a mean pre-CPB DOAC concentration of 56.01+/-44.89
ng/mL. The surgery types included five aortic dissections, two isolated
valves, one isolated CABG and one atrial myxoma, with a mean CPB duration
of 147.0 +/- 76.5 minutes. Due to the small number of subjects enrolled,
only drug removal analyses were performed. The mean percent reduction in
drug levels from pre- to post-CPB was significantly greater with the
device than with sham (62.21+/-8.9% vs. 27.95+/-8.6%, p=0.02). Of the six
patients with pre-CPB DOAC levels above the therapeutic threshold of 30
ng/mL, all three treated with the device dropped below 30 ng/mL after CPB,
compared with none of the three who received the sham device.
<br/>Conclusion(s): This is the first randomised study of the use of a
polymer bead device for the removal of DOACs intraoperatively in patients
undergoing urgent cardiac surgery within 36 hours of their last dose. The
device was found to be safe when used intraoperatively and resulted in a
significantly higher percentage reduction in DOAC levels compared with
controls. However, whether this significant reduction in DOAC levels
translates into a reduction in perioperative bleeding complications
requires investigation in a prospective clinical study.<br/>Copyright
&#xa9; 2025

<93>
Accession Number
2042230490
Title
Effects of Remimazolam on Perioperative Inflammatory Response and
Neurocognitive Disorders in Elderly Patients Undergoing Video-Assisted
Thoracic Surgery: A Randomized Controlled Trial.
Source
Drug Design, Development and Therapy. 19 (pp 11951-11963), 2025. Date of
Publication: 2025.
Author
Hu J.; Huang Y.; Li J.; Yang J.; Pan P.; Xiang S.; Ding Y.; Yang P.; Liu
C.
Institution
(Hu, Huang, Li, Yang, Pan, Yang, Liu) Department of Anesthesiology,
Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China
(Xiang, Ding) Department of Thoracic Surgery, Chongqing University Three
Gorges Hospital, Wanzhou, Chongqing, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: The systemic inflammatory response triggered by video-assisted
thoracic surgery (VATS) is associated with the risk of perioperative
neurocognitive disorders (PND). Remimazolam, a newer benzodiazepine
anesthetic, has unknown anti-inflammatory properties and uncertain effects
on elderly patients. This study investigated the effects of remimazolam on
postoperative inflammation and neurocognitive disorders in elderly
patients undergoing VATS. <br/>Patients and Methods: Ninety-two patients
aged 60 years or older scheduled for VATS were randomized to receive
either remimazolam (induction: 0.25 mg/kg; maintenance: 0.5-1.5 mg/kg/h)
or propofol (induction: 2 mg/kg; maintenance: 4-6 mg/kg/h). The primary
outcome was the serum C-reactive protein concentration at 24 h
postoperatively. Secondary outcomes included the incidence of PND,
assessed using the 3-Minute Diagnostic Confusion Assessment Method and the
Mini-Mental State Examination on postoperative days 1, 3, 5, and 7.
Exploratory outcomes included inflammatory cells (leucocytes and
neutrophil counts), cytokines (IL-6, TNF-alpha, S100beta), stress markers,
and the systemic inflammatory response index. Other measures comprised
hemodynamic parameters, anesthesia parameters, and potential adverse
events. <br/>Result(s): All 92 patients completed the intention-to-treat
analysis. At 24h postoperation, the remimazolam group showed significantly
higher CRP, IL-6, leukocyte counts, neutrophil counts, and systemic
inflammatory response index than the propofol group. No differences were
found in TNF-alpha, S100beta, or PND incidence (8.7% vs 6.5%). Stress
marker levels were comparable between groups at all time points.
Additionally, the remimazolam group demonstrated shorter anesthesia
awakening time (P<0.001), with reduced incidence of hypotension (P <0.001)
and injection pain (P = 0.015). <br/>Conclusion(s): Although remimazolam
is less effective than propofol in suppressing the early postoperative
inflammatory response in elderly patients undergoing VATS, it did not
increase the risk of PND or infection. It has significant advantages in
hemodynamic stability, facilitates faster recovery, and reduces injection
pain, establishing it as a preferred anesthetic option for geriatric VATS,
though its inflammatory mechanisms require clarification.<br/>Copyright
&#xa9; 2025 Hu et al.

<94>
Accession Number
2041289810
Title
THE EFFECT OF DEXMEDETOMIDINE ON HEMODYNAMIC RESPONSE DURING DOUBLE-LUMEN
TUBE INSERTION: A RANDOMISED CONTROLLED TRIAL.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of
Cardiothoracic and Vascular Anesthesia. Valencia Spain. 39(12 Supplement)
(pp 111), 2025. Date of Publication: 01 Dec 2025.
Author
Vithayathil R.; R H.G.M.; George G.
Institution
(Vithayathil) BEDFORD HOSPITAL SOUTH WING, BEDFORD, United Kingdom
(R, George) CHRISTIAN MEDICAL COLLEGE, VELLORE, India
Publisher
W.B. Saunders
Abstract
Objective: Thoracic surgery with one lung ventilation often requires
double lumen tube (DLT) insertion which causes a significant and prolonged
hemodynamic response which can be detrimental high risk groups. This study
aims to evaluate the effect of a single pre-induction bolus of
dexmedetomidine 0.5 mcg/kg on hemodynamic responses to laryngoscopy and
DLT insertion and assess the requirement of additional anaesthetic to
maintain hemodynamic stability. Design and method: Sixty patients coming
for thoracic surgery requiring DLT insertion were recruited. Thirty were
assigned to the dexmedetomidine group (A) and thirty to placebo group (B).
Group A received 0.5 mcg/kg dexmedetomidine over 10 minutes and Group B
received normal saline over 10 minutes. Heart rate (HR), Systolic blood
pressure (SBP), Diastolic Blood pressure (DBP) and Mean Blood Pressure
(MAP) were recorded at baseline, after loading dose of drug, post
induction, before intubation, at intubation, and thereafter at regular
intervals until 30 minutes after intubation. Usage of supplementary
anaesthetic was noted. <br/>Result(s) and Conclusion(s): Patients in Group
A had significantly lower HR after loading dose (P<0.001), before
intubation (P< 0.001), at intubation (p< 0.001) as well as at T5
(p<0.006), T10 (p<0.007) T15 (p<0.001), and T25 (p<0.007). Group A has
lower SBP(p=0.049) and DBP(p=0.005) after loading dose. Significantly
fewer patients in Group A required additional propofol (14 vs 27) (p<
0.001) and lesser doses (21.3 vs 41.0 [mg]) (p=0.008). Less Group A
patients required fentanyl (15 vs 21) (p=0.114) and at reduced doses (17.5
vs 27.3 [mcg]) (p= 0.105).<br/>Copyright &#xa9; 2025

<95>
Accession Number
649733925
Title
Effect of Early Nutritional Support Nursing Intervention on Postoperative
Recovery in Patients With Critical Cardiac Surgery: A Systematic Review
and Meta-analysis.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. (no pagination), 2025. Date of
Publication: 26 Dec 2025.
Author
Li Z.; Wei L.; Jing Y.; Zhang S.
Institution
(Li) Department of Cardiovascular and Macrovascular, Shandong Provincial
Third Hospital, Jinan, Shandong, China
(Wei) Department of Cardiovascular and Macrovascular, Shandong Provincial
Third Hospital, Jinan, Shandong, China
(Jing) Department of Cardiovascular and Macrovascular, Shandong Provincial
Third Hospital, Jinan, Shandong, China
(Zhang) Department of Cardiovascular and Macrovascular, Shandong
Provincial Third Hospital, Jinan, Shandong, China
Abstract
PURPOSE: The purpose of this review was to evaluate the impact of early
nutritional support on mortality, cardiopulmonary bypass times, aortic
cross-clamp time, duration of mechanical ventilation, length of intensive
care unit stay, and hospital stay. DESIGN: Systematic Review and
Meta-Analysis. <br/>METHOD(S): A comprehensive search was conducted in
PubMed, EMBASE, Web of Science, CINAHL, and Cochrane Library to identify
21 studies comprising 1,846 participants for final inclusion.
Random-effects models using the DerSimonian-Laird method were applied to
estimate pooled effect sizes, with heterogeneity assessed using I2
statistic. Publication bias was evaluated through funnel plots and Egger's
test, and sensitivity analyses were conducted to ensure robustness of
findings. FINDINGS: The intervention showed no significant effect on
mortality (odds ratio: 0.694, 95% confidence intervals [CI]: 0.367 to
1.310) or procedural times, including cardiopulmonary bypass (standardized
mean differences [SMD]: -0.011, 95% CI: -0.287 to 0.264) and aortic
cross-clamp (SMD: 0.521, 95% CI: -0.140 to 1.183). However, significant
reductions were observed in duration of mechanical ventilation (SMD:
-0.306, 95% CI: -0.499 to -0.114, P = .002) and hospital length of stay
(SMD: -0.462, 95% CI: -0.739 to -0.185, P = .001). Intensive care unit
length of stay showed no significant effect. Moderate-to-substantial
heterogeneity was noted for most outcomes. <br/>CONCLUSION(S): Early
nutritional support nursing interventions can significantly reduce
mechanical ventilation duration and hospital length of stay, supporting
their role in enhancing recovery following cardiac surgery. Further
research is needed to standardize protocols and identify optimal patient
populations for these interventions.<br/>Copyright &#xa9; 2025 The
American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All
rights reserved.

<96>
Accession Number
2042116082
Title
Paravalvular Leak After Transcatheter Aortic Valve Replacement (TAVR): A
Literature Review.
Source
Journal of Clinical Medicine. 14(24) (no pagination), 2025. Article
Number: 8905. Date of Publication: 01 Dec 2025.
Author
Sciaramenti G.; Menzato E.; Clo' S.; Izzo C.; Rotondo L.; Dal Passo B.;
Meossi S.; Tezze R.; Frascaro F.; Tonet E.; Marchini F.; Cocco M.;
Tumscitz C.; Penzo C.; Campo G.; Pavasini R.
Institution
(Sciaramenti, Menzato, Clo', Izzo, Rotondo, Dal Passo, Meossi, Tezze,
Frascaro, Tonet, Marchini, Cocco, Tumscitz, Penzo, Campo, Pavasini)
Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara,
Italy
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Severe aortic stenosis represents a significant prognostic burden,
particularly in symptomatic patients. The advent of transcatheter aortic
valve replacement (TAVR) has revolutionized the treatment of patients
previously considered ineligible for surgical aortic valve replacement
(SAVR). TAVR provides a relatively safe intervention that leads to
improvements in survival, symptoms, and functional status within months of
implantation. A major complication following TAVR is the occurrence of
paravalvular leaks (PVLs), which have been associated with increased
mortality and higher rates of heart failure-related hospitalizations. PVLs
refer to abnormal blood flow between the implanted valve and the aortic
wall, which can compromise the functionality of the device. Careful
pre-procedural planning enables the identification of patients at higher
risk for PVL development. Although the incidence of PVLs has decreased
with the introduction of newer-generation transcatheter valves, the
condition remains clinically relevant. Due to the complex anatomy of the
aortic valve apparatus and interference from the prosthetic frame,
accurate evaluation of PVLs requires a multimodal diagnostic approach.
Current evidence on PVL management is limited. In most cases, a
conservative approach is adopted, while interventional strategies (such as
pre- and post-dilatation, percutaneous PVL closure, and TAVR-in-TAVR) are
reserved for selected patients. We performed a systematic literature
review to summarize the incidence, predictors, diagnostic techniques, and
management strategies of PVLs following TAVR.<br/>Copyright &#xa9; 2025 by
the authors.

<97>
Accession Number
2042115985
Title
Intravascular Imaging-Guided Percutaneous Coronary Intervention:
Transforming Precision and Outcomes in Contemporary Practice.
Source
Journal of Clinical Medicine. 14(24) (no pagination), 2025. Article
Number: 8883. Date of Publication: 01 Dec 2025.
Author
Alqawasmi M.; Blankenship J.C.
Institution
(Alqawasmi) Department of Internal Medicine, University of New Mexico,
Albuquerque, NM, United States
(Blankenship) Division of Cardiology, Department of Internal Medicine,
University of New Mexico, Albuquerque, NM, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Percutaneous coronary intervention (PCI) has evolved significantly over
the past two decades, yet challenges in achieving optimal stent deployment
and long-term outcomes persist, particularly in complex coronary anatomy.
Intravascular imaging (IVI) modalities such as intravascular ultrasound
(IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy
(NIRS) have transformed the precision of PCI by providing detailed
cross-sectional visualization of vessel architecture, plaque morphology,
and stent apposition. Compared to angiography-guided PCI, imaging-guided
PCI enables more accurate lesion assessment, appropriate stent sizing, and
detection of suboptimal results including under-expansion, malapposition,
and edge dissections, factors strongly linked to restenosis and stent
thrombosis. Large-scale randomized trials (e.g., ULTIMATE, ILUMIEN) and
meta-analyses have demonstrated that imaging-guided PCI reduces major
adverse cardiovascular events (MACE) and improves long-term stent patency,
particularly in left main, bifurcation, and calcified lesions. Despite
these benefits, adoption remains variable due to cost, procedural
complexity, and training gaps. Emerging advances, including artificial
intelligence-enhanced imaging, hybrid devices, and fusion of imaging with
physiologic assessments, promise to integrate imaging more seamlessly into
routine practice. This review summarizes current evidence, practical
applications, and future directions of IVI-guided PCI, underscoring its
growing role in contemporary interventional cardiology and its potential
to personalize and optimize coronary revascularization
strategies.<br/>Copyright &#xa9; 2025 by the authors.

<98>
Accession Number
2042114819
Title
Prosthesis-Patient Mismatch Following Aortic Valve Replacement-A
Comprehensive Review.
Source
Journal of Clinical Medicine. 14(24) (no pagination), 2025. Article
Number: 8868. Date of Publication: 01 Dec 2025.
Author
Talapaneni S.; Ahmad D.; Khandelwal M.; Mesiha M.; Jalali P.; Celik N.B.;
Tabraiz S.A.; Dankwa S.; Hameed I.; Milewski R.; Vallabhajosyula P.
Institution
(Talapaneni, Ahmad, Khandelwal, Mesiha, Jalali, Celik, Tabraiz, Dankwa,
Hameed, Milewski, Vallabhajosyula) Division of Cardiac Surgery, Department
of Surgery, Yale University School of Medicine, New Haven, CT, United
States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Objective: Prosthesis-patient mismatch (PPM) occurs after aortic valve
replacement (AVR) when the effective orifice area of the implanted
prosthetic valve is small relative to the patient's body surface area.
Beyond simply elevating transvalvular gradient, PPM profoundly affects
cardiac remodeling, coronary physiology, and ultimately patient survival.
This comprehensive review synthesizes current evidence regarding PPM
pathophysiology, clinical consequences, and therapeutic strategies.
<br/>Method(s): We conducted a narrative review of PPM in surgical (SAVR)
and transcatheter (TAVR) aortic valve replacement. PubMed and Embase were
systematically searched using terms related to AVR and PPM and reference
lists of key studies and reviews were screened. Studies addressing PPM
prevalence, hemodynamic impact, clinical outcomes, and mitigation
strategies were included. <br/>Result(s): PPM, defined as an iEOA <= 0.85
cm²/m² (moderate) or <=0.65
cm²/m² (severe), demonstrates variable prevalence
across studies, typically ranging from 5 to 30% after SAVR and 2-35% after
TAVR. It is associated with increased transvalvular gradients, reduced
left ventricular mass regression, persistent coronary flow abnormalities,
higher rates of heart failure, and both early and late mortality.
Supra-annular self-expanding transcatheter aortic valve replacement (TAVR)
devices and newer generation stentless or bovine pericardial surgical
valves exhibit lower PPM rates than older stented or porcine valves.
Valve-in-valve (ViV) TAVR and bioprosthetic valve fracture (BVF) can
improve outcomes in failed surgical valves but are less effective in small
annuli. TAVR-in-TAVR procedures are limited by anatomic and technical
constraints, especially in maintaining coronary access and minimizing
residual gradients. <br/>Conclusion(s): PPM remains a common and
clinically consequential complication of AVR that compromises long-term
outcomes. It is largely preventable through accurate preoperative imaging,
valve sizing, and consideration of annular enlargement. Optimal outcomes
require matching valve characteristics to individual patient anatomy and
physiology. In an era of expanding TAVR use, preventing PPM during the
index procedure is critical to optimizing survival and preserving future
reintervention options.<br/>Copyright &#xa9; 2025 by the authors.

<99>
Accession Number
649719613
Title
Clinical Manifestations.
Source
Alzheimer's & dementia : the journal of the Alzheimer's Association.
21(Supplement 3) (pp e099172), 2025. Date of Publication: 01 Dec 2025.
Author
Park S.; Yan E.; Martinez-Rodriguez R.; Desai B.; Chung J.; Saripella A.;
Englesakis M.; Fishman K.N.; Chung F.
Institution
(Park, Martinez-Rodriguez, Desai, Chung) University of Toronto, Toronto,
ON, Canada
(Yan, Saripella, Chung) Toronto Western Hospital ,University Health
Network, Toronto, ON, Canada
(Yan, Chung) Temerty Faculty of Medicine, University of Toronto, Toronto,
ON, Canada
(Englesakis) University Health Network, Toronto, ON, Canada
(Fishman) Baycrest Hospital, Toronto, ON, Canada
(Fishman) Ontario Shores Centre for Mental Health Sciences, Toronto, ON,
Canada
Abstract
BACKGROUND: Cognitive impairment is prevalent in the surgical population
but remains significantly under-recognized. This systematic review and
meta-analysis aims to (1) assess the prevalence of specific impaired
cognitive domains in surgical patients perioperatively and (2) examine
postoperative changes across the domains. <br/>METHOD(S): A comprehensive
search was conducted in five electronic databases from inception until
March 19, 2024. Studies were included if they met the following criteria:
(1) surgical patients >=18 years of age; (2) sample size of >=100 surgical
patients; (3) assessed cognitive domain(s) preoperatively with a
neuropsychological battery or clinical evaluation; and (4) reported the
prevalence of impaired cognitive domains or changes perioperatively. The
exclusion criteria included neurosurgery; those with overlapping data;
cross-sectional, case control, and case series studies; and non-English
articles. <br/>RESULT(S): Of the 12,082 articles screened, 21 studies with
5,725 patients were included (11 non-cardiac surgery, 10 cardiac surgery).
Preoperatively, executive function had the highest pooled prevalence of
impairment (18%; 95% CI: 13%, 24%), followed by visuospatial function
(16%; 95% CI: 6%, 26%) and attention/working memory/processing speed (14%,
95% CI: 9%, 18%). Rates were lower in perceptual-motor control (13%; 95%
CI: 9%, 36%), language (13%; 95% CI: 8%, 17%), and learning/memory (12%;
95% CI: 8%, 16%) (Figure 1). Postoperatively, impairment was most
pronounced at one week, with 35% (95% CI: 4%, 66%) in attention/working
memory/processing speed, 34% (95% CI: 16%, 51%) in executive function, and
28% (95% CI: 16%, 40%) in learning/memory. Impairment reduced at three
months postoperatively, with a prevalence of 16% (95% CI: 3%, 35%) in
attention/working memory/processing speed, 15% (95% CI: 6%, 24%) in
executive function, and 12% (95% CI: -2%, 25%) in learning/memory (Figure
2). <br/>CONCLUSION(S): Cognitive domains were impaired preoperatively in
12% to 18% of surgical patients. The most commonly impaired domains were
executive function, visuospatial function, and attention/working
memory/processing speed. One-week post-surgery, the prevalence of impaired
cognitive domains rose to 28% to 35%, then decreased by three months to
levels similar to preoperative rates (12% to 16%). Identifying commonly
impaired cognitive domains can inform the selection of cognitive screening
tools to assess surgical patients at greater risk for adverse
outcomes.<br/>Copyright &#xa9; 2025 The Alzheimer's Association.
Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of
Alzheimer's Association.

<100>
Accession Number
649721027
Title
Management of new-onset postoperative atrial fibrillation after coronary
artery bypass grafting.
Source
Expert review of cardiovascular therapy. (no pagination), 2025. Date of
Publication: 25 Dec 2025.
Author
Herrmann F.E.M.; Jeppsson A.; Taha A.
Institution
(Herrmann, Jeppsson, Taha) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Herrmann) Department of Cardiac Surgery, LMU University Hospital, LMU
Munich, Munich, Germany
(Herrmann) DZHK (german Center for Cardiovascular Research) Partner Site
Munich Heart Alliance, Munich, Germany
(Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Taha) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
Abstract
INTRODUCTION: New-onset postoperative atrial fibrillation (POAF) is the
most common arrhythmia after coronary artery bypass grafting (CABG).
Traditionally regarded as a benign and self-limiting event, more recent
evidence highlights its association with prolonged hospitalization,
increased healthcare utilization, and a heightened risk of stroke,
recurrent atrial fibrillation, and heart failure. Understanding its
significance is essential for patient care and long-term outcomes. PubMed
was searched using terms related to POAF and CABG, supplemented by the
review of relevant guidelines and key publications. AREAS COVERED: This
narrative review summarizes recent evidence on the epidemiology,
pathophysiology, prophylaxis, and treatment of POAF after CABG. Evidence
for pharmacological prophylaxis (e.g. amiodarone, beta-blockers,) and
surgical strategies (e.g. posterior pericardiotomy, atrial pacing) is
summarized, along with current approaches for acute management and stroke
prevention. The literature reveals significant heterogeneity in treatment
strategies, particularly regarding anticoagulation, with emerging trials
expected to refine clinical practice. EXPERT OPINION: Current evidence
suggests that POAF functions more as an indicator of underlying patient
vulnerability than as a direct driver of adverse outcomes. Clinically,
management must balance arrhythmia control, stroke and bleeding risk, and
individualized anticoagulation decisions. Research efforts should
prioritize robust risk stratification tools and randomized evidence to
guide tailored therapy.

<101>
Accession Number
649719945
Title
Low-dose nicardipine during cardiopulmonary bypass improves carotid
hemodynamics in CABG patients: a randomized controlled trial.
Source
Journal of cardiothoracic surgery. 20(1) (pp 468), 2025. Date of
Publication: 24 Dec 2025.
Author
Zhu D.; Han Y.; Zhou X.; Wang Z.; Sun B.; Shi H.; Zhao Y.
Institution
(Zhu, Zhou, Wang, Sun) Department of Anesthesiology, Perioperative and
Pain Medicine, Nanjing First Hospital, Nanjing Medical University,
Nanjing, Jiangsu, China
(Han) Department of Anesthesiology, Children's Hospital of Jiangnan
University (Wuxi Children's Hospital), Wuxi, Jiangsu, China
(Shi) Department of Anesthesiology, Perioperative and Pain Medicine,
Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu,
China
(Zhao) Department of Anesthesiology, Perioperative and Pain Medicine,
Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu,
China

<102>
Accession Number
649733588
Title
Effects of Intravenous Subanesthetic-Dose Esketamine on Early
Postoperative Pain in Elderly Patients Undergoing Thoracoscopic Lung
Surgery: A Randomized Double-Blind Controlled Trial.
Source
Drug design, development and therapy. 19 (pp 11289-11305), 2025. Date of
Publication: 2025.
Author
Zhao H.; Liu Z.; Zhang Y.; Liu M.; Ning Y.; Gao D.; Hui K.; Ji Q.; Zhang
L.
Institution
(Zhao, Liu, Ning, Gao, Hui, Ji, Zhang) Department of Anesthesiology,
Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing
University, Nanjing, China
(Zhang, Liu) Department of Anesthesiology, Nanjing Jinling Hospital,
Medical College of Nanjing Medical University, Nanjing, China
Abstract
Purpose: Thoracic surgery is one of the postoperative surgical procedures
with the most severe pain. This study aimed to assess whether
intraoperative subanesthetic esketamine could reduce the proportion of
elderly patients experiencing moderate-to-severe pain following
thoracoscopic lung resection. <br/>Patients and Methods: A total of 136
elderly patients undergoing thoracoscopic pulmonary surgery were randomly
assigned to two groups: the esketamine group (0.25 mg/kg loading, 0.25
mg/kg/h infusion) and the control group (received normal saline). The
primary outcome was the proportion of patients experiencing
moderate-to-severe pain on the first postoperative day (POD1), defined as
a Numerical Rating Scale (NRS) pain score >=4 during coughing. The
secondary outcomes were the postoperative Athens Insomnia Scale (AIS),
Hospital Anxiety and Depression Scale (HADS) scores, opioid consumption,
hemodynamics, and adverse events. <br/>Result(s): The primary outcome
incidence was lower in the esketamine group (51.5% [35/68]) than in the
control group (69.1% [47/68]; relative risk [RR], 0.75; 95% confidence
interval [CI], 0.56-0.99; P = 0.035). The proportion of patients with
moderate-to-severe pain in the esketamine group decreased by 25.5%. The
analysis revealed an absolute risk reduction (ARR) of 17.6% and a number
needed to treat (NNT) of 5.7 (rounded to 6). The incidence of
postoperative sleep disturbance (PSD) on POD1 (23.5% vs 44.1%; RR, 0.53;
95% CI, 0.32-0.88; P = 0.011) is lower in patients who receive esketamine.
Compared to the control group, the esketamine group demonstrated lower
HADS scores and reduced opioid consumption, without significant
differences in hemodynamic parameters or an increased incidence of
neuropsychiatric adverse events. <br/>Conclusion(s): This study
demonstrated that intraoperative subanesthetic esketamine reduced the
proportion of moderate-to-severe pain in elderly patients after
thoracoscopic surgery, decreased the incidence of sleep disturbances,
improved anxiety and depression scores, and lowered opioid consumption,
without increasing neuropsychiatric adverse events.<br/>Copyright &#xa9;
2025 Zhao et al.

<103>
Accession Number
2042409072
Title
Impact of intravenous infusion of lidocaine on intrapulmonary shunt and
postoperative cognitive function in patients undergoing one-lung
ventilation.
Source
Advances in Clinical and Experimental Medicine. 34(7) (pp 1139-1144),
2025. Date of Publication: 01 Jul 2025.
Author
Yang D.; Yang Q.; Wang Y.; Liu F.; Xing Z.; Li S.; Zhang J.
Institution
(Yang, Yang, Wang, Liu, Xing, Zhang) Department of Anesthesiology,
Affiliated Hospital of Yangzhou University, China
(Li) Department of Anesthesiology, First People's Hospital Affiliated to
Shanghai Jiaotong University, China
Publisher
Wroclaw Medical University
Abstract
Background. Intravenous infusion of lidocaine as an anesthesia adjuvant
can improve patient outcomes, but its impact on intrapulmonary shunt
during one-lung ventilation (OLV) has not been clarified. Objectives. To
determine the effect of intravenous lidocaine infusion on intrapulmonary
shunt during OLV and postoperative cognitive function in video-assisted
thoracoscopic surgery (VATS). Materials and methods. Sixty patients who
underwent OLV for thoracic surgery were randomized to receive intravenous
infusion of lidocaine (lidocaine group, n = 30) or normal saline (control
group, n = 30) for anesthesia induction. Arterial and venous blood gases
were measured during two-lung ventilation and at 15 and 30 min after OLV
(OLV + 15 and OLV + 30). The Mini-Mental State Examination was
administered before the surgery and at postoperative 12 months to assess
patient cognitive function. Results. No significant difference was found
in intrapulmonary shunt fraction (Qs/Qt) between the lidocaine group and
the control group at OLV + 15 (p = 0.493) and OLV + 30 (p = 0.754). The
lidocaine group used significantly lower doses of propofol and
remifentanil compared to the control group (both p < 0.001). Furthermore,
no significant difference was observed in the incidence of postoperative
cognitive dysfunction between the lidocaine group and the control group at
1 year post-operation (3.3% vs 6.7%, p = 0.554). Conclusions. Intravenous
lidocaine administered in VATS had no significant impact on intrapulmonary
shunt during OLV or postoperative cognitive function. However, it
significantly reduced the doses of anesthetics used during the
surgery.<br/>&#xa9; Copyright by Author(s). This is an article distributed
under the terms of the Creative Commons Attribution 3.0 Unported (CC BY
3.0) (https://creativecommons.org/licenses/by/3.0/)

<104>
[Use Link to view the full text]
Accession Number
649718840
Title
Association of Preoperative Frailty and Postoperative Outcomes in Older
Adults Undergoing Major Cardiac Procedures: A Systematic Review and
Meta-Analysis.
Source
Anesthesia and analgesia. (no pagination), 2025. Date of Publication: 23
Dec 2025.
Author
Thangavelu V.; Bhatia O.; Hasija A.; Rajapakse N.; Yan E.; Saripella A.;
Englesakis M.; Chung F.
Institution
(Thangavelu, Bhatia, Rajapakse, Chung) From the Temerty Faculty of
Medicine, University of Toronto, Toronto, ON, Canada
(Hasija) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, Ontario, Canada
(Yan, Saripella, Chung) Department of Anesthesia and Pain Management,
University of Toronto, Toronto Western Hospital ,University Health
Network, Toronto, ON, Canada
(Yan) Postgraduate PhD Program, Institute of Medical Science, Temerty
Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Englesakis) Library & Information Services, Department of Anesthesia and
Pain Management, University Health Network, Toronto, ON, Canada
Abstract
BACKGROUND: Frailty, characterized by reduced physiological resilience, is
a pivotal risk factor in older adults undergoing major cardiac procedures.
Although previous analyses have linked frailty to adverse surgical
outcomes, knowledge gaps persist due to methodological inconsistency
across frailty tools and limited synthesis of complications such as
delirium, infection, and renal dysfunction. The objective of this
systematic review and meta-analysis is to determine the prevalence of
preoperative frailty in older adults undergoing major cardiac procedures,
and assess its association with postoperative outcomes, including cardiac,
respiratory, renal, infectious, stroke, and bleeding complications,
postoperative delirium, hospital and intensive care unit (ICU) length of
stay, nonhome discharge, hospital readmission, and both 30-day and 1-year
mortality. <br/>METHOD(S): A prespecified protocol was registered with
PROSPERO (CRD#42024574916), following Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase,
and Cochrane databases were searched for English-language studies of
patients undergoing major cardiac procedures, including coronary artery
bypass grafting (CABG), aortic or mitral valve replacement or repair,
transcatheter aortic valve replacement (TAVR), or combined procedures.
Validated frailty instruments (eg, Fried Frailty Phenotype, Clinical
Frailty Scale) were required to determine preoperative frailty, along with
reporting at least 1 postoperative outcome. Noncardiac surgeries, minor
procedures, case reports, and reviews were excluded. Random-effects
meta-analyses generated odds ratio (OR) or standardized mean difference
(SMD) values with 95% confidence intervals (CI). <br/>RESULT(S): Nineteen
studies (n = 11,667; mean +/- SD age 71.9 +/- 8.1 years, 28% female) met
inclusion criteria, spanning North America, Europe, Asia, and Oceania. The
overall prevalence of preoperative frailty was 16.8%. Frailty was
significantly associated with delirium (OR, 4.11; 95% confidence interval
[CI], 2.00-8.45; P <.001), infection (OR, 3.72; 95% CI, 2.27-6.12; P
<.001), renal complications (OR, 2.72; 95% CI, 2.05-3.60; P <.001), and
extended hospital (SMD, 0.69 ; 95% CI, 0.35-1.02; P <.001) and ICU (SMD,
0.72; 95% CI, 0.51-0.94; P <.001) stays. Frailty increased the odds of
30-day (OR, 3.58; 95% CI, 2.16-5.93; P <.001) and 1-year (OR, 2.25; 95%
CI, 1.56-3.25; P <.001) mortality. <br/>CONCLUSION(S): Frailty affects
nearly 1 in 5 older adults requiring major cardiac procedures. Frailty was
significantly associated with adverse postoperative outcomes, including
delirium, infections, renal complications, extended length of stay, and
mortality. As frailty is potentially modifiable, targeted strategies-such
as prehabilitation, nutritional optimization, and enhanced perioperative
monitoring-may improve outcomes. Incorporating routine frailty screening
into standard preoperative practice allows for earlier identification of
high-risk patients, efficient resource allocation, and perioperative care
planning.<br/>Copyright &#xa9; 2025 International Anesthesia Research
Society.

<105>
Accession Number
649728582
Title
A randomised controlled trial comparing of the efficacy and safety of left
lung isolation for minimally invasive direct coronary artery surgery using
video-imaging double-lumen endobronchial tube with a bronchial blocker
paced through a video-imaging single-lumen tracheal tube.
Source
BMC anesthesiology. (no pagination), 2025. Date of Publication: 26 Dec
2025.
Author
Fang Y.; Wang M.; Liu T.; Han P.; Zhao M.; Deng Y.; Shi C.; Han B.; Zhang
J.; Li M.; Ling Y.; Guo X.; Zhou Y.; Han Y.
Institution
(Fang, Wang, Liu, Han, Zhao, Deng, Shi, Han, Zhang, Li, Guo, Zhou, Han)
Department of Anesthesiology, Peking University Third Hospital, Beijing,
China
(Ling) Department of Cardiac Surgery, Peking University Third Hospital,
Beijing, China
Abstract
BACKGROUND AND OBJECTIVES: Minimally invasive coronary artery bypass
grafting (MIDCAB) requires effective left lung isolation, yet evidence
comparing video-imaging single-lumen tracheal tubes with bronchial
blockers (VSLT + BB) and vedio-imaging double-lumen endotracheal tubes
(VDLT) remains limited. This randomized controlled trial aimed to: (1)
quantitatively compare time efficiency for device placement and lung
isolation between VSLT + BB and VDLT; (2) evaluate perioperative airway
complications; and (3) assess differential impacts on postoperative
recovery, including postoperative sore throat, hoarseness, and Quality of
Recovery-15 (QoR-15) scores. <br/>METHOD(S): In this single-blind
randomized controlled trial, 97 MIDCAB patients were allocated to VSLT +
BB or VDLT groups. Primary outcomes were tube positioning time; secondary
outcomes included total intubation time, oxygenation parameters,
hemodynamic variables, and postoperative complications. <br/>RESULT(S):
VDLT exhibited shorter tube positioning time (128 +/- 37 vs. 159 +/- 58 s;
p < 0.001) but longer total intubation time (192 +/- 40 vs. 159 +/- 58 s;
p < 0.001). VSLT + BB demonstrated higher PaO2 at 10-min post-OLV (226.0
vs. 168.0 mmHg; p = 0.035) with lower airway pressures (p < 0.05).
Postoperative sore throat (33% vs. 13%; OR 2.84, 95% CI 1.04, 7.71; p =
0.018) and hoarseness at 48 h (55% vs. 31%; OR 2.45, 95% CI 1.08, 5.59; p
= 0.018) were higher with VDLT. Lung collapse quality, hypoxemia rates,
pulmonary complications, and QoR-15 scores showed no significant
differences (all p > 0.05). <br/>CONCLUSION(S): In MIDCAB surgery, VDLT
demonstrated significantly shorter tube positioning time compared with
VSLT + BB. However, VSLT + BB exhibited shorter total intubation time than
VDLT by avoiding postoperative tube exchange. Both techniques provided
clinically acceptable lung isolation with comparable lung collapse quality
and hypoxemia incidence. VSLT + BB exhibited lower airway pressures and
higher oxygenation indices during early OLV, whereas VDLT was associated
with higher rates of minor airway complications (sore throat, hoarseness).
No significant differences were observed in pulmonary complications,
hemodynamic stability, or recovery quality. TRIAL REGISTRATION:
ChiCTR2300072124, 3/6/2023.<br/>Copyright &#xa9; 2025. The Author(s).

<106>
Accession Number
649676415
Title
PRE-OPERATIVE MODERATE COGNITIVE IMPAIRMENTS AND THEIR IMPORTANCE IN
POSTOPERATIVE COGNITIVE DYSFUNCTION DEVELOPMENT IN POSTCORONARY BYPASS
PATIENTS.
Source
International Journal of Stroke. Conference: 16th World Stroke Congress.
Abu Dhabi . 19(Supplement 1) (pp 117), 2024. Date of Publication: 01 Oct
2024.
Author
Syrova I.; Tarasova I.; Trubnikova O.; Barbarach O.
Institution
(Syrova, Tarasova, Trubnikova, Barbarach) Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Background and Aims: To determine the incidence and risk factors of
postoperative cognitive dysfunction (POCD) after coronary bypass (CABG) in
patients with pre-operative moderate cognitive impairment (MCI).
<br/>Method(s): Up to CABG two groups were formed, consisting of 50
patients with presence and 51 without MCI. Neuropsychological research (12
tests) was conducted up to CABG, on the 10th day and after 1 year. Early
(10 days after surgery) and remote (1 year later) POCD were diagnosed with
a 20% decrease in the rate of 20% of tests. <br/>Result(s): Prior to CABG,
they had a lower level of formation (p=0.03), a lower fraction of the left
ventricle ejection, (p=0.02) and a more severe coronary tract lesion on
the SYNTAX scale, (p=0.01) than patients without MCI. Factors significant
for the development of early POCD were the duration of with
cardiopulmonary bypass (p=0.035) and the severity of multi-organ
insufficiency, rated on the SOFA scale (p=0.04). In persons with
pre-operative MCI, 72% of cases were diagnosed with early POCD, 54% with
remote POCD, and 81% with early POCD. <br/>Conclusion(s): Chronic heart
failure with low rates of left ventricular ejection fraction, severe
coronary artery damage and low levels of education contribute to the
development of MCI in patients with ischemic heart disease.
Pre-operational MCI is not the main cause of POCD. However, its presence
and development in these patients of early POCD contributes to its
retention a year after surgery.

<107>
Accession Number
2041864270
Title
UM, I DON'T THINK THAT SHOULD BE THERE: TRACHEAL BRONCHUS FOUND
INCIDENTALLY IN A 23-YEAR-OLD FEMALE WITH MODERATE PERSISTENT ASTHMA.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A5361-A5362),
2025. Date of Publication: 01 Oct 2025.
Author
Ocomen R.; Khan W.A.; Tamae Kakazu M.A.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Lung Pathology Case Report Posters (G) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
Tracheal bronchus (TB) is a rare anatomic variant where the accessory
bronchus originates directly from the trachea [1]. It occurs in
approximately 0.1-2% of the world population and is associated with other
congenital anomalies [2] [3]. TB is usually found incidentally on Chest
X-ray, CT of Chest, and primarily bronchoscopy. Multi-detector CT with 3D
imaging is the gold-standard in diagnosing tracheobronchial anomaly [4].
There are 3 types of TB classified by approximation of bronchus to the
carina along with the diameter of the distal trachea. The most common
symptoms for TB are cough, chest pain, and shortness of breath [5]. CASE
PRESENTATION: A 23-year-old G1P0 female at 28 weeks pregnant with history
of moderate persistent asthma with exacerbation, nasal polyposis, allergic
rhinitis, COVID infection in 2023 presenting to the ED for 3-week history
of worsening dyspnea and cough. She presented to urgent care eleven days
before arrival and again to the ED three days before arrival for lower
respiratory tract infection, receiving antibiotics both visits. Upon
presentation, the patient was febrile, tachycardic, and on room air. She
was wheezing and had conversational dyspnea. Initial labs were significant
for normal white blood count and positive Influenza A infection. Chest
X-ray showed a focal pulmonary opacity in the right mid lung. Appropriate
treatment was started, however the patient developed acute hypoxic
respiratory failure requiring oxygen upon admission. Computed tomography
angiogram (CTA) thorax was unremarkable for pulmonary embolism. Imaging
notable for tracheal bronchus into the right upper lobe, partial anomalous
venous return with prominent right superior pulmonary vein draining into
the superior vena cava, a branch of the right superior pulmonary vein
abuts the right upper lobe pulmonary artery branch concerning for possible
arteriovenous malformation or close approximation of vessels, dilated main
pulmonary artery, patchy consolidation and ground glass opacity in right
upper lobe, and few opacities in right lower lobe, and mildly dilated
heart. Other notable findings during admission included positive MRSA
nasal PCR and Mycoplasma pneumonia with negative streptococcus/legionella
antigen along with unremarkable MPO, pANCA, and PR3. Prior to discharge,
adult congenital heart disease commended further cardiac imaging after
pregnancy. <br/>DISCUSSION(S): Our patient was found to have Type III TB,
which is less common than Type II but more common than Type I.
Furthermore, she was found to have cardiac anomalies, which is common with
patients with TB [2]. It will be interesting to look at her cardiac MRI to
investigate other cardiac anomalies. At this time, it is unknown whether
the patient's persistent pneumonia was due to complications of TB vs
ineffective treatment of outpatient antibiotics as she had not required ED
visit or hospital admission for recurrent infection or dyspnea since 2007.
Furthermore, it could be possible that her asthma symptoms could be masked
by her TB, although she was diagnosed with childhood asthma.
<br/>CONCLUSION(S): Tracheal bronchus is a rare respiratory tract
anatomical variance usually found incidentally on CT chest and
bronchoscopy with high association with other congenital anomalies and
increase risk for infection. REFERENCE #1: 1) Elfeky, M. (2023, October
22). Tracheal Bronchus <br/> radiology reference article <br/>
radiopaedia.org. Radiopaedia.
https://radiopaedia.org/articles/tracheal-bronchus?lang=us REFERENCE #2:
2) Ruchonnet-Metrailler, I., Taam, R., & Blic, J. (2015, April 20).
Presence of tracheal Bronchus in children undergoing flexible
bronchoscopy. Respiratory Medicine.
https://www.sciencedirect.com/science/article/pii/S095461111500116X#:~:tex
t=Tracheal%20bronchus%20is%20reported%20in,the%20associated%20symptoms%2C%
20or%20malformations. REFERENCE #3: 3) Wong, L., Cheruiyot, I., Santos de
Oliveira, M., Keet, K., Tomaszewski, K., Walocha, J., Tubbs, S., & Henry,
B. (2020, November 4). Congenital anomalies of the tracheobronchial tree:
A meta-analysis and clinical considerations. The Annals of Thoracic
Surgery.
https://www.sciencedirect.com/science/article/abs/pii/S0003497520318543 4)
Winters, R., & Soos, M. (2025, January 19). Tracheal Bronchus. StatPearls
[Internet]. https://www.ncbi.nlm.nih.gov/books/NBK547715/ 5) Lam, K.,
Hoang, L. V., & Anh, L. V. (2022, September 27). Tracheal Bronchus and
associated pathologies detected by multidetector-row computed tomography
in the Vietnamese population. Journal of Clinical Imaging Science.
https://clinicalimagingscience.org/tracheal-bronchus-and-associated-pathol
ogies-detected-by-multidetector-row-computed-tomography-in-the-vietnamese-
population/ DISCLOSURES: No relevant relationships by Wahaaj Khan No
relevant relationships by Robert Ocomen Consultant relationship with
InflaRx Please note: 5/2024. All the honorariums have been donated to
Corewell Health Foundation. Added 02/17/2025 by Maximiliano Tamae Kakazu,
source=Web Response, value=Consulting fee Consultant relationship with
Pfizer Please note: 3/2023. All the honorariums have been donated to
Corewell Health Foundation. Added 02/17/2025 by Maximiliano Tamae Kakazu,
source=Web Response, value=Consulting fee Site PI for VENT AVOID trial
relationship with A-Lung Please note: $1-$1000 by Maximiliano Tamae
Kakazu, value=No direct payment to me Removed 02/23/2025 by Maximiliano
Tamae Kakazu, source=Web Response Expert advice education asthma
relationship with Regeneron Please note: 11/11/21 by Maximiliano Tamae
Kakazu, value=Donated to SH Foundation Removed 02/23/2025 by Maximiliano
Tamae Kakazu, source=Web Response Consultant relationship with InflaRx
Please note: 5/2024 Added 02/23/2025 by Maximiliano Tamae Kakazu,
source=Web Response, value=Donated to Corewell Foundation Advisory
Committee Member relationship with Pfizer Please note: 2/2023 Added
02/23/2025 by Maximiliano Tamae Kakazu, source=Web Response, value=Donated
to Corewell Foundation<br/>Copyright &#xa9; 2025 American College of Chest
Physicians

<108>
Accession Number
2041864837
Title
PROLONGED VV-ECMO FOR BLEOMYCIN-INDUCED ARDS: ENHANCING QUALITY OF LIFE IN
SEVERE PULMONARY TOXICITY.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A3094-A3095),
2025. Date of Publication: 01 Oct 2025.
Author
Yazdi B.; Vazquez C.G.; Yazdi V.; Segar R.; Kalapurakal G.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Critical Care Case Report Posters (T) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
Bleomycin, an antitumor antibiotic for germ cell tumors, carries a risk of
pulmonary toxicity in up to 10% of patients. Major risk factors include
poor renal function, advanced age (>70), stage IV disease, and cumulative
doses >300,000 IU. Management involves discontinuing bleomycin and
assessing lung injury patterns, with glucocorticoids potentially
beneficial in interstitial pneumonitis and diffuse alveolar damage. As
pulmonary toxicity-related mortality is rare, end-stage management remains
unclear. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is a
last-resort therapy for ARDS when mechanical ventilation fails, minimizing
ventilator-induced lung injury, supporting lung healing in reversible
cases, and is can serve as a bridge to transplant. We present a
36-year-old male who developed ARDS due to bleomycin-induced lung injury,
requiring glucocorticoid therapy and VV-ECMO. CASE PRESENTATION: A
36-year-old male with a history of stage III seminoma, treated with
bleomycin, etoposide phosphate, cisplatin (BEP) therapy, recurrent deep
vein thrombosis (DVT) on anticoagulation, chronic kidney disease (CKD)
Stage 3b, BMI 45 with no history of smoking or vaping who initially
presented to the emergency department with shortness of breath. Patient
had completed six chemotherapy cycles with BEP therapy, combined bleomycin
dosage was unknown. CT scan revealed diffuse ground-glass opacities with
dense peripheral infiltrates, raising concern for bleomycin-induced
pneumonitis which likely had progressed to fibrosis. Empiric steroids were
initiated, and the patient was placed on bilevel positive airway pressure
(BIPAP) subsequently requiring intubation with inhaled nitric oxide due to
persistent hypoxia and hypercapnia. Bedside bronchoscopy with lavage was
negative for infection. Patient continued to decompensate, and
cardiovascular surgery was consulted for VV-ECMO for persistent hypoxemia.
The patient was not a transplant candidate due to CKD progressing to ESRD.
After initiation of VV-ECMO, the patient was able to be extubated and
communicate with family. He was fully extubated for roughly 6 months while
on VV-ECMO and was able to express wish to change code status until he
expired from likely PEA arrest. <br/>DISCUSSION(S): VV-ECMO is a
last-resort therapy for ARDS when mechanical ventilation fails to provide
adequate gas exchange. It minimizes ventilator-induced lung injury,
supports lung healing in reversible cases, and can serve as a bridge to
transplant. Patients can be extubated and communicate while on VV-ECMO.
Randomized Control Trials (CESAR, EOLIA) did not strongly support VV-ECMO
over mechanical ventilation for mortality benefit in severe ARDS, though
CESAR showed improved quality-adjusted life years. Average duration of
VV-ECMO is typically 10 days which is in contrast to the roughly 6 months
duration in this case. In our case, prolonged VV-ECMO increased
ventilator-free days, improving this patient's quality of life. However,
VV-ECMO carries risks, including device failure, renal failure, emboli,
cardiac arrest, bleeding, and infection. Bacteremia is common, requiring
prolonged antibiotics. Despite these risks, ECMO was likely
life-prolonging in this case and consideration is reasonable. By using
ECMO, the patient was able to be extubated and communicate with family and
health team members. <br/>CONCLUSION(S): Prolonged ECMO may improve
quality of life in critically ill patients by increasing ventilator-free
days, facilitating extubation, and enabling communication, allowing for
informed decision-making and end-of-life discussions. REFERENCE #1: Combes
A, Hajage D, Capellier G, et al; EOLIA Trial Group, REVA, and ECMONet.
Extracorporeal membrane oxygenation for severe acute respiratory distress
syndrome. N Engl J Med. 2018;378(21):1965-1975. doi:10.1056/NEJMoa1800385.
O'Sullivan JM, Huddart RA, Norman AR, et al. Predicting the risk of
bleomycin lung toxicity in patients with germ-cell tumours. Ann Oncol.
2003;14(1):91-96. doi:10.1093/annonc/mdg020. Peek GJ, Mugford M,
Tiruvoipati R, et al; CESAR Trial Collaboration. Efficacy and economic
assessment of conventional ventilatory support versus extracorporeal
membrane oxygenation for severe adult respiratory failure (CESAR): a
multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-1363.
doi:10.1016/S0140-6736(09)61069-2. REFERENCE #2: Posluszny J, Rycus PT,
Bartlett RH, et al; ELSO Member Centers. Outcome of adult respiratory
failure patients receiving prolonged (>=14 days) ECMO. Ann Surg.
2016;263(3):573-581. doi:10.1097/SLA.0000000000001176. Roncolato FT,
Chatfield M, Houghton B, et al. The effect of pulmonary function testing
on bleomycin dosing in germ cell tumours. Intern Med J.
2016;46(8):893-898. doi:10.1111/imj.13158. REFERENCE #3: Sleijfer S.
Bleomycin-induced pneumonitis. Chest. 2001;120(2):617-624.
doi:10.1378/chest.120.2.617Zangrillo A, Landoni G, Biondi-Zoccai G, et al.
A meta-analysis of complications and mortality of extracorporeal membrane
oxygenation. Crit Care Resusc. 2013;15(3):172-178. PMID: 23944202.
DISCLOSURES: No relevant relationships by Carolina Gonzalez Vazquez No
relevant relationships by George Kalapurakal No relevant relationships by
Rachel Segar No relevant relationships by Bayan Yazdi No relevant
relationships by Vahid Yazdi<br/>Copyright &#xa9; 2025 American College of
Chest Physicians

<109>
Accession Number
649676616
Title
INFLUENZA VACCINATION STRATEGY TO PREVENT STROKE IN HIGH-RISK SUBJECTS: A
PRESPECIFIED ANALYSIS OF THE VIP-ACS TRIAL.
Source
International Journal of Stroke. Conference: 16th World Stroke Congress.
Abu Dhabi . 19(Supplement 1) (pp 17), 2024. Date of Publication: 01 Oct
2024.
Author
Silva G.; Monfardini F.; Rizzo L.; Berwanger O.; Fonseca H.
Institution
(Silva, Monfardini, Rizzo, Fonseca) Hospital Israelita Albert Einstein,
Sao Paulo, Brazil
(Berwanger) George Institute, London, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background and Aims: In-hospital double-dose influenza vaccination failed
to improve major cardiovascular events (MACE) in patients with acute
coronary syndrome compared to standard-dose vaccination. The impact of the
higher-dose regime in patients with previous stroke, however, remains
uncertain. This study is a prespecified analysis of the Vaccine against
Influenza to Avoid Cardiovascular Events after the Acute Coronary Syndrome
(VIP-ACS) trial. <br/>Method(s): The VIP-ACS trial was a randomized,
pragmatic, multicenter, open-label trial with blinded-adjudication
endpoints. Adult patients admitted due to ACS and hospitalized for 7 days
were randomized to an in-hospital double-dose quadrivalent inactivated
influenza vaccine or a standard-dose vaccine at 30 days
post-randomization. The primary outcome was a hierarchical composite of
death, myocardial infarction, stroke, unstable angina, hospitalization for
heart failure, urgent coronary revascularization, and hospitalization for
respiratory causes, analyzed by the win ratio method. The key secondary
outcome was a hierarchical composite consisting of CV death, MI, and
stroke (MACE). Patients were followed for 12 months each influenza season.
<br/>Result(s): The original trial enrolled 1,801 patients were enrolled
between July 2019 and November 2020, from whom 67 patients had a history
of stroke. Mean age was 56.7 (49.4 - 63.1) years; 70% were male. In these
patients, the double-dose vaccination was significantly better for the
primary composite outcome (WR:2.61; 95% CI:1.09-6.25; P=0.03) as well as
for MACE (WR:3.01; 95%CI:1.15-7.87; P=0.02, double-dose vaccination 41.3%
wins vs 13.7% wins in standard-dose group). <br/>Conclusion(s): After an
ACS, in-hospital double-dose influenza vaccination prevented
hospitalizations and death compared with standard-dose vaccination at 12
months in individuals with previous stroke.

<110>
Accession Number
2041864442
Title
A CASE OF CARDIAC TUMOR WITH PULMONARY ARTERY EXTENSION DIAGNOSED WITH
ENDOBRONCHIAL ULTRASOUND-GUIDED BIOPSY.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A5981-A5982),
2025. Date of Publication: 01 Oct 2025.
Author
Moran J.; Anani A.R.; Alshami T.A.L.A.; Boer B.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Endobronchial Ultrasound SESSION TYPE: Rapid Fire Case
Reports PRESENTED ON: 10/20/2025 02:35 pm - 03:05 pm INTRODUCTION:
Endobronchial ultrasound-guided transbronchial needle aspiration
(EBUS-TBNA) is a standard technique for diagnosing mediastinal and hilar
tumors. However, its role in diagnosing cardiac tumors or those involving
large mediastinal vessels is rarely explored, with only few cases reported
in literature. Below, we present a case of a cardiac tumor with right
pulmonary artery involvement successfully diagnosed through EBUS-TBNA.
CASE PRESENTATION: A 70-year-old male with a history of renal cell
carcinoma (RCC), status post left nephrectomy 24 years ago, presented with
exertional shortness of breath and chest and neck pain for the past two
weeks. A CT chest revealed a large mediastinal mass measuring 8.3 cm in
diameter, involving the right pulmonary artery and pericardium. Positron
emission tomography (PET) scanning confirmed the mass, demonstrating
increased metabolic activity with a standardized uptake value (SUV) of
4.4, though no extra-thoracic metastases were identified. Brain magnetic
resonance imaging (MRI) was negative for metastatic involvement.
Additionally, a cardiac echocardiogram showed a large pericardial
effusion.Endobronchial ultrasound-guided transbronchial fine needle
aspiration (EBUS-TBNA) was performed, targeting the mass in the
intrapulmonary artery and obtaining transpulmonary intracardiac samples.
The pathology report revealed chondromyxoid stroma with spindle cells and
extensive necrosis. The differential diagnosis included hamartoma, myxoid
liposarcoma, fibromyxoid sarcoma, primary pulmonary myxoid sarcoma,
extra-axial myxoid chondrosarcoma, and renal cell carcinoma with
sarcomatoid transformation.The patient also underwent pericardiocentesis,
during which 480cc of hemorrhagic pericardial fluid was drained, although
cytology was negative. A pericardial drain was placed for two days before
removal. After a comprehensive multidisciplinary team discussion, the
consensus was to proceed with radiation therapy as the next step in the
management of the patient's condition. <br/>DISCUSSION(S): Mediastinal
tumors often involve intracardiac structures and major mediastinal
vessels, such as the pulmonary arteries. EBUS-TBNA proves valuable in
assessing lesions within the pulmonary artery. A systematic review of 12
cases demonstrated a diagnostic yield in 9 of 10 cases, with sarcoma as
the predominant diagnosis. Mehta et al.'s review of trans- and
intrapulmonary EBUS-TBNA in 10 patients showed adequate samples in all
cases, achieving diagnosis in 9, with no complications. Fohlch et al.
noted that the risk of bleeding during EBUS-TBNA of the transpulmonary
artery is minimal, likely due to the low-pressure system. However, this
procedure should be performed by skilled pulmonologists in select cases
unsuitable for VATS or Chamberlain procedures.Finally, Color flow can be a
useful tool intraoperatively to assess blood flow. In our case, there was
no distal flow noted in the right pulmonary artery due to complete
occlusion by the tumor. <br/>CONCLUSION(S): EBUS-TBNA can be a useful
modality for diagnosing mediastinal tumors with cardiac involvement and/or
extension into major mediastinal vessels such as the pulmonary arteries in
highly selected cases. REFERENCE #1: . Al-Saffar, F., Ibrahim, S., Seeram,
V., Bajwa, A. A., & Shujaat, A. (2015). Use of endobronchial ultrasound to
evaluate nonthrombotic endovascular lesions in pulmonary arteries. Journal
of Bronchology & Interventional Pulmonology, 22(1), 28-32.
https://doi.org/10.1097/lbr.0000000000000133 REFERENCE #2: . Folch, E.,
Santacruz, J. F., Fernandez-Bussy, S., Gangadharan, S., Kent, M. S.,
Jantz, M., Stather, D. R., Machuzak, M. S., Gildea, T. R., & Majid, A.
(2016). The feasibility of EBUS-guided TBNA through the pulmonary artery
in highly selected patients. Journal of Bronchology & Interventional
Pulmonology, 23(1), 7-13. https://doi.org/10.1097/lbr.0000000000000245
REFERENCE #3: . Mehta, R. M., Biraris, P. R., Pattabhiraman, V.,
Srinivasan, A., Singla, A., Kumar, S., & Cutaia, M. (2018). Defining
expanded areas in EBUS sampling: EBUS guided trans- and intra-pulmonary
artery needle aspiration, with review of transvascular EBUS. The Clinical
Respiratory Journal, 12(5), 1958-1963. https://doi.org/10.1111/crj.12764
DISCLOSURES: No relevant relationships by Tala Alshami No relevant
relationships by Abedel Rahman Anani Proctor, train other physicians
relationship with Intuitive Surgical Please note: ongoing Added 02/26/2025
by Brian Boer, source=Web Response, value=Consulting fee No relevant
relationships by Joseph Moran<br/>Copyright &#xa9; 2025 American College
of Chest Physicians

<111>
Accession Number
2041864617
Title
PULMONARY TRIPLE THREAT: A RARE CASE OF PULMONARY MUCORMYCOSIS COINFECTION
WITH ASPERGILLUS AND MSSA IN AN UNCONTROLLED DIABETIC LEADING TO EXTENSIVE
CAVITARY PNEUMONIA.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1317-A1318),
2025. Date of Publication: 01 Oct 2025.
Author
Lavine R.O.S.S.; Byers M.; Ward R.Y.A.N.; Nguyen B.; Chen D.; Guy E.S.;
Purvesh P.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Report Posters (M) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/21/2025 10:20 am - 11:05 am INTRODUCTION:
Pulmonary mucormycosis co-infection with aspergillus is rarely seen except
in severely immunocompromised individuals. Additionally, among diabetics,
rhino-orbital-cerebral mucormycosis (ROCM) is the most common presentation
whereas lung involvement is uncommon. This case highlights a rare
occurrence of triple infection with Mucor, Aspergillus and Staphylococcus
Aureus with extensive lung destruction. CASE PRESENTATION: A 50-year-old
man with poorly controlled diabetes presented with 8 days of progressive
chest pain, shortness of breath, and occasional hemoptysis. On initial
evaluation, he was septic and hypoxic on room air. Laboratory evaluation
demonstrated leukocytosis, hemoglobin A1c of 14.1 and diabetic
ketoacidosis. Chest x-ray (CXR) and computed tomography (CT) imaging of
the chest showed a large lingular cavitary lesion, multifocal
consolidations and early cavitary lesions in the right middle and lower
lobes (Figure 1). Sputum samples were collected and he was started on
cefepime and doxycycline. Later that day, he developed respiratory failure
and quickly required intubation and mechanical ventilation with subsequent
bilateral pneumothoraces and bilateral chest tube placement. Bronchoscopy
showed necrotic mucosa in the right middle lobe (Figure 3). Due to the
necrosis and known uncontrolled diabetes, there was concern for pulmonary
mucormycosis and empiric liposomal amphotericin B was started. Initial BAL
cultures grew methicillin sensitive staphylococcus aureus and
antimicrobials were narrowed to appropriate coverage and liposomal
amphotericin B stopped. On hospital day 7 the BAL cultures grew Rhizomucor
and liposomal amphotericin B was restarted. Later in the hospital course,
the respiratory culture also grew aspergillus species. One week later, CT
chest showed dramatic progression of bilateral consolidations and
cavitations overtaking most of the pulmonary parenchyma (Figure 2).
Surgical resection was not recommended by Cardiothoracic Surgery.
<br/>DISCUSSION(S): Mucormycosis can be classified based on anatomic
localization: ROCM, pulmonary, cutaneous, gastrointestinal, disseminated,
and mucormycosis of uncommon sites. ROCM is the most common presentation
in diabetics; lung involvement is uncommon. Approximately 50% of pulmonary
mucormycosis presents with bacterial co-infection. Co-infection of Mucor
species and Aspergillus is typically seen in severely immunocompromised
patients. If the suspicion for mucor is high, even if initial cultures
grow bacteria, one should consider continuing amphotericin B until fungal
cultures are negative. Diagnosis relies on histopathology and culture.
Blood tests are of limited diagnostic value as blood cultures are often
negative even in disseminated disease. Lipid formulations of amphotericin
B (LFAB) are considered first line therapy but newer triazoles
(posaconazole, isavuconazole) may be effective in patients refractory or
intolerant of LFAB. A case report described the use of bronchoscopic
pulmonary infusion of amphotericin B with rapid resolution of pulmonary
mucormycosis and multiple cavitary lesions refractory to resection and
antifungal treatment. Surgical resection can be definitive treatment if
the infection is lobar. One case report described multifocal resection in
a transplant patient. Given the rarity of this condition, there aren't any
large randomized controlled trials to help guide treatment and more
research is needed for this life-threatening condition.
<br/>CONCLUSION(S): Clinicians should maintain high index of suspicion of
pulmonary mucormycosis in patients presenting with rapidly progressing
cavitary pneumonia in immunocompromised individuals despite the presence
of co-infection with other microbial species. REFERENCE #1: Corzo Leon DE,
Ahumada-Topete VH, Ostrosky-Zeichner L. Bacterial co-infections in
mucormycosis in severely ill populations: an overlooked and complex
challenge. Access Microbiol. 2024 Nov 12;6(11):000850.v4. doi:
10.1099/acmi.0.000850.v4. PMID: 39534303; PMCID: PMC11556431. REFERENCE
#2: Ling FX, Qu DM, Lu YQ, Li R, Zhao L. Successful treatment of mixed
pulmonary Aspergillus and Mucor infection using intrabronchial
amphotericin B infusion: a case report and literature review. BMC Pulm
Med. 2024 Sep 4;24(1):436. doi: 10.1186/s12890-024-03234-z. PMID:
39232717; PMCID: PMC11373109. REFERENCE #3: Ravindra CM, Rajaram M,
Madhusmita M, ChToi P, Sneha L. Pulmonary Aspergillus and Mucor
Co-Infection: A report of two cases. Sultan Qaboos Univ Med J. 2021
Aug;21(3):495-498. doi: 10.18295/squmj.8.2021.126. Epub 2021 Aug 29.
Erratum in: Sultan Qaboos Univ Med J. 2022 Nov;22(4):597. doi:
10.18295/squmj.9.2022.054. PMID: 34522421; PMCID: PMC8407904. DISCLOSURES:
No relevant relationships by Michelle Byers No relevant relationships by
Derek Chen No relevant relationships by Elizabeth Guy No relevant
relationships by Ross Lavine No relevant relationships by Bryan Nguyen No
relevant relationships by Patel Purvesh No relevant relationships by Ryan
Ward<br/>Copyright &#xa9; 2025 American College of Chest Physicians

<112>
Accession Number
649685018
Title
Reply to the editor: The role of acute normovolemic hemodilution and
retrograde autologous priming in reducing intraoperative packed red blood
cell transfusion needs in coronary artery bypass surgery: A randomized
controlled trial.
Source
Perfusion. (pp 2676591251412715), 2025. Date of Publication: 24 Dec 2025.
Author
Labanca R.; Bonizzoni M.A.; Ajello V.
Institution
(Labanca, Bonizzoni) Department of Anesthesia and Intensive Care, IRCCS
San Raffaele Scientific Institute, Milan, Italy
(Ajello) Department of Cardiothoracic Anesthesia, University Hospital Tor
Vergata, Rome, Italy

<113>
Accession Number
2042440194
Title
Apolipoprotein B/LDL-C discordance and lipoprotein(a) as predictors of
ASCVD risk in genetically confirmed heterozygous familial
hypercholesterolemia (HeFH): A Retrospective Cohort Study (2005-2023).
Source
Atherosclerosis Plus. Conference: Atherosclerosis Plus. Glasgow United
Kingdom. 62(Supplement) (pp 3-4), 2025. Date of Publication: 01 Dec 2025.
Author
Genedy N.; Zouwail S.A.
Institution
(Genedy, Zouwail) Department of Metabolic medicine, University Hospital of
Wales, Cardiff, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Predicting ASCVD in familial hypercholesterolemia (FH)
patients remains challenging despite effective LDL cholesterol (LDL-C)
management. This study investigates whether lipoprotein(a) levels and
ApoB/LDL-C discordance improve ASCVD risk prediction in genetically
confirmed FH patients. <br/>Method(s): A retrospective study included 425
FH mutation-positive patients (LDLR, APOB, PCSK9) and 1,210
mutation-negative controls in South Wales. Lp(a) was measured in nmol/L,
and LDL-C calculated using the Friedwald equation. ApoB/LDL-C discordance
was assessed via regression analysis. ROC curve analysis established
optimal Lp(a) (158 nmol/L) and ApoB/LDL-C discordance thresholds. ASCVD
outcomes included myocardial infarction, stroke, coronary
revascularization, and peripheral vascular disease, age-adjusted and
analyzed by logistic regression and Kaplan-Meier survival curves.
<br/>Result(s): Elevated Lp(a) (>158 nmol/L) significantly predicted ASCVD
independently (sensitivity 75%, specificity 68%, AUC=0.72). ApoB/LDL-C
discordance similarly enhanced ASCVD prediction beyond LDL-C reduction
alone. Significant residual ASCVD risk persisted despite LDL-C reductions
>=50%. Kaplan-Meier curves demonstrated improved risk stratification by
incorporating Lp(a) and ApoB discordance beyond LDL-C alone. [Formula
presented] <br/>Conclusion(s): Including Lp(a) and ApoB/LDL-C discordance
markedly improves ASCVD risk prediction in FH patients beyond LDL-C alone.
These biomarkers should be routinely assessed to optimize cardiovascular
risk management in clinical FH care. References:* McGowan, M.P., Dehkordi,
S.H.H., Moriarty, P.M. & Duell, P.B. (2019) Diagnosis and treatment of
heterozygous familial hypercholesterolemia. Journal of the American Heart
Association, 8(24), p.e013225. * Reiner, Z., Catapano, A.L., De Backer,
G., Graham, I., Taskinen, M.R., Wiklund, O., Agewall, S., Alegria, E.,
Chapman, M.J., Durrington, P. & Erdine, S. (2011) ESC/EAS guidelines for
the management of dyslipidaemias. European Heart Journal, 32(14),
pp.1769-1818. * Sayed, A., Peterson, E.D., Virani, S.S. et al. (2024)
Individual variation in the distribution of apolipoprotein B levels across
the spectrum of LDL-C or Non-HDL-C Levels. JAMA Cardiology, 9(8),
pp.741-747. * Marston, N.A., Giugliano, R.P., Melloni, G.E.M. et al.
(2022) Association of apolipoprotein B-containing lipoproteins and risk of
myocardial infarction in individuals with and without atherosclerosis:
distinguishing between particle concentration, type, and content. JAMA
Cardiology, 7(3), pp.250-256. * Pencina, M.J., D'Agostino, R.B.,
Zdrojewski, T. et al. (2015) Apolipoprotein B improves risk assessment of
future coronary heart disease in the Framingham Heart Study beyond LDL-C
and non-HDL-C. European Journal of Preventive Cardiology, 22(10),
pp.1321-1327. * Benn, M., Nordestgaard, B.G., Jensen, G.B. &
Tybjaerg-Hansen, A. (2007) Improving prediction of ischemic cardiovascular
disease using apolipoprotein B: the Copenhagen City Heart Study.
Arteriosclerosis, Thrombosis, and Vascular Biology, 27(3), pp.661-670. *
Sniderman, A.D., Williams, K., Contois, J.H. et al. (2011) A meta-analysis
of low-density lipoprotein cholesterol, non-high-density lipoprotein
cholesterol, and apolipoprotein B as markers of cardiovascular risk.
Circulation: Cardiovascular Quality and Outcomes, 4(3), pp.337-345. *
Mora, S., Buring, J.E. & Ridker, P.M. (2014) Discordance of low-density
lipoprotein cholesterol with alternative LDL-related measures and future
coronary events. Circulation, 129(5), pp.553-561. * Grundy, S.M., Stone,
N.J., Bailey, A.L. et al. (2019) 2018
AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the
management of blood cholesterol. Circulation, 139(25),
pp.e1082-e1143.<br/>Copyright &#xa9; 2025

<114>
Accession Number
2041864554
Title
THORACIC ENDOMETRIOSIS: A RARE CAUSE OF RECURRENT PLEURAL EFFUSION.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A4263), 2025.
Date of Publication: 01 Oct 2025.
Author
Koyani B.; Mendpara A.; Kotadiya S.M.I.T.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Disorders of the Mediastinum and Pleura Global Case Report
Posters SESSION TYPE: Global Case Report Posters PRESENTED ON: 10/21/2025
01:45 pm - 02:30 pm INTRODUCTION: Thoracic endometriosis is a rare and
often misdiagnosed condition, characterized by the presence of endometrial
tissue in the thoracic cavity. It can manifest with a range of symptoms,
including recurrent pleural effusion, pneumothorax, and hemoptysis. We
report a case of thoracic endometriosis presenting with recurrent pleural
effusion, highlighting the diagnostic challenges and management options.
CASE PRESENTATION: A 32-year-old woman presented with a 2-year history of
recurrent right-sided pleural effusion, coinciding with her menstrual
cycle. She had undergone multiple thoracocenteses and was treated with
antibiotics and anti-inflammatory medications, with no resolution of
symptoms. Imaging studies, including chest radiograph and computed
tomography (CT) scan, revealed a large, right-sided pleural effusion with
associated nodular pleural thickening. Video-assisted thoracic surgery
(VATS) was performed, and histopathological examination of the pleural
biopsy revealed endometrial tissue, confirming the diagnosis of thoracic
endometriosis. <br/>DISCUSSION(S): Thoracic endometriosis is a rare
condition, with an estimated incidence of 1-5% among women with
endometriosis. The diagnosis is often delayed due to its non-specific
symptoms and the rarity of the condition. In this case, the patient's
symptoms were initially attributed to other causes, and it was only after
multiple investigations and surgical intervention that the diagnosis of
thoracic endometriosis was made. Management options for thoracic
endometriosis include hormonal therapy, surgery, and a combination of
both. <br/>CONCLUSION(S): Thoracic endometriosis is a rare cause of
recurrent pleural effusion, and its diagnosis requires a high index of
suspicion. A multidisciplinary approach, including gynecology, thoracic
surgery, and radiology, is essential for accurate diagnosis and effective
management. This case highlights the importance of considering thoracic
endometriosis in the differential diagnosis of recurrent pleural effusion
in women of reproductive age. REFERENCE #1: Joseph J, Sahn SA. Thoracic
endometriosis: a case report and review of the literature. Respiration.
2013;85(3):261-265. doi: 10.1159/000342205 REFERENCE #2: Alifano M,
Trisolini R, Cancellieri A, et al. Thoracic endometriosis: a systematic
review. J Thorac Dis. 2018;10(3):1726-1734. doi: 10.21037/jtd.2018.02.44.
REFERENCE #3: Chang CY, Chen CP, Hung SH, et al. Thoracic endometriosis: a
case report and review of the literature. J Clin Ultrasound.
2017;45(6):351-355. doi: 10.1002/jcu.22444 DISCLOSURES: No relevant
relationships by SMIT KOTADIYA No relevant relationships by Brijesh Koyani
No relevant relationships by Avani Mendpara<br/>Copyright &#xa9; 2025
American College of Chest Physicians

<115>
Accession Number
2041864281
Title
AN UNCOMMON CAUSE OF PERICARDIAL EFFUSION: VANCOMYCIN-RESISTANT
ENTEROCOCCUS FAECALIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A1827-A1828),
2025. Date of Publication: 01 Oct 2025.
Author
Greef D.D.; Perez P.H.; Blogg J.; Patel K.; Lee G.I.N.A.; Chandrasekaran
N.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Chest Infections Case Report Posters (R) SESSION TYPE: Case
Report Posters PRESENTED ON: 10/22/2025 12:30 pm - 01:15 pm INTRODUCTION:
Pericardial effusion occurs when fluid accumulates in the fibroelastic sac
surrounding the heart. Common causes of pericardial effusions include
viral infections, malignancy, renal failure with uremia, and autoimmune
disorders; however, bacterial causes are rare. We present an unusual case
of pericardial effusion caused by Vancomycin-resistant Enterococcus (VRE)
faecalis. CASE PRESENTATION: A middle-aged male with a history of type 2
diabetes, ESRD on hemodialysis, atrial fibrillation, STEMI, bullous
pemphigoid, and multiple prior strokes with left-sided hemiparesis and
dysphagia presented with hyperglycemia while completing a course of oral
corticosteroids. The hospital course was complicated by acute hypoxic
respiratory failure, requiring intubation and transfer to the intensive
care unit. CT chest showed multifocal loculated bilateral pleural
effusions and a moderate-to-large pericardial effusion without signs of
tamponade or hemodynamic instability. He underwent a pericardial window,
bilateral lung decortication, and thoracostomy tube placement. Pericardial
fluid came back positive for VRE faecium. Cytology was negative for
malignancy in both pleural and pericardial samples. The patient also
underwent bronchoscopy, which revealed minimal secretions in the right
lung and copious bloody mucoid secretions in the left lung. BAL cultures
grew Methicillin-resistant staphylococcus aureus (MRSA) in the right lower
lobe and VRE in the left lower lobe. The patient was treated with
broad-spectrum IV antibiotics. Autoimmune and infectious workup (including
HIV, tuberculosis, P. jirovecii, and Strongyloides) were negative. The
patient was initially unable to be extubated, requiring a tracheostomy and
PEG tube. Over time, he was weaned to a T-piece, showed improvement, and
was discharged to a long-term acute care hospital. <br/>DISCUSSION(S): The
etiology of pericardial effusions includes malignancy, uremia, autoimmune
diseases, and infections. Bacterial causes of pericardial effusions are
relatively rare, with the most common culprits being Staphylococcus
aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis. It is
highly unusual for VRE pericardial effusion to occur, as this organism is
typically a gastrointestinal commensal. However, it can act as an
opportunistic pathogen in immunocompromised individuals, particularly
those with chronic illnesses, prolonged hospital stays, and a history of
extensive broad-spectrum antibiotic use. In our patient, the detection of
VRE faecium in the pericardial effusion, along with the presence of a
concurrent pulmonary infection, raises the possibility of contiguous
spread. ESRD, chronic corticosteroid use and frequent contact with
healthcare settings likely increased his risk of acquiring this atypical
infection. The successful management of bacterial pericardial effusion
involves early diagnosis, prompt drainage of the pericardial space, and
targeted antimicrobial therapy. A delay in diagnosis can lead to
life-threatening complications such as cardiac tamponade and constrictive
pericarditis. Linezolid or daptomycin is the preferred treatment for VRE
infection, as Enterococcus faecium is inherently resistant to vancomycin
and other antibiotics, which further complicates treatment. Additionally,
if direct pulmonary extension is suspected, as was the case here,
linezolid should be chosen over daptomycin since the latter is inactivated
by surfactant in the lungs. <br/>CONCLUSION(S): VRE as a cause of
pericardial effusion is extremely rare. Clinicians should maintain a high
level of suspicion in immunocompromised patients, particularly those with
ESRD, corticosteroid use, or recent hospitalizations involving multi-drug
resistant organisms. REFERENCE #1: Pankuweit, S., Ristic, A. D.,
Seferovic, P. M., & Maisch, B. (2005). Bacterial pericarditis: diagnosis
and management. American journal of cardiovascular drugs : drugs, devices,
and other interventions, 5(2), 103-112.
https://doi.org/10.2165/00129784-200505020-00004Arias CA, Murray BE. The
rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol.
2012;10(4):266-278. REFERENCE #2: Adler Y, Charron P, Imazio M, et al.
2015 ESC Guidelines for the diagnosis and management of pericardial
diseases. Eur Heart J. 2015;36(42):2921-2964.Sagrista-Sauleda J, Barrabes
JA, Permanyer-Miralda G, Soler-Soler J. Purulent pericarditis: review of a
20-year experience in a general hospital. J Am Coll Cardiol.
1993;22(6):1661-1665. REFERENCE #3: Imazio M, Gaita F, LeWinter M.
Evaluation and treatment of pericarditis: a systematic review. JAMA.
2015;314(14):1498-1506.O'Driscoll T, Crank CW. Vancomycin-resistant
enterococcal infections: epidemiology, clinical manifestations, and
optimal management. Infect Drug Resist. 2015;8:217-230. DISCLOSURES: No
relevant relationships by Jesse Blogg No relevant relationships by Neena
Chandrasekaran No relevant relationships by Danielle De Greef No relevant
relationships by Pedrito Hernandez Perez No relevant relationships by Gina
Lee No relevant relationships by Kaivan Patel<br/>Copyright &#xa9; 2025
American College of Chest Physicians

<116>
Accession Number
2041864633
Title
IMPACT OF ACTIVE CANCER ON MORTALITY AND COMPLICATIONS AFTER TRANSCATHETER
AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Chest. Conference: Official Publication of the American College of Chest
Physicians. Chicago United States. 168(4 Supplement) (pp A250-A251), 2025.
Date of Publication: 01 Oct 2025.
Author
Khawar M.; Ali U.M.A.D.; Jaffar M.S.; Das A.; Qadeer A.; Shah S.A.; Akhlaq
M.A.; Saeed H.; Tayyab M.; Abdullah M.; Cheema B.A.; Pathak P.; Hadeed
Khawar M.M.
Publisher
Elsevier Inc.
Abstract
SESSION TITLE: Cardiothoracic Disorders: The Heart of Chicago SESSION
TYPE: Rapid Fire Original Inv PRESENTED ON: 10/20/2025 10:20 am - 10:50 am
PURPOSE: Patients with active cancer undergoing transcatheter aortic valve
replacement (TAVR) present a unique clinical challenge due to the complex
interplay between cancer-related factors and cardiovascular disease. While
TAVR is an established intervention for high-risk populations, limited
data exist on its safety and outcomes in cancer patients. This systematic
review and meta-analysis aim to evaluate mortality and complication risks
in patients with active cancer undergoing TAVR compared to non-cancer
controls, providing evidence to guide clinical decision-making.
<br/>METHOD(S): A comprehensive systematic search was conducted across
major databases, including PubMed, Embase, OVID, Web of Science, and
Scopus, to identify studies comparing TAVR outcomes between patients with
active cancer and non-cancer controls. Inclusion criteria required studies
that reported clinical outcomes such as mortality, procedural
complications, and post-procedure adverse events. Data were extracted and
pooled using the Mantel-Haenszel method, applying random-effects or
fixed-effects models based on heterogeneity (Higgins I2). Statistical
significance was set at p < 0.05. <br/>RESULT(S): A total of 12 studies,
comprising 573,192 patients (67,684 with active cancer and 505,508 without
cancer), were included in the final analysis. The findings indicate that
patients with active cancer undergoing TAVR experience significantly
higher risks of both early and late all-cause mortality compared to
non-cancer patients. Early all-cause mortality was significantly elevated
(OR 1.31, 95% CI [1.15-1.49], p < 0.0001), while late all-cause mortality
showed an even more pronounced increase (OR 2.24, 95% CI [1.85-2.70], p <
0.0001). Additionally, major bleeding complications were markedly higher
in cancer patients (OR 1.80, 95% CI [1.68-1.92], p < 0.0001), suggesting a
heightened vulnerability to hemorrhagic events post-procedure. However,
there were no significant differences between cancer and non-cancer
patients in cardiovascular mortality (OR 1.33, 95% CI [0.94-1.89], p =
0.11), myocardial infarction (OR 1.60, 95% CI [0.82-3.11], p = 0.17), or
stroke (OR 0.61, 95% CI [0.28-1.35], p = 0.22). Similarly, rates of acute
kidney injury (OR 0.92, 95% CI [0.49-1.73], p = 0.80) and the need for
permanent pacemaker implantation (OR 1.12, 95% CI [0.85-1.48], p = 0.42)
were comparable between groups. These results highlight a critical need
for careful perioperative management and individualized risk assessment in
patients with active cancer undergoing TAVR. <br/>CONCLUSION(S): Patients
with active cancer undergoing TAVR experience significantly increased
risks of short-term and long-term mortality and major bleeding
complications compared to non-cancer patients. However, other
cardiovascular complications, including MI, stroke, AKI, and pacemaker
implantation rates, appear comparable. These findings highlight the need
for careful risk stratification, individualized management strategies, and
further research to optimize outcomes in this vulnerable population.
CLINICAL IMPLICATIONS: Given the increased mortality and bleeding risks,
oncologic status should be incorporated into pre-procedural risk
assessment models for TAVR. The balancing of procedural benefits against
potential complications remains critical. Future studies should explore
cancer-specific risk mitigation strategies, including perioperative
anticoagulation, optimized procedural timing, and tailored post-TAVR
surveillance protocols. DISCLOSURES: No relevant relationships by Muhammad
Abdullah No relevant relationships by Syed Abdullah shah No relevant
relationships by Muhammad Armaghan Akhlaq No relevant relationships by
Umad Ali No disclosure on file for Bilal Asad Cheema No relevant
relationships by Ashesh Das No relevant relationships by Muhammad Soban
Jaffar No relevant relationships by Muneeb Khawar No relevant
relationships by Mirza M Hadeed Khawar No relevant relationships by Mirza
M Hadeed Khawar No relevant relationships by Prutha Pathak No relevant
relationships by Abdul Qadeer No relevant relationships by Hannan Saeed No
relevant relationships by Muhammad Tayyab<br/>Copyright &#xa9; 2025
American College of Chest Physicians

<117>
Accession Number
649682448
Title
Cold stored platelets-are they safe and effective.
Source
Vox Sanguinis. Conference: 38th International Congress of the ISBT.
Barcelona Spain. 119(Supplement 1) (pp 123), 2024. Date of Publication: 01
Jun 2024.
Author
Spinella P.
Institution
(Spinella) University of Pittsburgh, Pittsburgh, United States
Publisher
John Wiley and Sons Inc
Abstract
Platelets for transfusion for the past 50 years have routinely been stored
at room temperature due to improved survival and recovery compared to cold
storage, which was the standard until the early 1970s. It has been known
since that time that a cold stored platelet has improved hemostatic
function compared to room temperature platelets. Despite RCT data from the
1970's indicating superior hemostatic function with cold storage of
platelets, patients who need platelets for bleeding have been recieving
room temperature stored platelets. Recent interest in hemostatic
resuscitation principles for patients with severe bleeding has caused a
reassessment of cold stored platelets for active bleeding. The FDA in the
US has recently provided guidance that cold stored platelets up to 14 days
of storage were permissible for active bleeding. A definitive trial is
also ongoing in the US and Australia to determine the efficacy and safety
of cold stored plateletes in 1000 actively bleeding cardiac surgery
patients (adults and children). This presentation will review the efficacy
and safety data of cold stored plateltes for patients with severe bleeding
and will also summarize the CHIPS trial.

<118>
Accession Number
649681607
Title
Use of intravenous albumin-a guideline from the International
Collaboration for Transfusion Medicine Guidelines.
Source
Vox Sanguinis. Conference: 38th International Congress of the ISBT.
Barcelona Spain. 119(Supplement 1) (pp 274-275), 2024. Date of
Publication: 01 Jun 2024.
Author
Callum J.; Skubas N.; Bathla A.; Keshavarz H.; Clark E.; Rochwerg B.;
Fergusson D.; Arbous S.; Bauer S.; China L.; Fung M.; Jug R.; Neill M.;
Paine C.; Pavenski K.; Shah P.; Robinson S.; Shan H.; Szczepiorkowski Z.;
Thevenot T.; Wu B.; Stanworth S.; Shehata N.
Institution
(Callum) Department of Pathology and Molecular Medicine, Queen's
University and Kingston Health Sciences Centre, Kingston, Canada
(Skubas) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, United States
(Bathla) Canadian Blood Services, Toronto, Canada
(Keshavarz) Canadian Blood Services, Ottawa, Canada
(Clark) Department of Medicine, University of Ottawa, Ottawa, Canada
(Rochwerg) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, Canada
(Fergusson) Ottawa Hospital Research Institute, Ottawa, Canada
(Arbous) Department of Critical Care, Leiden University Medical Center,
Leiden, Netherlands
(Bauer) Department of Pharmacy, Cleveland Clinic, Cleveland, United States
(China) Department of Hepatology and ILDH, Royal Free NHS Trust, London,
United Kingdom
(Fung) Department of Pathology and Laboratory Medicine, University of
Vermont Medical Center, Burlington, United States
(Jug) University of Cincinnati, College of Medicine, Cincinnati, United
States
(Neill) Kingston Health Sciences Centre, Kingston, Canada
(Paine) Department of Medicine, University of Washington, Washington,
United States
(Pavenski) Department of Laboratory Medicine and Pathobiology, University
of Toronto, Toronto, Canada
(Shah) Department of Pediatrics, Institute of Health Policy, Management,
and Evaluation, Mount Sinai Hospital, Toronto, Canada
(Robinson) Department of Clinical Haematology, NHS Guy's and St Thomas,
London, United Kingdom
(Shan) Department of Pathology, Stanford University, School of Medicine,
Stanford, United States
(Szczepiorkowski) Department of Pathology and Laboratory Medicine,
Dartmouth-Hitchcock Medical Center, New Hampshire, United States
(Thevenot) Service d'Hepatologie, Centre Hospitalier Regional et
Universitaire de Besancon, Besancon, France
(Wu) Department of Internal Medicine, Loma Linda University, Loma Linda,
United States
(Stanworth) University of Oxford, Oxford, United Kingdom
(Shehata) Department of Medicine, University of Toronto, Toronto, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Albumin is commonly employed across a wide range of clinical
settings to improve hemodynamics, facilitate fluid removal, and manage
complications of cirrhosis. The International Collaboration for
Transfusion Medicine Guidelines (ICTMG) developed guidelines for the use
of albumin in patients requiring critical care, undergoing cardiovascular
surgery, kidney replacement therapy, or experiencing complications of
cirrhosis. <br/>Aim(s): To develop clinical recommendations on the use of
albumin in patients requiring critical care, undergoing cardiovascular
surgery, kidney replacement therapy, or experiencing complications of
cirrhosis. <br/>Method(s): A guideline development panel was appointed to
facilitate this guideline development process. This included clinicians,
methodologists, subject matter experts, and a patient representative. The
evidence informing this guideline arises from systematic literature
reviews and meta-analyses of randomized clinical trials. The search for
evidence was conducted in multiple databases from inception to November
23, 2022. Analytical framework and PICO (Population, intervention,
comparator, and outcome) questions were developed that focused on
mortality and other clinically important outcomes for adults and pediatric
patients requiring critical care, undergoing cardiovascular surgery,
kidney replacement therapy, or with cirrhosis. The guideline panel
reviewed the evidence and formulated guideline recommendations using the
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
methodology. The guideline also underwent a revision upon public
consultation. <br/>Result(s): The panel formulated 14 recommendations on
the use of albumin. In adult critical care (3 recommendations), neonatal
critical care (2 recommendations), pediatric critical care (1
recommendation), cardiovascular surgery (2 recommendations), kidney
replacement therapy (1 recommendation), and complications of cirrhosis (5
recommendations). Of the 14 recommendations, 2 had moderate certainty of
evidence, 5 had low certainty of evidence, and 7 had very low certainty of
evidence. Two of the 14 recommendations suggested conditional use of
hyperoncotic albumin for patients with cirrhosis undergoing largevolume
paracentesis or with spontaneous bacterial peritonitis. Twelve of 14
recommendations did not suggest transfusing albumin in a wide variety of
clinical situations where it is commonly transfused. Summary /
<br/>Conclusion(s): There are currently few evidence-based indications
that support the routine use of albumin in clinical practice to improve
patient outcomes. This guideline provides clinicians with actionable
recommendations on the use of albumin in patients requiring critical care,
undergoing cardiovascular surgery, kidney replacement therapy, or
experiencing complications of cirrhosis.

<119>
Accession Number
2042069584
Title
Transcatheter Edge-to-Edge Mitral Valve Repair for Severe Regurgitation in
Cardiogenic Shock: A Comprehensive Review.
Source
Journal of Cardiovascular Development and Disease. 12(12) (no pagination),
2025. Article Number: 455. Date of Publication: 01 Dec 2025.
Author
Biswas M.; Katz W.E.; Suffoletto M.; Rhinehart Z.; Smith A.C.; Fowler J.;
Sade L.E.
Institution
(Biswas, Katz, Suffoletto, Rhinehart, Smith, Fowler, Sade) School of
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Biswas, Katz, Suffoletto, Rhinehart, Smith, Fowler, Sade) Department of
Internal Medicine, Division of Cardiology, Heart and Vascular Institute,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Cardiogenic shock is a critical pathological state marked by end-organ
hypoperfusion due to severe cardiac dysfunction and is associated with
high mortality. A substantial portion of patients with cardiogenic shock
have concomitant severe mitral regurgitation (MR), which exacerbates
hemodynamic instability by reducing forward cardiac output and contributes
to pulmonary edema and respiratory failure through regurgitant backflow.
In this high-risk setting, mitral transcatheter edge-to-edge repair
(M-TEER) offers a minimally invasive treatment that can lead to
hemodynamic and symptomatic improvement and potential mortality benefit.
Initially indicated for patients with severe MR at prohibitive surgical
risk, M-TEER is now guideline-supported for both primary and secondary MR
in select populations. Emerging data suggest that M-TEER can reduce heart
failure hospitalizations and improve patient quality of life. As clinical
indications for M-TEER continue to expand, there is growing interest in
the role of M-TEER as a stabilizing intervention in patients with
cardiogenic shock and severe MR. This review aims to synthesize the
current evidence surrounding the use of M-TEER in cardiogenic shock with a
focus on patient selection, procedural and clinical considerations, and
short- and long-term outcomes.<br/>Copyright &#xa9; 2025 by the authors.

<120>
Accession Number
649686081
Title
Effects of Esketamine on Postoperative Cognitive Function in Elderly
Patients Undergoing Pulmonary Lobectomy: A Randomised, Single-Blind
Controlled Clinical Trial.
Source
Actas espanolas de psiquiatria. 53(6) (pp 1320-1331), 2025. Date of
Publication: 01 Dec 2025.
Author
Li X.; Mao H.; Luo J.; Jiang W.; Li P.; Zhou L.; Tian L.; Liu Z.; Qiu Y.
Institution
(Li, Luo, Jiang, Li, Zhou, Qiu) Department of Anesthesiology, West China
Hospital, Sichuan University, Chengdu, Sichuan, China
(Mao) West China School of Medicine, Sichuan University, Chengdu, Sichuan,
China
(Tian, Liu) Lung Cancer Center, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Abstract
BACKGROUND: Elderly patients undergoing pulmonary lobectomy with incision
are at a high risk for postoperative cognitive dysfunction (POCD).
Intraoperative esketamine may offer potential neuroprotective benefits.
This study aimed to evaluate the efficacy of intraoperative esketamine in
reducing the incidence of POCD in elderly patients undergoing pulmonary
lobectomy with incision. <br/>METHOD(S): In this single-blind, controlled
clinical trial, patients (aged 65-75 years) undergoing conventional
pulmonary lobectomy were randomly allocated to receive esketamine (0.3
mg/kg/h) or remifentanil (0.1-0.2 microg/kg/min) during surgery. Cognitive
function was assessed using the mini-mental state examination (MMSE) and
negative emotional scores were recorded at baseline and multiple
postoperative time points. Intraoperative and postoperative parameters,
including heart rate (HR) and mean arterial pressure (MAP), pain scores
and adverse events, were recorded. Blood samples were collected to measure
amyloid-beta (Abeta) and microtubule-associated protein tau (tau)
concentrations. <br/>RESULT(S): No significant difference was found in the
incidence of postoperative delirium between the two groups, but the
esketamine group exhibited a significantly lower incidence of POCD on days
1 and 3 postoperatively than the control group. The esketamine group also
had significantly higher serum Abeta42/40 levels and significantly lower
tau levels on day 1 postoperatively. At the end of surgery, the HR, MAP
and pain visual analogue scale score of the control group were
significantly higher than those of the esketamine group. No significant
differences were observed in terms of adverse events between the two
groups. <br/>CONCLUSION(S): Intraoperative administration of esketamine
(0.3 mg/kg/h) was associated with a lower incidence of POCD and more
stable hemodynamic indicators in elderly patients undergoing thoracic
surgery, without increasing adverse events. The application of esketamine
indicates a possible benefit with a favourable safety profile in reducing
postoperative cognitive decline in this population. TRIAL REGISTRATION:
Chinese Clinical Trial Registry, ChiCTR2200065266.

<121>
Accession Number
2042130258
Title
Intravenous Lidocaine Modulates the Perioperative Hepatic Inflammatory
Response: Implications for Personalized Medicine in Thoracic Surgery.
Source
Journal of Personalized Medicine. 15(12) (no pagination), 2025. Article
Number: 620. Date of Publication: 01 Dec 2025.
Author
Galve A.I.; Garutti I.; Vara E.; Gonzalez G.; Cusati G.; Rancan L.; Huerta
L.; Casanova J.; Simon C.
Institution
(Galve, Garutti, Cusati, Casanova) Anesthesiology Department, Hospital
General Universitario Gregorio Maranon, Madrid, Spain
(Vara, Gonzalez, Rancan) Department of Biochemistry and Molecular Biology
III, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
(Huerta, Simon) Thoracic Surgery Department, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Purpose: Lung resection surgery (LRS) induces a strong local and systemic
inflammatory response that may extend to peripheral organs, including the
liver. This study aimed to evaluate the potential effect of intravenous
lidocaine on hepatic inflammatory and apoptotic responses during lung
resection surgery with one-lung ventilation (OLV) in an experimental
porcine model. <br/>Method(s): Eighteen mini pigs were randomly assigned
to three groups: lidocaine (LIDO), control (CON), and sham (SHAM). Animals
underwent left caudal lobectomy. The LIDO group received a continuous
intravenous infusion of lidocaine (1.5 mg/kg/h) during surgery. The CON
group received the same volume of saline, and the SHAM group underwent
thoracotomy without lobectomy or OLV. Different samples were collected at
baseline, during surgery, and 24 h postoperatively to assess inflammatory
cytokines and apoptosis-related proteins. Liver biopsy was taken 24 h
after de surgery. <br/>Result(s): One-lung ventilation and lung resection
surgery increased the expression of proinflammatory markers in the liver
biopsy and enhanced apoptotic protein expression and iNOS production.
Lidocaine administration attenuated these effects, showing lower levels of
inflammatory mediators, a better balance between iNOS and eNOS, and
reduced apoptotic activity compared with controls. <br/>Conclusion(s): Our
findings suggest that intravenous lidocaine may serve as a personalized
perioperative strategy to attenuate systemic inflammatory and apoptotic
responses, contributing to improved hepatic protection during thoracic
surgery.<br/>Copyright &#xa9; 2025 by the authors.

<122>
Accession Number
2042071850
Title
Does Minimally Invasive Valve Surgery Improve Quality of Life Compared to
Sternotomy? A Systematic Review.
Source
Journal of Clinical Medicine. 14(24) (no pagination), 2025. Article
Number: 8660. Date of Publication: 01 Dec 2025.
Author
Marinescu A.D.; Oprea S.A.; Costache V.S.
Institution
(Marinescu, Oprea) Faculty of Medicine, Doctoral Studies, Titu Maiorescu
University, Bucharest, Romania
(Oprea, Costache) Department of Cardiovascular Surgery, Sanador Hospital,
Bucharest, Romania
(Costache) Faculty of Medicine, Department of Cardiovascular Surgery, Titu
Maiorescu University, Bucharest, Romania
Publisher
Multidisciplinary Digital Publishing Institute (MDPI)
Abstract
Background/Objectives: Minimally invasive valve surgery (MIVS) is
increasingly employed as an alternative to conventional median sternotomy
(MS) in the treatment of valvular heart disease. However, its impact on
postoperative quality of life (QoL) remains incompletely understood. This
systematic review and meta-analysis aimed to compare QoL outcomes between
MIVS and MS, focusing on physical, psychological, and social dimensions,
both in the short- and long-term postoperative periods. <br/>Method(s): A
comprehensive search was conducted in PubMed, Scopus, Web of Science, and
Wiley Online Library databases for studies published between January 2020
and September 2025. Eligible studies included adult patients undergoing
MIVS or MS and assessed QoL using validated instruments (SF-36, EQ-5D,
MLHFQ, KCCQ). Random-effects models were used for meta-analysis, and
standardized mean differences (SMDs) were calculated to estimate pooled
effects. <br/>Result(s): Fifty-six studies with a combined sample of over
10,000 patients were included. MIVS was associated with significantly
better short-term QoL outcomes across physical (SMD = 0.88; 95% CI:
0.74-1.02) and psychological domains (SMD = 0.47; 95% CI: 0.35-0.59).
Patients also experienced earlier social reintegration and improved body
image perception. Although these benefits diminished beyond 12 months,
MIVS maintained a modest but persistent advantage in long-term QoL (>=5
years). Structured psychological support and cardiac rehabilitation
programmes further enhanced physical and emotional recovery.
<br/>Conclusion(s): MIVS confers meaningful benefits in postoperative QoL,
particularly during the early recovery phase. Sustained improvements
depend on comprehensive postoperative care, including rehabilitation and
psychosocial support. Further long-term, standardized research is required
to strengthen evidence and guide patient-centred surgical
decision-making.<br/>Copyright &#xa9; 2025 by the authors.

<123>
Accession Number
649689556
Title
Public Health.
Source
Alzheimer's & dementia : the journal of the Alzheimer's Association.
21(Supplement 6) (pp e097007), 2025. Date of Publication: 01 Dec 2025.
Author
Huang W.W.; Fan S.; Li W.-Y.; Thangavelu V.; Saripella A.; Englesakis M.;
Yan E.; Chung F.
Institution
(Huang) School of Medicine, University of Limerick, Limerick, Munster,
Ireland
(Fan) Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
(Li) University of Toronto, Toronto Western Hospital ,University Health
Network, Toronto, ON, Canada
(Thangavelu, Yan, Chung) Temerty Faculty of Medicine, University of
Toronto, Toronto, ON, Canada
(Saripella, Yan, Chung) Toronto Western Hospital ,University Health
Network, Toronto, ON, Canada
(Englesakis) University Health Network, Toronto, ON, Canada
Abstract
BACKGROUND: The growing number of older persons undergoing surgery are at
a higher risk of neurocognitive disorder due to multimorbidity and
age-related changes. The prevalence of postoperative neurocognitive
disorder in this population requires further investigation. This
systematic review and meta-analysis aims to estimate the pooled prevalence
of perioperative neurocognitive disorder in older non-cardiac surgical
patients. <br/>METHOD(S): A comprehensive search of multiple databases was
conducted from inception to January 24, 2024. This review included studies
of non-cardiac surgical inpatients aged >=60 years old who underwent
perioperative cognitive assessments. The primary outcome was the
prevalence of postoperative neurocognitive disorder or cognitive
dysfunction (POCD). Data were analyzed using a random-effects model to
calculate pooled prevalence rates. Quality assessment employed the
Newcastle-Ottawa Scale and MOOSE guidelines. Meta-regression was performed
with Open Meta Analyst and RStudio 4.3.3. <br/>RESULT(S): Thirty-nine
studies (n = 12,921) were included with mean age of 70.0 +/- 8.9 years and
44.3% women. The overall prevalence of POCD was 23% (95% CI: 20%, 27%) at
day 7, 16% (95% CI: 7%, 25%) at 1 month, 10% (95% CI: 8%, 13%) at 3 months
and 3% (95% CI: 2%, 4%) at 1 year (Figure 1). Our meta-regression showed a
higher prevalence of POCD in abdominal surgery at day 7 (beta = 0.13, 95%
CI: 0.03-0.22, p = 0.01) and 3 months (beta = 0.49, 95% CI: 0.40-0.58, p <
0.001), versus orthopedic surgeries. <br/>CONCLUSION(S): The overall
prevalence of POCD in older non-cardiac surgical populations was 23%, 16%,
10%, and 3% at day 7, 1 month, 3 months, and 1 year, respectively.
Abdominal surgery had a higher prevalence of POCD than orthopedic surgery.
The significant risk of POCD calls for cognitive screening, risk
mitigation and intervention to provide better perioperative care and
improve surgical outcomes.<br/>Copyright &#xa9; 2025 The Alzheimer's
Association. Alzheimer's & Dementia published by Wiley Periodicals LLC on
behalf of Alzheimer's Association.