Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A15645-A15645, November 8, 2022. Introduction:Posterior mediastinal hematoma (PMH) is a rare complication of anti-coagulation (AC) use. We present a complex case of a patient with a sub-massive pulmonary embolism (PE) whose care was complicated by PMH causing airway obstruction following thrombectomy.Case:A 60-year-old male with a history of prostate cancer in remission presented after a syncopal event. On admission, he was afebrile, mildly tachycardic (100bpm), normotensive (135/91), with no oxygen requirement. Laboratory data showed high sensitivity troponin 244 ng/L and BNP 82 pg/ml. CTPA revealed a saddle PE with right heart strain (PESI score 100). He was initiated on anticoagulation and underwent successful mechanical thrombectomy using a Penumbra aspiration catheter. He had acute respiratory failure later that evening, necessitating intubation. Repeat CTPA showed increased clot burden and new onset PMH (Figure 1). Of note, his AC was continued due to clot burden. A repeat thrombectomy was performed using the FlowTriever System Device (Inari Medical, Irvine, CA). Despite this intervention, he continued to struggle with extubation, and a new stridor was noted. Bronchoscopy revealed external compression of proximal trachea correlating with the PMH location. He was deemed too high risk for evacuation of the PMH. Therefore, he underwent tracheostomy to bypass the area of compression. This subsequently allowed for successful extubation.Discussion:While thrombectomy can cause iatrogenic bleeding, no bleeding was seen on the post-procedure angiogram in our patient. Thus, these findings are attributed to PMH. PMH has been reported 6 times in literature (table 1), one associated with PE. Management options include hematoma evacuation or holding AC and performing serial follow up imaging. Our patient did not undergo evacuation of hematoma, and a tracheostomy was used instead to bypass the obstruction. This highlights the need to individualize management of these complex patients.

Circulation, Volume 146, Issue Suppl_1, Page A13952-A13952, November 8, 2022. Introduction:Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality.Hypothesis:We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time.Methods:We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality.Results:Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p

Circulation, Volume 146, Issue Suppl_1, Page A13046-A13046, November 8, 2022. Introduction:Pocket hematoma is a feared complication of cardiac implantable electronic device (CIED) placement. About half the patients undergoing the procedure are on anticoagulation with consequent increased frequency of device-pocket hematoma. The risk of hematoma is variable based on the type of anticoagulation therapy. The purpose of this study was to compare the risk of device-hematoma in patients oninterruptednovel oral anticoagulants (NOAC) versusuninterruptedvitamin K antagonists (VKA) during the peri-operative period.Methods:We performed a meta-analysis using electronic literature search to retrieve studies with CIED surgery on uninterrupted VKA versus interrupted NOAC (range 12-96 hours). Primary outcome of interest was pocket-hematoma. Outcomes were pooled under random-effects meta-analyses and reported as risk ratios (RRs) and 95% CIs. 5 studies with low heterogeneity (I2=14%), 4 observational and 1post-hocanalysis of a randomized trial, were included. 1002 patients NOAC group=376 and VKA group=626 were followed for 4-6 weeks.Results:Baseline characteristics were similar, mean age 71 years and 71% male across both groups. There was no significant difference in endpoints: pocket hematoma (major and minor) {RR 0.74 (0.43-1.29), P=0.29}; major hematoma {RR 0.53 (0.24-1.19), P=0.13}; hematomas with new implants {RR 0.82 (0.46-1.48), P=0.51}; hematomas with generator changes {RR 1.90 (0.84-4.31), P=0.12}; hematomas with device-upgrade {RR 0.41 (0.15-1.07), P=0.07}; major bleed {RR 0.18 (0.03-1.09), P=0.06}; pericardial effusion {RR 1.01 (0.13-8.19), P=0.67}(Fig 1). One study reported peri-implantation infection (n=4/311 NOAC, n=2/467 VKA). One patient out of all 5 studies had systemic thromboembolism in each group (1/837 NOAC, 1/1000 VKA).Conclusion:Interrupted NOAC use is not associated with a higher risk of pocket hematoma compared to uninterrupted VKA after CIED placement.

Circulation, Volume 146, Issue Suppl_1, Page A11273-A11273, November 8, 2022. Introduction:Unlike type 1 myocardial infarction (T1MI) which is caused by plaque rupture and erosion, type 2 myocardial infarction (T2MI) is due to the mismatch between supply-demand of oxygen. To date, there were limited studies available and consequently, the outcomes of patients with T1MI compared to T2MI remained inconclusive.Hypothesis:We aimed to compare the outcomes of T1MI and T2MI patients in terms of mortality and adverse cardiovascular outcomes.Methods:We performed a systematic literature search of databases for relevant articles from inception until March 20, 2022.Results:340,802 patients had T1MI while the remaining 52,855 patients had T2MI. Mean age was similar between both groups (T1MI: 69.4 years, T2MI: 71.8 years) while proportion of female was found to be more higher in T2MI (61% vs 38%). Our analysis revealed that patients with T1MI had a significantly lower odds of all-cause mortality (OR 0.44, 95%CI 0.34 to 0.56, p

Circulation, Volume 146, Issue Suppl_1, Page A12626-A12626, November 8, 2022. Background:With an ageing and increasingly multi-morbid population, the use of coronary artery bypass grafting (CABG) is expected to increase. As short-term CABG mortality rates have decreased, estimating long-term outcomes for patients with specific risk factors has become more relevant. Previous single observational studies have identified risk factors for adverse long-term outcomes, such as older age and diabetes.Purpose:Understanding the pre-operative characteristics that affect late mortality post-CABG can lead to effective risk stratification and enhancement of secondary prevention programmes, thereby aiming to improve long-term prognosis after the procedure.Methods:MEDLINE, Embase, Google Scholar, and Cochrane electronic databases were searched to identify all relevant articles evaluating associations between pre-operative risk factors and long-term mortality (≥5 years ) post-CABG. Studies with

Circulation, Volume 146, Issue Suppl_1, Page A13502-A13502, November 8, 2022. Introduction:In patients with acute myocardial infraction (AMI), multivessel coronary artery disease (CAD) is associated with worse prognosis than single-vessel CAD. Several observational studies have reported worse clinical outcomes in AMI patients with non-infarct-related artery chronic total occlusion (n-IRA CTO). We performed a systematic review and meta-analysis to evaluate the prognostic significance of n-IRA CTO in patients with AMI.Methods:Systematic review was performed querying PubMed, Google Scholar, Cochrane and clinicaltrials.gov from Inception through May 2022. Studies comparing AMI patients with and without n-IRA CTO were included. Outcomes included in-hospital, 30-day and long-term mortality, cardiac mortality, major adverse cardiovascular events (MACE), and major bleeding. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models.Results:Five prospective, eight retrospective and 3 subgroup analyses of randomized control trials (RCTs) (n-IRA CTO n=2,521, no CTO n=18,397) were identified. Presence of n-IRA CTO was associated with higher in-hospital (RR 2.86, 95% CI 1.77-4.62, p

Circulation, Volume 146, Issue Suppl_1, Page A12471-A12471, November 8, 2022. Introduction:Ventricular tachycardia (VT) poses a significant risk in patients with ischemic cardiomyopathy. Antiarrhythmic drugs (AAD) and catheter ablation are the 2 strategies employed to reduce the risk of future VT episodes. It is not established if one strategy is superior to the other.Hypothesis:Recently, randomized trials have been published comparing the efficacy and safety of both strategies for VT management. Unfortunately, most of these trials included a relatively small number of patients and had different outcomes or composite of outcomes limiting their utility.Methods:We performed a meta-analysis of randomized clinical trials comparing these treatment modalities for VT management. Criteria for appropriate studies were the inclusion of outcome data for both ablation and AAD arms, history of documented VT or ICD therapy before enrollments, and use of ICD to reliably monitor the incidence. Due to recent advances in substrate-based VT ablation and changes in ICD algorithms we limited our search for studies published in last 10 years. We identified four studies that met our inclusion and exclusion criteria.Results:Our included studies randomized 609 patients, 303 in ablation, and 310 in AAD groups. All-cause mortality data were available for all included studies. The cumulative odds ratio (OR) for all-cause mortality for VT ablation compared to AADs was 0.88, 95% confidence interval [0.56-1.39], p-value 0.58. Cumulative OR for cardiac death was 0.81 [95% CI 0.47-1.38], p-value 0.44, OR for ICD shocks was 0.82[0.57-1.18], p-value 0.29 and the OR for heart failure or cardiac rehospitalization was 0.82 [95% CI 0.53-1.25] p-value 0.35. Treatment-related complications were reported in only two studies with cumulative OR 0.31 [95% CI 0.19-0.51] p

Circulation, Volume 146, Issue Suppl_1, Page A13752-A13752, November 8, 2022. Introduction:Treating individuals with stable multivessel coronary artery disease (CAD) and retained ventricular function is still debatable. Percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) are all options for treatment, and they are all employed in tandem with rigorous secondary prevention. One technique’s significant long-term mortality benefit over the other is still debatable for multivessel disease management.Hypothesis:To compare the long-term mortality and complications of coronary artery bypass graft (CABG) versus Percutaneous Coronary Intervention (PCI) among patients with multivessel disease.Methods:Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in March 2022. We only included randomized clinical trials (RCTs) that reported the outcome differences between CABG and PCI. The primary outcome was long-term all-cause mortality. The secondary outcomes were re-intervention rate and major adverse cardiac events (MACE). The statistical analysis was performed using Comprehensive Meta-analysis software version 3.Results:A total of 6 Randomized Control Trails (RCTs) studies were included in the analysis comprising 7,126 patients (3558 PCI and 3568 CABG). The median follow up period was 6.33 years. Long-term mortality from any cause (after 2 years follow up or more) was significantly higher in PCI group compared to CABG group (HR: 1.44; 95% CI, 1.25-1.67; P < 0.01; I2= 18.78%). This trend was consistent among diabetic patients (HR: 1.39; 95% CI, 1.14-1.69; P < 0.01; I2= 23.73%). CABG procedure was associated with lower rate of additional or repeat intervention (RR: 0.25; 95% CI, 0.17-0.37; P < 0.01; I2= 74.4%). Cardiovascular-specific mortality and MACE were lower among CABG group compared to PCI (RR: 0.77; 95% CI, 0.58-0.95; P < 0.01; I2= 0%), (RR: 0.77; 95% CI, 0.64-0.93; P < 0.01; I2= 0%), respectively.Conclusions:The study shows that CABG provides lower long-term mortality rates, including diabetic patients, a lower rate of repeat intervention, and lower major adverse cardiac events. Therefore, CABG is an effective and safe approach for patients with multivessel diseases compared to PCI, especially in the long term.

Circulation, Volume 146, Issue Suppl_1, Page A14167-A14167, November 8, 2022. Introduction:Recently, there has been a dramatic surge of interest in leadless pacemakers (LP). Although benefits of LP versus transvenous pacemakers (TVP) have been reported in small institutional and some registry-based studies, the systematic comparison and pooling of data remain limited. Therefore, we sought to meta-analyze the safety and benefit of leadless pacemakers over conventional transvenous pacemaker systems.Method:We followed PRISMA guidelines to conduct the study. The study protocol has been registered in the PROSPERO (CRD42022325376). Databases were searched for published literature from inception to April 12, 2022. Comparative studies on TVP with LP reporting device-related, cardiac, vascular, thoracic complications, and infection were included. Studies were analyzed using RevMan 5.4.1 with odds ratios (OR) to assess overall complications, device dislodgement, reintervention, and other complications. The I-squared (I2) test was used to assess the heterogeneity.ResultTotal 879 studies were imported from databases. After the removal of 265 duplicates, 614 papers were screened for eligibility. Among 41 papers screened for full text, 17 meet the inclusion criteria. There were 50% lower odds of overall complications in the LP group (OR 0.50, 95% CI 0.32 to 0.78; n = 20825). Similarly, 73% lower odds of device dislodgment (OR 0.27, 95% CI 0.14 to 0.50; n = 6897), 46% lower odds of re-intervention (OR 0.54, 95% CI 0.45 to 0.64; n= 17009), 87% lower odds of pneumothorax (OR 0.13, 95% CI 0.03 to 0.57; n = 4261), however 2.08 higher odds of pericardial effusion (OR 2.08, 95% CI 1.04 to 4.16; n = 4842) observed in LP group.ConclusionMeta-analysis of observational studies suggests that LP demonstrates a more favorable complication profile than TVP, although with higher rates of pericardial effusion. However, patient selection was not uniform between studies, and inferences remain limited.

Circulation, Volume 146, Issue Suppl_1, Page A12314-A12314, November 8, 2022. Introduction:Chronic total occlusion (CTO) percutaneous intervention (PCI) is an evolving challenge within interventional cardiology. Anticoagulation during percutaneous intervention remains part of the standard of care for patients undergoing PCI to prevent thrombotic complications peri-procedurally. Unfractionated heparin (UFH) is a commonly used for CTO PCI-related anticoagulation. However, bivalirudin (BV), a synthetic, reversible, direct thrombin inhibitor, has been utilized as an alternative to UFH in CTO patients undergoing PCI. This meta-analysis aims to investigate the efficacy and safety of bivalirudin versus UFH for CTO PCI.Methods:We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases through May 2022 for all studies evaluating efficacy and safety of bivalirudin versus UFH in CTO patients undergoing PCI. The primary outcome was mortality. Secondary outcomes were major adverse cardiac events (MACE), major bleeding events, peri-procedure myocardial infarction (MI), in-stent thrombosis, and unplanned revascularization. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effects model. Heterogeneity was assessed by I2 statistic.Results:A total of 5 studies containing 1347 patients with CTO undergoing PCI on anticoagulation (631 BV versus 716 UFH) were included. No significant difference existed between BV and UFH regarding mortality [RR: 0.54 (95% CI: 0.19-1.56); P 0.26 , I2 0%]. Major bleeding events were significantly lower in BV compared with UFH [RR: 0.33 (95% CI: 0.19-0.66); P 0.001, I2 0%]. MACE [RR: 0.75 (95% CI: 0.55-1.00); P 0.05, I2 2%], peri-procedure MI [RR: 0.80 (95% CI: 0.56-1.15); P 0.24, I2 0%], in-stent thrombosis [RR: 0.68 (95% CI: 0.19-2.39); P 0.55, I2 17%] and unplanned revascularization [OR: 0.77 (95% CI: 0.29-2.07); P 0.61, I2 0%] were similar between the two groups.Conclusions:BV seems to be safer than UFH in preventing major bleeding in anticoagulated patients with CTO undergoing PCI; there is no significant difference between groups in terms of mortality, MACE, peri-procedure MI, in-stent thrombosis, or unplanned revascularization. Future randomized controlled trials are needed.

Circulation, Volume 146, Issue Suppl_1, Page A14100-A14100, November 8, 2022. Background:Treatment with various sodium-glucose cotransporter 2 inhibitors (SGLT-2Is) has decreased cardiovascular events in patients with heart failure (HF). Therefore, we conducted a network meta-analysis to investigate which SGLT-2Is are more effective in patients with HF.Methods:PubMed, Web of Science, Scopus, and Embase, were systematically searched from inception to February 2022. We included randomized controlled trials (RCTs) that investigated the use of SGLT-2Is vs. placebo in HF patients. The main outcomes were all-cause, cardiovascular mortality, serious adverse events, and hospitalizations due to HF. The random-effects method model and inverse variance statistics were used to calculate the odds ratio (OR) with a 95% confidence interval (CI).Results:Our study included 12 RCTs with a total number of 69,024 patients (37,923 in the SGLT2 inhibitors group and 31,101 in the placebo group). Five RCTs used empagliflozin, 4 used dapagliflozin, 1 used canagliflozin, 1 used ertugliflozin, and 1 used sotagliflozin. Our analysis showed that empagliflozin has a statistically significant lowest odds for both cardiovascular mortality and serious adverse effects (OR: 0.80 with 95% CI [0.67-0.96]) and (OR: 0.84 with 95% CI [0.76-0.93]), respectively compared to other SGLT-2Is. All SGLT-2Is have been associated with the same lower odds without preferences for one over the others regarding all-cause mortality. Furthermore, the hospitalization rate due to HF showed a statistically significant decrease with all the SGLT-2Is except for canagliflozin, which showed insignificant results with (OR: 0.63 with 95% CI [0.39-1.01]).Conclusion:No differences between the SGLT-2Is included in this analysis were observed in terms of all-cause mortality. Empagliflozin had the lowest odds of cardiovascular mortality and serious adverse effects. Canagliflozin was the only SGLT-2Is that showed no significant results in odds of hospitalization for HF.

Circulation, Volume 146, Issue Suppl_1, Page A10489-A10489, November 8, 2022. Introduction:The optimal transfusion strategy for patients with ACS is unclear. Current data are inconclusive and there is a paucity of long term data; therefore, we performed a subgroup analysis of patients with AMI in the Transfusion Thresholds in Cardiac Surgery (TRICS-III) randomized controlled trial (RCT) to add evidence addressing this important clinical question, and interpret the results in the context of a systematic review and meta-analysis.Methods:The TRICS-III trial randomized patients undergoing cardiac surgery on cardiopulmonary bypass with a moderate-to-high risk of death to restrictive transfusion (transfuse at hemoglobin

Circulation, Volume 146, Issue Suppl_1, Page A11149-A11149, November 8, 2022. Background:the practice of pretreatment with oral P2Y12inhibitors in ST-Elevation Myocardial Infarction (STEMI) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue.Hypothesis:We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEMI patients with cardiovascular and bleeding outcomes.Methods:PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P2Y12versus no pretreatment in STEMI, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogeneity was assessed with I2statistics.Results:A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged from 7 days to 19 months. The P2Y12inhibitors included clopidogrel, prasugrel and ticagrelor. At 30 days, P2Y12pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56-0.91; p=0.006; I2=75%), stent thrombosis (RR, 0.33; 95% CI, 0.12-0.95; p=0.04; I2=83%), and major bleeding (RR, 0.81; 95% CI, 0.74-0.90; p

Circulation, Volume 146, Issue Suppl_1, Page A13056-A13056, November 8, 2022. Introduction:There has been growing evidence comparing Coronary Computed Tomography Angiography (CCTA) versus the standard of care(SOC) in patients with suspected stable coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis to compare CCTA versus SOC in patients with stable CAD.Methods:We searched multiple databases for randomized controlled trials (RCTs) comparing CCTA with SOC with various functional testing approaches for the evaluation of stable CAD. We used a random-effects model to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Outcomes included all-cause mortality, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).Results:We identified 6 RCTs with a total of 19,881 patients with stable CAD, of which 9,995 underwent CCTA and 9,886 underwent UC. There were no significant differences between CCTA and SOC in terms of all-cause mortality (RR: 0.91; 95% CI: 0.70-1.19; p=0.64), MI (RR: 0.78; 95% CI: 0.58-1.05; p=0.70), hospitalizations for UA (RR: 1.20; 95% CI: 0.95-1.51;p=0.64), invasive angiography (RR: 0.11; 95% CI: 0.32-1.61; p

Circulation, Volume 146, Issue Suppl_1, Page A12549-A12549, November 8, 2022. Introduction:Evaluating the efficacy of newer medical therapies in black patients with heart failure with reduced ejection fraction (HFrEF) remains an important and unanswered question. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in HFrEF to compare outcomes in black versus non-black patients with a specific focus on new therapies, namely ARNIs and SGLT2 inhibitors.Methods:Medline, Embase and Cochrane CENTRAL were searched from inception until May 2022. Pairs of reviewers independently identified RCTs that 1) compared either an SGLT2 inhibitor or an ARNI to placebo/standard of care in HFrEF patients and 2) reported outcomes stratified by race. Outcomes were pooled using the Generic Inverse Variance or Mantel-Haenszel models, and risk of bias was assessed using the Cochrane tool.Results:Four RCTs (n=17,797; 6.6% black) were identified, all of which were published in the past decade. In the placebo/control arm, black patients had a higher rate of heart failure hospitalization or cardiovascular death compared to non-black/white patients (OR: 1.52, 95% CI: 1.26, 1.84; absolute difference: 81, [95% CI: 43, 124] more events per 1,000 patients). In two RCTs, there was a trend towards a greater reduction in the composite of cardiovascular death or heart failure hospitalization with SGLT2 inhibitors in black patients (n=483; RR: 0.61, 95% CI: 0.45, 0.83) compared to white patients (n=6,445; RR: 0.84, 95% CI: 0.75, 0.95; p-interaction=0.06). In two RCTs, treatment with an ARNI was associated with reductions in the composite of cardiovascular death or heart failure hospitalization in both black patients (n=744; HR: 0.67, 95% CI: 0.40, 1.11) and non-black/white patients (n=6,109; HR: 0.80, 95% CI: 0.72, 0.89; p-interaction= p=0.49).Conclusions:Black patients are poorly represented in contemporary heart failure trials, and have worse outcomes compared with non-black patients. Newer therapies such as ARNIs and SGLT2 inhibitors are efficacious in black patients. SGLT2 inhibitors may afford greater risk reduction in black compared to non-black patients.

Circulation, Volume 146, Issue Suppl_1, Page A11804-A11804, November 8, 2022. Background:Research on fast-track recovery protocols postulate epidural anaesthesia (TEA) in cardiac surgery contribute to improved postoperative outcomes. However, concerns about TEA’s safety and current equivocal evidence, hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the effects of TEA in cardiac surgery.Methods:We searched four databases for randomised controlled trials (RCTs) assessing the use of TEA against only GA in adults undergoing cardiac surgery, up till 4 June 2022. We conducted random effects meta-analyses (DerSimonian and Laird), evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the GRADE approach. Primary outcomes were ICU and Hospital length of stay, with other outcomes including postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit.Results:Our meta-analysis included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009), hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no significant reduction in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS, and ET, suggesting a clinical benefit. TEA also significantly reduced transfusion requirements, pain scores, delirium, arrhythmia, and pooled pulmonary complications, without additional complications such as epidural hematomas.Conclusions:TEA reduces ICU and hospital lengths of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications. These findings favour the use of TEA in cardiac surgery, and warrants consideration for use in cardiac surgeries worldwide.