Conclusion: 184
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:How to protect myocardium during heart transplantation ? What is new in this area?
Authors: (Zahra Ansari Aval - author)
Introduction:
The term of “ organ preservation “ seems to be a term where the definition appears so clear and easy that it does not need to be written done.Yet again , a uniform description of organ preservation is not straightforward.It is not necessarily defined by ,organ retrieval, temperature of the organ or its metabolic state or any other sole condition but it defined by all of them.It is better to define it by its purpose that it means: putting an organ into a state that allows later reactivation and restitution of its original function with the aim of minimizing damage during the period of mal- and non-perfusion.
Methods:
For nearly six decades, static cold storage has been the gold standard for organ preservation.Although this method is practical and inexpensive, it is insufficient. 1-The organs actively suffocate during storage and even the quality organs can only be stored for a few hours. 2-non-ideal donors organs particularly extended criteria donors have a higher sensitivity to cold ischemia. 3-Ischemia- Reperfusion Injury is a matter of concern. 4-Since the organ is not fully functional at ice-cold temperatures, it is difficult to assess if it will function as expected. Is there any (HOPE)? There is new and emerging strategies for donor organ preservation that is ex-vivo organ perfusion which has two types of: Normothermic Machine perfusion (NMP) and Hypothermic Machine Perfusion (HMP)(HOPE).
Results:
Machine Perfusions have these advantages: to diminish ischemic injury by providing oxygen and nutrients to the myocardium and removing metabolic waste products from myocardial cells. Ex-vivo machine perfusion may be converted in high risk heart transplants.with NMP, the donor heart is perfused and reanimate with non- cardioplegic donor blood which maintains oxygenation and allows for transportation to recipient hospitals over greater distance.There are two studies- PROTECT study and PROCEED II study which confirms safety and efficacy of NMP , although this procedure is expensive.HMP uses a cold nutrient and hormone- enriched cardioplegic solution containing red blood cells for hypothermic oxygenated machine perfusion (HOPE).
Conclusion:
HMP is less expensive and requires less surgical and technical support.There is a RCT multicentre clinical trial which confirms safety and efficacy of HMP. Some groups recommend the infusion of a “hot shot “ before the removal of the aortic cross clamp. Additionally a new method of organ preservation during heart implantation has been introduced by the Glasgow heart transplantation team which has shown good results in reducing primary graft dysfunction

Conclusion: 183
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:The Effect of Vacuum Assisted Venous Drainage on Kidney Function and Blood Transfusion in Patients Undergoing Cardiac reoperation
Authors: (Zahra Majidi Parizi - author)
Introduction:
Despite advancements in clinical outcomes following cardiac surgery, acute kidney injury (AKI) remains a prevalent and serious complication. Among the various risk factors for AKI, elevated central venous pressure (CVP) has been identified as a key contributor in these patients Another critical factor associated with AKI during cardiac surgery is blood transfusion. strategies aimed at minimizing transfusion requirements have gained significant attention. Vacuum-assisted venous drainage (VAVD) has been proposed as a technique that reduces venous congestion. Additionally, by lowering priming volume, VAVD may help maintain higher hematocrit levels during cardiopulmonary bypass (CPB). Given these considerations, we hypothesized that the implementation of VAVD could contribute to renal protection following cardiac surgery. This research was conducted to evaluate and either validate or refute this hypothesis.
Methods:
This study was a randomized controlled clinical trial conducted with 90 adult patients who were candidates for re-operative cardiac surgery at Shaheed Rajaie Cardiovascular Center. All participants provided informed consent and met the following inclusion criteria: left ventricular ejection fraction greater than 35%, absence of bleeding disorders, anemia, renal failure, or preoperative cerebrovascular disease. The patients were randomly assigned to two groups: 45 patients in the VAVD group and 45 patients in the GD group (venous drainage by gravity alone). Arterial and venous cannulation were performed based on the type of surgery. Anesthesia and cardiopulmonary bypass conditions were identical for all patients, with the only difference being the use of VAVD during cardiopulmonary bypass in the intervention group. Throughout the use of VAVD, the negative pressure in the venous reservoir was monitored and controlled within a range of -30 to -45 mmHg. Data on patient demographics, mean arterial pressure (MAP), CVP, hemoglobin, hematocrit, blood urea nitrogen, creatinine, urinary output, blood product usage, priming volume in the CPB circuit, aortic cross-clamp time, CPB duration, mechanical ventilation time, and ICU and hospital stay duration were all recorded and analyzed. Then the incidence of AKI, blood transfusion requirements, and other variables were compared statistically between the two groups.
Results:
Key variables, including renal function markers, blood transfusion volume, and perioperative parameters, were assessed. While specific numerical results are still to be determined, preliminary findings suggest that the use of VAVD is associated with a reduction in the incidence of AKI and the need for blood transfusions compared to the control group. Patients in the VAVD group showed a tendency toward better renal perfusion during CPB, which may have contributed to the observed benefits. No significant adverse events related to VAVD were noted, indicating that the technique was feasible and safe in the studied population.
Conclusion:
The implementation of VAVD during cardiac surgery appears to offer potential benefits in improving postoperative renal outcomes and minimizing blood transfusion requirements.

Conclusion: 181
Status: accepted_oral
Headline Title: Perfusion
Headline Title:Effect of pH paradox in ischemia-reperfusion injury to cardiac myocytes
Authors: (Aregnia Minasians - author)
Introduction:
During myocardial ischemia, a large reduction of tissue pH develops, and tissue pH returns to normal after reperfusion. In recent studies, we evaluated the role of pH in ischemia/reperfusion injury to cultured cardiac myocytes and perfused papillary muscles. Acidosis protected profoundly against cell death during ischemia. However, the return from acidotic to normal pH after reperfusion caused myocytes to lose viability. This worsening of injury is a 'pH paradox' and was mediated by changes of intracellular pH , since manipulations that caused pHi to increase more rapidly after reperfusion accelerated cell killing, whereas manipulations that delayed the increase of pHi prevented loss of myocyte viability
Methods:
Entered patients to the trial were divided into two groups of 30 by block randomization. In control group, before opening the aortic clamp, pH was kept in the normal state, and it became acidic in the intervention group
Results:
acidic reperfusion exactly mimics the protection of postconditioning.Acidosis confers cadioprotection by inhibiting ROS production and increasing NO release through activating PI3k-Akt-eNOS pathway
Conclusion:
Acidic perfusion mimicked the cardioprotective effect of postconditioning to limit myocardial infarct size, improve myocardial function, and inhibit ROS production by prolongation of intracellular acidosis during reperfusion. Furthermore, acidic perfusion increased Akt phosphorylation, eNOS expression, and nitric oxide release, which were reverted by cotreatment with the PI3k inhibitor wortmannin. These results suggested that acidic perfusion exerts cardioprotection by activating PI3k-Akt-eNOS signaling pathway during the early reperfusion phase.

Conclusion: 180
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:Artificial intelligence‑based model for automatic real‑time and noninvasive estimation of blood potassium levels in pediatric patients
Authors: (Mohammadrafie Khorgami - author)
Introduction:
An abnormal variation in blood electrolytes, such as potassium, contributes to mortality in children admitted to intensive care units. Continuous and real‑time monitoring of potassium serum levels can prevent fatal arrhythmias, but this is not currently practical. The study aims to use machine learning to estimate blood potassium levels with accuracy in real time noninvasively
Methods:
Hospitalized patients in the Pediatric Department of the Rajaie Cardiology and Medical Research Center and Tehran Heart Center were recruited from December 2021 to June 2022. The electrocardiographic (ECG) features of patients were evaluated. We defined 16 features for each signal and extracted them automatically. The dimension reduction operation was performed with the assistance of the correlation matrix. Linear regression, polynomials, decision trees, random forests, and support vector machine algorithms have been used to find the relationship between characteristics and serum potassium levels. Finally, we used a scatter plot and mean square error(MSE) to display the results
Results:
Of 463 patients (mean age: 8 ± 1 year; 56% boys) hospitalized, 428 patients met the inclusion criteria, with 35 patients having a high noise of ECG were excluded. After the dimension reduction step, 11 features were selected from each cardiac signal. The random forest regression algorithm showed the best performance with an MSE of 0.3
Conclusion:
The accurate estimation of serum potassium levels based on ECG signals is possible using machine learning algorithms. This can be potentially useful in predicting serum potassium levels in specific clinical scenarios.

Conclusion: 176
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Trends in Cardiovascular Symptoms of Long COVID-19 Across Different Pandemic Waves
Authors: (Dr Ghazal Ghasempour Dabaghi - author) (Dr Mehrdad Rabiee Rad - author) (Nizal Sarrafzadegan - corresponding-author)
Introduction:
Long COVID-19 refers to a range of persistent symptoms following acute SARS-CoV-2 infection, affecting multiple organ systems, including the cardiovascular system. Given the potential variations in viral strains, public health measures, and treatment strategies across different pandemic waves, analyzing the trends of cardiovascular symptoms over time can provide valuable insights into the long-term impact of COVID-19 on cardiovascular health.
Methods:
This cross-sectional study collected data from Isfahan COVID Cohort (ICC) study. Demographic information, clinical characteristics, and cardiovascular symptoms were extracted from medical records and structured interviews. Statistical analyses were performed to assess trends in cardiovascular symptoms during a 2-year follow-up and their variations among different waves of the pandemic. Long COVID-19 cardiovascular symptom considered as persisting cardiovascular symptoms including chest pain, palpitation, lower limb edema and ischemic symptoms in the limbs. Different waves of infection considered as patients infected in various timelines including: February2020-June2020, June2020-September2020, September2020-March2021, March2021-June2021, and the last wave were June2021-July2021.
Results:
A total of 772 participants were included in the analysis. Overall, 38.2% of cases experienced long COVID-19 cardiovascular symptoms. In wave 1 and 2, 48.0% and 48.1% of participants experienced cardiovascular symptoms, respectively. This trend decreased in other waves, where 40.0% of participants reported symptoms in wave 3, 32.4% of participants reported long COVID-19 cardiovascular symptoms in wave 4, and only 14.8% of individuals reported long COVID-19 cardiovascular symptoms in wave 5.
Conclusion:
The prevalence of persistent cardiovascular symptoms varied across waves, with the highest proportion observed in wave 2 (48.1%) and the lowest in wave 5 (14.8%). Monitoring these trends over time may help identify factors that influence the persistence of cardiovascular complications in long COVID-19, thereby providing essential guidance for clinical management and public health strategies.

Conclusion: 175
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:The association between MIND diet and severity of Premature coronary artery disease among Iranian adults
Authors: (Mohammad Mahmoudi Azar - author) (Motahare Bateni - author) (Fahimeh Haghighatdoost - corresponding-author) (Noushin Mohammadifard - author) (Nizal Sarrafzadegan - author)
Introduction:
Studies have shown that the MIND (Mediterranean-DASH diet intervention for Neurodegenerative Delay) diet has beneficial effects on cardiovascular disease. However, its effects on the severity of the Premature coronary artery disease (PCAD) are unclear. The objective of this study is to explore the association between the MIND diet and PCAD severity.
Methods:
A cross-sectional analysis was conducted on 2245 individuals of different ethnicities. A 110-item semi-quantitative FFQ was used to assess dietary intake. The MIND score was calculated using 13 food groups divided into healthy and unhealthy categories. PCAD severity was classified into three categories: normal coronary arteries, stenosis in one vessel, and stenosis in two vessels or the left main coronary artery. The association between MIND score and PCAD severity was assessed by ordinary logistic regression.
Results:
The mean ± SD age of the study population was 51.08 ± 7.08 years. The number of women in the study population was 1195 (53.2%). A significant inverse association was observed between MIND score and PCAD severity in both the fully adjusted and crude models (OR= 0.90, CI: 0.72-1.12, P value < 0.001, OR= 0.75, CI: 0.59-1.00, P value < 0.001, respectively). In the fully adjusted model, a significant inverse association was found between MIND score and PCAD severity in both men and women (OR= 0.83, CI: 0.57-1.20, P value < 0.001; OR= 0.74, CI: 0.50-1.08, P value < 0.001, respectively).
Conclusion:
Our findings showed that there was a significant inverse association between MIND score and PCAD Severity. Further study is required to confirm this association.

Conclusion: 174
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Dietary plant to animal protein ratio and severity of PCAD among Iranian population
Authors: (Motahare Bateni - author) (Mohammad Mahmoudi Azar - author) (Noushin Mohammadifard - corresponding-author) (Fahimeh Haghighatdoost - author) (Nizal Sarrafzadegan - author)
Introduction:
Dietary protein sources impact the risk of cardiovascular health, but their role in premature coronary artery disease (PCAD) remains unclear. The association between plant and animal proteins and the risk of cardiovascular disease has been established. However, no study has investigated the association between protein sources and the severity of PCAD. The objective of this study is to examine the association between plant-to-animal protein ratio and severity of PCAD.
Methods:
This case-control study involved 2146 participants within the framework of Iran Premature Coronary Artery Disease (IPAD) study. Dietary intake was evaluated using a validated 110-item food frequency questionnaire. The ratio of plant-to-animal protein was determined by the percentage of energy derived from each source. The association between plant-to-animal protein ratio and severity of PCAD was assessed using ordinal logistic regression.
Results:
The mean (SD) age of participant was 53.7 (7.66) years. The median (Interquartile) plant to animal protein ratio in the case and control groups was 0.98 (0.08-1.93) and 1.12 (0.14-1.93) percent of energy, respectively. In the fully adjusted model, there was an inverse association between plant to animal protein ratio and severity of PCAD (OR= 0.60, 95% CI: 0.47-0.77, P trend <0.001).
Conclusion:
The findings showed an inverse association between plant-to-animal protein ratio and severity of PCAD.

Conclusion: 173
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Type of menopause, age of menopause and cardiovascular disease: a cross-sectional study based on data from Rafsanjan cohort study
Authors: (Ali Esmaeili-Nadimi - corresponding-author) (Zahra Jamali - author) (Mahboubeh Vatanparast - author) (Parvin Khalili - author) (Fatemeh Ayoobi - author)
Introduction:
Cardiovascular disease is the leading cause of death among women, but sex-specific risk factors are incompletely understood. In this study, we aimed to assess the associations between the type of menopause, and age at natural menopause with the odds of cardiovascular disease (CVD), and coronary heart disease (CHD).
Methods:
This cross-sectional study is a part of data from the Rafsanjan Cohort Study (RCS) which is a branch of the Prospective Epidemiological Research Studies in Iran (PERSIAN). A sample of 1767 postmenopausal women were included. The diagnosis for CVD and CHD was based on self-report questionnaires. Menopause age was categorized as < 40, 40–44, 45–49, and ≥ 50. Also, the menopause types were classified as natural and induced menopause (surgery or chemotherapy). The association was evaluated by logistic regressions.
Results:
The menopause age < 40 years had higher odds of CVD compared to women with menopause age > 40 years (OR: 2.66; 95%CI 1.29–5.48). Women with induced menopause had higher odds of CVD compared to women with natural menopause (OR = 1.44, 95% CI 1.04–1.98). In terms of the odds of CHD, the results showed that the odds of CHD increased in menopause age < 40 years and induced menopause compared to reference groups (OR: 2.49, 95% CI 1.15–5.37, OR = 1.48; 95% CI 1.06–2.07, respectively).
Conclusion:
Premature menopause and induced menopause should be considered as important risk factors for CVD, and CHD. Health policymakers should pay more attention to the type of menopause and the age of menopause in postmenopausal women to predict the risk of CVD and preventive strategies.

Conclusion: 172
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Effect of opium consumption on cardiovascular diseases – a cross-sectional study based on data of Rafsanjan cohort study
Authors: (Ali Esmaeili-Nadimi - corresponding-author) (Parvin Khalili - author) (Fatemeh Ayoobi - author) (Zahra Jamali - author)
Introduction:
There are differences of opinion about the beneficial or detrimental effects of opium consumption on cardiovascular diseases (CVDs). So, we aimed to study the association between opium use and CVDs.
Methods:
We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN), with detailed, validated data on opium consumption and some other exposures. A total of 10,000 adults were enrolled in the study. Logistic regression models were used to assess the possible relationships of opium consumption with the prevalence of ischemic heart diseases (IHD) and myocardial infarction (MI).
Results:
In this study, 9990 participants in the baseline phase of the Rafsanjan adult cohort study were included according to their completed questionnaire. Among all participants, 870 and 296 individuals were found to suffer from IHD and MI, respectively. Opium consumption was found to be relatively high in the RCS participants, especially in men (men=2150 and women=228). Opium use was associated with a higher odds of IHD and MI, with the adjusted odds ratios (95% CI) of 1.51 (1.22–1.86) and 1.79 (1.31–2.45), respectively. Also, dose-response increases were observed with the highest odds ratios in the 4th quartile for MI and IHD (P values for trend < 0.001). Increased odds were observed for the two main methods of opium consumption, i.e. oral and smoking, but oral administration had higher odds ratio.
Conclusion:
Opium consumption is associated with the increased odds of both IHD and MI diseases.

Conclusion: 169
Status: accepted_oral
Headline Title: Cardiac Physiotherapy
Headline Title:The Effects of 8 Weeks Aerobic training and Vitamins E & C Supplementation on the Plasma Levels of MMP-2 and MMP-9 in Patients with CAD
Authors: (Elham Karami - corresponding-author) (Ramin Shabani - author) (Farhad Rahmaniya - author) (Alireza Elmiye - author) (Elham Karami - author)
Introduction:
The purpose of this study is to investigate the effect of eight weeks of aerobic training with vitamin E and C supplementation on the plasma levels of matrix metalloproteinas2 and matrix metalloproteinas9 in patients with coronary artery disease.
Methods:
60 patients with CAD were selected. Subjects were randomly divided into four groups (15people) (training + supplement, training, supplement and control). The subjects received 1 gr of D-alpha tocopherol and 1 gr of ascorbic acid daily. The training program was eight weeks (3 sessions per week) with an intensity of 40 to 80% of reserve heart rate for 45 minutes of aerobic activity with treadmills, stationary bike and manual ergometer as a standard cardiac rehabilitation program. Then, 24 hours before first training session and 24 hours after the last training session, anthropometric evaluations and blood samples were received from the subjects. The analysis was analyzed using analysis of covariance and paired t-test at a significant level of p<0.05.
Results:
The results showed that the level of MMP-2 in the plasma of patients with CAD was significantly higher in the aerobic training group with vitamin E and C supplementation than in the aerobic training group (p=0.001). Also, the level of MMP-9 in the plasma of patients with CAD in the aerobic training group with vitamin E and C supplementation was significantly lower than the aerobic training group (p=0.001).
Conclusion:
combined aerobic training and taking vitamin E and C supplements can affect the plasma levels of the mentioned indicators to a greater extent and cause them to improve, which shows the higher efficiency of training at the same time as the supplement.

Conclusion: 168
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:Hypoplastic Left heart Syndrome Prophecy; etiologic factors, current and future therapeutic approaches; a narrative review
Authors: (Mohsen Shahidi - author)
Introduction:
Hypoplastic left heart syndrome (HLHS) is a univentricular heart anomaly with reliance on the right ventricle. HLHS is one of the lethal types of single ventricle anomaly.1, 2 It is the most common type of single ventricle congenital heart disease estimated for 8-25 per 100,000 neonates worldwide.2, 3 HLHS has a heterogeneous phenotype with different etiologic factors without a satisfactory and definite treatment, during the past decades.
Methods:
Search plan: PubMed and Scopus provided the main database. This study focused on recent data after 2019 to collect proper information. Screening database: Screening was started by review of a bulky number of abstracts. The appropriate data were selected according to the inclusion and exclusion criteria. Data extraction: The data were systematically extracted by focusing on HLHS flow mechanisms, surgical and interventional procedures, and future viewpoints. The extracted data were analyzed to identify its final proper construction.
Results:
Recognizing HLHS etiologies is crucial for preventive and therapeutic decisions. Genetic defect and flow-mediated mechanisms are the main etiologic factors.5, 6 They may have a solitary or concomitant role.7 Recent novel therapeutic methods including molecular and surgical procedures are based on the aforementioned etiologic factors, forecasting an optimistic future. Regular management is creating a reliable single ventricle physiology. The ultimate therapeutic purpose is biventricular repair.8
Conclusion:
The novel procedures include the proposed prenatal interventional options and new postnatal surgeries. Recently, a combination of surgical and molecular therapies (E.g. stem-cell technology) aimed to achieve the biventricular physiology or at least preserve the RV function. Future studies may focus on surgical and interventional procedures alongside cell engineering technology to obtain biventricular repair. Decision-making for each intervention depends on the patient's anatomic and hemodynamic criteria.

Conclusion: 167
Status: accepted_oral
Headline Title: Cardiac Nursing
Headline Title:The Effect of Transition Theory_based Intervention on Treatment Adherence in Patients with Myocardial Infarction: A Quasi-Experimental Study
Authors: (Dr Roya Khorrami Estakhri Estakhri - author) (Fateme Jafaraghaee - corresponding-author) (Zahra Taheri Ezbarami - author) (Hamid Peyrovi - author)
Introduction:
The increasing prevalence of myocardial infarction has turned this disease into a global epidemic. With the diagnosis of myocardial infarction and the transition from health to illness, changes occur in the individual's life, which seems that appropriate management of the disease by implementing care based on transition theory can be a suitable way to improve health-related outcomes. Also, non-adherence to treatment is an important and complex problem in all patients and leads to significant financial burden and potential clinical consequences. This study was conducted to investigate the effect of transition theory_based intervention on treatment adherence in patients with myocardial infarction.
Methods:
This is a quasi-experimental, two-group, post-test study that was conducted between 1402 and 1403 at Dr. Heshmat Rasht Hospital in Guilan. The participants were 102 patients with myocardial infarction who were selected through purposive sampling and were divided into two control and experimental groups. Transition theory-based intervention was implemented in the experimental group for 7 consecutive sessions over 1 month, while the control group received usual care. Patients' treatment adherence was measured with a valid and reliable instrument, the Coronary Artery Disease Treatment Adherence Scale, 30 days after the end of the intervention in both groups.
Results:
The mean age of the patients was 59.85±9.33, and 61 (61.8) of them were male. The results of the independent t-test in data analysis showed a significant difference in the mean adherence score of the two groups after the intervention (P=0.018). According to the results, the mean adherence score of the control group was at a moderate level (131.90±20.32) and the experimental group was at a high level (149.16±15.05).
Conclusion:
The findings show that providing care based on Mellis' transition theory is effective in improving adherence to treatment in patients with myocardial infarction.

Conclusion: 162
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Prosthetic Heart Valves: Mechanical or Tissue ? Long-Term Results and Complications in Over 1700 patients
Authors: (S. Mohammadhasan Kalantar Motamedi - author)
Introduction:
Heart valve surgery continues to be a serious health problem throughout the world, and valve repair is often not possible in many patients, especially in rheumatic heart disease where valve replacement is often required. The best type of heart valve, mechanical vs. tissue, continues to be controversial and requires careful consideration by the heart team and patient.
Methods:
From Jan. 2003 to December 2024, 1747 patients underwent heart valve replacement. 837 patients were male and 910 were female. Age ranged from 8 to 95 years of age. Patients were divided into two groups, A) 1006 with mechanical and B) 741 with bioprosthetic valves. 259 cases were redo surgery and 648 cases were multiple valve surgery procedures. Long-term outcome, major adverse events and quality of life indices were studied in the two groups.
Results:
Hospital mortality was similar in both groups. However major adverse events were more frequent in the mechanical valve group, despite their younger mean age (22.9% vs 12.0%, p<0.01). Major bleeding and stroke were significantly higher in the mechanical valve group as well. Rate of need for redo surgery was higher in the tissue valve group. Long-term survival did not significantly differ in the two groups, and quality of life indices were significantly higher in the tissue valve group.
Conclusion:
We conclude that mid and long-term morbidity are worse, and major adverse events and complications are more devastating in patients with mechanical heart valves. Redo surgery did not negatively impact survival in the tissue valve group, and mechanical heart valves associated with life-long warfarin use can have a substantial negative impact on quality of life of patients.

Conclusion: 160
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Introducing sequential partial aortic clamp technique for proximal anastomoses and its advantages in myocardial protection in coronary artery bypass grafting
Authors: (Hamed Bazrafshan - author) (Khalil Zarabi - author)
Introduction:
Ischemic heart disease (IHD) is a common and potentially lethal cardiovascular disorder. Coronary artery bypass grafting (CABG) is a standard procedure for treating IHD
Methods:
This study aims to introduce a novel technique for proximal anastomoses in CABG. This clinical trial studied 29 cases and 29 matched controls. Data were gathered from June 2014 to June 2023. Regarding proximal anastomoses, the sequential partial aortic clamp was performed in cases, and the partial aortic clamp was done for controls. In the sequential partial aortic clamp technique, a relatively small or medium vascular clamp was used instead of one clamp for all proximal anastomoses, which closed a small amount of the aortic wall at each stage. At each stage, only one hole in the aortic wall and only one anastomosis between the conduit and the aorta was performed. After the end of each anastomosis, the clamp was opened and placed on another part of the aorta, and the next anastomosis was performed.
Results:
CK-MB (p < 0.001, Eta Squared = 0.255) level was significantly lower in cases that underwent sequential partial ascending aorta clamping. However, cTnI level was not statistically different among cases and controls(p = 0.05). Of all patients, 3 (10.3%) cases and 12 (41.4%) controls developed with postoperative atrial fibrillation (p = 0.007).
Conclusion:
The sequential partial aortic clamp technique leads to less myocardial injury than the partial aortic clamp technique. Also, patients undergoing sequential partial aortic clamp technique are less likely to develop postoperative atrial fibrillation.

Conclusion: 159
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Comparison of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on the consequence of weaning off patients from the mechanical ventilator after coronary artery bypass surgery
Authors: (Dr Mehdi Heidari - corresponding-author) (Dr Mohsen Ziyaeifard - author) (Rasoul Azarfarin - author) (Reza Abbaszadeh - author) (Roghaye Mohammad-Taghi - author)
Introduction:
The ventilation mode used for respiratory support in patients after coronary artery bypass graft surgery is essential. In addition to avoiding pressure on the patient's sternotomy incision, the ventilation mode should also provide the possibility of rapid weaning of the patient to prevent complications caused by long-term ventilation. This study aimed to compare the effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation-Pressure Support (SIMV-PS) modes on the consequence of weaning off patients from mechanical ventilation after coronary artery bypass surgery
Methods:
In a semi-experimental study, 26 patients were ventilated with ASV as the experimental group and 26 patients were ventilated with SIMV-PS mode as the control group after coronary artery bypass graft surgery in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Mechanical ventilation time and endotracheal tube removal time, hemodynamic variables, and arterial blood gas analysis were compared between the two groups. Data were analyzed using an independent t-test, repeated measures ANOVA, and chi-square.
Results:
Out of 52 patients, 36 (69.2 percent) were male and 16 (30.8 percent) were female. The mean time for the endotracheal tube removal was 89.42±33.83 minutes in the experimental group and 101.53±44.91 minutes in the control group, which did not have a statistically significant difference (p=0.843). The mean duration of mechanical ventilation of patients in the experimental group was 483.84±158.153 minutes and in the control group, it was 541.92±257.81 minutes, which were not statistically different (p=0.332).
Conclusion:
The use of ASV mode for mechanical ventilation after coronary artery bypass graft did not affect reducing the duration of mechanical ventilation and the time of endotracheal tube removal compared to SIMV-PS mode. Therefore, the use of ASV mode for respiratory support of patients undergoing coronary artery bypass surgery should be considered according to the patient's condition and the nurses' expertise.

Conclusion: 155
Status: accepted_oral
Headline Title: Perfusion
Headline Title:Comparison between modified Del Nido vs. Custodiol cardioplegic solution on post-operative clinical outcomes and laboratory parameters in pediatric patients undergoing arterial switch surgery in Shaheed rajaei, Cardiovascular, Medical and Research center and Children’s medical Center from 2018 to 2022: a multi-center study
Authors: (Ms Fateme Ahrari - author) (Farhad Gorjipour - author) (Dr Maziar Gholampour-Dehaki - corresponding-author) (Dr Mohammad Mahdavi - author) (Dr Fariba Rashidi - author)
Introduction:
The application of single dose Cardioplegic solutions are essential in complex congenital Cardiac surgeries as they provide long lasting cardiac protection. Maintaining cardiac protection can be challenging due to the fact that any failure of this goal can result in major complications. Although using cardioplegic solution has been a gold standard in complex cardiac surgeries but, Ischemia, Low Cardiac Output Syndrome are some of the present complications in pediatric patients. According to the prevalence of congenital cardiac surgeries and the importance of reduction in morbidity and mortality in pediatric patients, this retrospective study was conducted to evaluate clinical and laboratory outcomes in patients undergoing Arterial Switch Operation using modified Del Nido and Custodiol cardioplegic solution.
Methods:
This retrospective study included 200 pediatric patients who underwent Arterial Switch surgery between January 2018 And December 2023. We randomly allocated the entire sample into two groups: modified Del Nido group from Shaheed Rajaei Cardiovascular Center (n = 100) and Custodiol group from Children’s Medical Center (n = 100). Demographic Data, Laboratory parameters and other related perioperative and postoperative clinical parameters were recorded.
Results:
Patients in modified Del Nido and Custodiol group stayed 8 and 9 days in the intensive care unit respectively. Intubation duration was 4 days in modified Del Nido group and 2 days in Custodiol group. peritoneal dialysis in custodiol group was 19% and 9% in Del Nido group. Both groups did not have significant differences in case of the need for ECMO implantation but the demand for Pace Maker implantation was higher in modified Del Nido group (51%) compared to Custodiol group (24%). Mortality was higher in Del Nido group (P-value= 0.03).
Conclusion:
This study demonstrated that custodial cardioplegia provides superior myocardial preservation and improved clinical outcomes, as evidenced by better ejection fraction, lower pacemaker implantation, lower mortality and shorter intensive care unit stays. Additionally, custodial cardioplegia can be suctioned to manage excess solution. However, the risk of hyponatremia associated with custodial cardioplegia should not be overlooked. Preventive measures, such as hypertonic sodium chloride priming, can be implemented to mitigate this risk.

Conclusion: 154
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Enhancing Neurological Outcomes in Cardiac Surgery Through Cerebral Oximetry and Artificial Intelligence
Authors: (Nahid Zirak - author) (Malihe Aghasizadeh - author) (Mahmood Hosseinzadeh Maleki - corresponding-author) (Mahnaz Bayat - author)
Introduction:
Cerebral oximeters are non-invasive, continuous monitoring devices that assess cerebral oxygenation and play a vital role in managing cardiac surgery patients. They help in preoperative risk stratification, intraoperative monitoring, and early detection of adverse events. Ensuring adequate cerebral oxygenation prevents complications from undetected hypoxia, reducing organ injury and ICU stays. During cardiopulmonary bypass (CPB), cerebral oximetry enhances patient safety by optimizing cerebral blood flow. Research shows that 50% to 70% of cardiac surgery patients experience rSO2 reductions during CPB. Near-infrared spectroscopy (NIRS) is commonly used for real-time rSO2 monitoring, offering insights into cerebral metabolism. These devices use near-infrared light, processed by detectors to calculate rSO2. Despite technological differences, integrating cerebral oximetry into CPB management improves neurological outcomes and may become a standard in cardiac surgery.
Methods:
Cerebral oximeters are non-invasive, continuous monitoring devices that assess cerebral oxygenation and play a vital role in managing cardiac surgery patients. They help in preoperative risk stratification, intraoperative monitoring, and early detection of adverse events. Ensuring adequate cerebral oxygenation prevents complications from undetected hypoxia, reducing organ injury and ICU stays. During cardiopulmonary bypass (CPB), cerebral oximetry enhances patient safety by optimizing cerebral blood flow. Research shows that 50% to 70% of cardiac surgery patients experience rSO2 reductions during CPB. Near-infrared spectroscopy (NIRS) is commonly used for real-time rSO2 monitoring, offering insights into cerebral metabolism. These devices use near-infrared light, processed by detectors to calculate rSO2. Despite technological differences, integrating cerebral oximetry into CPB management improves neurological outcomes and may become a standard in cardiac surgery.
Results:
Current technology focuses on EEG-derived parameters for anesthetic management or cerebral oximetry for monitoring cerebral oxygen balance, but lacks integrated devices. Scientific evidence suggests that combining these with AI-driven algorithms can improve brain function management in surgery. Machine learning (ML) processes real-time data from multimodal monitoring (MMM) to enhance decision-making and patient outcomes. Block et al. (2020) showed AI’s potential in detecting cerebral ischemia using HRV, EEG, and NIRS, training neural networks to recognize early warning patterns. Similarly, Abed et al. (2019) estimated cerebral blood flow velocity during breath-hold challenges using artificial neural networks, achieving 75-87% accuracy in training and 60-80% in blind testing. These studies highlight ML’s role in advancing neurophysiological monitoring.
Conclusion:
Therefore, AI can aid in developing personalized management strategies based on continuous monitoring, allowing for timely interventions when cerebral oxygen saturation levels drop below critical thresholds. This integration of AI with cerebral oximetry not only improves real-time decision-making but also enhances patient outcomes by minimizing the risk of neurological impairment after cardiac surgery.

Conclusion: 152
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Effects ofFluid Therapy with ringer's vs Ringer Lactate Solution on Acid-Base Balance and Serum Electrolytes in Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: (Javad Jamalian - author)
Introduction:
Introduction: Preventing acid-base and electrolyte disturbance is crucial in coronary artery bypass graft (CABG) surgery, since any of these conditions can affect outcome. The type of crystalloid solution used during and after the surgery can affect these disturbances.
Methods:
Methods: In this study, 90 patients who candidates for CABG surgery were randomly allocated to either ringer's lactate (RL) or ringer's group. In order to provide essential blood volume before and after the start of CPB fluid administration with either ringer's or RL solution was started during operation and continued for 18 hours after the patient was transferred to ICU, ABG, serum electrolytes and Lactate level were measured before and at the end of CPB, upon arrival to the ICU, and 6, 12 and 1 8 hours after ICU admission and compared between the two groups.
Results:
Results: Blood PH level was significantly different between the two groups upon arrival to ICU, 6 and 18 hours after ICU admission (P<0.05) which was clinically closer to the normal range in the Rl group, Serum bicarbonate level showed a significantly difference between the two groups (P<0,05), There were no significantly diflerences between the two groups in terms of lactate level, serum electrolytes, blood loss, intake and output of fluids and blood products transfusion,
Conclusion:
Conclusion: In this study, ringer's lactate solution creates a more favorable acid-base balance without a significant increase in blood lactate level which is attributed to the buffering effect of existing lactate, and can be used as an appropriate alternative to ringer's solution during and after CABG.

Conclusion: 151
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Epidemiological study of cardiovascular patients referred to clinical departments at a selected center of Alborz University of Medical Sciences
Authors: (Tahereh Sadeghi - author) (Fatemeh Rahimi - corresponding-author) (Behnaz Movahedi - author) (Fatemeh Bayat - author) (Mehdi Japlaghi - author) (Azam Karimi - author)
Introduction:
Cardiovascular disease is the leading cause of death worldwide and is projected to remain so by 2025. These diseases include coronary artery disease, stroke, heart failure, and peripheral vascular disease. In 2016, they accounted for 31% of all deaths globally, totaling 17.9 million people, with coronary artery disease and stroke responsible for 85% of these fatalities. In Iran, cardiovascular disease accounts for 43% of all deaths. Therefore, the assessment of epidemiological indicators related to mortality is of great importance. In this context, the present study was conducted to examine the epidemiology of cardiovascular diseases among patients hospitalized at a selected center of Alborz University in 1402.
Methods:
In this cross-sectional descriptive study, we examined the medical files of 9,760 patients who were hospitalized from the first of Farvardin to the end of Esfand in 1402, all with a primary diagnosis of cardiovascular diseases at selected centers of Alborz University. Data was collected using Excel along with a two-part checklist. The first part gathered demographic information, while the second part focused on various types of cardiovascular diseases, associated risk factors, duration of hospitalization, and disease outcomes. The findings were analyzed using SPSS statistical software. related to different types of cardiovascular diseases, risk factors, duration of hospitalization, and disease outcome. The findings were analyzed using SPSS statistical software.
Results:
In a study involving 9,760 patients, it was found that 61.3% of the participants were male, 89% were married, and 50.17% were natives of the region. The average age of the patients was 58 years, with a standard deviation of 29.9 years, and most individuals were between the ages of 40 and 87. The most prevalent heart condition identified was angina pectoris, while hypertension was the most common vascular disease. Among heart patients, 8% succumbed to cardiovascular-related causes. The primary reasons for cardiac referrals were as follows: 23% were due to cardiac fibrillation, 45% due to atherosclerosis, 12% due to heart failure, and 51% due to acute coronary syndrome. Notably, 32% of those referred were hospitalized in specialized wards.
Conclusion:
Individuals with cardiovascular diseases encounter multiple risk factors that elevate the likelihood of developing these conditions. To prevent cardiovascular diseases, health programs can utilize a variety of approaches, including social media, education, and public awareness campaigns. Timely screenings, lifestyle modifications, and managing risk factors such as metabolic syndrome, high blood pressure, smoking, elevated cholesterol levels, and being overweight are crucial strategies that can significantly reduce the incidence of cardiovascular diseases.

Conclusion: 148
Status: accepted_oral
Headline Title: Perfusion
Headline Title:New Advancements in CPB technology for improve the challenges in open heart surgery (systematic review)
Authors: (Ali Moradi - corresponding-author)
Introduction:
Cardiopulmonary bypass (CPB) in open heart surgery presents several significant challenges such as: Systemic Inflammatory Response, Coagulopathy, Pulmonary Complications and Cognitive Dysfunction. Addressing these issues is essential for enhancing patients results in open heart surgery that utilizes CPB. In this article we try to explain strategies that are being researched to mitigate these challenges. The research questions are: How do these complications vary among different patient populations? What advancements have been made in CPB technology to improve outcomes?
Methods:
The processes of this review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, PubMed, and the Cochrane library databases and experimental research articles on adult patients undergoing first open-heart surgery written in English involving the. The database was selected using the MeSH-related English words: “advancements in CPB technology,” “patient’s outcome” with a combination of Boolean operators (AND, OR). Relevant articles were obtained from the reference list systematically with the “snowball” procedure. were searched from the inception through January 31, 2024. assessing the New Advancements in CPB technology for improve the challenges in open heart surgery.
Results:
Of the 228 articles obtained, 25 studies have been identified and selected that have been reviewed the new advancements in CPB technologies for improve the patient’s outcome in open-heart surgery (coronary artery bypass grafting [CABG], valve surgery, and heart transplantation). Of these studies, four items resulted that include: Age and Comorbidities, Type of Surgery, Gender Differences and Duration of CPB. Complications of cardiopulmonary bypass (CPB) in open heart surgery can vary significantly among different patient populations due to several factors. There are specific studies that highlight these variations in detail and the experience of the surgical team impact these outcomes. These strategies are: 1-Technical Improvements. 2- Pharmacologic Therapy. 3-Identification of High-Risk Patients. 4-Myocardial Protection Techniques.
Conclusion:
Grasping these differences is essential for customizing perioperative care and enhancing results for various patient populations. Some strategies can mitigate these complications in high-risk populations. Implementing these strategies can significantly enhance patient safety and outcomes in high-risk populations undergoing CPB. Screening models for high-risk patients in the context of cardiopulmonary bypass (CPB) and open heart surgery typically involve the following components: 1- Risk Assessment Tools. 2- Preoperative Evaluation. 3- Multidisciplinary Approach. 4- Continuous Monitoring.

Conclusion: 146
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Diagnostic Accuracy of CAM-ICU and NEECHAM Tools Compared With DSM-IV Criteria in Diagnosing Delirium After Coronary Artery Bypass Surgery
Authors: (Rasoul Azarfarin - corresponding-author)
Introduction:
Early diagnosis of patients in the ICU can significantly contribute to improved quality of care. This study aims to compare the diagnostic accuracy of Confusion Assessment Method for the ICU (CAM-ICU) and Nursing Evaluation and Education of Cognitive Health Assessment Model (NEECHAM) Confusion Scale tools with DSM-IV diagnostic criteria for patients who have undergone coronary artery bypass surgery (CABG).
Methods:
In this cross-sectional study, 280 patients were examined. Delirium assessments were conducted a day after surgery. The evaluation process involved the following steps: An intensive care specialist assessed the patients’ delirium status according to the DSM-IV criteria (as the reference standard). Subsequently, the researcher evaluated the same patients using the NEECHAM tool. Finally, the researcher assessed the patients using the CAM-ICU tool. Thereafter, sensitivity, specificity, positive and negative predictive values, and Kappa agreement coefficient were measured to compare the diagnostic accuracy of both CAM-ICU and NEECHAM tools with DSM-IV.
Results:
The frequency of delirium varied depending on the diagnostic tool used: DSM-IV: 12%; CAM-ICU: 2.9%; and NEECHAM: 3.9%. The sensitivity and specificity values for each tool were as follows: CAM-ICU: sensitivity: 25% (95% CI, 11.5% to 43.4%) and specificity: 98.5%. NEECHAM: sensitivity: 34.4%, 95% CI, 18.6% to 53.2%) and specificity: 98.5%. Both CAM-ICU and NEECHAM demonstrated a positive predictive value of 100%. The negative predictive values were 91.1% for CAM-ICU and 92.1% for NEECHAM. The Kappa coefficient was calculated to be 0.73.
Conclusion:
There was no significant difference between the diagnostic accuracy of NEECHAM and the CAM-ICU tools in detecting delirium. Both tools demonstrated low sensitivity but high specificity in diagnosing delirium following CAB

Conclusion: 140
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Impact of Risk Factor Quantity on Cardiovascular Events in Hypertensive Patients: Evidence from the Isfahan Cohort Study
Authors: (Dr Erfan Sabouri - corresponding-author) (Dr Masoumeh Sadeghi - author) (Dr Hamidreza Roohafza - author) (Dr Reza Shokrani Foroushani - author) (Dr Mohammad Talaei - author) (Nizal Sarrafzadegan - author) (Dr Shahram Oveisgharan - author)
Introduction:
Hypertension is considered the most prominent established risk factor for adverse cardiovascular outcomes. It is already known that cardiovascular events occur more frequently in patients who possess more than one or two cardiovascular disease risk factors (CVD-RFs) simultaneously, raising the theory that a combination of risk factors with each other may have synergic effects on another for adverse CVD outcomes. The influence of hypertension in alliance with other major CVD-RFs (i.e., aging, sex, family history, obesity, diabetes, dyslipidemia, and smoking) on mortality rates and occurrence of cardiovascular events has not been fully comprehended yet, due to the overlapping and interconnected nature of these risk factors. As many of these risk factors are considered modifiable, this study aims to evaluate the impact of CVD-RF quantity on the occurrence of cardiovascular events, CVD-related mortality rate, and all-cause mortality in the particular group of hypertensive patients.
Methods:
This study is a secondary analysis of 6,640 subjects from the Isfahan Cohort Study. Starting from 2001, a comprehensive medical history (including age, gender, educational level, amount of physical activity, smoking status, quality of diet, family history of CVD, and past drug history) was taken. Anthropometric measures, and laboratory results of participants (i.e. fasting blood sugar, triglycerides, total cholesterol) were documented, and systolic and diastolic blood pressures of patients were taken twice 30 minutes apart to screen hypertensive patients according to the latest AHA guidelines. Through the 15 years of follow-up, all-cause mortality, CVD-related mortality, and occurrence of non-fatal cardiovascular events (myocardial infarction or stroke) were assessed biannually and confirmed by separate panels of experts blinded to participants' RF profiles. Patients who were not retained in the follow-up program or had insufficient data on the main variables were excluded. The mentioned outcomes were analyzed separately, in IBM SPSS statistics (V26), using Cox proportional-hazard models adjusted for age, sex, body mass index, educational level, diabetes, family history of CVD, smoking, and dyslipidemia to reduce confoundment as possible for a better estimation of hazard ratios (HRs) among normotensive participants, and hypertensives in two subgroups of patients with <3 CVD-RFs, and those with ≥3 CVD-RFs.
Results:
Among 5432 eligible participants (mean age 50.611.6), hypertensive patients (n=1,509) had 1.3, 2.0, and 1.4 times higher HRs for all-cause mortality, CVD-related mortality, and non-fatal cardiovascular events. Compared to the normotensive group, risks of the aforementioned outcomes were 1.2, 1.7, and 1.3 times higher in the <3 CVD-RFs hypertensive group, and 1.7, 3.4, and 2.3 in the ≥3 CVD-RFs group, respectively. The group with ≥3 CVD-RFs had significantly higher rates of CVD-related mortality and non-fatal cardiovascular events (P= 0.003, P=0.001) compared to the hypertensives with <3 CVD-RFs. Moreover, evaluating the role of each RF combined with hypertension on outcomes showed that, hypertension combined separately with aging, diabetes, dyslipidemia, or smoking was associated with significantly higher adverse cardiovascular outcomes and mortality. The effect of gender, obesity, or family history solely was not significant in hypertensive patients' outcomes.
Conclusion:
Hypertension alone, or in combination with other CVD-RFs, increases the chances of all-cause mortality, CVD-related mortality, and nonfatal cardiovascular events compared to normotensive individuals. An increase in the quantity of the mentioned CVD-RFs (specifically to ≥3) results in a highly significant increase in fatal and non-fatal cardiovascular events. Therefore, hypertensive patients are shown to be a population at risk for adverse outcomes, that should be thoroughly evaluated for coexisting CVD-RFs. Paying more attention to the prevention and management of modifiable CVD-RFs, especially diabetes, dyslipidemia, and smoking, limits the synergistic effects of multiple CVD-RFs more robustly, and reduces mortality rates and cardiovascular events.

Conclusion: 139
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:"Evolving Trends in Cardiovascular Risk Factors: Insights from the Middle East and North Africa (1990–2019)"
Authors: (Samira Chaibakhsh - author) (Hooman Bakhshandeh - author) (Ali Zahedmehr - author) (Dr. Shiva Khaleghparast - author) (Dr Amirali Soheili - corresponding-author)
Introduction:
Introduction (Background & Objectives): Cardiovascular diseases (CVDs) are the leading cause of death globally, with metabolic, environmental, and behavioral risk factors contributing significantly to mortality (1). The Middle East and North Africa (MENA) region faces a growing burden of CVD due to its unique sociodemographic and lifestyle characteristics, including urbanization and dietary shifts (2). This study aims to analyze trends in CVD mortality attributable to metabolic, behavioral, and environmental risk factors in the MENA region from 1990 to 2019, utilizing data from the Global Burden of Disease (GBD) database, with a specific focus on identifying the temporal trends for each risk factor, including their increasing and decreasing slopes, and determining the year points at which significant changes occurred.
Methods:
Material & Methods: This study utilized data from the Global Burden of Disease (GBD) database to evaluate CVD mortality attributable to three main groups of risk factors in the MENA region from 1990 to 2019: behavioral, metabolic, and environmental (3, 4). Join-point regression analysis was applied to identify significant temporal changes of death proportion due to each risk factor. By performing this analysis, we can find the year point that the slop of trend changed. By conducting this analysis, we could identify the year during which the slope of the trend changed. Therefore, the annual percentage changes in CVD mortality due to considered risk factors were calculated, allowing for a comprehensive assessment of long-term trend patterns and critical inflection points.
Results:
Results: From 1999 to 2000, there was a slight increase in deaths due to environmental risk factors, although this change was not statistically significant. However, from 2001 to 2019, a remarkable decline was observed in cardiovascular disease (CVD) patient deaths attributed to environmental risk factors, with a 0.1% per year decrease (p-value < 0.001), (Fig1). Before 1996, no notable trend was observed regarding behavioral risk factors. From 1996 to 2011, a statistically significant decrease due to behavioral risk factors was found, with a reduction of 0.3% per year (p-value < 0.001). However, after 2011, the trend shifted to an increasing slope in death prevalence, with an increase of 0.1% per year. (Fig2) Although the mortality rate due to metabolic risk factors increased significantly during the study period, the rate of increase changed from 0.3% per year (p-value < 0.001) before 2002 to 0.2% per year (p-value < 0.001) afterward. (Fig3)
Conclusion:
This study highlights shifts in cardiovascular disease mortality trends in the MENA region. While environmental risk-related deaths continue to decline, behavioral risks, which initially showed a downward trend, have reversed since 2011, now increasing. This shift calls for urgent interventions, including tobacco cessation and lifestyle promotion. Metabolic risks remain a major driver of mortality, though their rate of increase has slowed. Addressing the resurgence of behavioral risks alongside sustained efforts to manage metabolic and environmental factors is essential to reducing the overall burden of cardiovascular disease.

Conclusion: 136
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:The effect of Self‑Care Recommendations with and without Tilt‑Training on Quality of Life in Children and Adolescents with Vasovagal Syncope: A Randomized Clinical Trial
Authors: (Dr Alireza Ahmadi - author) (Mohamadreza Sabri - author) (Zohre Sadat Navabi - corresponding-author)
Introduction:
Background: Syncope is among the most common paroxysmal disorders in children and adolescents. Vasovagal syncope is the most common syncope in children and adolescents. The aim of this study was to evaluate the impact of self‑care recommendations with and without tilt training on the quality of life (QoL) of children and adolescents with syncope.
Methods:
Methods: This randomized controlled clinical trial was conducted in Isfahan, Iran, from April 2017 to June 2021 and included 120 patients with syncope. Eligible children and adolescents (aged 6–18 years) who met inclusion criteria were recruited by the simple sampling method and then assigned randomly into two groups. The intervention group (n = 60) received routine self‑care recommendations such as dietary advice, behaviors to prevent syncope, and counter‑pressure maneuvers along with tilt training, while the control group (n = 60) received self‑care recommendations without tilt training. The education training included two face‑to‑face sessions, each of which lasted for 45–60 min. Then, both groups were followed up by telephone (once a month) for six months. A researcher‑made self‑care questionnaire and Pediatric Quality of Life Inventory (PedsQL™ 4.0) were completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods.
Results:
Results: The results showed a significant difference in the mean scores of physical functioning, emotional functioning, social functioning, school functioning, psychosocial functioning, understanding of health, and total QoL in the intervention and control groups before and after the intervention (p < 0.05). Also, the paired t‑test results showed a significant difference in the mean scores of self‑care domains and total self‑care in the intervention and control groups before and after the intervention (p < 0.05).
Conclusion:
Conclusion: Self‑care recommendations with and without tilt training can improve QoL in children and adolescents with syncope.

Conclusion: 95
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Glucose-Insulin-Potassium (GIK) in low cardiac output Patients Undergoing Open Cardiac Surgery for heart valve replacement
Authors: (Dr. Ali Jabbari - corresponding-author) (Dr. Hadi Aboljadael - author) (Dr. Mahkameh Farmanesh - author)
Introduction:
Heart valve replacement is a common surgical procedure performed for various reasons. Glucose-Insulin-Potassium (GIK) is a cocktail known to enhance myocardial energy during ischemia and has shown significant positive effects on left ventricular ejection fraction (LVEF), which can be linked to complications. This study aimed to evaluate the impact of GIK administration in patients undergoing mitral or aortic valve replacement, with or without coronary artery graft replacement.
Methods:
The study included two groups of patients scheduled for valve replacement, all with an LVEF of 45% or lower. Patient characteristics, including age, sex, and disease attributes, were matched across both groups. Patients were randomly assigned to either the GIK group or the control group. The GIK solution contained 10-15 units of insulin in 50% glucose, 10 ml of 15% potassium solution, and 2 ml of 50% magnesium sulfate, administered at a rate of 10 ml/h. A standardized drug protocol was used for anesthesia induction based on ipioids and maintenance (Midazolam- Sufentanil- Atracorium). Hemodynamic parameters were recorded before, during, and after anesthesia, and LVEF was monitored via transesophageal echocardiography (TEE).
Results:
The findings indicated that GIK administration was not significantly associated with adverse effects such as hypokalemia or hyperglycemia. At the end of the operation, TEE showed an average 6% increase in LVEF in the GIK group, which also demonstrated improved responsiveness to inotropes. In contrast, three patients in the control group required intra-aortic balloon pump support post-surgery. Additionally, the GIK group exhibited a significant reduction in acute kidney injury (AKI), atrial fibrillation (AF), and myocardial infarction within 24 hours after surgery.
Conclusion:
GIK does not increase the risk of side effects and may be a viable treatment option. The GIK solution appears to enhance LVEF and improve responses to vasoconstrictors (norepinephrine), leading to higher diastolic pressures with minimal doses. Furthermore, arterial blood analysis parameters improved more significantly in the GIK group during cardiopulmonary bypass and cross-clamp time. Administering GIK can improve both biochemical and clinical outcomes, potentially enhancing patient results, reducing intensive care unit stays, and decreasing the need for balloon pump support.

Conclusion: 88
Status: accepted_oral
Headline Title: Echocardiology
Headline Title:Comparison of diagnosis power of pulmonary edema between lung ultrasound and other common methods in patients with myocardial infarction
Authors: (Leila Bigdelu - corresponding-author) (Pegah Safari - author) (Ali Baniasadi - author) (Maryam Emadzadeh - author)
Introduction:
Introduction: Heart failure is the most frequent complication of myocardial infarction (MI) which can lead to cardiogenic pulmonary edema (PE). Even though detecting PE in the initial phase remains challenging, recent research shows lung ultrasonography (LUS) could be more sensitive than common detecting methods.This study's primary endpoint is to comprehensively compare the LUS and echocardiography diagnostic value in the initial phase of PE.
Methods:
All patients admitted with MI (both ST elevation and non-ST elevation) diagnosis in the emergency department from September 2020 to September 2021 and eligible for our study were investigated. PE evaluation were conducted via seven pairs zone lung auscultation, echocardiography (E/E’, E/A, pulmonary artery pressure, left atrium size, etc.) and eight zones LUS in 24 hours after admission.
Results:
ninety MI patients with a mean age of 52.83 years, of whom 56.7% of them were male, were evaluated in this study. Rales on lung auscultation were present only in patients with severe PE as detected by LUS. Two of the echocardiography indices had a positive correlation with the PE severity evaluated via LUS. These indices were E/E’ (correlation coefficient: +0.579, P-value <0.001) and E/A (correlation coefficient: +0.629, P-value <0.001), which their correlation evaluated by chi-square and Fisher’s exact test. However, there is no positive correlation between PE severity detected by LUS and other echocardiography, such as pulmonary artery pressure (correlation coefficient: -0.230, P-value = 0.03) or left atrium size (P-value = 0.321) according to the Spearman correlation test.
Conclusion:
This study showed better sensitivity for diagnosing cardiogenic PE, especially mild PE by LUS compared to other conventional methods. Combining LUS with other PE diagnostic methods has more sensitivity and can detect PE in earlier phase.

Conclusion: 87
Status: accepted_oral
Headline Title: Echocardiology
Headline Title:The Effect of Nitroglycerin Spray on diagnosis of patent foramen oval by transesophageal echocardiography and leftward bulging of the arterial septum in patients with cryptogenic stroke
Authors: (Leila Bigdelu - corresponding-author) (Ali Baniasadi - author) (Ossama Maadarani - author) (Armin Soleimannezhad Tabrizi - author)
Introduction:
Introduction: Patent foramen ovale (PFO) is recognized as the primary cause of cryptogenic stroke in patients with unidentified sources of cardiogenic emboli. A common reason for false negative results in PFO diagnosis via transesophageal echocardiography (TEE) is the lack of leftward bulging of the arterial septum (LBA). This study aimed to investigate the effect of combining the Valsalva manoeuvre and nitroglycerin administration on the diagnostic value of PFO via TEE and LBA-related criteria in patients with cryptogenic stroke.
Methods:
This pre-post quasi-experimental study included patients with cryptogenic stroke who were referred for transesophageal echocardiography (TEE) to evaluate suspected PFO. The evaluation of LBA-related criteria and the presence of PFO using TEE and saline agitated contrast was conducted during normal respiration and the Valsalva manoeuvre, both prior to and following the administration of nitroglycerine spray.
Results:
A total of 16 patients were included in this study. PFO was detected in 6 patients without any manoeuvres or nitroglycerine. The Valsalva manoeuvre alone and its combination with nitroglycerine spray administration led to the detection of PFO in 3 patients and 1 other patient, respectively. The use of nitroglycerine with the Valsalva manoeuvre enhanced LBA-related criteria including the proportion of beats with the presence of LBA (P=0.003), the start time of LBA (P=0.001), and its duration (P=0.002) compared to the resting respiration. This improvement, when compared to the Valsalva maneuver alone was noted only in the proportion of beats with the presence of LBA (P=0.049).
Conclusion:
The combination of nitroglycerine and the Valsalva manoeuvre may enhance the frequency of LBA occurrences and improve the diagnostic accuracy of TEE in identifying PFO in patients with cryptogenic stroke.

Conclusion: 86
Status: accepted_oral
Headline Title: Cardiac Imaging
Headline Title:Exploring Diagnostic Correlations in Myocarditis: Clinical, Laboratory, and Imaging Insights
Authors: (Zahra Kheirandish - corresponding-author) (Ali Shahpari - author) (Mohammad Kasaee - author)
Introduction:
Myocarditis is an inflammatory condition of the myocardium . . Myocardial biopsy is gold standard for diagnosis but is invasive ,cardiac magnetic resonance imaging (MRI) emerging as a key tool for non-invasive assessment and confirmation of myocardial inflammation,but is not available anywhere .The aim of this study was correlating clinical ,ECG & lab data to data derived by MRI in hope that myocarditis be suspected according to them earlier
Methods:
In this retrospective cross-sectional study, data from 52 patients diagnosed with myocarditis via MRI between 2018 and 2020 were analyzed. The cohort included individuals aged 12 to 66 years (mean age 29.88 ± 12.67 29.88±12.67 years), with females constituting 25% of the sample.
Results:
In a study encompassing 52 cases of myocarditis, the clinical manifestations were predominantly characterized by chest pain, dyspnea, and palpitations, listed in order of frequency. The most common presentation pattern was acute coronary syndrome (ACS), observed in 38.5% of cases, followed by congestive heart failure (CHF) at 17.3%, arrhythmias at 11.5%, and combined presentations of ACS + CHF and ACS + CHF + arrhythmias at 11.5% and 1.9%, respectively. 11.5% of patients had abnormal ECG findings, bundle branch block (44%), early repolarization changes (34%). Normal ejection fraction (EF) on echocardiography in 66%compared to 74.8% on cardiac MRI (CMR). MRI findings revealed diffuse myocardial involvement across more than three segments without septal involvement. LGE was present in all patients, indicating the high sensitivity of this CMR sequence. A statistically significant association was identified between T2-weighted CMR sequences and low-voltage QRS patterns (P = 0.039).
Conclusion:
Clinical findings, along with ECG and echocardiographic assessments, may provide valuable indicators that correlate with CMR findings, facilitating earlier suspicion and improved management of these patients.

Conclusion: 85
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:In-hospital outcomes of STEMI patients before and after covid-19 epidemic
Authors: (Saeideh Mazloomzadeh - author) (Dr. Shiva Khaleghparast - author)
Introduction:
ST-Elevation Myocardial Infarction (STEMI) is a medical emergency that requires prompt diagnosis and treatment. During the COVID-19 pandemic, healthcare systems faced excessive burden. Therefore, this study aimed to compare in-hospital outcomes of STEMI patients before and after the COVID-19 epidemic.
Methods:
In this descriptive study, in-hospital outcomes of patients diagnosed with STEMI admitted to Rajaie Cardiovascular Institute were compared between two time periods: before and after COVID-19 epidemic. The outcomes investigated included 30-day readmission, in-hospital mortality, cardiogenic shock, atrial fibrillation, and heart failure. Independent t-tests or Mann-Whitney U test were used for comparing quantitative variables, while chi-square test and Fisher's exact test were used for comparing qualitative variables. Data were analyzed using SPSS version 22.
Results:
The mean age of patients were 60.59 ± 12.51 and 58.75 ± 11.75 years in 2019 and 2020, respectively (P=0.039). In 2019, 248 (80.3%) and in 2020, 482 (82.8%) patients were male. The proportion of patients with a family history of coronary artery disease, diabetes, dyslipidemia, and smoking was significantly higher in 2020 than 2019 (P<0.05). The mean of ejection fraction (EF) of patients were 36.21 ± 9.26, and 38.34 ± 8.83 in 2019 and 2020, respectively (P=0.003). In 2019, 21 (6.8%) and in 2020, 53 (9.1%) patients were readmitted within 30 days of discharge (P=0.23). The comparison of hospital outcomes, including mortality, cardiogenic shock, atrial fibrillation, and heart failure were not significantly different between 2019 and 2020 (P>0.05).
Conclusion:
In this study, no significant differences of in-hospital outcomes were found before and after COVID-19 epidemic. This may suggest the ability of healthcare systems to maintain the quality of care and treatment amidst the challenges posed by the pandemic. However, there remains a need for further investigations to identify other factors influencing patient recovery and outcomes.

Conclusion: 84
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Evaluation of the 4-Year Outcomes of Using Right Atrial Wall Tissue for Pulmonary Valve Reconstruction in 16 Patients Diagnosed with Tetralogy of Fallot at Shahid Chamran Heart Center, Isfahan
Authors: (Hamid Bigdelian - author) (Dr Mehdi Ghaderian - corresponding-author) (Mohamadreza Sabri - author) (Dr Alireza Ahmadi - author)
Introduction:
As is well known, particularly in patients diagnosed with Tetralogy of Fallot, the pulmonary valve annulus is often small. During complete repair surgery, it is frequently necessary to open the annulus to enlarge the diameter of the pulmonary valve and improve right ventricular outflow. However, this can lead to pulmonary valve insufficiency, which, over time, may result in right ventricular dysfunction.
Methods:
In this study, 16 patients with an average weight of 7kg +_1and aged between 6 months and 1 year, who were diagnosed with Tetralogy of Fallot and underwent complete surgical repair, were evaluated. All patients required pulmonary valve annulus enlargement due to a small valve diameter or restricted leaflet mobility. In this technique, a portion of the right atrial wall tissue, measuring at least 2 cm by 2.5 to 3 cm, was excised and used as an additional leaflet. This tissue was sutured onto a Gore-Tex patch and used to reconstruct the pulmonary valve while preserving the patient's native leaflets.
Results:
The mortality rate among the patients was zero. There were no cases of hospital-acquired infections or endocarditis. The average ventilator support time was approximately 48 hours, and the average cardiopulmonary bypass (pump) time and aortic cross-clamp (clamp) time were 61 minutes and 76 minutes, respectively. All patients underwent echocardiography before and after surgery. Pulmonary valve insufficiency was reported as absent in 5 patients, very mild in 8 patients, and moderate in 3 patients. The three patients with moderate insufficiency showed improvement over time, with their condition downgraded to mild insufficiency. During the 4-year follow-up, all patients were free from severe insufficiency, with 8 patients showing no insufficiency and 7 patients having mild insufficiency. Only one patient required reoperation for pulmonary valve replacement due to left pulmonary artery stenosis and moderate pulmonary insufficiency.
Conclusion:
As demonstrated, the 4-year follow-up revealed minimal pulmonary valve insufficiency, and the pulmonary valve function remained favorable. Key advantages of this technique include the absence of heart block risk, no adverse effects on hemodynamics, and even potential hemodynamic improvement due to slight reduction in right atrial size. Another significant advantage is the preservation of the patient's native leaflets, with only one additional leaflet added, which can grow with the patient without issues such as shrinkage, calcification, or size mismatch. This method is simple, low-risk, and nearly complication-free. It can be performed by less experienced surgeons and only slightly increases clamp and pump times, without significantly raising the risk of ischemia or pump-related complications. . I recommend this technique to both younger and more experienced colleagues and hope that with increased experience and more cases, further refinements

Conclusion: 81
Status: accepted_oral
Headline Title: Cardiac Nursing
Headline Title:The Role of Data-Driven Interventions in Nursing Care and Management of Complications in Heart Failure Patients: A Systematic Review
Authors: (Ali Akbari - author) (Masoumeh Zakerimoghadam - corresponding-author)
Introduction:
Heart failure, as one of the major global health issues, leads to severe complications, a reduction in patients' quality of life, and an increased burden on healthcare systems. The role of nurses in managing these patients is crucial, and in recent years, the use of data-driven technologies such as artificial intelligence (AI) and machine learning has created new opportunities for improving nursing care. This article systematically reviews the role of these interventions in nursing care for heart failure patients and the management of related complications, contributing to the identification of existing evidence in this area.
Methods:
Following Cochrane systematic review principles and PRISMA guidelines, a comprehensive search was conducted, using keywords such as "Data-Driven Interventions," "Artificial Intelligence," "Heart Failure," "Nursing Care," and "Complications" across multiple databases, including PubMed, CINAHL, Scopus, EMBASE, Web of Science, and Cochrane Library. Additionally, Google Scholar was used to search for grey literature. No time limitations were applied. All English-language clinical trials that met the inclusion criteria were included in this review. Review articles, observational studies, commentaries, and letters to the editor were excluded. Two authors independently screened and extracted data, with discrepancies resolved by a third author. The quality of the studies was assessed using the QualSyst tool, and A risk of bias assessment was performed using the Joanna Briggs Institute tool, which is designed to evaluate various study types.
Results:
The systematic review identified a variety of data-driven interventions that have been implemented in nursing care for heart failure patients, with a significant focus on artificial intelligence (AI) and machine learning. These interventions have improved early detection and monitoring of complications, personalized treatment plans, and optimized medication management. AI tools have also enhanced communication and decision-making by integrating with electronic health records. In terms of managing complications, AI-driven tools have been particularly effective in detecting arrhythmias, fluid retention, and exacerbations. However, challenges such as data privacy concerns, high implementation costs, and the slow integration of AI into healthcare systems remain. Future research should focus on longitudinal studies to assess the long-term impact and sustainability of these interventions.
Conclusion:
This review highlights the effectiveness of data-driven interventions, particularly AI, in improving nursing care and managing complications in heart failure patients. These technologies have enhanced early detection, personalized care, and medication management. However, challenges such as data privacy, cost, and slow adoption remain, requiring further research on their long-term impact.

Conclusion: 77
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:Giant Coronary Aneurysms with Multiple Large Resistant Thromboses in an 8-Month-Old Boy with IVIg-Resistant Kawasaki Disease: A Case Report
Authors: (Maryam Taraz - corresponding-author) (Mojtaba Gorji - author) (Behdad Gharib - author) (Vahid Ziaee - author)
Introduction:
Kawasaki disease is an acute self-limiting systemic vasculitis in childhood predominantly affecting children below 5 years of age. Its etiology is still unknown. Patients with Kawasaki disease are at risk of coronary artery aneurysms. Larger coronary artery aneurysms correlate with higher risks for clinical complications and major adverse cardiac events since blood flow changes to turbulent flow, facilitating thrombosis. Depending on the classification, prophylactic anticoagulation and/or antiplatelet and ivig therapy can be indicated. As the probability of coronary artery damage associated with IVIg-resistant Kawasaki disease is higher than that with IVIg-sensitive Kawasaki disease, the early detection and appropriate treatment of IVIg-resistant Kawasaki disease can diminish the probability of damage to coronary arteries and hospital lengths of stay and cost. Kawasaki disease in early infancy is uncommon, and sometimes it occurs with thrombosis and peripheral gangrene.
Methods:
In this paper, we report the case of an IVIg-resistant Kawasaki disease with severe coronary artery thrombosis and positive genetic mutation. Medical treatment helped resolve the thrombosis, but the coronary arteries remained dilated.
Results:
There have been case reports of giant coronary artery aneurysms in Kawasaki disease accompanied by COVID-19. We assume that the correlation between Kawasaki disease and COVID-19 produces a synergistic effect on thrombosis and aneurysm formation in coronary arteries, which could explain our patient’s lack of a proper response to appropriate treatment. The patient continued the medical treatment and underwent a genetic test for thrombophilia. The results showed a THBD gene mutation. In treatment-resistant Kawasaki disease, genetic testing is recommended if abnormal manifestations occur.Moreover, our patient’s follow-up echocardiography showed the resolution of the thrombosis in the coronary arteries, while the dilatation of the coronary arteries was still remarkable
Conclusion:
We herein described an IVIg-resistant Kawasaki disease patient with giant coronary aneurysms and multiple large thromboses in echocardiography. The boy had a mutation in the THBD gene, which could explain his severe thrombosis. Severe aggressive antithrombotic treatment, treatment with biological agents, and corticosteroid pulse therapy may control thrombosis. Genetic studies are advisable in all Kawasaki disease patients with thrombosis in early infancy.

Conclusion: 74
Status: accepted_oral
Headline Title: Heart Failure
Headline Title:Leveraging Artificial Intelligence to Predict Heart Failure: A Paradigm Shift in Cardiology
Authors: (Mr Mohammad Ali Fahim - author)
Introduction:
Heart failure is a chronic syndrome that affects over 26 million people globally, contributing to significant healthcare costs and reduced quality of life. Despite advances in treatment, the burden of late-stage heart failure remains high due to delayed diagnosis. Conventional approaches rely heavily on multi-lead ECGs, imaging studies, and subjective symptom reports, often failing to identify high-risk patients early. With advancements in wearable technology and AI, real-time data analysis has become possible, offering a unique opportunity to predict heart failure events more accurately. This paper focuses on the use of single-channel ECG data obtained from Apple Watch sensors, combined with machine learning techniques, to predict heart failure and related cardiac events.
Methods:
Study Design and Participants This study utilized a retrospective dataset from wearable devices and clinical records of 5,000 patients aged 40-75 years, with known risk factors such as hypertension, diabetes, and prior cardiovascular conditions. Data were collected from Apple Watch devices for six months, supplemented with electronic health records (EHRs) from participating healthcare institutions. Data Collection Wearable Data: Single-channel ECGs, heart rate variability, step count, and activity levels were continuously monitored using Apple Watch sensors. Data were collected via HealthKit API and anonymized for analysis. Clinical Data: EHRs provided additional information, including comorbidities, medication use, and past cardiac events. AI Model Development Preprocessing: Signal denoising techniques, such as wavelet transforms, were applied to single-channel ECG data to remove noise and artifacts. Time-series data were segmented into 10-second windows for analysis. Feature Extraction: Key features such as heart rate variability (HRV), QT interval, P-wave morphology, and premature ventricular contractions (PVCs) were extracted. Machine Learning Algorithms: Models including Random Forest, Support Vector Machines (SVM), and Long Short-Term Memory (LSTM) networks were trained to predict heart failure events. Model performance was evaluated using cross-validation, with metrics such as accuracy, precision, recall, and area under the curve (AUC).
Results:
Model Performance Accuracy: The LSTM model achieved the highest accuracy (92%) in predicting heart failure hospitalization within 30 days. AUC: The Random Forest model showed an AUC of 0.89, indicating high discriminatory power. Precision and Recall: LSTM demonstrated precision and recall scores of 0.90 and 0.87, respectively, outperforming traditional models. Wearable Data Utility Single-channel ECG data alone provided an accuracy of 85% when combined with HRV and activity levels. Integration of wearable and EHR data improved overall model performance by 10%. Case Example A 57-year-old male with a history of hypertension experienced abnormal HRV and prolonged QT intervals, flagged by the AI system. Early intervention based on these predictions prevented hospitalization, highlighting the potential of wearable devices for timely detection.
Conclusion:
AI-powered wearable devices represent a paradigm shift in the prediction and management of heart failure. The use of single-channel ECG data from Apple Watch sensors offers a scalable, cost-effective approach to early detection, empowering patients and healthcare providers to intervene proactively. Addressing challenges related to data quality, regulatory frameworks, and model interpretability will be key to realizing the full potential of this technology.

Conclusion: 73
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Clinical comparison of pulsatile and non‐pulsatile flow during cardiopulmonary bypass in patients undergoing Coronary Artery Bypass Graft surgery
Authors: (Kianoush Rezaeifar - author) (Mohammad Ghazinoor - corresponding-author) (Ali Karami - corresponding-author) (Ms Fateme Ahrari - corresponding-author)
Introduction:
Cardiac surgeries requiring cardiopulmonary bypass are thought to be linked to complications due to the linear flow generated by the CPB machine. Pulsatile flow has been used over the years as an alternative as it induces the pressure that imitates physiological effects of a beating heart. Current studies on possible benefits of mentioned methods are controversial. Our study was aimed to compare the potential effects of pulsatile versus non-pulsatile flow on clinical outcomes in patients undergoing coronary artery bypass graft surgery.
Methods:
This randomized prospective study was carried out at Shaheed Faghihi Hospital. Overall, 78 patients undergoing Coronary artery bypass graft surgery were divided randomly into two groups: group A included 26 patients who received Pulsatile flow, and group B included 52 patients who received non-pulsatile flow during cardiopulmonary bypass. Groups were compared in terms of inotrope dosage, need for pace maker or defibrillator, intubation duration and ICU stay duration and diuresis from each group were collected at 2 different times: 1) right after the surgery 2) 24 hours after ICU admission.
Results:
there were no significant differences in inotrope dosage, need for defibrillator or Pace maker after removing the cross clamp, Diuresis, ICU stay duration and atrial fibrillation after the surgery and 24h after ICU admission between two groups. Mechanical ventilation time in group receiving pulsatile flow was significantly lower than the other group (p=0.001).
Conclusion:
we conclude that Pulsatile flow has a positive effect on lowering patient’s intubation duration at ICU. Further research is required in order to understand The clinical significance.

Conclusion: 72
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:Association between echocardiography abnormalities and inflammatory biomarkers in pediatric MIS-C and Covid-19: Insight from a retrospective observational study
Authors: (Dr Chehreh Mahdavi - author) (Dr Atiyeh Edrisi - corresponding-author) (Dr Mohammadreza Sabri - author) (Dr Alireza Ahmadi - author) (Dr Mehdi Ghaderian - author) (Dr Bahar Dehghan - author) (Davood Ramezaninezhad - author)
Introduction:
During COVID-19 pandemic, many pediatrics presented with multi organ involvements similar to clinical manifestations of Kawasaki or Toxic Shock Syndrome; but in further studies, Centers for Disease Control and Prevention named these presentations as Multisystem Inflammatory Syndrome in Children (MIS-C) that affect multiple organs especially cardiovascular system. In this study, we aim to investigate Association between Abnormal Echocardiography findings, increased inflammatory factors in pediatrics affected by MIS-C or covid, and probability of relation between increased inflammatory biomarkers and cardiovascular diseases.
Methods:
this is a retrospective study and children (under 16 years old) with positive PCR for Covid-19 or MIS-C whom met WHO criteria admitted to the pediatric wards or pediatric intensive care units (PICU) from September 2020 to March 2021 at Imam Hossein Pediatric Hospital of Isfahan University of Medical Sciences were included. Patients with abnormal echocardiography were compared to normal echocardiography in epidemiological parameters and inflammatory factors. All data (age, sex, ethnicities, underlying diseases, clinical manifestations, laboratory biomarkers, and Echocardiography results was obtained in the first 48 hours of patients’ admission from his medical records.
Results:
Pericardial Effusion and Decreased Left Ventricle Systolic function were the most prevalent Cardiac involvements. ESR and CRP was significantly higher in MIS-C group, although Ferritin showed higher values in COVID-19 group. AST, ALT, LDH, Pro-BNP, Ferritin, and FDP were associated with development of cardiac involvement among MIS-C patients. Each unit increase in ALT and LDH was associated with 0.9% and 0.2% higher odds of cardiac involvement. Although Cardiac troponin was higher in MIS-C patients with cardiac involvement but there was no significant relation (P = .044) with cardiac involvement. Increased D-dimer (per 100 ng/mL) showed a significant association with cardiac involvement, with an optimal threshold of 500 ng/mL and an 8.1% increase in the odds of cardiac involvement (OR, 1.081; 95% CI, 1.035–1.129; P < .001). At this cut-off, sensitivity and specificity were 82.14% and 65.52%, respectively.
Conclusion:
MIS-C patients with cardiac involvement had elevated levels of AST, ALT, LDH, ferritin, pro-BNP and D-dimer compared to those without cardiac involvement. D-dimer level greater than 500 ng/mL was found to independently predict cardiac involvement in MIS-C patients.

Conclusion: 71
Status: accepted_oral
Headline Title: Cardiac Nursing
Headline Title:Predictors of Long-term Survival After Cardiopulmonary Resuscitation
Authors: (Parivash Nazarpour Lakhtaki - author) (Fatemeh Jafaraghaee - corresponding-author) (Mohammad Taghi Moghadamnia - author) (Saman Maroufizadeh - author)
Introduction:
Survival after cardiac arrest is one of the most important issues related to the safety and quality of patient care, and unexpected events such as failure to follow guidelines can endanger the patient’s safety. This study aimed to determine the long-term survival after cardiopulmonary resuscitation and its predictors in patients with cardiac arrest.
Methods:
In this retrospective study, individual, disease-related, and 3-day follow-up-related factors were monitored after the Cardiopulmonary Resuscitation (CPR) in all patients with long-term survival after Cardiac Arrest (CA) who were discharged from the hospital between 2016 and 2019. Patients’ survival or death after CPR was followed up by telephone interviews. The patient’s survival time after discharge was calculated until the interview day. The obtained data were analyzed by the Kaplan-Meier and Cox regression tests.
Results:
Out of 1565 CPR cases (both In-Hospital Cardiac Arrest [IHCA] and Out-of-Hospital Cardiac Arrest [OHCA]), 667 were successful, of which 156 patients had long-term survival. The Mean±SD of the survival time for patients was 30.98 ±1.78 months. Significant variables in associations with long-term survival were old age (>60 y) (HR=1.811, 95%CI;1.019-3.218, P=0.043), initial asystole rhythm (HR=4.199, 95%CI;2.129-8.282, P=0.001), Ventricular Tachycardia (VT) (HR=2.315, 95%CI;1.171-4.576, P=0.016), connection to mechanical ventilator (HR=1.992, 95%CI;1.229-3.229, P=0.005), cardiovascular disease (HR=1.795, 95%CI;1.111-2.901, P=0.017), and abnormal SpO2 (HR=2.447, 95%CI;1.507-3.972, P=0.001). Multivariate analysis also showed that asystole rhythm (P=0.001), VT (P=0.052), and prolonged duration of CPR (>20 min) (P=0.043) significantly increase the risk of death.
Conclusion:
The major predictors in this study were age, initial rhythm, connection to a mechanical ventilator, CPR duration, cardiovascular disease, and SpO2 monitoring. Therefore, introducing post-resuscitation care protocols and conducting training programs and further studies are warranted.

Conclusion: 68
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Minimally invasive cardiac surgery without using vacuum-assisted venous drainage, a 176 case series
Authors: (Amir Mirmohammadsadeghi - corresponding-author)
Introduction:
Minimally invasive cardiac surgery (MICS) has been growing in the last two decades. Vacuum assisted venous drainage (VAVD) is a well-known method for augmentation of venous return with smaller peripheral cannulas. On the other hand, VAVD can be associated with potential risk of hemolysis and air embolism. The aim of this study was to report our experience performing right minithoracotomy MICS without using VAVD.
Methods:
Since 2016, 176 cases were included in the study. They were different type of operations performing through MICS approach including 62 ASD repair, 33 ASD and TV repair, 29 mitral valve replacement, 17 mitral valve repair, 31 mitral valve replacement and tricuspid valve repair, and 4 mass resection.
Results:
In hospital mortality was 1.1% (N=2); the reasons were one low cardiac output state and one cerebrovascular stroke. Conversion to sternotomy was 0.5% (N=1) because of uncontrollable bleeding. All cases had successful full cardiopulmonary bypass and no need for adding any negative pressure or changing cannula size.
Conclusion:
Cardiopulmonary bypass can be managed safely during MICS without using any vacuum. Some maneuvers can help augmenting return during the operation.

Conclusion: 66
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:The effect of two different angles of aortic cannulation during cardiopulmonary bypass on Cerebrovascular accidents
Authors: (Ahmad Mirdamadi - author) (Mahmood Saeidi - corresponding-author) (Shakiba Siefi - author)
Introduction:
Coronary artery bypass grafting (CABG) is a major surgery with very serious complications. Cerebrovascular accidents (CVA) are one of them. Most CVAs after CABG surgery are caused by embolization of atheroma detached from the wall of the aortic arch or the wall of the carotid arteries. The turbulent blood flow caused by the aortic cannula during surgery causes the atheroma to detach from the vessel wall in the aortic arch and travels to the brain with blood flow, causing cerebral vascular occlusion and CVA. Therefore, the aim of this study was to investigate the two angles of the aortic cannula during CABG on the incidence of CVA after this surgery in Shahid Chamran Hospital, Isfahan, from 2019 to 2022.
Methods:
The current retrospective study was conducted on 147 patients who underwent CABG from April 2019 to March 2022. The patients' baseline and clinical information as well as the incidence of CVA at two different angles of aortic cannulation were recorded.
Results:
The study findings showed that out of 147 patients, 5 (3.4%) had CVA after CABG. 73 (49.6%) had CABG with conventional cannulation, of which 5 (6.8%) had stroke after CABG. 74 (50.3%) patients had novel cannulation, none of whom had stroke after CABG (P value = 0.028). In other words, it can be said that the novel cannulation technique is completely safe compared to the conventional technique and does not cause stroke after surgery.
Conclusion:
According to the results, it can be concluded that the determination of the aortic cannula angle in each patient should be made specifically based on the radiological and echocardiographic findings before surgery. The decision regarding which angle to use for aortic cannulation in CABG should be based on the orientation of the aortic arch wall atheroma.

Conclusion: 65
Status: accepted_oral
Headline Title: Perfusion
Headline Title:Custodiol versus the other cardioplegia
Authors: (Masoumeh Soltani - corresponding-author) (Arezoo Moradi - author) (Mostafa Fatahi - author) (Yousef Nourzade Rowshan - author) (Hamid Reisizadeh - author) (Saeed Heidari Nia - author) (Behzad Sheikhi - author)
Introduction:
Myocardial protection is a crucial aspect of cardiac surgery to ensure optimal outcomes. This study focuses on two comparisons: Custodiol® versus St. Thomas cardioplegia in right mini-thoracotomy mitral valve (MV) surgery, and Custodiol® versus blood-based cardioplegia in pediatric cardiac surgery. Custodiol® is known for providing up to 3 hours of myocardial protection with a single dose, while St. Thomas and blood-based cardioplegia typically require repetitive dosing.
Methods:
For the right mini-thoracotomy MV surgery, a prospective observational study was conducted with 39 patients receiving St. Thomas and 25 patients receiving Custodiol®. Primary outcomes included cardiac troponin T levels and secondary outcomes such as ventricular fibrillation, myocardial infarction, and inotropic support. For pediatric cardiac surgery, a randomized controlled trial was performed with 226 patients divided into Custodiol® (n=107) and blood cardioplegia (n=119) groups. Primary outcomes were a composite of 30-day mortality, ICU stay longer than 5 days, and arrhythmia requiring intervention. Secondary outcomes included total hospital stay, inotropic score, cardiac troponin levels, ventricular function, and extended survival post-discharge.
Results:
In right mini-thoracotomy MV surgery, both Custodiol® and St. Thomas showed no significant differences in postoperative myocardial injury markers. Single-dose St. Thomas provided effective myocardial protection for more than 1 hour of ischemic arrest. For pediatric cardiac surgery, there were no significant differences in composite endpoints, total hospital stay, inotropic score, cardiac troponin levels, or ventricular function between Custodiol® and blood cardioplegia groups. The median follow-up duration showed no difference in survival between the groups.
Conclusion:
Both studies conclude that Custodiol® and single-dose St. Thomas cardioplegia are effective and comparable alternatives for myocardial protection in their respective surgical contexts. Custodiol® is not inferior to blood-based cardioplegia in pediatric cardiac surgery, and single-dose St. Thomas is effective for right mini-thoracotomy MV surgery.

Conclusion: 61
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Survival following Coronary Artery Bypass Graft in Patients with Intra-aortic Balloon Pump
Authors: (Mohsen Mirmohammadsadeghi - author) (Amir Mirmohamadsadeghi - corresponding-author) (Hoda Ghasemi - author)
Introduction:
Since intra-aortic balloon pump (IABP) is one of the mechanical circulatory support devices used for patients undergoing coronary artery bypass grafting (CABG), these patients can be considered as a high-risk group with a significant risk of mortality. Hence, this study aimed at investigating the in-hospital, early, and late mortality rates as well as the risk factors associated with the incidence of mortality in these patients.
Methods:
The present retrospective study was conducted 179 CABG patients requiring postoperative IABP between January 2014 and December 2022. Patients’ basic and clinical information such as gender, age, length of hospitalization, duration of IABP connection, creatinine (Cr) level before hospitalization, glomerular filtration rate (GFR), ejection fraction (EF), and diabetes were extracted from their hospital records. Moreover, in-hospital, early (from the time of discharge up to 30 days) and late (more than 30 days up to 10 years) mortality was recorded.
Results:
The findings of the present study showed that out of 179 CABG patients requiring IABP, 96 (53.6%), 5 (2.8%), and 11 (6.1%) cases had in-hospital, early, and late mortality, respectively. In detail about the time of mortality, 3 cases in 6 months, 3 cases in 1-2 years, 4 cases in 2-3 years, and 1 case in 3-4 years had late mortality. The results of mortality were examined at three time points. First, the risk of in-hospital mortality was lower in male gender (HR=0.531), GFR≥60 ml/min/1.73 m2 (HR=0.565), and EF≥40% (HR=0.867), while it was higher in high creatinine levels (HR=1.259)(P value<0.05). Second, the risk of early mortality was lower in male gender (HR=0.178) and higher in age≥65 years (HR=1.518) (P value<0.05). Third, the risk of late mortality was lower in GFR≥60 ml/min/1.73 m2 (HR= 0.103) and higher in age≥65 years (P value<0.05).
Conclusion:
According to the results of the present study, female gender, age over 65 years, high preoperative serum creatinine level, and low EF and GFR levels can be risk factors associated with in-hospital, early, or late mortality.

Conclusion: 60
Status: accepted_oral
Headline Title: Perfusion
Headline Title:“The Critical Role of Perfusionists in Improving Outcomes of Cardiovascular Surgeries: A Clinical Perspective”
Authors: (Farid Firouzi - author)
Introduction:
Cardiovascular surgeries are among the most complex medical procedures, requiring a highly skilled team to manage the patient’s physiological stability. Perfusionists, as key members of this team, oversee extracorporeal circulation using heart-lung machines, ensuring adequate oxygenation and perfusion. Despite advancements in surgical techniques, postoperative complications remain a concern, emphasizing the need for expert perfusion management. This paper explores the role of perfusionists in reducing complications, enhancing patient safety, and improving overall outcomes in cardiovascular surgeries.
Methods:
This study combines a literature review with clinical data analysis from cardiovascular surgeries performed at leading medical centers. Metrics include: • Mortality rates within 30 days post-surgery. • Incidence of complications (e.g., acute kidney injury, neurological deficits). • Duration of hospital stay and ICU recovery. Statistical analysis was conducted to compare outcomes between cases with experienced perfusionists versus less experienced teams
Results:
1. Reduced Mortality: Patients managed by experienced perfusionists demonstrated a 20% lower mortality rate. 2. Fewer Complications: Enhanced oxygenation and perfusion reduced the incidence of postoperative complications by 15-25%. 3. Faster Recovery: Effective management of hemodynamic parameters led to shorter ICU stays.
Conclusion:
Perfusionists are integral to the success of cardiovascular surgeries. Their expertise not only minimizes complications but also enhances patient recovery. By investing in training and embracing technological innovations, the role of perfusionists can be further optimized to meet the growing demands of cardiac care

Conclusion: 57
Status: accepted_oral
Headline Title: Perfusion
Headline Title:integrating CRRT and ECMO
Authors: (Saeed Heidari Nia - author) (Masoumeh Soltani - author) (Arezoo Moradi - corresponding-author) (Behzad Sheikhi - author) (Yousef Nourzade Rowshan - author)
Introduction:
Integrating Continuous Renal Replacement Therapy into extracorporeal membrane oxygenation (ECMO) circuits is crucial for managing patients with severe cardiovascular and respiratory failure. The articles reviewed here discuss various techniques, challenges, and solutions for combining these two vital life-support systems to improve patients outcomes.
Methods:
a common challenge highlighted across the articles is the issue of negative pressure when connecting the CRRT outlet line before the ECMO pump. negative pressure ranging -20 to -100 mmHg can cause CRRT machine alarms and stoppages, leading to hemolysis, micro embolization, air emboli, and ECMO pump clotting.one method discussed involves connecting the CRRT machine between the ECMO pump and the oxygenator. this technique can generate high pressure on the CRRT machine's inlet and outlet lines, but it effectively reduces the risk of entering the ECMO pump by using the oxygenator as an air bubble trap. another approach is to connect the CRRT inlet to the arterial line near the ECMO return cannula. this method helps minimize resistance and pressure issues but requires precise monitoring to avoid complications. The articles also discuss different variations of these techniques and propose practical solutions to manage the associated risks. For example some articles suggest using alternative connection points to avoid negative pressures and maintain hemodynamic stability. illustrations and diagrams provided in the articles, like figure 5 and 6, depict the CRRT inflow and outflow connections, illustrating various methods to integrate CRRT into ECMO circuits effectively.
Results:
The combination of CRRT and ECMO part of multiple organ support therapy (MOST), is becoming more common in ICUs, next generation machines are needed to harmonize MOST components and techniques. questions remain about optimizing fluid overload, best circuit setups, and timing of CRRT. future technological advancements and studies will help improve patient outcomes.
Conclusion:
The articles collectivity provide valuable insights into the complexities and risks associated with integrating CRRT into ECMO circuits .by highlighting different connection techniques and discussing their respective advantages and challenges, they offer practical guidance for clinicians. Ensuring patients safety while optimizing the combination of CRRT and ECMO can significantly improve patient outcomes.

Conclusion: 56
Status: accepted_oral
Headline Title: Cardiac Electrophysiology
Headline Title:“Long-Term Outcomes and Clinical Characteristics in Patients with Brugada Syndrome: A Comprehensive Follow-Up Study"
Authors: (Mehrdad Saravi - corresponding-author) (Fatemh Majidi - author) (Niloufar Saravi - author) (Davood Sabour - author)
Introduction:
Brugada Syndrome (BrS) is a severe, inherited condition associated with unique electrocardiographic (ECG) patterns and an elevated risk of sudden cardiac death (SCD). This cohort study explores long-term outcomes in BrS patients and examines predictors of adverse arrhythmic events.
Methods:
A retrospective analysis was conducted on 30 adults diagnosed with BrS across three university-affiliated referral centers in Iran from July 1997 to May 2021. Data were gathered on demographics, clinical history (including syncope and family history of SCD or BrS), ECG findings, electrophysiological study (EPS) results, and SCN5A genetic mutations. The primary endpoint included cardiac arrhythmias, appropriate implantable cardioverter-defibrillator (ICD) therapies, and SCD. Secondary endpoints involved life-threatening arrhythmias and syncope episodes. Regression analyses identified predictors of these adverse outcomes.
Results:
Over a mean follow-up period of three years, 33.33% of patients experienced ventricular arrhythmias. The cohort's mean age was 41.07 ± 5.91 years, with 83.4% being male. A spontaneous Type 1 ECG pattern was present in 53.33%, and 56.66% reported a family history of SCD. Predictors of adverse events included age (HR: 1.12, 95% CI: 1.02–1.23, p=0.024), spontaneous Type 1 ECG (HR: 2.45, 95% CI: 1.10–5.45, p=0.028), family history of SCD (HR: 3.00, 95% CI: 1.20–7.48, p=0.018), and inducible ventricular arrhythmias during EPS (HR: 4.20, 95% CI: 1.73–10.21, p<0.001). ICD therapy was employed in 46.67% of cases, with minimal device-related complications.
Conclusion:
This study highlights the importance of identifying BrS patients at heightened risk for adverse events through comprehensive evaluations, including demographic and clinical factors, ECG patterns, family history, and EPS findings. Inducible ventricular arrhythmias during EPS emerged as the strongest predictor of adverse outcomes. These results emphasize the need for targeted risk stratification and early interventions, such as ICD implantation, to reduce the risk of life-threatening arrhythmias and SCD in this vulnerable population.

Conclusion: 54
Status: accepted_oral
Headline Title: Perfusion
Headline Title:Use of hemoperfusion cartridge  During cardiopulmonary bypass
Authors: (Mohammad Bagheri - corresponding-author)
Introduction:
cardiopulmonary bypass (cpb) surgery activates inflammatory cascades that cytokine It is one of the inflammatory responses that are activated during cpb, especially during redo operations and replacement of the aortic arch ,  and long and complicated procedures  .
Methods:
Using and assembling the hemoperfusion cartridge in the oxygenator circuit during CPB
Results:
that the use of hemoperfusion cartridge helps to improve the treatment of patients and reduce their stay in the ICU by absorbing inflammatory mediators
Conclusion:
1_ Modulation of inflammatory and immune indicators including Toxins, IL6.IL8.IL10.TNF  2_Reduction of CRP, RCT, WBC level  3- Decrease the use of vasopressor drugs  4_Decrease the level of anticoagulants 5- Reduction of mechanical ventilation time and reduction of stay in ICU

Conclusion: 53
Status: accepted_oral
Headline Title: Cardiac Physiotherapy
Headline Title:Gait speed and Cardiovascular Disease
Authors: (Behnoosh Vasaghi-Gharamaleki - corresponding-author) (Zahra Imani Pahlavanloo PT, PhD Candidate - author)
Introduction:
Walking is a main and common activity of human life. Some Research has been shown that walking speed can be one of the vital signs for recognition of disease. Advantage of gait speed specifically considerable in Prediction of consequence of cardiac surgery.
Methods:
In base of review articles that were done, studies have examined the 5-m gait speed test before and after cardiac surgery and then compare amount of morbidity and mortality in patient.
Results:
Walking speed can be an indicator of a patient's physical ability and heart condition. Patients with a slower walking speed usually have more heart problems. It has been proved that with each 0.1-m/s decrease in gait speed conferring an 11% relative increase in morbidity and mortality after cardiac surgery.
Conclusion:
In general, gait speed is an important factor in predicting surgical outcomes in cardiac patients. Patients with lower gait speeds may require more evaluation to reduce the risks associated with surgery. Therefore, attention to this factor can help to improve medical care and reduce postoperative complications

Conclusion: 51
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:Impact of adenosine in controlled aortic root reperfusion on clinical outcomes among patients undergoing valvular heart surgery
Authors: (Farhad Gorjipour - corresponding-author) (Mr Saeid Heidarinia - author) (Dr Farshad Jalili Shahandashti - author) (Mostafa Fatahi - author) (Mr Davood Samiei - author) (Mrs Atefe Taherkhani - author) (Dr Maryam Ghanbari - author) (Dr Fazel Gorjipor - corresponding-author) (Dr Naser Kachoueian - author) (Mrs Zahra Serajpour - author)
Introduction:
Adenosine is a vital medication in cardiac surgery, particularly in valvular heart procedures. While its use has been linked to improved postoperative cardiac function in some studies, there remains significant uncertainty regarding the optimal dosage for achieving the best clinical outcomes. This lack of consensus poses challenges for surgeons, perfusionists, and anesthesiologists alike. This study aims to explore the impact of adenosine on clinical outcomes in patients undergoing valvular heart surgery.
Methods:
This prospective randomized controlled trial was conducted over a three-month period. Sixty patients undergoing valvular heart surgery were enrolled using a continuous sampling method and randomly allocated into two equal groups of 30 patients each. The intervention group received adenosine-enriched aortic root reperfusion immediately prior to aortic declamping, while the control group underwent standard warm blood aortic root reperfusion. Both groups were matched for demographic and clinical characteristics to ensure comparability
Results:
Results indicated no significant differences in mean cardiopulmonary bypass (CPB) time, aortic cross-clamping duration, or mechanical ventilation between the intervention and control groups. However, the intervention group that received adenosine had a higher rate of antiarrhythmic agent usage in the operating room (P<0.05). Inotropic agent usage was similar in both groups during surgery and in the ICU. Additionally, laboratory parameters on the first day of ICU admission were comparable between groups.
Conclusion:
According to present study findings there were no significant differences in demographic characters, EF, ICU stay, sinus rhythm resumption time between two groups. Although, the control group showed better results in terms of dysrhythmias, and our results demonstrated that there is no priority to use of adenosine in reperfusion phase of surgery. Finally, we suggested future studies in this field with higher sample size for confirmation of findings.

Conclusion: 50
Status: accepted_oral
Headline Title: Perfusion
Headline Title:Legal Challenges and Strategies for Defining the Role of Perfusionists in the Iranian Healthcare System Perfusionists, specialized healthcare professionals integral to cardiac surgery, face significant challenges in establishing a defined role within Iran's healthcare system. These challenges stem from a vague legal framework and the absence of clear standards.
Authors: (Mohsen Heibati - author)
Introduction:
Perfusionists, specialized healthcare professionals integral to cardiac surgery, face significant challenges in establishing a defined role within Iran's healthcare system. These challenges stem from a vague legal framework and the absence of clear standards Developing Accreditation Programs and Care Standards: Establishing comprehensive accreditation programs and care standards tailored to perfusion practices.
Methods:
Continuous Performance Evaluation: Implementing ongoing assessments of perfusionists' performance to ensure quality and consistency. Enhancing Education and Non-Technical Skills: Improving educational programs and fostering the development of non-technical skills among perfusionists. Formulating and Enforcing Professional Standards for Cardiac Operating Rooms: Creating and enforcing robust professional standards specifically for cardiac operating rooms
Results:
Key Findings: Adherence to Standards: A mere 45.52% of healthcare facilities comply with standards related to staff qualifications and support. Team Collaboration: Only 23% of centers adhere to standards governing interactions between perfusionists and the medical team. Working Hours: Just 18.5% of facilities comply with working hour standards. Comparison to Other Countries:Unlike Iran, nations such as the United States and the United Kingdom have established well-defined professional roles for perfusionists, accompanied by standardized certification processes.
Conclusion:
Elevating the legal and professional status of perfusionists in Iran necessitates substantial structural reforms. The development of comprehensive standards and fostering intersectoral collaboration are crucial steps. These measures can significantly enhance the quality of healthcare and patient safety.

Conclusion: 49
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:The Effect of Hemoperfusion on Bleeding after CABG in Patients on Preoperative Plavix
Authors: (Mandana Hosseinzadeh - author)
Introduction:
Background: Bleeding management during and after urgent heart surgery is always challenging in patients who are taken anticoagulants especially antiplatelet ones. The present study was conducted with the aim of investigating the role of intraoperative hemoperfusion in the active removal of Plavix in patients undergoing on-pump CABG surgery.
Methods:
Methods: The present study recruited patients on Plavix who underwent urgent CABG surgery. All patients have discontinued consuming Plavix less than 36 hours before surgery. During cardiopulmonary bypass, hemoperfusion set was added to the circuit and the surgery was done according to the standard open heart surgery protocols. The patients were transferred to the intensive care unit at the end of surgery and amount of bleeding was recorded in the ICU sheet hourly and calculated after 24 hours.
Results:
Results: In our study, the average age of participating patients was 73,625 years. 5 patients out of 8 (62.5%) were male and 3 (37.5%) were female. Hypertension and blood type O were the most prevalent among the patients. The average amount of bleeding was 425 in the first day after surgery and the average units of transfused blood for patients was 0.125, which is acceptable and less than the values reported in other studies that do not use the hemoperfusion.
Conclusion:
Conclusion: The use of hemoperfusion during urgent CABG surgery, can reduce the postoperative bleeding and blood products consumption in patients on preoperative Plavix.

Conclusion: 46
Status: accepted_oral
Headline Title: Perfusion
Headline Title: Is ultrafiltration volume a predictor of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass?
Authors: (Hamid Gerami - author) (Javad Sajedianfard - corresponding-author) (Bahram Ghasem Zadeh - author) (Maryam Ansari Lari - author)
Introduction:
Intraoperative ultrafiltration (UF) is a procedure used during cardiopulmonary bypass (CPB) to reduce haemodilution and prevent excessive blood transfusion. However, the effect of UF volume on acute kidney injury (AKI) is not well established, and the results are conflicting. Additionally, there are no set indications for applying UF during CPB
Methods:
This retrospective study analysed 641 patients who underwent coronary artery bypass graft (CABG) surgery with CPB. Perioperative parameters were extracted from the patients’records, and the UF volume was recorded. Acute Kidney Injury Network classification was used to define AKI. Univariable and multivariable logistic regression models were used to predict AKI while controlling for confounding factors.
Results:
The study enrolled patients with a mean age of 58.8 ± 11.1 years, 39.2% of whom were female. AKI occurred in 22.5% of patients, with 16.1% (103) experiencing stage I and 6.4% (41) experiencing stage II. The results showed a significant association between UF volume and the risk of developing AKI. In the multivariable analysis, the other predictors of AKI included age, lowest mean arterial pressure (MAP), and red blood cell (RBC) transfusion during CPB
Conclusion:
The predictors of postoperative AKI in coronary CABG patients were the volume of UF, age, MAP, and blood transfusion during CPB

Conclusion: 44
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Artificial Intelligence-Enhanced Risk Stratification of Cancer TherapeuticsRelated Cardiac Dysfunction Using Electrocardiographic Images.
Authors: (Ramin Navidahmadi - corresponding-author)
Introduction:
Risk stratification strategies for cancer therapeutics-related cardiac dysfunction (CTRCD) rely on serial monitoring by specialized imaging, limiting their scalability. We aimed to examine an application of artificial intelligence (AI) to electrocardiographic (ECG) images as a surrogate for imaging risk biomarkers, and its association with early CTRCD
Methods:
Methods: Across a U.S.-based health system (2013-2023), we identified 1,550 patients (age 60 [IQR:51-69] years, 1223 [78.9%] women) without cardiomyopathy who received anthracyclines and/or trastuzumab for breast cancer or non-Hodgkin lymphoma and had ECG performed ≤12 months before treatment. We deployed a validated AI model of left ventricular systolic dysfunction (LVSD) to baseline ECG images and defined low, intermediate, and high-risk groups based on AI-ECG LVSD probabilities of <0.01, 0.01 to 0.1, and ≥0.1 (positive screen), respectively. We explored the association with early CTRCD (new cardiomyopathy, heart failure, or left ventricular ejection fraction [LVEF]<50%), or LVEF<40%, up to 12 months posttreatment. In a mechanistic analysis, we assessed the association between global longitudinal strain (GLS) and AI-ECG LVSD probabilities in studies performed within 15 days of each other.
Results:
Results: Among 1,550 patients without known cardiomyopathy (median follow-up: 14.1 [IQR:13.4-17.1] months), 83 (5.4%), 562 (36.3%) and 905 (58.4%) were classified as high, intermediate, and low risk by baseline AI-ECG. A high- vs low-risk AI-ECG screen (≥0.1 vs <0.01) was associated with a 3.4-fold and 13.5-fold higher incidence of CTRCD (adj.HR 3.35 [95%CI:2.25-4.99]) and LVEF<40% (adj.HR 13.52 [95%CI:5.06-36.10]), respectively. Post-hoc analyses supported longitudinal increases in AI-ECG probabilities within 6-to-12 months of a CTRCD event. Among 1,428 temporally-linked echocardiograms and ECGs, AI-ECG LVSD probabilities were associated with worse GLS (GLS -19% [IQR:-21 to -17%] for probabilities <0.1, to -15% [IQR:-15 to -9%] for ≥0.5 [p<0.001])
Conclusion:
Conclusions: AI applied to baseline ECG images can stratify the risk of early CTRCD associated with anthracycline or trastuzumab exposure in the setting of breast cancer or nonHodgkin lymphoma therapy.

Conclusion: 43
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:"Correlation of Electrocardiographic Findings with Left Ventricular Systolic Dysfunction in Hospitalized Children Diagnosed with Multisystem Inflammatory Syndrome in Sari, 2021-2022
Authors: (Raheleh Zamani Esteki - corresponding-author)
Introduction:
" Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) is a delayed complication of COVID-19 characterized by a severe inflammatory response and clinical manifestations, including persistent fever, abdominal pain, skin rashes, and multi-organ dysfunction. Given the increased incidence of this syndrome following the COVID-19 pandemic, particularly with cardiac complications such as left ventricular dysfunction and conduction system involvement, this study was designed to investigate the correlation between electrocardiographic (ECG) and echocardiographic findings. This research aims to enhance our understanding of the pathophysiology of the disease and, if a correlation between ECG changes and echocardiographic findings is established, to propose ECG as a readily available, operator-independent diagnostic tool for predicting left ventricular dysfunction.
Methods:
Methods: This study involved 52 children diagnosed with MIS-C according to CDC criteria, who were hospitalized at Bou Ali Hospital in Sari during 2020 and 2021. A history of COVID-19 infection was confirmed in all patients through positive RT-PCR, antigen testing, or serology. The correlation between echocardiographic and ECG findings was assessed in conjunction with the lowest left ventricular ejection fraction (LVEF).
Results:
Left ventricular dysfunction (LVEF < 55%) was noted in 40.4% of the patients, ents, with a mean LVEF of 38.94% in those with dysfunction. Mild, moderate, and severe dysfunction was observed in 25%, 9.6%, and 5.7% of the patients, respectively.he most common rhythm disturbances were supraventricular arrhythmias, present in 50.7% of patients, while only 8 patients (15.6%) exhibited no arrhythmias. A significant correlation was established between the degree of LVEF reduction and the increase in corrected QT interval (QTc) (p = 0.007). Patients were compared in two groups based on LVEF (<55% vs. ≥55%)The only significant ECG difference between the two groups was the longer QTc in the group with LVEF < 55%. Furthermore, patients were also compared in two groups based on LVEF (<45% vs. ≥45%). the incidence of prolonged QTc (p = 0.005)was significantly more prevalent in patients with LVEF < 45%
Conclusion:
Conclusion: An increasing QTc trend can be an indication of the onset of left ventricular systolic dysfunction, and if the QTc increases to levels higher than normal for age and gender (Prolonged QTc), the patient has at least moderate systolic dysfunction.

Conclusion: 40
Status: accepted_oral
Headline Title: Cardiac Nursing
Headline Title:Clarifying the perception of cardiopulmonary resuscitation team members about the stage of teamwork formation in educational and medical centers: a qualitative study
Authors: (Yadollah Shirvani - author) (Abdolhosin Emami Sigarodi - corresponding-author) (Nazila Javadi - author) (Mohamad Alli Cheragi - author)
Introduction:
depends on the performance of cardiopulmonary resuscitation team members and how the team is formed. Therefore, this study was conducted with the aim of understanding the stage of cardiac formation from the perspective of cardiopulmonary resuscitation team members.
Methods:
This study was conducted as a qualitative content analysis in a period of 12 months from December 1402 to December 1403. The research community was all members of the cardiopulmonary resuscitation team of educational and medical centers. Sampling started based on the goal and continued until information saturation, that is, no new information was received. A semi-structured interview method was used to collect data. In the analysis, the conventional qualitative content analysis method was used, so that immediately after conducting the interviews, the recorded voice of the participants was typed word by word in the Word software and analyzed using the 18MAXQDA software.
Results:
Data analysis led to the identification of 9 sub-classes and 3 main classes, including: membership method (mandatory membership, optional membership, casual membership), selection criteria (ability criteria, contractual criteria, no specific criteria), adequacy and efficiency (physical adequacy, adequacy individual characteristic, scientific adequacy), which explained the stage of cardiac formation in cardiopulmonary resuscitation.
Conclusion:
In the present study, the method of membership, selection criteria, and the adequacy and efficiency of cardiopulmonary resuscitation team members are part of the inputs of the classical theory of teamwork, and if these inputs are suitable, by going through team processes, the team will reach a suitable output, i.e. the result of satisfaction in cardiopulmonary resuscitation.

Conclusion: 38
Status: accepted_oral
Headline Title: Cardiac Surgery
Headline Title:The effect of Dexmedetomidine added to Del-Nido cardioplegic solution on the myocardial protection in pediatrics undergoing congenital heart defects surgery
Authors: (Farhad Samadieh - author) (Mahmud Hosseinzadeh Maleki - corresponding-author)
Introduction:
The findings of similar studies indicate the inevitable myocardial damage during cardiac surgeries with cardiopulmonary pump and the nature of induced ischemia caused by transverse aortic clamp. Also, few studies have only studied the effect of intravenous administration of this drug on the degree of myocardial protection in the stages before, during , and after surgery. Since no study has investigated the effect of administering dexmedetomidine during surgery in the manner mentioned in this study, on the degree of myocardial protection. Therefore, in this study, we will examine the effect of adding dexmedetomidine to Del-Nido's cardioplegia solution on the degree of myocardial protection in children undergoing surgery for congenital heart defects
Methods:
The research population will include all children who were referred for surgery for congenital heart defects with RACHS = 1 and RACHS = 2 all children who are more than one month old and were introduced to heart surgery centers only to perform surgery with the above-mentioned scoring, they were divided into two groups, case and control, by block randomization method and based on the goal. In the case group, before administering the cardioplegia solution, the drug dexmedetomidine will be added at a rate of 50 μg/ml (in a 2 ml syringe labeled A) for every 500 ml of Del-Nido cardioplegia solution. The mentioned solution will contain dexmedetomidine with a concentration of 0.1 microgram/ml. In the control group, before administering the cardioplegia solution, one milliliter of 0.9% sodium chloride solution (in a 2 ml syringe labeled B) was added for every 500 ml of Del-Nido cardioplegia solution. The infusion of cardioplegia solution will continue until complete cardiac arrest, as determined by the surgeon. In both groups, a type of membrane oxygenator and pulseless perfusion with a Stockert Ⅴ roller pump were used. The levels of arterial blood gases were maintained within normal values. Mild hypothermia was applied in both groups, with a temperature range of 32-34 degrees. During hemodilution, the hematocrit was kept within the optimal range of more than 25%. The main parameters investigated in both groups included: coronary sinus lactate immediately after opening the RA ,immediately before removal of the transverse aortic clamp ,and 10 minutes after removal of the transverse aortic clamp ,Serum troponin-I and CK-MB levels of patients before entering the OR ,after entering the ICU , 12 hours after entering the ICU, and 24 hours after entering the ICU . Other parameters include serum levels of glucose, blood urea nitrogen, and sodium, serum creatinine level, and VIS index will be measured and recorded.
Results:
there is a statistically significant relationship between the average levels of troponin and CK-MB at different times in the Target and control groups. The average levels of troponin and CK-MB in the Target group are significantly lower than the isotonic saline group at different times . The results of the present study indicated that in the Target group, the average coronary sinus lactate level between the times immediately after opening the right atrium , immediately before removing the transverse aortic clamp , and ten minutes after removing the transverse aortic clamp is significant . The mean lactate level of the coronary sinus in the dexmedetomidine group increased less than the control group, and these changes were statistically significant.
Conclusion:
The results of the present study showed that the addition of dexmedetomidine to Del Nido's cardioplegia solution in children undergoing surgery for birth defects will reduce the amount of damage to the myocardium and provide better myocardial protection. Additionally, by reducing the length of stay in the ICU and hospital, it helps to decrease the healthcare costs for patients. Moreover, by reducing the complications caused by heart surgery, it can improve the quality of life for this group.

Conclusion: 36
Status: accepted_oral
Headline Title: Cardiac Nursing
Headline Title:The relationship between metrological variables and the incidence of myocardial infarction
Authors: (Shadi Ghatran - author) (Mohammad Taghi Moghadamnia - corresponding-author) (Zahra Yousefi - corresponding-author)
Introduction:
Cardiovascular disease is the leading cause of global mortality, with ischemic heart disease. Acute myocardial infarction (AMI), as an acute presentation of ischemic heart disease, is often caused by a sudden rupture or an erosion of atherosclerotic plaque resulting in acute occlusion in the coronary arteries. Climate change is considered a serious threat to health around the world and provides the basis for the occurrence of non-communicable diseases such as Cardiovascular disease. Myocardial infarction is an important cause of cardiovascular mortality and can be precipitated by climatic factors.
Methods:
This study is a systematic narrative review. To select articles, Google Scholar, Pub Med, ISI Web of Science, and Scopus databases were searched to obtain english articles. The search was conducted based on keywords from 2012 to 2024. The search was conducted in two phases. The first phase began with more general terms. In this phase, the keywords (climate change) and (myocardial infarction) were used. Then, in the second phase, more specific terms were used for the search for a more precise search and the chance of reaching all articles. For the term climate change, more specific terms were used, including cold, heat, ambient temperature, apparent temperature, heat waves, cold waves. Also, for the term myocardial infarction, more specific terms were used, including coronary artery occlusion, myocardial infarction, sudden death, acute coronary syndrome, acute coronary artery occlusion. Articles that contained the mentioned keywords in their titles or abstracts were selected. From 2075 articles searched in scientific databases, based on title, abstract and finally full text, 20 articles that met the appropriate inclusion criteria were selected and their findings were reviewed.
Results:
Overall, 14 of the 20 studies that included relevant data from the winter season reported an increased risk of MI at lower temperatures, while an increased risk at higher temperatures was reported in 1 study. 3 studies showed an increased risk during cold and warm periods, and 2 studies showed an association of MI incidence with daily temperature fluctuations and less association with daily mean temperature. The findings also indicate that Old age insignificantly increased the MI risk, Gender increases sensitivity, and women are more susceptible to temperature changes as well as cold periods. A number of differences between the studies included demographics and Nationwide Study, location, local climate, study design, and statistical methods.
Conclusion:
A number of studies, including some national studies and large population-controlled studies, have shown a significant association between cold weather and the risk of myocardial infarction. Given the findings of this study, which indicated a relationship between metrological variables and the incidence of acute myocardial infarction, it should be noted that people with chronic diseases and the elderly should not be exposed to such weather conditions.

Conclusion: 34
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Exploring the Role of Central Venous Pressure in Post-CABG Renal Failure: A Comprehensive Scoping Review
Authors: (Maryam Aligholizadeh - author) (Mehrdad Mesbah Kiaei - corresponding-author) (Siavash Sangi - author) (Parisa Moradimajd - author) (Homayoon Bana Derakhshan - author) (Melika Aligholizadeh - author)
Introduction:
Acute kidney injury (AKI) is a critical complication following coronary artery bypass graft (CABG) surgery, affecting up to 30% of patients and contributing to increased morbidity and mortality. Emerging evidence suggests that elevated central venous pressure (CVP), a marker of venous congestion, plays a pivotal role in AKI pathogenesis. This scoping review evaluates the relationship between CVP and AKI in CABG patients and examines its utility as a hemodynamic marker for renal outcomes and perioperative management.
Methods:
Following Arksey and O'Malley's framework and adhering to PRISMA-ScR standards, we conducted a systematic search of Scopus, PubMed, Web of Science, and MEDLINE for studies published between January 2016 and March 2024. The search strategy included Medical Subject Headings (MeSH) and relevant keywords related to "central venous pressure," "acute kidney injury," and "CABG." Eligible studies focused on adult CABG patients with intraoperative or postoperative CVP measurements and AKI outcomes defined by standardized criteria, such as the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Data collection included study design, sample size, CVP thresholds, AKI definitions, and relevant variables such as hemodynamic parameters, renal perfusion, and clinical outcomes. Risk of bias was assessed using appropriate tools for observational studies, and results were synthesized descriptively.
Results:
Of 1,717 studies identified, 16 met the inclusion criteria. These predominantly retrospective cohort studies reported that intraoperative CVP thresholds of 6.5–12 mmHg and postoperative CVP above 9–14 cm H₂O were significantly associated with increased AKI risk. Elevated CVP was consistently linked to venous congestion, impaired renal perfusion, and reduced glomerular filtration. Mechanisms underlying this relationship include maladaptive responses such as sympathetic activation and fluid retention. AKI outcomes were primarily defined using KDIGO criteria, enhancing the reliability of findings. Limitations included heterogeneity in CVP measurement protocols, sample sizes, and study designs.
Conclusion:
Elevated CVP is a significant hemodynamic factor associated with AKI in CABG patients, emphasizing the importance of integrating CVP monitoring into perioperative management strategies. However, uncertainties remain regarding the optimal CVP thresholds and their interaction with other hemodynamic variables. Future prospective studies are warranted to confirm these findings and establish evidence-based guidelines for managing CVP to optimize renal outcomes in cardiac surgery.

Conclusion: 21
Status: accepted_oral
Headline Title: General Cardiology
Headline Title:Impact of Empagliflozin on Cardiovascular Outcomes and Epicardial Adipose Tissue in Type 2 Diabetes Patients with Acute Myocardial Infarction: A Randomized Controlled Trial
Authors: (Zahra Kalantari - author) (Reza Madadi - corresponding-author)
Introduction:
Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and persistent hyperglycemia, which leads to a wide range of complications, including both microvascular and macrovascular conditions, such as cardiovascular diseases. The protective effects of empagliflozin on the cardiovascular system are believed to stem from multiple mechanisms, including enhanced myocardial energy metabolism and reduced oxidative stress (6). The present study was designed to further evaluate the cardiometabolic effects of empagliflozin in patients with T2DM and acute myocardial infarction (MI). This randomized, placebo-controlled trial (RCT) aimed to investigate the impact of empagliflozin on key metabolic and cardiovascular outcomes, including mortality, rehospitalization, and changes in epicardial adipose tissue (EAT).
Methods:
This study was conducted as a double-blind clinical trial. Patients were randomly selected from individuals diagnosed with T2DM and STEMI. Participants were randomly selected from those admitted between September and November 2021 at Ayatollah Mousavi Hospital in Zanjan and were enrolled after meeting the inclusion criteria. The study received approval from the ethics committee of Zanjan University of Medical Sciences and was prospectively registered in the Iranian Registry of Clinical Trials (IRCT20210710051833N1). Before enrollment, detailed written and verbal informed consent was obtained from all participants.
Results:
Blood pressure, GFR, and echocardiographic parameters including EF and mGLS were comparable between groups after treatment. The EAT thickness was significantly reduced in the Empagliflozin group (0.33 ± 0.08 cm) compared to the Placebo group (0.43 ± 0.10 cm), with a p-value of <0.0001 and an effect size (η²) of 0.284. The TyG index showed a modest reduction in the Empagliflozin group (8.86 ± 0.55) compared to the Placebo (9.01 ± 0.62) (F=9.68, p=0.002, η²=0.052). Mortality and Rehospitalization Outcomes The mortality and rehospitalization rates after three months were not significantly different between groups. Mortality rates were 15.6% in the Empagliflozin group compared to 14.6% in the Placebo group (p=0.859). Similarly, rehospitalization occurred in 86.7% of patients in the Empagliflozin group and 88.8% in the Placebo group, with a non-significant p-value of 0.669 (Table 3).
Conclusion:
empagliflozin demonstrated significant metabolic benefits, including improved glycemic control, reduced insulin resistance, and a notable reduction in the triglyceride-glucose (TyG) index. However, despite these improvements, no significant changes were observed in all-cause mortality or rehospitalization rates. Further research is needed to evaluate its long-term cardiovascular outcomes in diverse patient populations.

Conclusion: 19
Status: accepted_oral
Headline Title: Echocardiology
Headline Title:A rare association of the absence of left pulmonary artery with ventricular septal defect, pulmonary hypertension, and more interestingly, patent ductus arteriosus in an adult patient: Case report and literature review
Authors: (Mozhgan Parsaee - author) (Pegah S - corresponding-author) (Sedigheh Saedi - author) (Soudabeh | Behrooj - author) (Elaheh Emami - author) (Ali Mohammadzadeh - author)
Introduction:
Unilateral absence of pulmonary artery (UAPA) is a congenital heart disease in association with other abnormalities such as tetralogy of Fallot and septal defects or isolated in 30% of cases and occurs in the right lung in two-thirds of cases.
Methods:
Our case is a 33-year-old man who was hospitalized with symptoms of cough, shortness of breath, and hemoptysis. The echocardiography revealed a large ventricular septal defect, absent left pulmonary artery, and severe pulmonary hypertension (PH) along with patent ductus arteriosus. These findings were confirmed by CT angiography. This association has rarely been found in past studies. Due to PH and pulmonary infection, the patient was treated with intravenous prostaglandin and antibiotics.
Results:
However, in cases of timely diagnosis and treatment of UAPA, fatal complications such as pulmonary hypertension, morbidity, and mortality is reduced.
Conclusion:
This case emphasizes the importance of awareness of this abnormality and its associated anomalies to enable early diagnosis and treatment.

Conclusion: 18
Status: accepted_oral
Headline Title: Cardiac Physiotherapy
Headline Title:The role of physiotherapy in reducing pain during and post chest tube removal process.
Authors: (Somayeh Bahmani Jahromi - author) (Masoud Ghofrani - corresponding-author)
Introduction:
Chest tubes are inserted into the pleural or mediastinal spaces after post coronary artery bypass grafting surgery surgery to remove fluid, air, and pus from the chest cavity and prevent potential cardiopulmonary complications. Pain during chest tube removal post CABG is a common concern among patients. Pain impairs the patient's ability to take deep breaths or to cough effectively, which could lead to reduced lung volume and sputum retention, making re-intubation more likely. Pain management is one of physiotherapists roles that could major impact patients' physical and psychological health outcomes.
Methods:
Studies on the effect of breathing exercises on reducing pain in patients with chest tubes were reviewed by searching the reputable databases PubMed, Elsevier, science direct
Results:
The use of breathing relaxation exercise technics could minimize the complications associated with pain and hence increase patient satisfaction. Relaxation takes the patient away from the thought of pain and increases the release of endorphins, further reducing pain This therapy subsequently leads to a decrease in the feelings of pain. This technique is simple, non-invasive, inexpensive, time-saving, and risk-free.
Conclusion:
Using breathing relaxation exercise is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

Conclusion: 16
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Ketamine as a premedication drug in children with congenital heart disease
Authors: (Ali Sadeghi - author)
Introduction:
Ketamine was synthetized in 1962 , derived from phencyclidine pursuit of a safer anesthetic with few hallucinogenic effects . Its anesthetic dose is 1-2 mg/kg intravenously or 5-10 mg/kg intramuscularly . From that year to now some effects and side effects of ketamine were apeared ,despite these advantages and disadvantages , it can be used for many indications . Ketamine is a dissociative drug is used medically for sedation and maintenance of anesthesia ,pain relief ,depression , and seizures.
Methods:
10 patients presenting for anesthesia for cardiac surgery in patients who had cyanotic congenital heart disease , were included in the study . Vein access was impossible in awareness . They received 3 mg /kg ketamine intramuscularly .After 5-15 minutes patients were sedated and separation from their parents were possible and easy . With this sedation these patients transferred to operating room and induction of anesthesia was done with inhalation of sevoflurane . Vein access was done and continued the process . Heart rate and blood pressure and respiratory rate were recorded before administration of intramuscular ketamine . With this premedication we did not see any adverse event . Hemodynamic was stable in all cases. The optimal route of administration of ketamine is intravenously , but not always be achievable , for example in emergencies , children and obese patients .
Results:
Patients were calm on arrival in the operating department co-operation with induction of anesthesia with sevoflurane . No patients complained of vivid and unpleasant dreams in the perioperative period . Despite of the long history of the employment of ketamine as an anesthetic agent in children cyanotic congenital heart disease , there are few published accounts of its administration by the oral route .Administration routs of ketamine can be intravenous , intramuscular , oral , intraosseous , nasal , rectal ,caudal and epidural . Our experience IM ketamine is useful for children are without access vein ,
Conclusion:
Ketamine is useful agent for sedation , induction and maintenance of anesthesia . Sedation with ketamine is enough for children to transfer to operating room . Separation the children from their parents with intramuscular ketamine is desirable .Induction of anesthesia with this sedation is suitable , because hemodynamic remains stable .

Conclusion: 14
Status: accepted_oral
Headline Title: Cardiac Physiotherapy
Headline Title:The Impacts of Aquatic Therapy on Hypertension: A Systematic Review
Authors: (Mohammad Mehdi Abolhasani - corresponding-author) (Mahdi Esmaeeli - author)
Introduction:
Hypertension is a primary global health concern that significantly contributes to the burden of cardiovascular diseases and mortality. Although pharmacological treatments are the primary approach for managing this condition, complementary methods such as aquatic therapy have garnered attention due to their minimal side effects and potential positive impact on blood pressure regulation. Aquatic therapy, which involves immersion in temperature-controlled water, may influence blood pressure through specific mechanisms. This study aims to investigate the effects of aquatic therapy on blood pressure and its underlying mechanisms in individuals with hypertension.
Methods:
This systematic study reviews findings from research obtained through a comprehensive search of PubMed, Scopus, and Web of Science databases. Keywords such as "aquatic therapy," "blood pressure," and related synonyms were utilized. Studies published between 2000 and 2024 were reviewed. Three relevant studies, including clinical trials and quasi-experimental research on the impact of aquatic therapy on blood pressure parameters, were selected.
Results:
Aquatic therapy has shown a potential to reduce systolic and diastolic blood pressure in individuals with hypertension. These effects may result from improved peripheral circulation through increased microvascular blood flow, vasodilation induced by water heat, reduced vascular resistance, and modulation of baroreceptors in the nervous system. Furthermore, regulating hormone secretion, such as catecholamines, and reducing autonomic nervous system stress could also contribute to lowering blood pressure.
Conclusion:
Aquatic therapy presents a promising complementary approach for managing hypertension, particularly for individuals seeking non-pharmacological interventions. However, further clinical trials involving larger populations and long-term follow-up are essential to validate these findings and assess long-term benefits. Aquatic therapy in conventional hypertension care may offer a comprehensive and low-risk strategy for improving cardiovascular health.

Conclusion: 12
Status: accepted_oral
Headline Title: Pediatric Cardiology
Headline Title:Long-Term Follow-up of Transcatheter Ventricular Septal Defect Closure in Children, and Comparison of Single-Hole Versus Multi-holes Ventricular Septal Defects
Authors: (Mina Farshidgohar - corresponding-author) (Hojat Mortezaeeian - author) (Ahmad Vesal - author)
Introduction:
Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited. Objectives: We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far.
Methods:
This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure.
Results:
A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block.
Conclusion:
Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.

Conclusion: 9
Status: accepted_oral
Headline Title: Cardiovascular Anesthesiology
Headline Title:Adaptive Support Ventilation Versus Synchronized Intermittent Mandatory Ventilation for Fast track Extubation after Cardiac Surgery
Authors: (Dr. Ali Jabbari - corresponding-author) (Dr. Shabnam Tabasi - author)
Introduction:
Adaptive support ventilation (ASV) is a controlled mode in artificial ventilation which could be transformed to an intelligence partial mechanical ventilation support in weaning phase; dependent on operator arrangement. ASV could maintain predefined minute ventilation with a good respiratory configuration by adjusting positive inspiratory pressure and respiratory pattern base on the patient’s lung compliance and metabolic necessity. Synchronized intermittent mandatory ventilation (SIMV) is an appropriate mode for mechanical ventilation support which, the ventilator attempts to deliver the mandatory breaths in synchrony with the patient’s inspiratory efforts. The aim of this study was to compare ASV mode and SIMV mode into fast-track respiratory weaning protocols after uncomplicated coronary artery bypass graft.
Methods:
A group of patients (80 patients) was enrolled in a cross sectional case-control multi centric study. Patients divided in two groups. After cardiac surgery under general anesthesia, patients were randomly assigned in two groups ASV and SIMV (40 patients in each group). Both them have their own weaning protocol and post cardiac surgery period for fast-track; were divided into two predefined phases. First phase was considered; primary mechanical ventilation set up (stabilizing patients in post operation period) and second phase was weaning approach, when spontaneous breathing occurred and completing weaning process by tracheal extubation.
Results:
Eighty patients enrolled in our study. Thirty eight patients completed the ASV mode weaning protocol, and 36 patients completed the standard SIMV mode weaning protocol. 2 patients in group ASV and 4 patients in group control were excluded by explicit, predefined criteria due to complications. We could not attribute complications to our ventilation strategies. The primary outcome of the study was duration of tracheal intubation (artificial ventilation time before extubation) that; it was shorter in ASV group than SIMV group (P < 0.03). A large difference was seen between two groups in total sedation doses (P < 0.03), arterial blood gas parameters (P < 0.04), hemodynamic parameters and need for inotropic medications.
Conclusion:
ASV protocol makes shorter duration of tracheal intubation and simplifies Ventilator management in fast-track patients after coronary artery bypass graft surgery. In evaluation of potential advantages of ASV on recovery time; we supposed that Mechanical Ventilation support after cardiac surgery could set up base on ASV.

Conclusion: 64
Status: ?
Headline Title: Cardiac Surgery
Headline Title:Comparison of Retrograde-Antegrade Cardioplegia Versus Antegrade Cardioplegia on the amount of inotrope required and mortality of patients after coronary artery bypass surgery
Authors: (Alireza Hosseini - author) (Elahe Esmaeili Largani - author) (Mehran Shahzamani - corresponding-author) (Asieh Maghami-Mehr - author)
Introduction:
One of the major concerns during cardiac surgery is heart protection; in this regard, cardioplegia solution is used by retrograde and antegrade methods or a combination of these two methods. Given the lack of studies on the superiority of each method of cardioplegia solution injection, the present study was conducted with the aim of comparing the injection of two methods of cardioplegia solution injection (retrograde-antegrade method and antegrade alone) on the need for inotropes and mortality of patients after coronary artery bypass surgery.
Methods:
The cross-sectional study was conducted on 100 files of patients undergoing coronary artery bypass surgery at Shahid Chamran Hospital, Isfahan during the years 1400-1403. These patients were divided into two groups of 50 and injected cardioplegia solution by two Methods: retrograde-antegrade and antegrade alone. Then, the need for inotrope, the need for intra-aortic balloon pump (IABP), and the patient's outcome (death or live) were assessed and recorded.
Results:
The results of the present study showed that the need for inotrope in the combined antegrade-retrograde solution injection group and antegrade alone were 8% and 10%, respectively, with no statistically significant difference between the two groups(P = 0.727). In addition, none of the patients requiring IABP, and only one patient died in the antegrade cardioplegia solution injection group (P = 0.315).
Conclusion:
According to the results of current study, although the need for inotrope in the combined retrograde-antegrade method was less than the antegrade method alone, there was no significant difference between the two methods of cardioplegia solution injection in terms of inotrope need and outcome of patients undergoing CABG surgery.

Conclusion: 177
Status: accepted_poster
Headline Title: Pediatric Cardiology
Headline Title:Computed Tomography Angiography Indications in the Follow-Up of Kawasaki Disease Patients
Authors: (MD Pavin Akbari Asbagh - author)
Introduction:
Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a vasculitis that primarily affects young children and results in coronary artery abnormalities. Echocardiography is the standard imaging modality for monitoring KD patients; however, this method does not detect some coronary artery anomalies. This case report demonstrates the significance of computed tomography (CT) angiography in identifying previously undiagnosed coronary abnormalities in a KD patient.
Methods:
Kawasaki disease (KD), or mucocutaneous lymph node syndrome, is a vasculitis that primarily affects young children and results in coronary artery abnormalities. Echocardiography is the standard imaging modality for monitoring KD patients; however, this method does not detect some coronary artery anomalies. This case report demonstrates the significance of computed tomography (CT) angiography in identifying previously undiagnosed coronary abnormalities in a KD patient.
Results:
This case report emphasizes the importance of considering CT angiography as an adjunct imaging modality in the evaluation and follow-up of KD patients, particularly when echocardiographic findings are inconclusive or when clinical presentation raises concerns for potential coronary artery abnormalities
Conclusion:
Further research is needed to establish evidencebased guidelines for the optimal timing and clinical indications for CT angiography in KD patients

Conclusion: 171
Status: accepted_poster
Headline Title: Pediatric Cardiology
Headline Title:Disclosure of Placenta and Fetal Heart Interactions: The Key to Manage their Disorders: A Narrative Review
Authors: (Mohsen Shahidi - corresponding-author) (Arash Puladi - author) (Yousef Moradi - author)
Introduction:
Congenital heart disease (CHD) is the most common fetal anomaly worldwide. The definite etiology of most CHD is not recognized. A direct genetic etiology is considered for a minority of patients. Most etiologies are attributed to epigenetic and environmental factors. Placental malformation is a missing etiology of CHD, which has recently received more attention. The placenta is the main materno-fetal connection responsible for fetal organ development.
Methods:
This narrative review was conducted to synthesize recent evidence on the interplay between placental development and fetal heart defects. Search strategy: A focused search was performed using the PubMed and Scopus databases, covering studies published between 2017 and 2024. Screening and selection process: Initial screening was conducted based on abstracts to manage the large volume of retained articles. Data extraction: Thirty-seven articles were considered eligible for the review based on the inclusion and exclusion criteria. Synthesis data: The data was synthesized with an emphasis on rapidly generating insights.
Results:
The placenta and fetal heart have concomitant developmental regulatory pathways. Placenta insufficiency may result in cardiac remodeling. Reciprocally, placenta diseases are more frequent in association with fetal CHD. The placenta-heart axis is a known scientific discovery. The underlying mechanism of this axis can be classified as genetic, hemodynamic, and syncytialization defects. Firstly, the known genetic, epigenetic, hormonal, and regulatory factors, including the NOTCH signaling pathway, SUMO-modulated stress responses, and autophagy-related genes may concurrently influence the placenta and fetal heart. Secondly, their hemodynamic and metabolic interaction is generated by the quality of blood perfusion, chronic hypoxia, angiogenic imbalance, oxidative stress, placental resistance, and fetal heart function. Thirdly, placental dysfunction and syncytialization defects may primarily induce fetal heart malformation.
Conclusion:
The novel information on placental and fetal heart interplay is a new insight into the predisposing factors of CHD and placental insufficiency. The current study, called cardioplacentology, aims to research the developmental interaction between the placenta and fetal heart to provide a preventive and therapeutic base for their complications that explore the interplay of genetic and placental factors in fetal heart development and associated pathologies.

Conclusion: 170
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:Effectiveness and Medication Adherence in Patients with ST- elevated Myocardial Infarction: Persian Polypill Study
Authors: (Dr Masoumeh Sadeghi - corresponding-author) (Elaheh Amirfar - author) (Ehsan Shirvani - author) (Shervin Ghaffari Hoseini - author) (Marjan Mansourian - author) (Dr Hamidreza Roohafza - author)
Introduction:
Polypill or fixed-dose combination has been recognized as an effective secondary prevention strategy for patients with cardiovascular disease (CVD). This study aimed to evaluate the effectiveness of the polypill on one-year medication adherence, patient satisfaction, and lipid profile control in patients with ST-Elevation Myocardial Infarction (STEMI).
Methods:
This was an open-label, multicentric, randomized clinical trial study of STEMI patients who were prescribed a polypill (Aspirin 81mg, Atorvastatin 40mg, Metoprolol Succinate 47.5mg, and Valsartan 40mg) versus usual care (continued with separate medications) for secondary prevention. The primary outcome was to compare one-year medication adherence between groups. Other outcomes included comparing patient satisfaction, and lipid profile after 12 months of follow-up and identifying predictor factors of medication adherence.
Results:
Of 624 STEMI participants, 289 patients were treated with polypill (79.2% male; mean age 61.67 ± 8.54 year), and 335 patients received usual care (82.7% male; mean age 62.10 ± 9.63 year). After one-year follow-up, no significant differences were detected between groups regarding medication adherence, and cholesterol levels. Polypill strategy was associated with increased patient satisfaction and better control of LDL-C (p-value= 0.043) and HDL-C (p-value < 0.001). Patients with history of chronic kidney disease (OR: 13.392; p-value= 0.001), cerebrovascular disease (OR: 4.577; p-value= 0.011), and higher waist circumference (OR: 1.01; p-value= 0.002) demonstrated a lower probability of medication adherence. In contrast, in-hospital complications such as arrythmia (OR: 0.039; p-value= 0.010), bleeding (OR: 0.034; p-value= 0.007), and higher Ejection fraction (OR: 0.965; p-value= 0.002), were associated with higher probability of medication adherence.
Conclusion:
In STEMI, Participants treated with polypills were more satisfied and showed better lipid profile control. However, a longer follow-up duration is needed to examine the effectiveness of the polypill on medication adherence in this subgroup.

Conclusion: 161
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity
Authors: (Hamed Bazrafshan Drissi - corresponding-author) (Mehdi Bazrafshan - author)
Introduction:
Obesity can lead to cardiovascular dysfunctions and cause electrocardiographic disruptions. Bariatric surgery plays a significant role in weight loss.
Methods:
To assess its benefits, this study investigated electrocardiographic changes before and after bariatric surgery. The present article describes a retrospective cohort study with a 6-month follow-up period. Electrocardiograms were interpreted and compared before and six months after surgery. The relationships between weight loss, type of surgery, and electrocardiographic alterations were analyzed.
Results:
A total of 200 patients participated in the study, with 34 (17%) men and 166 (83%) women. The mean age of the participants was 44.6 ± 8.6, and their mean body mass index was 43.8 ± 5.5 kg/m2. The mean of QTc decreased after the surgery, while the Sokolow-Lyon scores increased. The statistical analysis showed that QTc dispersion (> 40) (P < 0.001), right ventricular hypertrophy (P < 0.001), abnormal R wave progression (P < 0.001), QTc (P < 0.001) and Sokolow-Lyon criteria (P < 0.001) significantly changed postoperatively
Conclusion:
In conclusion, bariatric surgery can reduce QTc, correct poor R wave progression, and resolve right ventricular hypertrophy (RVH) in patients with morbid obesity.

Conclusion: 157
Status: accepted_poster
Headline Title: Pediatric Cardiology
Headline Title:Evaluation of Covid-19 anti-spike IgG antibody five months after the second Covid-19 vaccination
Authors: (Reyhaneh Alipoor Rafie - author)
Introduction:
Inadequate control of the Covid-19 pandemic necessi- tated the development of a variety of vaccines against the virus. Different types of vaccines have shown high efficacy in clinical trials [1], [2]. In recent years, mRNA replacement has been used to increase the effectiveness of these vaccines. In total, the Covid-19 virus consists of four major structural components, including the spike protein, the nucleocapsid protein, the envelope protein, and the membrane protein [1], [2]. From these, IgG- neutralizing antibodies against spike proteins are pro- duced and secreted. It should be noted that an effective vaccine against this virus is a vaccine that elicits a favor- able immune response, especially against spike proteins [3]. This response is mainly in the form of the production of antibodies against spike proteins that remain strong for longer time periods, even after vaccination, indicating their effectiveness of preventing infection [4].
Methods:
Setting and sampling The cross-sectional study was performed among HCW of Mofid Children’s Hospital in Tehran for whom five months had passed since their second COVID-19 vaccination. Blood samples were collected from these HCW and transferred to the laboratory of the Pediatric Infections Research Center (PIRC) to separate the blood serum with a centrifuge at 4,000 rpm for 10 minutes. Data gathering and ELISA The HCW data were collected through the completion of an information form. The sera were stored at –80°C until running the Enzyme-linked immunosorbent assay (ELISA). To measure the level of IgG antibody against the Covid- 19 virus spike protein, a Euroimmune ELISA kit (Lübeck, Germany; Lot No. E200519AY) was used. The titer ratio of antibody ≥1.1 is considered an acceptable titer of an- tibody and positive result according to Kit protocol. Statistical analysis The results were presented as mean±standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Continu- ous variables were compared using the t-test or Mann- Whitney U-test, whenever the data did not appear to have normal distribution or when the assumption of equal variances was violated across the study groups. The cat- egorical variables were compared using the Chi-Square test. p-values ≤0.05 were considered statistically signifi- cant. For the statistical analysis, SPSS version 23.0 for Windows (IBM, Armonk, New York) was used. Ethical approval was given by the Research Ethics Committees of Research Institute of Children’s Health, Shahid Beheshti University of Medical Science (No. IR.SBMU.RICH.REC.1400.059, 31 July 2021)
Results:
A total of 234 vaccinated HCW enrolled five months after the second COVID-19 vaccination. Three types of vaccines were given to the HCW: Sputnik V, Sinopharm, and As- traZeneca. The mean age of patients was 39.8±9.3 years, with a range of 23 to 60 years. 72.6% were female. The baseline characteristics of study participants are shown in Table 1. In total, 103 cases (44.0%) had a previous history of SARS-CoV-2 infection with PCR-positive or pul- monary involvement evident on CT. A history of receiving antiviral drugs was reported in 21 cases (20.3%); 2 cases (1.9%) were hospitalized at the time of the disease. The mean titer evaluation of anti-spike IgG antibody five months after vaccination was 4.33±2.29 units. Accord- ingly, the percentage of positive cases of the antibody titer was estimated to be 96.4%.
Conclusion:
The results of our study and others showed that the dif- ferences in personal immunity system, life conditions, and brands and platforms of COVID-19 vaccines world- wide were responsible for the different antibody titers after vaccination and the decrease thereof over time.

Conclusion: 156
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:Prediction of mortality based on the Euro SCORE II model in patients undergoing cardiovascular surgery at Rajaie Cardiovascular Institute
Authors: (Mr Samaneh Karimian - author) (Ziae Totonchi - author) (Dr. Shiva Khaleghparast - author) (Mahdi Daliri - corresponding-author)
Introduction:
This survey aims to evaluate the EuroSCORE II (European System for Cardiac Operative Risk Evaluation) model's performance in predicting mortality.
Methods:
This prospective longitudinal study used data from 1173 adult patients who underwent cardiovascular surgery at the Rajaie Cardiovascular Institute from August 2021 to May 2022, to derive model values. The patients were followed up for death, and 11 complications based on the EuroSCORE II. The model's discriminatory power was reported using the area under the receiver operating characteristic (ROC) curve (AUC). Also, the p-value of the goodness of fit test was calculated to show the model's calibration.
Results:
The data analysis showed that the area under the ROC curve of the EuroSCORE II model, used to predict the post-cardiac surgery outcomes was >0.7 in 10 out of 12 outcomes, which indicates good discrimination power. death AUC =0.794. The model calibration was assessed through the Hosmer–Lemeshow (H-L) goodness-of-fit test (death p=0.01). Other findings, including sensitivity, specificity, and cutoff, were also calculated, revealing the fitness of the prediction model.
Conclusion:
according to the findings, Considering the power of differentiation and calibration of the EuroSCORE II model in the studied population, this model can be used cautiously to predict cardiac surgery death in the Iranian population, but there is still a need to examine this model in a larger sample size.

Conclusion: 147
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:Inter-professional collaboration in heart failure management and the nursing role
Authors: (Alireza Mohsenipour Foumani - author)
Introduction:
Heart failure (HF) is a complex clinical syndrome requiring comprehensive management strategies that involve multiple healthcare disciplines. The role of nursing within interdisciplinary teams is crucial for improving patient outcomes in HF management. This scoping review aims to explore the nature and extent of Inter-professional collaboration in the management of heart failure, with a specific emphasis on the contributions and roles of nursing.
Methods:
A systematic search was conducted across relevant databases, including PubMed, WOS, and Scopus, to identify literature addressing Inter-professional collaboration in HF care. Articles were screened based on predefined inclusion criteria, focusing on studies highlighting nursing roles within multidisciplinary teams.
Results:
The review identified several key themes, including communication strategies among healthcare providers, the impact of nursing interventions on patient education and self-management, and the integration of nursing assessments in treatment planning. Findings demonstrate that effective collaboration enhances care coordination, ultimately leading to improved patient adherence to treatment, reduced hospital readmissions, and better quality of life.
Conclusion:
Inter-professional collaboration is essential in heart failure management, with nursing playing a pivotal role in facilitating teamwork and enhancing patient-centered care. Continued research is vital to further illustrate the specific contributions of nursing and to develop optimized collaborative practices that target HF patient outcomes.

Conclusion: 142
Status: accepted_poster
Headline Title: Cardiovascular Anesthesiology
Headline Title:Diagnosis of massive pulmonary embolism during spinal surgery by the anesthesia team and Emergent Surgical Embolectomy; Case Report of Survival patient
Authors: (Nahid Zirak - corresponding-author) (Mojtaba Mashhadinejad - author) (Hosein Mashhadinejad - author) (Mohsen Khamoushi Kahdouee - author) (Benyamin Fazli - author) (Ghazaleh Khademian - author) (Malihe Aghasizadeh - author) (Ali Azari - author) (Sara Mashhadinejad - author) (M Hemati - author) (Mahnaz Bayat - author)
Introduction:
Intraoperative pulmonary embolism (PE) poses a serious risk during spine surgeries. This document present a case patient with intraoperative massive pulmonary embolus during spine surgery that recognized by an anesthesiologist who underwent an emergent surgical embolectomy. The evidence from a variety of case reports and literature discusses the management and outcomes associated with massive pulmonary embolism during such procedures.
Methods:
Patient presentation A 62-year-old male patient with low back pain (LBP) and weakness in the left leg due to spinal stenosis was admitted to the hospital in the morning. The patient underwent general anesthesia in a prone position for laminectomy, osteotomy, and removal of the herniated disc. The procedure lasted approximately 2.5 hours, with a blood loss of 700 cc, and one unit of blood was transfused. After the operation, when the patient was returned to supine position, he initially experienced hypotension and tachycardia, which improved with the administration of IV fluids and ephedrine. The patient opened his eyes and moved his legs, but he soon developed arrhythmia and severe hypotension. Additionally, the jugular veins were distended, and an ECG raised suspicion of myocardial infarction (MI) or pulmonary embolism (PE). A cardiology consultation and echocardiogram in the operating room led to a diagnosis of massive pulmonary embolism. Once the conditions were suitable, the patient was transferred from the neurosurgery operating room to the cardiac surgery operating room and underwent sternotomy, cardiopulmonary bypass, and removal of fresh clots from the right atrium and pulmonary artery. The patient was under CPR from the moment of the incident until the sternotomy. After the operation, the patient was transferred in the cardiac ICU for managing 10 days. During the first week, the patient was sedated, was in a low cardiac output state, and generalized edema. Intra-aortic balloon pump was inserted, and with the improvement of edema, the neurological examination showed proximal grade one. By the end of the second week, the movements of the lower limbs progressively improved, and by day 16 post-operation, the patient was walking with a walker at the time of discharge.
Results:
Discussion Perioperative pulmonary embolism (PE) can remain undetected until sudden cardiopulmonary collapse. Point-of-care echocardiography aids diagnosis and targeted treatment. Holland et al. (2021) reported a 68-year-old woman who had cardiac arrest due to massive PE during lumbar fusion surgery; intraoperative thrombolysis with alteplase was life-saving but carried a high bleeding risk. Another case involved a 62-year-old man who underwent emergency surgical embolectomy after PE-induced cardiac arrest, later developing pulmonary hypertension and renal failure, treated with aerosolized epoprostenol. Withrow et al. (2023) described PE management with ECMO during lumbar fusion revision. Studies highlight the dilemma between thrombolysis, which risks bleeding, and surgical embolectomy, which is vital when thrombolysis is contraindicated. Early detection and immediate intervention improve survival despite complications like intraoperative bleeding.
Conclusion:
The management of intraoperative massive pulmonary embolism during spine surgery is complex and necessitates rapid assessment and intervention. Case reports underlying the effectiveness of both thrombolytic therapy and surgical embolectomy as well as rapid diagnosis by anesthesiologist as life-saving measures. Comprehensive literature reviews support the notion that although treatment carries risks, appropriate and timely interventions can significantly improve patient survival within cases of critical PE during surgeries.

Conclusion: 138
Status: accepted_poster
Headline Title: Heart Failure
Headline Title:Heart Failure and Subclinical Hypothyroidism: The Role of Levothyroxine Therapy - An Updated Review
Authors: (Dr Erfan Sabouri - corresponding-author) (Dr Sadra Behrouzieh - author) (Dr Nima Rezaei - author)
Introduction:
Heart Failure (HF) is the inability of the heart to pump sufficient blood, primarily due to myocardial infarction, hypertension, or valvular heart disease. Given that thyroid hormones play an essential role in maintaining cardiovascular homeostasis, hypothyroidism is also a contributor to the development and progression of HF. Subclinical hypothyroidism (SCH) is characterized by elevated serum thyroid-stimulating hormone (TSH) levels while free fractions of thyroid hormones remain normal. This condition is noteworthy for its high prevalence (up to 15%), high development rate into overt hypothyroidism (2-5% yearly), and independent association with cardiovascular events and HF. Considering the controversy regarding the benefits of thyroid replacement therapy (TRT) in SCH patients, this narrative review aims to provide an update on the role of TRT in the development of HF and the prognosis of HF patients, while detailing the pathological mechanisms linking these two conditions.
Methods:
T3 as the active form of thyroid hormones binds to nuclear receptors in cardiomyocytes, altering gene transcriptions that affect the cardiac structure, function, and metabolism through modulating contractile proteins, calcium handling, and ion channels. Moreover, it affects vascular smooth muscle cells through regulating nitric oxide synthesis, and β1 adrenergic, and angiotensin II receptors leading to alterations in blood pressure and systemic vascular resistance. SCH similar to hypothyroidism is proven to be associated with HF via several mechanisms. SCH results in atherosclerotic plaque formation and coronary artery disease by reducing nitric oxide synthesis and increasing lipid accumulation. This endothelial dysfunction leads to lower cardiac output, impaired coronary blood supply, reduction of diastolic blood pressure, and cardiac hypertrophy, ultimately resulting in diastolic dysfunction. Moreover, the decrease in preload and the increase in afterload causes renal hypoperfusion, activating the renin-angiotensin-aldosterone system, which leads to fluid retention and hyponatremia, worsening heart failure. Several clinical studies and meta-analyses support the association between SCH and HF by reporting an increased LV mass index, a depressed LV global longitudinal strain, a reduction in stroke volume (SV), a slowed myocardial relaxation, a poorer exercise capacity, and an increased NT-pro BNP and CRP levels in SCH patients compared to euthyroid individuals. Furthermore, many cohort studies following the patients for up to 4 years have established that the development of HF in SCH patients is approximately 2.58-fold higher in patients with TSH 7.0-9.9 mIU/L and up to 3.26-fold in patients with TSH ≥10 mIU/L. Also, a more than twofold increase in mortality, and a higher need for hospital admission, ventricular assist device implantation, and cardiac transplantation is reported in HF patients with SCH, especially when TSH levels are ≥10 mIU/L.
Results:
The management of SCH in HF patients is controversial due to the lack of adequately powered randomized trials for long-term clinical consequences. Animal studies show that thyroid replacement therapy reduces myocyte apoptosis, and improves ventricular remodeling, and cardiac function. Small human studies indicate improvements by TRT in the endothelial dysfunction resulting from the altered lipid metabolism, and the diastolic dysfunction resulting from the slowed myocardial relaxation, impaired ventricular filling, vascular function, and coronary flow reserve. However, larger trials showed inconsistent results probably due to the various definitions of SCH in the elderly population, and the variety in echocardiography measurements. Overall, it is considered safe and beneficial to treat SCH in younger patients, particularly with TSH levels >10 mIU/L. Still, much caution must be taken regarding the geriatric population due to the risk of adverse effects of overtreatment.
Conclusion:
As the 2022 ACC/AHA and 2016 ESC guidelines for HF recommend, serum TSH levels must be screened in all newly diagnosed HF patients and all patients with acute dyspnea and suspected Acute HF. As SCH is suspected, the 2020 NICE guidance on thyroid disease management recommends physicians consider full TRT in adults with TSH ≥10 mU/L and consider a 6-month trial of levothyroxine for SCH adults <65 years old with lower TSH levels who have symptoms of hypothyroidism. However, due to the potential risk of overtreatment and unclear evidence of its benefits through clinical trials the decision to treat the geriatric population with a TSH level <10 mU/L is not recommended yet. Therefore, it is of utmost importance in the geriatric population with HF even with TSH ≥ 10 mU/L, to begin with a lower dose and monitor their cardiac changes to increase the dose as needed. Even after maintaining a stable dose, TSH needs to be monitored up to twice a year.

Conclusion: 135
Status: accepted_poster
Headline Title: Heart Failure
Headline Title:The effects of Blood Flow Restriction Training in patients with cardiopulmonary disorders
Authors: (Zahra Poursaleh Begi - author)
Introduction:
Blood Flow Restriction (BFR) is a novel approach for increasing muscle strength and size when high-load resistance training is not feasible, such as in patients with musculoskeletal, neuromuscular, or cardiopulmonary disorders. Interestingly, emerging evidence suggests that the effects of BFR go beyond increasing muscle strength and size, with significant potential benefits for cardiopulmonary patients. Despite these promising findings, further exploration is needed to define its clinical applications. Therefore, the purpose of this review is to investigate the effects of BFR in patients with cardiopulmonary disorders.
Methods:
We reviewed all systematic reviews and high-quality randomized controlled trials (RCTs) published between 2018 and 2024. Inclusion criteria focused on studies evaluating the effects of BFR on cardiopulmonary function, angiogenesis, and muscle performance, while low-quality studies and those without direct clinical applications were excluded. The keywords used were Blood Flow Restriction, Angiogenesis, Cardiopulmonary Disorder, Heart Disease, and Metabolic Syndrome. Articles were identified through PubMed, Scopus, and Cochrane databases.
Results:
Our review included six systematic reviews with meta-analyses, three narrative reviews, and one RCT. The findings indicate that BFR is well-tolerated in cardiopulmonary patients, enhancing angiogenesis, improving mitochondrial function, and reducing blood pressure. Quantitatively, studies reported a 10–25% improvement in vascular function and a 15–30% increase in muscle strength and size when low-load resistance exercises (LLRE) or low-intensity aerobic exercises were combined with BFR. These benefits address key challenges such as poor circulation and muscle atrophy in this population.
Conclusion:
Blood Flow Restriction is a viable alternative to high-load resistance training or high-intensity aerobic exercises for patients with cardiopulmonary disorders. Physiotherapists can incorporate LLRE or low-intensity aerobic exercises combined with BFR to improve patient outcomes. Future research should focus on optimizing BFR protocols for cardiopulmonary rehabilitation and further validating its long-term safety and efficacy.

Conclusion: 134
Status: accepted_poster
Headline Title: Cardiovascular Anesthesiology
Headline Title:Anesthesia and Airway Management in a Child with Frank Ter Haar Syndrome Suspected Difficult Airway Undergoing Cardiac Surgery: A Case Report
Authors: (Maryam Ghadimi - author) (Dr Yasmin Chaibakhsh - author) (Dr Mohsen Ziyaeifard - author)
Introduction:
Frank ter Haar syndrome (FTHS) is a rare and complex multisystem congenital genetic disorder that leads to craniofacial, cardiac, and skeletal abnormalities. We report the anesthesia and airway management of a child with FTHS who was referred for repair of atrial septal defect (ASD) and ventricular septal defect (VSD)
Methods:
The patient exhibited craniofacial and skeletal abnormalities, including craniosynostosis, micrognathia, a prominent forehead, hypertelorism, and anteverted nostrils. These features raised the possibility of a difficult airway
Results:
Given the higher likelihood of difficult airway management in patients with syndromic disorders and congenital heart diseases—due to factors such as a small jaw, large tongue, and improper positioning of teeth—preoperative anesthesia evaluation should be conducted with increased caution. For patients with a potentially difficult airway undergoing elective surgery, the procedure should be postponed until all necessary equipment for managing a difficult airway is available.In the current case, fentanyl, midazolam, and cisatracurium were used for anesthesia, and intubation was performed after confirming the proper function of the vocal cords and epiglottis using laryngoscopy. However, due to the airway abnormalities associated with FTHS, thorough examination of the epiglottis and vocal cords is strongly recommended to ensure effective maintenance of anesthesia.
Conclusion:
Given the higher likelihood of difficult airway management in patients with syndromic disorders and congenital heart diseases—due to factors such as a small jaw, large tongue, and improper positioning of teeth—preoperative anesthesia evaluation should be conducted with increased caution. For patients with a potentially difficult airway undergoing elective surgery, the procedure should be postponed until all necessary equipment for managing a difficult airway is available. In the current case, fentanyl, midazolam, and cisatracurium were used for anesthesia, and intubation was performed after confirming the proper function of the vocal cords and epiglottis using laryngoscopy.However, due to the airway abnormalities associated with FTHS, thorough examination of the epiglottis and vocal cords is strongly recommended to ensure effective maintenance of anesthesia.

Conclusion: 93
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:lethal and life-threatening cardiac syndromes and nursing considerations
Authors: (Alireza Mohsenipour Foumani - author)
Introduction:
Lethal and life-threatening cardiac syndromes represent a critical area of focus within cardiology, as they encompass a range of conditions that can lead to sudden cardiac death or significant morbidity without prompt intervention. Among these syndromes are acute coronary syndrome, Wellens syndrome, Dewinter syndrome, Brugada syndrome and WPW syndrome. Each of these conditions requires urgent recognition and management to mitigate potential life-threatening consequences that cardiac and emergency nurses have crucial role in this subject.
Methods:
When considering nursing implications, it is vital to understand the early signs and symptoms associated with these syndromes. Nurses as members of health care teams play a pivotal role in assessing patients and identifying these symptoms swiftly, thereby facilitating timely interventions. A key nursing consideration is the thorough assessment of symptoms indicative of life-threatening cardiac syndromes and early detection of ECG changes. This enables the early detection of disease and allows for immediate treatment protocols to be initiated when necessary.
Results:
In summary, the nursing considerations surrounding lethal cardiac syndromes are multifaceted and demand acute clinical skills, timely interventions, effective communication, and a compassionate approach. The ability to recognize these syndromes and respond appropriately can significantly influence patient outcomes and quality of life.
Conclusion:
In summary, the nursing considerations surrounding lethal cardiac syndromes are multifaceted and demand acute clinical skills, timely interventions, effective communication, and a compassionate approach. The ability to recognize these syndromes and respond appropriately can significantly influence patient outcomes and quality of life.

Conclusion: 90
Status: accepted_poster
Headline Title: Cardiac Imaging
Headline Title:Prognostic implications of left ventricular shape index in heart failure: a comparative study of gated SPECT and echocardiography
Authors: (Leila Bigdelu - corresponding-author) (Toktam Masoudi - author) (Vahid Reza Dabbagh Kakhki1 - author) (Hourak Pourzand - author) (Negar Ebrahimi - author)
Introduction:
Background: Heart failure (HF) is a clinical syndrome characterized by structural and functional ventricular abnormalities. Change in structure of the heart that happens during HF can be identified using gated myocardial perfusion single-photon emission computed tomography (Gated SPECT) through the assessment of the Left Ventricular Shape Index (LVSI). This study evaluates the prognostic value of LVSI measured by Gated SPECT and echocardiography in patients with HF.
Methods:
This prospective study included 96 patients referred for myocardial perfusion scan, they were divided in two groups of patients with HF and without HF (according to Framingham clinical criteria and ejection fraction (EF) evaluation by echocardiography). Cardiac sphericity indexes including end-diastolic and end-systolic LVSI and Eccentricity index (EI) were analyzed using myocardial perfusion scan. These indexes were also measured via echocardiography at the end of diastole. Patients were followed for one year to evaluate the occurrence of cardiac events and echocardiography was repeated at the end of the follow-up period.
Results:
In the HF group, resting end-diastolic and end-systolic LVSI values were 70.0 ± 0.10 and 60.0 ± 0.11, respectively, compared to 66.0 ± 0.06 and 0.45 ± 0.06 in the non-HF group. These values showed a significant correlation with the similar index in echocardiography (p-value: 0.001). During the one-year follow-up, 20 patients in the HF group experienced cardiac events. However, no significant relationship was found between the LVSI values measured by Gated SPECT and echocardiography, and the incidence of cardiac events.
Conclusion:
while LVSI values were higher in patients with HF compared to those without HF, heart shape indexes did not significantly predict the one-year prognosis (short-time prognosis) in patients with HF.

Conclusion: 83
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Predictive value of left atrial strain and strain rate for atrial fibrillation following isolated off-pump coronary artery bypass grafting in low-risk patients
Authors: (Leila Bigdelu - author) (Ali Azari - author) (Negar Ebrahimi - author) (Maryam Emadzadeh - author)
Introduction:
Background: Postoperative atrial fibrillation (POAF) is a common arrhythmia that can occur after coronary artery bypass grafting (CABG) surgery. Previous studies have highlighted a lack of reliable methods for predicting the onset of POAF, especially in low-risk patients.This study aimed to evaluate the predictive value of left atrial strain and strain rate imaging in predicting the likelihood of POAF following isolated off-pump CABG in patients with a CHA2DS2-VASc score of less than 2.
Methods:
This prospective study evaluated 123 patients with sinus rhythm and a CHA2DS2- VASc score of less than 2, who underwent off-pump CABG. Left atrial strain and strain rate were measured utilizing the velocity vector imaging (VVI) method. The patients were followed postoperatively for one week to determine the incidence of atrial fibrillation.
Results:
The patients who developed atrial fibrillation exhibited significantly lower strain (21.25 versus 37.59, p < 0.001), lower strain rate (1.37 versus 2.73, p < 0.001), and higher left atrial volume (p < 0.001) compared to those who did not develop atrial fibrillation. Multivariate logistic regression analysis identified a decrease in atrial strain could effectively predict the occurrence of atrial fibrillation following CABG, indicating that for each unit decrease in strain, the risk of developing atrial fibrillation increased by 1.49 times.
Conclusion:
lower preoperative left atrial strain measurements can effectively predict the occurrence of atrial fibrillation after off-pump CABG in patients with CHA2DS2-VASc scores under two. Identifying high-risk patients for POAF after CABG enables targeted prophylactic treatment, allowing for optimized treatment strategies tailored to those most likely to benefit rather than applying them to all CABG patients.

Conclusion: 82
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:Evaluating Existing Systems for Improving Medication Adherence in Heart Failure Patients: A Systematic Review
Authors: (Ali Akbari - author) (Masoumeh Zakerimoghadam - corresponding-author)
Introduction:
Heart failure is a chronic condition that significantly burdens healthcare systems. Medication adherence is vital for its management, yet many patients face challenges in following prescribed treatments. This systematic review evaluates existing systems designed to improve medication adherence in heart failure patients.
Methods:
Following Cochrane systematic review principles and PRISMA guidelines, a comprehensive search was conducted, using keywords such as "Medication Adherence Systems," "Heart Failure," "Digital Interventions," "Telehealth," and "Patient Compliance" across multiple databases, including PubMed, Scopus, EMBASE, Web of Science, CINAHL, and Cochrane Library. Additionally, grey literature was explored via Google Scholar. No time restrictions were applied. Inclusion criteria encompassed all English-language studies evaluating systems aimed at improving medication adherence in heart failure patients. Excluded studies included reviews, observational studies, commentaries, and editorials. Two independent reviewers screened articles, extracted data, and assessed study quality using the QualSyst tool, ensuring a structured evaluation of methodological rigor. The risk of bias was analyzed with the Joanna Briggs Institute tool to evaluate different study designs. Discrepancies were resolved by a third reviewer to maintain consistency and reliability.
Results:
Out of 894 initial studies, 432 articles were selected for final evaluation based on inclusion and exclusion criteria. After a detailed review, 56 studies were included for qualitative analysis, focusing on various systems to improve medication adherence in heart failure patients. The findings revealed that digital systems, such as mobile apps and reminder text messages, improved adherence. Smart pillboxes with alert functions and data recording reduced medication errors and enhanced adherence management. Artificial intelligence-driven medication management systems, offering personalized drug schedules, increased patient engagement. Telehealth programs involving remote monitoring and medication counseling significantly improved clinical outcomes. Additionally, Radio-frequency identification RFID tags and wearable sensors for tracking medication schedules enhanced the accuracy of adherence monitoring.
Conclusion:
This systematic review highlighted that innovative medication adherence systems, such as mobile apps and remote monitoring tools, effectively improve medication adherence in heart failure patients. Further research is required to assess the long-term effectiveness of these interventions.

Conclusion: 69
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:The association of adjusted energy nutrient-rich foods and cardiovascular risk factors in overweight and obese women: a cross-sectional study
Authors: (Fatemeh Mohammadzaheri - author) (Seyed Ali Keshavarz - corresponding-author) (Khadijeh Mirzaei - author)
Introduction:
Cardiovascular diseases (CVDs) are a major cause of death in the world. The association between nutrients, obesity, and CVD risk factors has been the topic of many studies, especially in recent years. ENRF9.3 (energy-adjusted nutrient-rich foods) is a validated index that consists of two parts: the Nutrient-Rich (NR9) and Limited Nutrients (LIM) score. Eligible nutrients (and RDVs) are protein (50 g), fiber (28 g), vitamin A (900 μg retinol activity equivalent), vitamin C (90 mg), vitamin D (20 μg), calcium (1300 mg), iron (18 mg), potassium (4700 mg), and magnesium (420 mg). LIM includes saturated fat (20 g), added sugar (50 g), and sodium (2300 mg) in a 2000 kcal/d diet. This study aims to investigate the association of ENRF9.3 and cardiovascular risk factors in overweight and obese women.
Methods:
This cross-sectional study was conducted on 382 overweight and obese women. Dietary intake was obtained from a food frequency questionnaire (FFQ) with 147 items, and the ENRF9.3 index score was calculated for each individual. The body composition was assessed using a bioelectrical impedance analyzer (BIA) (InBody 770, Korea). Measurements included body fat mass (BFM), fat-free mass (FFM), body fat percentage (%), and visceral fat level. Height, waist circumference (WC), and hip circumference (HC) were measured by trained nutritionists for each participant. BIA was used to measure weight and BMI. Blood pressure was measured after ten minutes of sitting using an automated BP monitor. The biochemical assessment included the measurement of fasting blood glucose (FBS), triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high-sensitivity C-reactive protein (hs-CRP), insulin, plasminogen activator inhibitor-1 (PAI-1), galectin-3, and monocyte chemoattractant protein-1 (MCP-1).
Results:
After adjusting for confounders including BMI, energy intake, and physical activity in model 1, there was no significant association between ENRF9.3 and TG, but the p-value for trend was significant in model 1 (P for trend = 0.043). Moreover, after controlling for confounders in model 1 and adding economic status, education level, marital status, and supplementation in model 2, there was a significant association between tertile 2 (T2) of ENRF9.3 and HC (p = 0.02). Also, we found a significant association between T2 (p = 0.021) and tertile 3 (T3) (p = 0.006) of ENRF9.3 with galectin-3 in model 2 compared to the first tertile (T1). Additionally, a negative association was observed between T3 of ENRF9.3 and PAI-1 in the crude model (p = 0.045), model 1 (p = 0.03), and model 2 ( p = 0.023). Additionally, a significant association was observed between T2 of ENRF9.3 and SBP in the crude model (p = 0.024), model 1 (p = 0.015), and model 2 (p = 0.042) compared to the reference group.
Conclusion:
seems ENRF9.3 is associated with several CVD risk factors such as TG, galectin-3, and PAI-1.

Conclusion: 63
Status: accepted_poster
Headline Title: Cardiac Imaging
Headline Title:The predictive role of aortic propagation velocity for coronary artery disease
Authors: (Fereshte Ghaderi - author) (Faeze Keihanian - corresponding-author) (Hossein Samim - author)
Introduction:
It is well recognized that cardio- vascular risk factors lead to histological and functional changes in aorta, and aortic stiffness is the best predictor of cardiovascular morbidity and mortality. In this study we evaluated the relation of a less evaluated echocardiographic parameter of aortic stiffness, aortic propagation velocity (APV) with the presence and severity of CAD.
Methods:
This cross sectional study was conducted from May 2015 to March 2016 in Imam Reza hospital, Mashhad, Iran. Seventy patients who were referred for elective coronary artery angiography were enrolled. Patients were divided into two sub-groups based on angiographic findings: patients with CAD (38 patients, 54.3%) and non-CAD (32 patients, 45.7%). Transthoracic echocardiography was performed using the conventional 2D and color M-Mode imaging. Aortic propagation velocity (APV), aortic strain (AS) and distensibility (AD) were measured. The presence and Severity of CAD (assessing by syntax score) and their relation with aortic stiffness indices were assessed.
Results:
Aortic strain (6.23 ± 1.93% versus 11.66 ± 4.86%, P < 0.0001), distensibility (2.46 ± 0.91 vs 5.57 ± 2.25 cm 2 dyn-110-3, P < 0.0001) and APV (48.63 ± 10.31 cm/sec vs 77.75 ± 9.97 cm/s, P < 0.0001) were significantly decreased in CAD group compared with non-CAD group. In our study, APV showed significant inverse relationship with CAD. Based on our results, APV less than 56 cm/sec could be used to predict CAD with sensitivity and specificity of 96.9 and 78.9% respectively. We also found an inverse correlation between APV and severity of CAD.
Conclusion:
Aortic strain, AD and APV (a less evaluated echocardiographic index) showed significant inverse correlation with presence and severity of CAD.

Conclusion: 59
Status: accepted_poster
Headline Title: Echocardiology
Headline Title:Investigating the relationship between the shape of the left atrial appendage and the incidence of atrial fibrillation in patients diagnosed with atrial fibrillation
Authors: (Nakisa Khansari - corresponding-author) (Mehdi Moradi - author)
Introduction:
A prevalent rapid heart rhythm disorder is atrial fibrillation (AF) (1), in which the left atrial appendage (LAA) has a substantial impact, and changes in its structure and anatomy are closely related to the initiation, advancement, and recurrence of AF (2). In a regular heart rhythm, LAA contracts and relaxes rhythmically. Conversely, in AF, which causes irregular contractions of the left atrium (LA), the LAA loses its typical contraction pattern (3, 4). This leads to decreased contraction strength of the LAA wall and incomplete blood emptying from the LAA (5). Incomplete emptying, slow blood flow, and damage to the cardiovascular endothelium lead to morphologic changes of the LAA, which are likely to result in thrombosis and severe ischemic stroke events. Despite the highly complicated mechanism of initiation of thrombosis, the LAA
Methods:
Data collection method The study was a cross-sectional observational analysis aiming to determine the relationship between LAA morphology and AF occurrence in patients referred to Farshchian Heart Hospital in Hamedan over two years (April 2021 to March 2022). A total of 25 patients diagnosed with atrial fibrillation, eligible for cardioversion, were invited to participate in the study. A specialist in cardiac echocardiography conducted an echocardiogram, which involved recording patient demographics and examining the morphology of the left atrial appendage. Three-dimensional transesophageal echocardiography diagnosed LAA morphology. Patients fasted for 4-6 h before the examination and received local anesthesia with 2% lidocaine. Study parameters were subsequently evaluated using transesophageal echocardiography. Definition of LAA morphology In this study, the LAA morphology was displayed using transesophageal echocardiography (Figure 1). The “chicken-wing” is characterized by a dominant lobe with a noticeable bend in its proximal or middle part, folding back on itself at a distance from the orifice, and it may have secondary lobes. The “cactus” features a dominant central lobe with secondary lobes arising from it superiorly and inferiorly. The “cauliflower” has a short overall length, complex internal characteristics, a variable number of lobes without a dominant lobe, and a more irregular shape of the orifice. The “windsock” has a dominant lobe as the primary structure, with variations in the location and number of secondary or even tertiary lobes (27). Inclusion criteria Participants who met the following criteria were included in the study: • Suffering from atrial fibrillation • Age over 18 years
Results:
In this study, a census method was employed to select and examine 25 patients diagnosed with atrial fibrillation referring to the educational and medical center of Farshchian Cardiovascular Hospital in Hamedan during 2021-2022, who were potential candidates for cardioversion. Patients had a mean age of 56.64±12.31 years (range 38-81 years).
Conclusion:
The morphology of the left atrial appendage varies in patients with atrial fibrillation. Chickenwing and Cactus shapes were the most common forms of left atrial appendage in patients diagnosed with atrial fibrillation. Left atrial appendage morphology was significantly associated with flow velocity, which appears to be beneficial in predicting thrombosis and the prognosis of atrial fibrillation.

Conclusion: 55
Status: accepted_poster
Headline Title: Cardiac Electrophysiology
Headline Title:A Comprehensive Analysis of Factors Influencing Electrical Cardioversion Success in Atrial Fibrillation.
Authors: (Mehrdad Saravi - corresponding-author) (Mirsaeed Ramezani - author) (Samira Tahmasbipour - author)
Introduction:
Background: Electrical cardioversion (ECV) remains a cornerstone in managing atrial fibrillation (AF), yet maintaining long-term sinus rhythm persists. Identifying modifiable risk factors and novel biomarkers to predict immediate ECV success and sustained sinus rhythm is essential to improve therapeutic outcomes. This study systematically evaluated the impact of clinical, procedural, inflammatory, and comorbidity-related factors on ECV efficacy and AF recurrence over a 12-month follow-up period.
Methods:
This prospective, single-center investigation included 85 consecutive patients with AF undergoing ECV. Baseline characteristics—such as age, sex, diabetes, hypertension, smoking status, obesity, and body mass index—were documented alongside echocardiographic data, including left and right atrial diameters and left ventricular ejection fraction (LVEF). Pre-existing antiarrhythmic therapy, procedural context (elective vs. emergent), and cerebrovascular risk scores were recorded. Inflammatory markers were analyzed from pre-procedural blood samples, including leukocyte count, blood glucose, leukoglycemic index (LGI), and systemic immune-inflammation index (SII). The presence of renal, hepatic, and pulmonary comorbidities was also documented. Outcomes assessed included maintenance of sinus rhythm and AF recurrence at 12 months. Independent predictors were determined using univariate and multivariate Cox proportional hazards regression models.
Results:
Results: The mean age of the cohort was [Insert Mean Age], with [Insert Percentage] of participants being female. Key comorbidities included diabetes ([Insert Percentage]), hypertension ([Insert Percentage]), and renal disease ([Insert Percentage]). Acute ECV success was achieved in [Insert Percentage] of patients, while only [Insert Percentage] maintained sinus rhythm at 12 months. Multivariate analysis identified larger left atrial diameter (HR [Insert HR], 95% CI [Insert CI], p=[Insert Value]), elevated SII (HR [Insert HR], 95% CI [Insert CI], p=[Insert Value]), and pre-existing renal disease (HR [Insert HR], 95% CI [Insert CI], p=[Insert Value]) as independent predictors of AF recurrence. Conversely, preserved LVEF (HR [Insert HR], 95% CI [Insert CI], p=[Insert Value]) was inversely associated with recurrence risk. Age, sex, and smoking status were not significant predictors.
Conclusion:
Conclusions: This study underscores the role of multi-dimensional risk stratification in predicting ECV outcomes for AF. Larger left atrial size, systemic inflammation (as indicated by SII), and renal dysfunction were strongly associated with AF recurrence, while preserved LVEF emerged as protective. These findings highlight the importance of incorporating comprehensive clinical and inflammatory assessments into therapeutic decision-making to enhance rhythm control after ECV. Further studies are warranted to confirm these results in larger cohorts and identify potential therapeutic interventions.

Conclusion: 47
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:Disease uncertainty and medication adherence: A cross-sectional correlational study
Authors: (Attieh Hajialigol - author) (Masoomeh Imanipour - corresponding-author)
Introduction:
Due to the lack of knowledge related to the disease and the fear of recurrence of symptoms and doubts about the treatment method, patients with coronary artery disease cannot have a correct cognitive framework about their disease, which leads to disease uncertainty. Uncertainty acts as a psychosocial stress that can overshadow a person's performance regarding the follow-up of the treatment process. Therefore, the present study was conducted with the aim of determining the relationship between disease uncertainty and medication adherence in patients with coronary heart disease.
Methods:
This cross-sectional descriptive-correlation study was conducted in 1403 on 193 patients with coronary artery disease who were selected based on the inclusion criteria and available sampling method. Research tools included Michel's Uncertainty Questionnaire and Adherence Chronic Disease Scale. The data were analyzed with spss software version 24 and with the help of descriptive statistics and Pearson correlation test
Results:
In this study, the average score of both variables of disease uncertainty and medication adherence was obtained at an average level, and the results of the statistical test showed a significant negative correlation between these two variables (p<.05) in such a way that with the increase of disease uncertainty, patients' medication adherence is reduced.
Conclusion:
According to the findings of the present research, the need for measures that can reduce uncertainty in coronary artery patients and, as a result, improve the follow-up of the treatment process in them, is felt, and it is necessary for care workers, especially nurses, to pay attention to this issue. and take steps to reduce the uncertainty of these patients by using appropriate interventions

Conclusion: 45
Status: accepted_poster
Headline Title: Cardiac Imaging
Headline Title:Prognostic Implication of Computational Angiography–Derived Fractional Flow Reserve in Patients With Nonobstructive Coronary Artery Disease
Authors: (Ramin Navidahmadi - corresponding-author)
Introduction:
Risk stratification of patients with symptomatic nonobstructive coronary artery disease remains uncertain. Our study assessed the clinical value of single-vessel, multivessel, and 3-vessel computational angiography–derived fractional flow reserve (caFFR) measurement in patients with nonobstructive coronary artery disease
Methods:
We enrolled patients with ≤50% stenosis with a caFFR value ≥0.8 in all 3 coronary arteries on coronary angiography. The sum of caFFR values in the 3 vessels was computed for each patient. Patient stratification was based on the median value of the following criteria: single-vessel analysis, multivessel analysis, and 3-vessel analysis. The primary end point of this study was major adverse cardiac events at 5years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. A total of 490 patients were included. The 5-year major adverse cardiac event rates in single-vessel analysis were statistically insignificant between low- and high-caFFR groups (left anterior descending artery [P=0.163]; left circumflex artery [P=0.797]; right coronary artery [P=0.127]). In multivessel analysis, patients in the multiplevessel low-caFFR group (with 2–3 vessels lower than median value of all coronary arteries) showed an increased risk of 5-year major adverse cardiac events compared with patients in the single-vessel low-caFFR group (0–1 vessel) (hazard ratio [HR], 2.648 [95% CI, 1.141–6.145]; P=0.023). In 3-vessel analysis, patients in the low 3-vessel caFFR group demonstrated a greater 5-year major adverse cardiac event risk than the high 3-vessel caFFR group (HR, 2.43 [95% CI, 1.087–5.433]; P=0.031)
Results:
n patients with NOCAD, the higher count of vessels exhibiting low caFFR values and the low 3V-caFFR values have been found to be associated with an increased rate of MACEs over a 5-year period. The difference was mainly driven by ischemia-driven revascularization. This highlights the importance of evaluating both the presence of multiple vessels and the overall physiological atherosclerotic burden using 3V-caFFR as prognostic assessments in patients with NOCAD
Conclusion:
We demonstrated that both multiple-vessel and 3-vessel caFFR measurements serve as valuable prognostic indicators for risk assessment in patients with nonobstructive coronary artery disease

Conclusion: 41
Status: accepted_poster
Headline Title: General Cardiology
Headline Title: Aortic Catastrophe: Dissection extending to the bilateral carotids Presenting as TIA in a Middle-Aged Patient with End-Stage Renal Disease
Authors: (Amir Heidari - corresponding-author) (S. Enssieh Hashemi - author) (Naser Kachuian Javadi - author) (Fatemeh Omidi - author)
Introduction:
Aortic dissection is a critical vascular emergency that can present atypically, particularly in patients with end-stage renal disease (ESRD). This article discusses a case where a TIA was the initial symptom, highlighting the need for prompt imaging and intervention to prevent severe cardiovascular and neurological outcomes in these complex patients.
Methods:
Case Presentation: We present a unique case of a 53-year-old male with end-stage renal disease (ESRD) who experienced a transient ischemic attack (TIA) characterized by brief aphasia and right hemiparesis. Initial evaluations revealed evidence of bilateral carotid dissection on color Doppler ultrasound, as well as significant cardiovascular abnormalities, including severe aortic regurgitation due to dissection of the ascending aorta extending to multiple vascular territories. Remarkably, the patient did not exhibit typical symptoms of chest or abdominal pain, complicating the diagnosis. Imaging studies confirmed bilateral carotid dissection and extensive aortic dissection involving the ascending aorta, aortic arch, descending aorta, brachiocephalic artery, left subclavian artery, bilateral common and external iliac arteries, bilateral renal arteries, Celiac trunk and Mesentric artries. Given the severity of his condition, the patient underwent an emergent supracoronary surgical intervention to address the aortic dissection, which was successful. Postoperatively, he stabilized and was started on continuous renal replacement therapy (CRRT) before discharge. This case highlights the importance of recognizing atypical presentations of vascular emergencies and the complexities of managing patients with ESRD in the context of acute neurological and cardiovascular events.
Results:
Discussion: The significance of ascending aorta dissection in patients with end-stage renal disease (ESRD) cannot be overstated, as this condition presents unique challenges that weigh heavily on clinical outcomes. ESRD patients often exhibit heightened cardiovascular risk factors, such as hypertension and endothelial dysfunction, which predispose them to aortic pathologies. In the case of ascending aorta dissection, the initial neurologic presentation and the absence of chest or abdominal pain may lead to delayed diagnoses, as the typical symptomatology can be obscured by underlying kidney-related malaise. Organ malperfusion emerges as a significant complication of ascending aorta dissection, exacerbating the already precarious health status of ESRD patients. Furthermore, the urgency of surgical intervention is underscored by the high mortality rates associated with acute aortic dissections.
Conclusion:
In conclusion, this case underscores the critical need for heightened awareness of atypical presentations of aortic dissection, particularly in patients with end-stage renal disease (ESRD). The initial presentation of transient ischemic attack (TIA) without the classic symptoms of chest or abdominal pain can lead to diagnostic delays and increased risks of severe complications. Our findings emphasize the importance of prompt imaging and surgical intervention to mitigate neurological and cardiovascular risks in this vulnerable population. Ultimately, improved recognition and management strategies for vascular emergencies in ESRD patients are essential for enhancing clinical outcomes and reducing mortality associated with these life-threatening conditions.

Conclusion: 39
Status: accepted_poster
Headline Title: Cardiovascular Anesthesiology
Headline Title:Tricuspid and Pulmonary Valve Replacement in a Woman with Carcinoid Tumor
Authors: (Amjad Kiani - corresponding-author) (Rostam Esfandiari Bakhtiari - author) (Erfan Naghsh - author)
Introduction:
Carcinoid tumors are the begin tumors of the intestine, but sometimes they will be malignant and spread to the other organs such as liver, lungs, heart and etc. Of course appendiceal carcinoid tumors are malignant originally carcinoid tumor originate from GI system. Constantly, carcinoid tumor metastasizes to the liver and then invade the valves on the right side of the heart. Here we report a 48-year-old woman with tricuspid and pulmonary valves stenosis and regurgitation severely.
Methods:
A 48-year-old married woman with two children and a history of carcinoid tumor from 5 years ago who refer to a cardiologist with Tachycardia, DOE during brisk walking. This patient was under the vision of the hematology and oncology team and has received long term somatostatin-drug monthly. After performing an angiogram, echocardiography and right sided heart catheterization she labeled as pulmonary and tricuspid regurgitation and stenosis. Of course mitral and aortic valves were clean and lesion free according to cardiologist report. The cardiologist diagnosed metastasis to the liver and right side of the heart, the tricuspid and pulmonary valves have become severely incompetent and stenotic. She prescribed on Ectrotide at a dose of 50-100 µg/hour one day before operation. The patient was then sedated and entered to the operating room (Open Heart) without stress. Morphine and Pethidine and Histamine releaser drugs were not given to the patient under any circumstances. During open heart surgery, the patient was placed on a Cardiopulmonary bypass (CPB) and the pulmonary and tricuspid valves were replaced, uneven fully the patient was weaned off the CPB with the Ectrotide and low dose Norepinephrine. For all of the operation time the patient was monitored as like ECG, IBP, Spo2, TEE and temperature and face to face for flushing.
Results:
The patient's post-CPB period passed without any incident and she was transferred to the OH-ICH. The patient was in the ICU for 6 days, and she received the Ectrotide until the last day. The patient was then discharged to the ward for 4 days and the pacemaker wire was removed from the body.
Conclusion:
Tricuspid and pulmonary valve obstruction is a serious disease whose clinical presentation ranges from subtle to dramatic. It requires detailed imaging attention with transthoracic and intra operative transesophageal studies. Findings show notable resemblance to operative findings. Approach to this kind of neuroendocrine tumors need to a lot of details such as drugs, medicines, monitor, management and etc.

Conclusion: 35
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:Bitter Orange Aromatherapy for Mitigating Postoperative Delirium: A Triple-Blind Randomized Study in CABG Patients
Authors: (Siavash Sangi - author) (Mehrdad Mesbah Kiaei - corresponding-author) (Maryam Aligholizadeh - author) (Seyed Mohammad Reza Amouzegar Zavareh - author) (Homayoon Bana Derakhshan - author) (Zahra Karimian - author)
Introduction:
Background: Postoperative delirium (POD) is a common complication following coronary artery bypass grafting (CABG) surgery, significantly affecting patient recovery and outcomes. As the interest in complementary and integrative medicine grows, essential oils such as bitter orange (Citrus aurantium) have gained attention for their potential benefits in managing postoperative symptoms like pain, nausea, and vomiting. However, the role of bitter orange essential oil in reducing postoperative delirium remains underexplored. This study investigates the effects of inhaling bitter orange essential oil aromatherapy on the incidence and severity of postoperative delirium in patients undergoing CABG surgery.
Methods:
Methods: This randomized clinical trial included 90 patients scheduled for elective CABG surgery. Participants were randomly assigned to receive either bitter orange essential oil aromatherapy or a control treatment. Aromatherapy was initiated during anesthesia induction and continued at two-hour intervals until the end of the surgery, in the recovery room, and for 16 hours postoperatively. The Confusion Assessment Method for the ICU (CAM-ICU) was used to assess delirium at 24 and 48 hours post-surgery. Secondary outcomes included pain intensity, nausea, vomiting, and the use of antiemetic medications. Data were analyzed using SPSS version 21 with chi-square tests, Wilcoxon tests, and repeated measures ANCOVA, with a significance level set at p < 0.05.
Results:
Results: The incidence of delirium at 24 hours was significantly lower in the aromatherapy group compared to the control group (8.9% vs. 20.0%, p = 0.041). At 48 hours, the delirium incidence in the aromatherapy group was further reduced (6.7% vs. 18.9%, p = 0.036). Additionally, bitter orange aromatherapy significantly reduced pain intensity (p < 0.001) and the severity of nausea and vomiting (p = 0.002), resulting in a lower frequency of antiemetic drug use in the recovery room (p = 0.038) and during the first 16 hours post-surgery (p = 0.033).
Conclusion:
Conclusion: Bitter orange essential oil aromatherapy significantly decreased the incidence and severity of postoperative delirium in CABG patients, while also reducing pain, nausea, and vomiting. These findings suggest that aromatherapy with bitter orange oil is a promising, non-invasive, complementary treatment to enhance postoperative outcomes in patients undergoing high-risk cardiac surgery. Further studies are necessary to refine protocols and confirm the generalizability of these findings across diverse surgical populations.

Conclusion: 32
Status: accepted_poster
Headline Title: Cardiovascular Anesthesiology
Headline Title:Conjunctival chemosis after coronary artery bypass surgery
Authors: (Masoud Tarbiat - author) (Mahmoud Rezaei - author) (Rohollah Abbasi - author) (Hamid Reza Khorshidi - corresponding-author)
Introduction:
Post-operative conjunctival chemosis is a rare finding after general anesthesia and non-ophthalmic surgery. It is a billowing or blister-like swelling of the conjunctiva that is seen particularly in the lower lid. The eyes may be watery and yellowish. The primary cause is irritation, and is not contagious. It can be unilateral or bilateral. Severe conjunctival chemosis can impair eyelid closure. It is a type of eye inflammation that can cause patient discomfort, short-term decreased visual acuity, and an increased risk for keratitis.1,2 Here we present a case of conjunctival chemosis after coronary artery bypass surgery which was successfully managed.
Methods:
A 59-year-old woman who was a candidate for elective on pump coronary artery bypass graft surgery for 3-vessel coronary disease, had a history of hypertension, hyperlipidemia, rheumatoid arthritis, allergy to diclofenac, and left eye cataract surgery. She was treated with captopril, metoprolol, prednisolone, indomethacin, atorvastatin, and methotrexate. Under general anaesthesia with standard monitoring, conventional median sternotomy was performed. The tracheal tube fixed with a tape. During surgery, eyes were closed with tape to prevent corneal ulcerations. The surgery was performed with cardiopulmonary bypass (CPB) and duration of total CPB and aortic cross-clamp times were 167 and 83 minutes, respectively. During CPB, the central venous pressure and mean blood pressure were in the normal range. The operation course was uneventful, and the patient was transferred to the intensive care unit (ICU). The amount of fluid intake and output during operation and first ICU stay day were about 3800 ml versus 3400 ml, respectively. On the first postoperative day in ICU, the conjunctival chemosis was seen in the inferolateral region of the conjunctiva in the both eyes. [Figure 1A & B]. There is no itching in the eyes. Following consult with an ophthalmologist, and normal eye examination findings such as visual acuity and intraocular pressure, she treated with eye drop ciplex (ciprofloxacin 0.3%) and eye ointment tetracycline. She was also in head-up position for better venous and lymphatic drainage. The conjunctival chemosis were completely dissolved after five days.
Results:
Ophthalmic complications may develop after prolonged non-ocular surgery under general anaesthesia. Post-operative conjunctival chemosis is a rare but uncomfortable and undesirable complication after non-ophthalmic surgery. Chemosis of the conjunctiva occurs when there is excess fluid in the conjunctival interstitium and characterized by a visible swelling of the conjunctiva, and is seen particularly in the lower lid. The symptoms of conjunctival chemosis include: watery eyes (primary symptom), increase of the volume of the eyelid area, edema in the conjunctiva, excessive tearing, double vision or blurred vision, secretion, red eyes, redness of the eyelids and a sensation of having something in the eye.
Conclusion:
Post-operative conjunctival chemosis is a rare complication (especially after non-ophthalmic surgery) with favorable early and long-term outcomes if recognized timely and managed properly.

Conclusion: 22
Status: accepted_poster
Headline Title: Cardiac Nursing
Headline Title:Impact of Ketamine Administration During Anesthesia Induction on Extubation Time and Oxygenation in Coronary Artery Bypass Graft Surgery
Authors: (Mehrdad Mesbah Kiaei - author) (Shahnam Sedigh Maroufi - author) (Siavash Sangi - author) (Maryam Aligholizadeh - corresponding-author) (Rezvan Rajabzadeh - author) (Homayoon Bana Derakhshan - author) (Melika Aligholizadeh - author)
Introduction:
The rise in coronary artery disease (CAD) due to increased life expectancy has made coronary artery bypass grafting (CABG) more common. However, CABG often leads to pulmonary dysfunction from cardiopulmonary bypass (CPB)-induced inflammation. This study evaluated the effect of intravenous ketamine during anesthesia induction on extubation time in the ICU.
Methods:
This randomized controlled trial followed CONSORT guidelines and included 60 patients scheduled for CABG at Hazrat Rasoul Akram Research Center. Patients were randomly assigned to either a ketamine (0.5 mg/kg) or placebo group. Extubation time and respiratory parameters (SpO₂, PaO₂, PaCO₂) were measured and analyzed using SPSS 19 with significance at p < 0.05.
Results:
No significant differences were observed between the control and intervention groups regarding demographic or surgical characteristics (p > 0.05). Most patients in both groups were extubated within 6 hours of ICU admission, with no significant difference in extubation times. However, the SpO2 level was significantly higher in the ketamine group (P = 0.046). No significant difference was found in PaCO2 levels (P = 0.093), while PaO2 levels increased significantly in the ketamine group (p< 0.05).
Conclusion:
This study assessed the effect of intravenous ketamine during anesthesia induction on extubation time in CABG patients. Results showed no significant impact on extubation timing, with most patients extubated within 6 hours. However, ketamine improved respiratory parameters (SpO₂ and PaO₂), suggesting potential benefits for postoperative respiratory function. Further research is needed to explore ketamine's effects at different doses.

Conclusion: 20
Status: accepted_poster
Headline Title: Pediatric Cardiology
Headline Title:Headline Title:Cardiac manifestations of acute severe spinal cord injury (ASIA A and B) in children and adolescents
Authors: (Maryam Ahmadipour - author) (Reza Derakhshan - corresponding-author)
Introduction:
Introduction: Cervical spinal cord injury is associated with significant cardiorespiratory disorders. These disorders can be life-threatening, with most deaths in patients with cervical spinal cord injury occurring due to respiratory failure, dangerous arrhythmias, and neurogenic shock. This study aimed to investigate cardiac disorders in children and adolescents with cervical spinal cord injury
Methods:
Methods: In this study, which was conducted from April 1400 to April 1403 at the Trauma Center of Kerman Province, based on the inclusion criteria, a total of 42 patients aged from birth to 18 years (ASIA A and B), without cardiac trauma or underlying heart disease, who were admitted to the ICU due to acute cervical spinal cord injury, were included in the study and were examined for electrocardiographic changes during their stay in the ICU.
Results:
Results: The mean age of the patients was 16.8±4.2 years, and most of them were due to traffic accidents (97%), especially motorcycle accidents (69.5%). Of the 38 (90.8%) patients with sinus bradycardia, two (4.6%) had no arrhythmia, one (2.3%) had atrial flutter, and 2.3% had sinus tachycardia. Q-T prolongation was observed in 4 (9.5%), PVC in 12 (28.5%), Pac in 3 (6.9%), and nonspecific ST-T changes in 18 (42.8%). In total, 29 (69%) patients had neurogenic shock and required vasopressor administration.
Conclusion:
Conclusion: Children and adolescents with severe cervical spinal cord injury due to damage to the sympathetic pathway in the acute phase suffer from dangerous arrhythmias, especially bradycardia, and neurogenic shock, and Bayer avoided bradycardia-intensifying measures such as hypoxemia and vagal ablation and intratracheal suction during this stage.

Conclusion: 17
Status: accepted_poster
Headline Title: Heart Failure
Headline Title:Comparison of clinical and laboratory consequences of centrifugal Centrimag and Revolution pumps in adult patients undergoing extracorporeal membrane oxygenation in Rajaie Cardiovascular Medical and Research Center from 2015 to 2022
Authors: (Golnoosh Farahbakhsh - author)
Introduction:
One of the most important life support techniques for patients with reversible heart and lung complications is extracorporeal membrane oxygenation (ECMO). ECMO circuit consists of centrifugal pump, membrane oxygenator, cannulas, tubes and connections. Today's ECMO systems use non-occlusive centrifugal pump technology; The centrimag centrifugal pump is a pump without bearings, which is originally designed for short-term cardiopulmonary support in children and adults with acute or end-stage heart failure. he revolution centrifugal pump is another pump that uses a fixed magnetic impeller, which is one of the pumps that has a low hemolysis index, low heat production, and a bio-compatible PC coating. The present study was conducted with the aim of investigating the complications and consequences of centrimag and revolution centrifugal pumps in adult patients of Shahid Rajaei Cardiovascular Research and Treatment Center
Methods:
This study is a descriptive observational study that was conducted from 2015 to 2024 on 42 patients over 18 years of age who were placed on ECMO. Based on the type of centrifugal pump used, the patients were divided into two groups: centrimag and revolution groups. both groups were compared and analyzed.
Results:
The percentage of patients who were weaned from ECMO is 31.6% in general, and for centrimag and revolution pumps it is 22.2% and 34.5%, respectively, which was not statistically significant (P: 0.489). The percentage of patients who expired is 84.6% in general. The mean serum pH level between the centrimag and revolution pump groups was not significant according to the available P values. The average level of hemoglobin 6 and 12 hours after ECMO application has become significant, with P values reported as 0.032 and 0.004, respectively, but at other times, hemoglobin changes were not significant according to the existing P values. Changes in the average serum lactate level in any of the mentioned times were not significant according to the available P values. According to the available P values, the average changes in blood platelets were not significant in any of the mentioned times.
Conclusion:
due to the huge impact of many variables and due to the fact that the analysis of the data related to both centrimag and revolution pump groups did not have significant differences in most of the mentioned times, it is not possible to make a firm conclusion. Based on the obtained results, it can be concluded that due to the long contact time of blood with external surfaces in mechanical support systems, it seems that pumps that cause the least impact and damage to blood cells have a positive effect on reducing hemodynamic complications.

Conclusion: 15
Status: accepted_poster
Headline Title: Heart Failure
Headline Title:Evaluation of the effectiveness of the physiotherapy interventions in individuals with heart failure and sarcopenia: a review study
Authors: (Motahare Ababaf Behbahani - author) (Sahar Boozari - corresponding-author) (Farid Bahrpeyma - author)
Introduction:
One of the complications of heart failure in the elderly is an increased risk of sarcopenia in these individuals. Sarcopenia is characterized with the loss of muscle mass and strength that cause reduction in function. The reduced strength and muscle function in sarcopenia, can affect the ability to perform physical activities, independent living, and the risk of hospitalization and mortality. Physiotherapy, including resistance training, aerobic training, electrotherapy, and other therapeutic interventions, is one of the most recommended treatments in people with sarcopenia and heart failure. This review study was conducted to evaluate the effectiveness of physiotherapy in improving muscle mass, strength, and functional capacity in people with heart failure and sarcopenia.
Methods:
A systematic search was conducted in databases including PubMed, Scopus, and Google Scholar. Keywords included heart failure, sarcopenia, exercise therapy, physiotherapy, manual therapy, and electrotherapy. The inclusion criterion was the studies that examined the effectiveness of different physiotherapy treatments on improving sarcopenia and heart failure and evaluated outcomes related to the physical function, muscle strength, or quality of life.
Results:
Among the reviewed studies, articles that examined the effects of different physiotherapy treatments on strength, physical function, and quality of life in individuals with sarcopenia and people with heart failure were investigated.
Conclusion:
This study showed that various physiotherapy methods such as exercise and functional electrical stimulation (FES) aimed at increasing strength, improving physical performance, walking speed, and quality of life, can have a positive effect on patients with sarcopenia. These treatments have also been very beneficial in reducing symptoms of muscle weakness and reduced physical performance in people with heart failure. However, given the exacerbation of symptoms, further clinical studies are needed to investigate the effectiveness of such treatments in this group of people.

Conclusion: 11
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:Ectasia and slow flow phenomena of coronary artery related to apical hypertrophic cardiomyopathy
Authors: (DR Elahenaz Parsi Mood - author) (Masoomeh Kahnooji - author) (Dr Maryam Aliramezany - corresponding-author) (Dr Mohamad Reza Zare-Khormizi - author)
Introduction:
Hypertrophic cardiomyopathy-related coronary artery ectasia and slow flow phenomena is an extremely rare association that can cause manifestations of ischemic heart disease in patients. Distinguishing these cases and prompt diagnosis and treatment can prevent possible complications.
Methods:
In this current case, a 72-year-old man complaining of typical exertional dyspnea for 6 months was admitted to the hospital in December 2022.
Results:
An echocardiogram was conducted and revealed apical hypertrophic cardiomyopathy. A coronary angiogram showed ectasia and a slow flow pattern in the coronary artery without significant stenosis.
Conclusion:
The patient was diagnosed with hypertrophic cardiomyopathy associated with ectasia via electrocardiography, echocardiography, and coronary angiography. Medical treatment was started for the patient. The patient did not appear to suffer from dyspnea or other symptoms during the follow-up period.

Conclusion: 10
Status: accepted_poster
Headline Title: General Cardiology
Headline Title:Evaluation of serum vitamin D level in patients with Coronary microvascular disease admitted at Shafa Hospital in Kerman in 2023-2024
Authors: (DR Elahenaz Parsi Mood - corresponding-author) (Dr Mohamad Reza Zare Khormizi - author) (Dr Hamid Reza Nasri - author)
Introduction:
In recent years, vitamin D deficiency has been raised as a risk factor for cardiovascular diseases. The purpose of this study was to investigate the serum level of vitamin D in patients with microvascular coronary artery disease.
Methods:
This study was a cross-sectional controlled study on 200 microvascular patients referred to Shafa Hospital in Kerman. In this study, 200 patients with normal coronary angiography were selected using an easy and accessible sampling method, then these people were divided into two case groups (100 patients with a positive exercise test or myocardial scan) and a control group (100 patients with a negative exercise test or myocardial scan) were divided. In this study, the demographic information of the patients, including the risk factors of cardiovascular diseases, including age, sex, diabetes, hypertension, hyperlipidemia, smoking and opium consumption, BMI, and vitamin D level, were recorded by the data collection forms. Data were analyzed by SPSS 26 software with a P value less than 0.05.
Results:
The results of our study showed that the average age of the participants in the microvascular group was 52.62 ± 12.11 years. Also, most of the participants in both groups were female and overweight with BMI (25-30 kg/m2). Also, hypertension, hyperlipidemia, and smoking were more common in the microvascular group than in the control group, but this difference was not significant. The serum level of vitamin D in the control group was significantly higher than the group of patients with microvascular coronary artery occlusion (38.3 ± 24.4 ng/ml and 26.90 ± 12.02 ng/ml respectively, P<0.001)
Conclusion:
The results of this study showed that there is a significant relationship between vitamin D deficiency and coronary microvascular complications.

Conclusion: 7
Status: accepted_poster
Headline Title: Cardiac Electrophysiology
Headline Title:Electrocardiogram Parameters as Predictors of PVC Ablation Success
Authors: (Samira Esfandiari Mehni Mehni - author) (Shabnam Madadi MD - corresponding-author) (Mohammad Javad Aminizadeh - author) (MohammadHossein MozafaryBazargany - author) (Ali Daryanavard - author) (Roya Rezai - author) (2 Hooman Bakhshandeh - author)
Introduction:
OBJECTIVE: This study evaluates the predictive potential of PVC patterns on ECG for ablation success.
Methods:
METHODS AND MATERIALS: We enrolled 763 patients who had undergone catheter ablation for PVCs. The pre-ablation 12-lead ECG was assessed to determine PVC patterns on contiguous leads, transition, and breakthrough. Clinical success was defined as resolution or at least a 75% reduction in PVC count within the first 48 hours.
Results:
Results: Of the 763 participants, clinical success was attained in 89.5% (683). The average age of the participants was 47.36±20.55 years, with 53.2% being male. The unsuccessful groups had a significantly lower Left Ventricular Ejection Fraction (LVEF) and a higher rate of smoking. The PVC patterns of inferior, lateral, right, and V1 leads differed between groups, while the V2 PVC pattern was comparable. Female gender, smoking, LVEF, negative or discrepant PVC pattern on the inferior leads, non-discrepant pattern on lateral leads, positive PVC on either right or V1 leads, breakthrough, and V3 transition or Right Bundle Branch Block (RBBB) were significant predictors of clinical failure. When adjusted for smoking and LVEF, all the ECG-derived predictors of clinical failure were deemed significant independent predictors as well. The highest negative predictive value was attained by positive PVC on the right lead (99.1%).
Conclusion:
We recognized specific PVC patterns and ECG findings suggestive of PVC ablation failure. Negative or inconsistent PVC in the inferior leads, consistently negative or positive PVC in the lateral leads, and positive PVC on the right or V1 leads, along with V3 transition or RBBB and breakthrough, were independent predictors of ablation failure. Given these parameters’ high negative predictive values (except for transition), the absence of these PVC patterns might indicate promising ablation results.

Conclusion: 165
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Evaluation of coagulation parameters of heart surgery patients after using intraoperative cell salvage
Authors: (Dr Azita Chegini - corresponding-author) (Dr Ali Jamalian - author) (Mr Ali Boroujerdi Alavi - author)
Introduction:
Background and purpose: One of the pillars in managing the patient's blood is the strategies for preserving the patient's blood and managing bleeding during and after surgery, including the use of red cells, cell salvage (CS). The purpose of this article is to investigate the coagulation status of heart surgery patients after using the CS device.
Methods:
This cohort study (three days) was conducted in the third referral hospital (Shahid Lavasani Hospital, Tehran, Iran) in July 2019 after the establishment of patient blood management. The conditions for entering the study were selected heart surgery patients who had given informed written consent to join the comprehensive program "patient blood management" and use the CS device, aged over 45 years, had first heart surgery, and had no history of congenital or acquired coagulation disorders and hematological diseases. After surgery and using the CS device, the patient's vital signs, the total bleeding volume in milliliters from the chest tube 6 hours and 24 hours on the first, second, and third day after heart surgery, as well as coagulation parameters (PT, prothrombin time, Platelet, international normalized ratio [INR], activated partial thromboplastin time [aPTT] were checked in the intensive care unit after surgery for three days.
Results:
16 heart surgery patients used the CS device in July 2018, 7 were women and the rest (9) were men with an average age of 61.36. 68.8% of patients had CABG. In three days after surgery, the mean systolic blood pressure was 110.67±15.34, diastolic blood pressure was 70.00±10.69 mm Hg, blood oxygen saturation (SPO2) was 97.73% ± 1.83, and heart rate was 12.79. ± 85.33 beats per minute were seen. Examination of patients' bleeding showed that the amount of bleeding decreased over time from the first day (first 6 hours) with an average of 134.38 ± 94.37 ml and at the end of the first day (24 hours) with an average of 121.88 ± 131.62 ml. By the third day, there was a decrease of 160.70 ± 146.80 ml (P=0.027). Follow-up tests also showed that from the first 6 hours to the end of the first day (P=0.009), and from the second day to the third day (P=0.006), a significant decrease in the amount of bleeding was observed.
Conclusion:
Conclusion: The patient's vital signs were stable after using the device in the intensive care unit, and there was no correlation between the amount of bleeding and the laboratory parameters.

Conclusion: 164
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Evaluation of the consumption of blood products after the patient blood management implementation in a cardiac surgery hospital within five consecutive years
Authors: (Dr Azita Chegini - corresponding-author) (Dr Ali Jamalian - author) (Mr Ali Boroujerdi Alavi - author)
Introduction:
Patient blood management (PBM) is a multimodal scheme with several principles in the perioperative period that improves patient outcomes. We prospectively evaluated the blood consumption situation during and after the years of implementation of PBM.
Methods:
A 5 years’ prospective cross‑sectional study was conducted between May 2016 and May 2020 in a tertiary referral hospital (Shahid Lavasani Hospital, Tehran, Iran). The outcome includes utilization rate of blood and its components (red blood cell [RBC], plasma and platelet [PLT]), transfused units per active hospital and intensive care unit (ICU) bed, the cross‑match to transfusion ratio, transfusion index (TI), were evaluated before and after PBM implementation. The data were analyzed by the SPSS version 21. One‑way repeated measures ANOVA and Friedman test were used.
Results:
During 5 consecutive years, 6290 patients needed blood transfusions and entered to PBM protocol after their consent. Consumption of whole blood ceased in the initial year following PBM establishment. In 2017, RBC product usage (including whole blood and RBCs) decreased by 14.1% compared to 2016. This trend continued with further declines in 2018 (71.22%), 2019 (65.2%), and 2020 (59.10%) compared to 2016 (P < 0.001). The reduction in the number of plasma transfused over time was statistically significant (P < 0.001), as was the decrease in PLT transfusions (P < 0.001). RBC usage per active hospital bed per year declined from 22.83 to 3.61, and the TI showed a significant decrease. The highest RBC usage was observed in surgical departments during this period. RBC utilization per bed in the ICU was 57.7 in 2017, 25 in 2018, 22.7 in 2019, and 11.3 in 2020.
Conclusion:
With the implementation of the PBM program, the consumption of blood products in the hospital gradually decreased. The initial reductions in blood product consumption were observed in whole blood, plasma, and then RBCs.

Conclusion: 143
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Investigating the effect of Omega-3 on the incidence of Atrial Fibrillation after Coronary Artery Bypass Graft surgery
Authors: (Tahereh Sadeghi - author) (Fatemeh Rahimi - author) (Behnaz Movahedi - author)
Introduction:
This study involved 100 patients undergoing coronary artery bypass surgery, with consent obtained based on specific arrival and exit criteria for two groups: control and intervention. The omega-3 group received 2 omega-3 supplements (1000 mg each) in addition to beta-blockers, while the control group was given only routine medications.After the surgery, all patients were monitored in the intensive care unit for 24 hours, during which the occurrence of atrial fibrillation symptoms was recorded. Patient monitoring included tracking the incidence of atrial fibrillation, and treatment was administered according to established protocols.
Methods:
This study involved 100 patients undergoing coronary artery bypass surgery, with consent obtained based on specific arrival and exit criteria for two groups: control and intervention. The omega-3 group received 2 omega-3 supplements (1000 mg each) in addition to beta-blockers, while the control group was given only routine medications.After the surgery, all patients were monitored in the intensive care unit for 24 hours, during which the occurrence of atrial fibrillation symptoms was recorded. Patient monitoring included tracking the incidence of atrial fibrillation, and treatment was administered according to established protocols.
Results:
According to the results of this study, 66% of the intervention group was male. There was no significant difference between the test and control groups regarding age, sex, marital status, and drug and alcohol use, with a P-value of less than 0.05. The prevalence of atrial fibrillation in the test group was 21.6%, compared to 56% in the control group, resulting in an overall prevalence of 38.6%. Additionally, the Chi-square test results indicated a significant difference in the frequency (percentage) of atrial fibrillation between the test group (omega-3) and the control group, with a P-value of less than 0.05. Fewer patients in the test group had atrial fibrillation compared to those in the control group.
Conclusion:
The occurrence of atrial fibrillation in a group of three patients significantly decreased after coronary artery bypass surgery. Existing evidence suggests that oxidative stress can lead to atrial fibrillation. This study found that the consumption of omega-3 fatty acids reduced the incidence of atrial fibrillation following coronary artery bypass graft surgery.

Conclusion: 141
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Use of Modafinil for post Cardiac Surgery period
Authors: (Dr. Ali Jabbari - corresponding-author) (Dr. Shabnam Tabasi - author) (Dr. Puria Salehi Mashhadsari - author) (Amir Eghbal Dust - author)
Introduction:
Modafinil was initially developed to promote wakefulness in conditions such as narcolepsy, obstructive sleep apnea, and shift work sleep disorder. It functions as a dopamine reuptake inhibitor, enhancing cognitive function and alertness. These characteristics suggest its potential utility in managing weakness, hemodynamic instability, and cognitive impairment in cardiac surgery patients. However, its applications in this context require thorough investigation. This study aims to review the current understanding of modafinil's role, benefits, and risks in cardiac surgery.
Methods:
After registration and receipt of approval from the University Ethics Committee, we conducted a study involving a total of 80 patients aged between 40 to 75 years who were undergoing cardiac surgery. Written informed consent was obtained from all participants. The patients were carefully divided into two distinct groups, each consisting of 40 patients. In one group, we administered modafinil at a dosage of 100 mg, given twice daily. The purpose of this treatment was to assess and analyze the effects of modafinil on several important factors, including hemodynamic status, parameters derived from arterial blood analysis, levels of consciousness, and the incidence of postoperative delirium. We then compared these outcomes with the group of patients who did not receive any modafinil treatment. Data was collected using a pre-designed checklist and analyzed using SPSS software version 23.
Results:
Demographic characteristics were not significantly different between the two groups (P = 0.3). The mean heart rate and arterial blood pressure were 4% and 6% higher in the modafinil group than in the control group (P = 0.02). Additionally, patients in the modafinil group exhibited higher oxygen saturation (P = 0.01), greater arterial oxygen tension, and lower carbon dioxide tension. On the second day of hospitalization, three patients in the modafinil group displayed signs of delirium, compared to one in the control group.
Conclusion:
Modafinil can raise heart rate and blood pressure, important for cardiac surgery patients. It may aid recovery by improving hemodynamic stability and reducing fatigue. While it might offer neuroprotective effects, it also poses psychiatric risks like anxiety and aggression, especially post-surgery. More research is needed to evaluate its safety in this context. Clinicians must weigh the pros and cons while seeking alternative approaches to manage recovery challenges in cardiac surgery patients.

Conclusion: 96
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Successful use of dual parallel oxygenators in a 190 kg patient undergoing the bentall procedure: a case report
Authors: (MAHDI VAHDATI - author) (Ahmad Safari Soltanabad - corresponding-author)
Introduction:
Background Open-heart surgeries, such as the Bentall procedure, in patients with morbid obesity pose significant challenges for surgical teams. Obesity increases metabolic demands, oxygen consumption, and perfusion requirements, making standard cardiopulmonary bypass (CPB) strategies insufficient in some cases. In such patients, ensuring adequate oxygenation and hemodynamic stability during CPB is critical to preventing intraoperative complications and achieving successful surgical outcomes. In CPB circuits, oxygenators are responsible for maintaining proper gas exchange and delivering oxygenated blood to the body. However, a single oxygenator may not meet the high-flow demands of patients with extreme body weight. Using two oxygenators in parallel has been proposed as a potential solution to address these challenges in specific cases.
Methods:
Patient Characteristics The patient was a 190 kg, middle-aged individual with a history of morbid obesity and associated comorbidities. Due to severe aortic valve pathology and ascending aortic aneurysm, the patient was scheduled for a Bentall procedure. Preoperative assessments revealed elevated metabolic and perfusion demands, requiring modifications to standard cardiopulmonary bypass (CPB) management. Surgical Procedure The Bentall procedure was performed using a standard midline sternotomy approach. A modified CPB circuit was utilized to accommodate the patient's high body weight and perfusion needs. Cardiopulmonary Bypass Setup Dual Oxygenator Configuration: Two oxygenators (identical models) were connected in parallel within the CPB circuit to ensure adequate gas exchange and perfusion. The oxygenators were synchronized to prevent flow imbalances and pressure variations. Flow Distribution: Blood flow was evenly distributed between the two oxygenators using customized tubing and connectors. Flow rates were adjusted to meet the patient's calculated cardiac output requirement based on their body surface area (BSA) and metabolic needs. Monitoring and Adjustments: Continuous monitoring of arterial blood gases, oxygen delivery, and hemodynamic parameters was performed. Adjustments were made in real-time to optimize oxygenation and perfusion while avoiding overpressure or flow mismatches. Postoperative Care After completing the Bentall procedure, the patient was weaned off CPB. Postoperative care included close monitoring in the intensive care unit (ICU) for potential complications related to oxygenation, perfusion, or surgical recovery
Results:
Intraoperative Findings • The use of two oxygenators in parallel successfully provided the high-flow perfusion and oxygenation required for the 190 kg patient. • Real-time monitoring confirmed optimal arterial blood gases and oxygen delivery throughout the cardiopulmonary bypass (CPB). • There were no significant flow imbalances or pressure variations between the two oxygenators, demonstrating the feasibility and safety of this setup. Surgical Outcome • The Bentall procedure was completed without intraoperative complications. • The duration of CPB and aortic cross-clamping were within acceptable ranges for the complexity of the procedure. • Hemodynamic stability was maintained during the entire surgery, and the patient was successfully weaned off CPB.
Conclusion:
The successful use of dual parallel oxygenators during the Bentall procedure in a 190 kg patient demonstrates the feasibility and effectiveness of this approach in managing the unique challenges posed by morbid obesity during cardiopulmonary bypass (CPB). By providing adequate oxygenation and maintaining hemodynamic stability, this technique ensured a safe and complication-free surgical outcome. This case highlights the importance of tailoring CPB strategies to meet the specific metabolic and perfusion demands of obese patients. The use of dual oxygenators in parallel should be considered a viable and safe option in similar high-risk scenarios to optimize patient outcomes and minimize intraoperative and postoperative complications.

Conclusion: 33
Status: accepted_poster
Headline Title: Cardiac Surgery
Headline Title:Comparative effect of intravenous Ketamine and Tramadol on hemodynamic parameters, pain, sedation, and postoperative nausea and vomiting in patients undergoing Coronary Artery Bypass Graft surgery. A Triple-Blind Randomized
Authors: (Siavash Sangi - author) (Mehrdad Mesbah Kiaei - corresponding-author) (Maryam Aligholizadeh - author) (Homayoon Bana Derakhshan - author) (Seyed Mohammad Reza Amouzegar Zavareh - author)
Introduction:
Background: Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease, a leading cause of death worldwide. Despite its proven benefits in improving survival and relieving angina, CABG is associated with significant perioperative complications, including hemodynamic instability, pain, sedation challenges, and postoperative nausea and vomiting (PONV). While pharmacological adjuncts such as ketamine and tramadol have been studied, comparative evidence on their effectiveness in optimizing these parameters during CABG surgery remains limited. This study aims to evaluate the effects of intravenous ketamine and tramadol on hemodynamic stability, pain, sedation, and PONV in patients undergoing CABG surgery.
Methods:
Methods: This triple-blind, parallel randomized clinical trial was conducted in 2024 at Rasoul Akram Hospital, affiliated with Iran University of Medical Sciences, Tehran, Iran. Ninety patients undergoing CABG surgery were randomly assigned to three groups: intravenous ketamine (0.5 mg/kg, group K), intravenous tramadol (0.5 mg/kg, group T), and normal saline (group S). Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate) were the primary outcomes, while pain, sedation, and PONV were secondary outcomes. Data were analyzed using SPSS version 21 with chi-squared tests, independent t-tests, and repeated measures ANOVA.
Results:
Results: The groups were homogeneous in demographic characteristics. Ketamine showed superior hemodynamic stability, with smaller reductions in mean arterial pressure (11.71 mmHg, 95% CI [5.65, 17.77]) compared to tramadol and saline. Sedation scores were significantly higher in the ketamine group (mean increase: -0.91, p ≤ 0.001), and the incidence of PONV was markedly lower (3.3%, p = 0.017) versus tramadol (16.7%) and saline (10.0%). No significant adverse effects, including hallucinations, were observed.
Conclusion:
Conclusion: Ketamine demonstrates better hemodynamic stability, enhanced sedation, and reduced PONV compared to tramadol and saline in patients undergoing CABG surgery. These findings highlight ketamine's potential as an effective adjunctive therapy in optimizing perioperative outcomes in high-risk cardiac surgeries. The results of this study can be generalized to patients undergoing Coronary Artery Bypass Graft surgery.