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Total documents retrieved: 160 Results Generated From: Embase <1980 to 2026 Week 45> Embase Weekly Updates (updates since 2026-10-30) - (160 records) <1> Accession Number 2049933808 Title Impact of red blood cell transfusion on clinical outcomes after cardiovascular surgery: a reconstructed time-to-event meta-analysis. Source Journal of Cardiothoracic Surgery. 21(1) (no pagination), 2026. Article Number: 850. Date of Publication: 01 Dec 2026. Author Obi O.S.; Kumar V.; Rajith G.; Avila M.S.; Mohammed O.F.; Iqbal A.; Khan M.; Nweze U.D.; Kamil K.A.; Podrumar A.; Sa M.P. Institution (Obi) Lexington Medical Center, West Columbia, SC, United States (Kumar, Rajith) All India Institute of Medical Sciences, Assam, Guwahati, India (Avila) Lusiada University Center, Santos, Sao Paulo, Brazil (Mohammed) Osmania Medical College, Telangana, Hyderabad, India (Iqbal, Khan) Bacha Khan Medical College, Mardan, Pakistan (Nweze) Kaiser Permanente Fontana Medical Center, Fontana, CA, United States (Kamil) Chief, Department of Internal Medicine, Nasrat Bashir Curative Hospital, Kandahar, Afghanistan (Podrumar) Division of Hematology and Oncology, Nassau University Medical Center, East Meadow, NY, United States (Sa) Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, FL, United States Publisher BioMed Central Ltd Abstract Background: The impact of perioperative red blood cell transfusion on long-term outcomes after cardiovascular surgery remains controversial. This meta-analysis of reconstructed time-to-event data aimed to evaluate the association between red blood cell transfusion and clinical outcomes in adult patients undergoing cardiovascular surgery. Method(s): PubMed, Scopus, Embase, and the Cochrane Library were systematically searched for studies comparing perioperative red blood cell transfusion versus no transfusion in adults undergoing cardiovascular surgery. The primary endpoint was all-cause mortality at short- and long-term follow-up. A pairwise random-effects meta-analysis was done for 30-day mortality and other secondary outcomes, pooling risk ratios (RR) with 95% confidence intervals (CIs). Time-to-event data were reconstructed from published Kaplan-Meier curves to perform landmark analysis and estimate restricted mean survival time (RMST) differences between red blood cell transfused and non-transfused groups. Cox frailty regression analysis was used to obtain hazard ratios (HR). Meta-regression analyses were performed to explore sources of heterogeneity, and the certainty of evidence was assessed using the GRADE framework. Result(s): This systematic review and meta-analysis included 15 observational studies (13 retrospective and 2 prospective) comparing the impact of red blood transfusion on cardiovascular outcomes in adult patients after cardiovascular surgery. Red blood cell transfusion was associated with a higher incidence of 30-day mortality (RR = 2.57, 95% CI [1.96, 3.38], I2 = 0.0%, p < 0.001), long-term all-cause mortality (HR 1.79 (95% CI [1.75, 1.83]; p < 0.001)*, atrial fibrillation (RR 1.57 95% CI [1.21, 2.04]; p < 0.001), acute kidney injury (RR 4.52 95% CI [2.32, 8.80]; p < 0.001), myocardial infarction (RR 2.32 95% CI [1.60, 3.37]; p < 0.001), pneumonia (RR 5.10 95% CI [3.04, 8.57]; p < 0.001), reoperation for bleeding (RR 12.61 95% CI [7.99, 19.90]; p < 0.001), sepsis (RR 7.49 95% CI [2.64, 21.26]; p < 0.001), and stroke (RR 2.54 95% CI [2.04, 3.16]; p < 0.001). Conclusion(s): These findings suggest that perioperative red blood cell transfusion was associated with higher rates of mortality and adverse outcomes; however, these findings should be interpreted cautiously because of residual confounding, baseline differences between groups, and the observational nature of the included studies. Copyright © The Author(s) 2026. <2> Accession Number 2049974178 Title Optimal strategy for treatment of atherosclerotic cardiovascular disease-comparison of clopidogrel-based antiplatelet agent treatment versus aspirin plus low dose rivaroxaban therapy (OACART study): a study protocol for a multicenter, open-label, randomized, non-inferiority trial. Source Trials. 27(1) (no pagination), 2026. Article Number: 627. Date of Publication: 01 Dec 2026. Author Kwun J.-S.; Yoon C.-H.; Jeon K.-H.; Cho H.-W.; Park J.J.; Kang S.-H.; Lee W.; Suh J.-W.; Youn T.-J.; Kang H.-J.; Min P.-K.; Yu C.W.; Lee J.-H.; Rha S.-W.; Shin S.; Lee B.-K.; Youn Y.J.; Ko Y.-G.; Jang J.-Y.; Lee J.-K.; Park K.-H.; Choi Y.J.; Lee S.-R.; Park S.-D.; Cho D.-K.; Cho Y.-H.; Kim J.H.; Jeong J.-O.; Cho J.; Kim S.-Y.; Kang T.S.; Lee S.-U.; Chae I.-H. Institution (Kwun, Yoon, Jeon, Cho, Park, Kang, Lee, Suh, Youn, Chae) Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-Si, South Korea (Kwun, Yoon, Jeon, Cho, Park, Kang, Lee, Suh, Youn, Chae) Department of Internal Medicine, Seoul National University, Seoul, South Korea (Kang) Department of Internal Medicine, Cardiology Center, Seoul National University Hospital, Seoul, South Korea (Min) Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Yu) Korea University Anam Hospital, Seoul, South Korea (Lee) Chungnam National University Sejong Hospital, Sejong-Si, South Korea (Rha) Korea University Guro Hospital, Seoul, South Korea (Shin) Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea (Lee) Kangwon National University Hospital, Gangwon-Do, Chuncheon-Si, South Korea (Youn) Wonju Severance Christian Hospital, Gangwon-Do, Wonju-Si, South Korea (Ko) Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea (Jang) National Health Insurance Service Ilsan Hospital, Gyeonggi-Do, Goyang-Si, South Korea (Lee) Changwon Fatima Hospital, Gyeongsangnam-Do, Changwon-Si, South Korea (Park) Hallym University Sacred Heart Hospital, Gyeonggi-Do, Anyang-Si, South Korea (Choi) Bucheon Sejong Hospital, Gyeonggi-Do, Bucheon-Si, South Korea (Lee) Chonbuk National University Hospital, Jeollabuk-Do, Jeonju-Si, South Korea (Park) Inha University Hospital, Incheon, South Korea (Cho) Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea (Cho) Myongji Hospital, Gyeonggi-Do, Goyang-Si, South Korea (Kim) Chonnam National University Hospital, Gwangju, South Korea (Jeong) Chungnam National University Hospital, Daejeon, South Korea (Cho) St. Carollo Hospital, Jeollanam-Do, Suncheon-Si, South Korea (Kim) Jeju National University Hospital, Jeju-Si, South Korea (Kang) Division of Cardiology, Department of Internal Medicine, School of Medicine, Dankook University, Cheonan, South Korea (Lee) Kwangju Christian Hospital, Gwangju, South Korea Publisher BioMed Central Ltd Abstract Background: Recent studies have demonstrated the superior benefits of clopidogrel compared to aspirin in reducing mortality, myocardial infarction, stroke, and hospitalization in chronic stable patients with coronary stenting. Furthermore, dual pathway inhibition by combining low-dose rivaroxaban with aspirin (DPI) has shown superior effects in preventing cardiovascular death, myocardial infarction, and stroke in stable atherosclerotic patients. However, no studies have directly compared these treatment strategies in the same population. This randomized controlled trial aims to compare clopidogrel-based antiplatelet therapy with or without aspirin (CAPT) to DPI in a 1:1 ratio in patients with high-risk coronary artery disease (CAD) or in patients with both CAD and peripheral artery disease (PAD). Method(s): Optimal strategy for treatment of Atherosclerotic cardiovascular disease-comparison of Clopidogrel-based Antiplatelet agent treatment versus aspirin plus low dose Rivaroxaban Therapy (OACART) trial is a randomized multi-center study comparing the performance of the maintaining CAPT or DPI in a 1:1 ratio. The trial is powered for the non-inferiority of the CAPT in patients with chronic stable high-risk CAD or CAD+PAD to DPI with respect to the primary and secondary efficacy endpoints at 36 months. Result(s): Between November 2023 and April 2026, we will recruit 2758 participants from multi-center in Korea, and we will examine the net clinical outcome, including all-cause death, any myocardial infarction, any stroke, any ischemia-driven revascularization (CAD or PAD), acute limb ischemia, any major or minor amputations, any acute thromboembolism, and International Society on Thrombosis and Haemostasis major bleeding at 36 months after study enrollment. Conclusion(s): OACART trial will provide the optimal antithrombotic treatment strategy for patients with stable high-risk atherosclerosis. Trial registration: Clinical Research Information Service (CRIS) of Republic of Korea, KCT0008458, registered on May 22, 2023. https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28968&search_page=L . Copyright © The Author(s) 2026. <3> Accession Number 2049906123 Title Uniportal versus multiportal robotic-assisted thoracic surgery for anatomical pulmonary resection: a systematic review and meta-analysis of perioperative recovery and surgical quality. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 1130. Date of Publication: 01 Dec 2026. Author Barnawi A.B.; Alsharari M.S.; Alanazi H.S.; Alshehri R.M.; Alasiri S.A.; Alharbi L.; Almabkhut N.S.; Abuniyan N.R.; Hajjar W.M. Institution (Barnawi, Alsharari, Alanazi, Alshehri, Alasiri, Alharbi, Almabkhut, Abuniyan) College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia (Hajjar) Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia Publisher Springer Nature Abstract Uniportal robotic-assisted thoracic surgery (uRATS) seeks to combine the dexterity of robotic platforms with reduced access trauma, yet its comparative value over multiportal RATS (mRATS) remains uncertain. We systematically evaluated perioperative recovery and surgical quality after anatomical pulmonary resection. PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched through 2026. Comparative studies of uniportal/single-port versus multiportal robotic anatomical lung resection were included. Random-effects meta-analyses pooled risk ratios (RRs) and mean differences (MDs). Risk of bias was assessed using ROBINS-I V2 and certainty of evidence using GRADE. Nine non-randomised studies involving 813 patients were included, with seven studies rated at critical risk of bias. Postoperative complications occurred in 16.0% of uniportal and 30.2% of multiportal patients, with no statistically significant pooled difference (RR 0.49, 95% CI 0.22-1.06; p = 0.069; I2=66%). No significant differences were identified in major complications, conversion, mortality, operative time, blood loss, chest-tube duration, length of stay, or lymph-node yield, or R0 resection. Uniportal surgery was associated with shorter console time (MD - 23.5 min, 95% CI - 35.6 to - 11.4) and lower postoperative day-1 pain (MD - 0.6 points, 95% CI - 0.9 to - 0.3). The 0.5- point pain difference was below commonly used thresholds for clinical importance and lost statistical significance when digitised values were excluded (p = 0.092). Available observational evidence does not demonstrate a clear difference in perioperative safety or surgical quality between uniportal/single-port and multiportal robotic-assisted thoracic surgery. Exploratory subgroup analyses suggested differences in length of stay and operative time by comparator port count, potentially reflecting confounding by operative era and experience. A possible reduction in console time and early postoperative pain was observed, but these findings were based on very-low-certainty evidence and were sensitive to individual studies. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <4> Accession Number 2049403552 Title Responder analysis of adaptive postural balance cardiac rehabilitation exercise in patients with coronary artery disease and type 2 diabetes: secondary analysis of a randomized trial. Source Scandinavian Cardiovascular Journal. 60(1) (no pagination), 2026. Article Number: 2732500. Date of Publication: 2026. Author Qin D.; Liu G.; Liu X.; Zhao J.; Zhang Q.; Ma M. Institution (Qin, Liu, Liu, Zhao, Zhang, Ma) Department of Rehabilitation Medicine, Tianjin Chest Hospital, Tianjin, China (Ma) Chest Hospital, Tianjin University, Tianjin, China Publisher Taylor and Francis Ltd. Abstract Background: Patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) show variable responses to exercise-based cardiac rehabilitation. We compared metabolic and exercise responder rates after adaptive postural balance cardiac rehabilitation exercise (APBCRE) versus aerobic exercise (AE) and explored baseline factors associated with responder status. Method(s): This pre-specified secondary analysis included 167 patients with CAD and T2DM from a randomized trial who completed an 8-week intervention (APBCRE, n = 87; AE, n = 80). Metabolic response was defined as an HbA1c reduction of >=0.5%, and exercise response as a VO<inf>2</inf>max increase of >=3.5 mL.kg-1.min-1. Multivariable logistic regression evaluated associated factors. Result(s): APBCRE was associated with higher metabolic (48.3% vs 32.5%, p < 0.05) and exercise responder rates (31.0% vs 11.3%, p < 0.01) than AE. APBCRE was independently associated with metabolic response (OR 2.09, 95% CI 1.03-4.25; p = 0.043) and exercise response (OR 3.66, 95% CI 1.55-8.65; p = 0.003). Higher baseline HbA1c was associated with metabolic response (OR 5.04, 95% CI 2.14-11.86; p < 0.001), whereas insulin therapy was inversely associated (OR 0.25, 95% CI 0.07-0.90; p = 0.034). Lower baseline VO<inf>2</inf>max was associated with exercise response (OR 0.84, 95% CI 0.72-0.97; p = 0.016). Conclusion(s): APBCRE was associated with higher rates of clinically meaningful metabolic and exercise responses than AE. Responder analysis complements conventional outcome assessment and may support individualized cardiac rehabilitation. Copyright © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. <5> Accession Number 2047079789 Title Comparative effectiveness of figure-of-eight suture and manual compression for femoral venous hemostasis after atrial fibrillation ablation: A grade assessed meta-analysis. Source Journal of Thrombosis and Thrombolysis. 59(7) (pp 2029-2044), 2026. Date of Publication: 01 Oct 2026. Author Bacha Z.; Javed J.; Khan M.H.; Saif H.; Sikandar M.; Sajjad F.; Khalid M.; Abbas M.; Khan M.M.; Qasim M.; Mansoor A.; Yadk A.; Yadav I.; Haider M.U.; Aboumoussa I. Institution (Bacha, Saif, Sikandar, Sajjad, Khalid, Khan, Qasim) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Javed) Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan (Khan) Department of Medicine, Bacha Khan Medical College, Mardan, Pakistan (Abbas) Department of Medicine, Ayub Medical College, Abbottabad, Pakistan (Mansoor) Department of Medicine, Faisalabad Medical University, Faisalabad, Pakistan (Yadk) Department of Medicine, Detroit Medical Center, MI, United States (Yadav) Department of Medicine, Zucker School of Medicine at Hofstra, Hempstead, United States (Aboumoussa) Department of Medicine, University of Missouri, Kansas City, United States (Haider) Department of Medicine, Geisinger Health System, Wilkes-Barre, PA, United States Publisher Springer Abstract Atrial fibrillation is a common cardiac arrhythmia associated with serious complications such as stroke, heart failure, and mortality. Catheter ablation is frequently used for drug-resistant cases but requires femoral venous access and anticoagulation, increasing the risk of vascular complications. Manual compression is the standard method for post-ablation hemostasis, though it can be time-consuming and uncomfortable, whereas figure-of-eight sutures have emerged as a potential alternative. To compare safety and procedural outcomes of figure-of-eight sutures versus manual compression for venous hemostasis after ablation. A systematic literature search was conducted across Cochrane Library, PubMed/MEDLINE, Scopus, and Embase up to February 2026 to identify studies comparing figure-of-eight (Fo8) sutures with manual compression for post-ablation femoral venous hemostasis. Randomized controlled trials and observational cohort studies were included. Data extraction and quality assessment were performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analyses and meta-analyses were performed using RevMan software version 5.4. Nine studies with a total of 2,125 patients were analyzed. Figure-of-Eight (Fo8) suturing demonstrated no significant difference compared with manual compression for total, major, or minor vascular access site complications, bleeding, or hematoma. However, FO8 suturing was associated with significantly shorter time to hemostasis, earlier ambulation, and reduced time to discharge. Figure-of-eight suturing is as safe as manual compression for post-ablation femoral venous hemostasis, showing no increase in vascular access-site complications, bleeding, or hematoma. It provides the added benefit of faster hemostasis, earlier ambulation, and reduced discharge time. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <6> Accession Number 2050431787 Title Generalizability of the CREST-2 trial: A real-world analysis. Source Vascular Medicine (United Kingdom). 31(5) (pp 725-726), 2026. Date of Publication: 01 Oct 2026. Author Yahyavi A.; Shishehbor M.H. Institution (Yahyavi, Shishehbor) University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, United States (Shishehbor) University Medical Partners, Newark, CA, United States Publisher SAGE Publications Ltd <7> Accession Number 2049583926 Title Efficacy and hemodynamic safety of perioperative dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Neurology. 17 (no pagination), 2026. Article Number: 1895312. Date of Publication: 2026. Author Li A.; Wu H.; Zhang K.; Ying J. Institution (Li) Department of thoracic surgery, The First People's Hospital of Taizhou, Taizhou, China (Wu, Ying) Department of Emergency Medicine, The First People's Hospital of Taizhou, Taizhou, China (Zhang) Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Publisher Frontiers Media SA Abstract Background - Postoperative delirium (POD) is a common and clinically important complication after cardiac surgery in older adults. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and hemodynamic safety of perioperative dexmedetomidine for POD prevention in older adults undergoing cardiac surgery. Methods - We searched PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from inception through July 12th, 2026 for RCTs comparing perioperative dexmedetomidine with placebo or alternative sedative /analgesic regimens in elderly patients aged 60years or older, or in extractable elderly subgroups, undergoing cardiac surgery. Primary outcomes were POD incidence and delirium duration. Secondary outcomes included length of intensive care unit (ICU) stay, length of hospital stay, and the risk of bradycardia and hypotension. Results - Fifteen RCTs involving 3, 274 patients were included. Perioperative dexmedetomidine was associated with a lower incidence of POD (Risk Ratio [RR] 0.70, 95% Confidence Interval [CI] 0.56 to 0.86, p=0.001, I2=19%; GRADE: moderate certainty) and shorter duration of delirium among patients with POD (Mean Difference [MD] -1.12days, 95% CI -1.89 to -0.35, p=0.01, I2 =83%; GRADE: low certainty). The apparent benefit was more evident in active-comparator trials than in placebo/saline-controlled trials, but this comparator-dependent pattern should not be interpreted as proof of a uniform neuroprotective effect. However, dexmedetomidine was associated with increased bradycardia (RR 2.08, 95% CI 1.31 to3.31, p=0.0019, I2=0%; GRADE: low certainty). No significant differences were observed for length of ICU stay, length of hospital stay, or hypotension. Conclusion - Perioperative dexmedetomidine may reduce POD incidence in selected older cardiac surgery patients, particularly when compared with selected active sedative or analgesic regimens. However, the certainty of evidence was moderate, and the effect was less clear in saline/placebo-controlled trials. Evidence for delirium duration was based on few affected patients, showed substantial heterogeneity, and should not drive the main clinical conclusion. Dexmedetomidine increased reported bradycardia, and clinical use should be individualized with careful hemodynamic monitoring. Systematic review registration - https://osf.io/f6nwu Copyright © 2026 Li, Wu, Zhang and Ying. <8> Accession Number 2050940264 Title Comparative efficacy of digital health intervention delivery modalities on quality of life, anxiety, and depression in coronary heart disease: a systematic review and network meta-analysis. Source Frontiers in Psychiatry. 17 (no pagination), 2026. Article Number: 1912762. Date of Publication: 2026. Author Zhang Y.; Yu T.; Huang W.; Tian L.; Li M.; Wang J.; Li Z. Institution (Zhang, Yu, Tian, Li, Wang) College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Shandong, Jinan, China (Huang) The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine (TCM) Hospital, Guangdong, Shenzhen, China (Li) Shandong University of Traditional Chinese Medicine, Shandong, Jinan, China Publisher Frontiers Media SA Abstract Background - Nonadherence to traditional cardiac rehabilitation and persistent psychological distress among patients with coronary heart disease (CHD) severely undermine desired therapeutic outcomes. Digital health interventions (DHIs) emerge as promising strategies to effectively tackle this adherence and mental health issue remotely. Objective - The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the comparative efficacy of various DHI delivery modalities in improving quality of life (QoL), anxiety, and depression among patients with CHD. Methods - A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, CNKI, VIP, WanFang, and SinoMed databases to search for randomized controlled trials (RCTs)published from their inception to February 1,2026.We carried out a frequentist NMA using Stata 18.0to compare the efficacy of various DHIs against standard care. The quality of literature was assessed using the Cochrane Risk of Bias tool (version2.0).The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework, and interventions were ranked utilizing the surface under the cumulative ranking (SUCRA)curve. Results - A total of 44RCTs involving 8,495 patients were enrolled. The NMA revealed that for improving QoL, telephone follow-up (standardized mean difference 2.98, 95%CI 1.75-4.20) and social media (SMD 1.13, 95%CI 0.42-1.84) were statistically superior to usual care. Notably, telephone follow-up, with a SUCRA of 99.5%, appeared to be the most effective option. Regarding psychological outcomes, web-based platforms demonstrated the highest probability of being the best intervention for reducing both anxiety (SMD -1.56,95%CI-2.34 to -0.79;SUCRA 98.6%) and depression (SMD-1.07,95%CI-1.94to-0.20;SUCRA 91.4%).Safety analyses showed interactive modalities significantly reduced adverse events, whereas one-way SMS carried a significantly higher risk than interactive telephone support(OR 3.38,95%CI 1.13-10.13). Conclusions - The research suggests that telephone follow-up ranked highest among the included studies for improving short-term QoL, while web-based platforms showed a high probability of being effective for alleviating long-term anxiety and depression. However, these rankings should be interpreted cautiously, as intervention content, duration, and patient populations varied considerably across trials, and the small number of studies for certain modalities limits the robustness of direct comparisons. Social media interventions also emerged as a versatile option with benefits across all three outcomes, though their modest effect sizes warrant further optimization of engagement strategies. Passive SMS interventions present potential safety concerns, as their unidirectional nature may attenuate timely symptom recognition and delay appropriate care-seeking-a hypothesis supported by their significantly higher adverse event rates compared with interactive modalities. These results provide crucial evidence-based support for healthcare providers to tailor specific DHIs to individual patient needs. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261380157. Copyright © 2026 Zhang, Yu, Huang, Tian, Li, Wang and Li. <9> Accession Number 2050011307 Title Targeting non-coding RNAs and alarmins in myocardial ischemia-reperfusion injury: emerging molecular therapeutics for cardiothoracic surgery. Source Journal of Cardiothoracic Surgery. 21(1) (no pagination), 2026. Article Number: 847. Date of Publication: 01 Dec 2026. Author Muafa H.M. Institution (Muafa) Department of Surgery, 21 September University for Medical and Applied Sciences, Sana'a, Yemen Publisher BioMed Central Ltd Abstract Myocardial ischemia-reperfusion injury (MIRI) remains a major unresolved cause of perioperative myocardial dysfunction after coronary artery bypass grafting, valve surgery requiring cardiopulmonary bypass, heart transplantation, and other procedures involving controlled ischemia followed by reperfusion. Reperfusion is essential for tissue salvage, yet it initiates mitochondrial reactive oxygen species generation, calcium overload, mitochondrial permeability transition pore opening, endothelial dysfunction, sterile inflammation, microvascular obstruction, arrhythmogenesis, and regulated cardiomyocyte death. This review provides an updated conceptual synthesis of the current framework of MIRI around two interacting molecular layers: non-coding RNAs (ncRNAs) and alarmins, also known as damage-associated molecular patterns. MicroRNAs, long non-coding RNAs, and circular RNAs regulate apoptosis, autophagy, pyroptosis, ferroptosis, angiogenesis, fibrosis, and macrophage polarization through post-transcriptional repression, competing endogenous RNA networks, and epigenetic scaffolding. In parallel, alarmins such as high-mobility group box 1 (HMGB1), S100 proteins, extracellular histones, mitochondrial DNA, and interleukin-33 link tissue injury to innate immune activation through Toll-like receptors, RAGE, inflammasome pathways, and ST2-dependent cardioprotective signaling. Mechanistic crosstalk, exemplified by the MALAT1/miR-200c/HMGB1 axis and the interaction between HMGB1 antagonism and miR-21-dependent survival signaling, provides a rationale for multi-target cardioprotection rather than single-pathway blockade. Translational progress is ongoing but remains in early stages. Although antisense oligonucleotides, small interfering RNAs, mRNA therapeutics, biomimetic nanoparticles, exosome-based delivery, and local perioperative administration through cardioplegia or epicardial injection provide potential translational routes, no ncRNA- or alarmin-directed therapy is currently established for routine prevention of surgical MIRI. Copyright © The Author(s) 2026. <10> Accession Number 2038790630 Title Effect of Acapella versus Incentive Spirometry on Partial Pressure of Carbon Dioxide in Arterial Blood after Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial. Source Natural Resources for Human Health. 6(18S) (pp 137-148), 2026. Date of Publication: 30 Sep 2026. Author Naji B.A.; Jasim A.H. Institution (Naji, Jasim) Fundamentals of Nursing Department, College of Nursing, University of Baghdad, Baghdad, Iraq Publisher Visagaa Publishing House Abstract Background: Patients undergoing coronary artery bypass grafting (CABG) are at increased risk for postoperative pulmonary complications, which may include pneumonia, atelectasis, bronchospasm, exacerbation of chronic obstructive pulmonary disease (COPD), pneumothorax, pleural effusion, and various upper respiratory tract conditions. (1) The Acapella method is used to improve lung volume and airway patency in the early postoperative period in patients who have undergone coronary artery bypass grafting (CABG). Objective(s): to evaluate and compare the effect of acapella and incentive spirometry on Partial Pressure of Carbon Dioxide (PaCO2) after coronary artery bypass graft. Method(s): In a randomized controlled study, the effects of acapella versus incentive spirometry were compared in two cardiac centers (the Iraqi center of heart disease and Ibn Al-Bitar Specialized Center) from December 8th, 2025, to June 23rd 3, 2026. after getting the Ethical Approval Committee under No:37 on March 25, 2025.informed written agreement was gotten from all participant were involved in the study. The researchers' recruited volunteers who had undergone coronary artery bypass grafting (CABG) and randomly separated them into two groups: a study group and a control group. A total of 85 patients take part in the study. The main outcomes were measurements of PaCO2, were extracted from the patients' clinical records (ABGs), with the mean value calculated when the tests being conducted numerous times daily. PaCO2 measured 10 hours after extubation when patient is stable, one day after extubation, and day three after extubation after the procedure. The data were analyzed and interpreted by means of the statistical software SPSS (version 26.0). Qualitative variables such as age, sex, level of education, occupation, and place of residence were statistically analyzed using frequencies and percentages. Numerical variables were statistically analyzed using mean and standard deviation. A p-value below 0.05 was measured statistically significant. Result(s): The findings demonstrate significant reduction in PaCO2 levels over the three measurement periods in the control group (chi2= 15.630, p= 0.000) with moderate effect size (0.289); Incentive Spirometry group (chi2= 19.513, p= 0.000) with moderate effect size (0.325), and Acapella group (chi2= 27.214, p= 0.000) with large effect size (0.486). Conclusion(s): our study results showed that both Acapella and Incentive spirometry were associated with improved PaCo2 after Coronary Artery Bypass Graft, with Acapella showing the largest within-group effect. Recommendation: Join the acapella as adjunctive therapy with nursing practice care and rehabilitation of dyspnea for patients after coronary artery bypass grafting Surgery and conduct a clinical study to examine acapella with deep breathing and cough trials in patients who will undergo coronary artery bypass grafting surgery with lung problems such as chronic obstructive pulmonary disease and asthma. Copyright © 2026, Visagaa Publishing House. All rights reserved. <11> Accession Number 2049559156 Title Cardiovascular safety in middle-aged and older men under testosterone replacement therapy: a systematic review and meta-analysis. Source Endocrine. 91(1) (no pagination), 2026. Article Number: 329. Date of Publication: 01 Dec 2026. Author Qin H.; Zuo D.; Wang Z.; Li L.; Zuo L.; Lv Y.; Tu S.; Wang J.; Chen Y.; Li X.; He J.; Zou Q.; Lu Q.; Zheng Q.; Zhou Z. Institution (Qin) Department of Neurology, The First Affilliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (Zuo) Department of Anesthesiology, Xinyang Central Hospital, Xinyang, Henan, China (Wang) State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China (Wang) Department of Urology, Guangzhou, China (Wang) Pediatric Urodynamic Center, Department of Urology, Henan Joint International Pediatric Urodynamic Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Li, Lv) Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China (Zuo) Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China (Tu, Wang, Chen, Lu, Zheng) Department of Pharmacy, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, Changsha, China (Tu, Wang, Chen, Lu, Zheng) Institute of Clinical Pharmacy, Central South University, Changsha, China (Tu, Wang, Chen, Lu, Zheng) National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Hunan, Changsha, China (Li) Department of Pharmacy, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China (He) Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, China (Zou) School of Medica Imaging, Changsha Medical University, Changsha, China (Zhou) Department of Urology, The Second Xiangya Hospital of Central South University, Hunan, Changsha, China (Zhou) Department of Pharmacy & Department of Urology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Hunan, Changsha, China Publisher Springer Abstract Background: Testosterone replacement therapy (TRT) is a standard treatment for men with hypogonadism, offering potential benefits including improvements in sexual function, body composition, bone mineral density, mood, and metabolic health. However, its cardiovascular safety remains uncertain due to conflicting evidence. Objective(s): To assess the cardiovascular safety of testosterone replacement therapy in middle-aged and older men. Method(s): PubMed, Web of Science, EMBASE and the Cochrane Library databases were searched for randomized-controlled trials (RCTs) published up to July 25, 2024. The Cochrane Handbook for Systematic Reviews of Interventions, version 6.0, guided our meta-analysis. PROSPERO registration number 42,023,421,479. Result(s): This meta-analysis included 31 RCTs with a total of 9,437 participants, and treatment durations ranged from 40 days to 36 months. TRT was associated with significant reductions in total cholesterol (WMD: -10.20; 95% CI: -14.52, -5.88 mg/dL; P = 0.005), triglyceride (WMD: -7.03; 95% CI: -12.25, -1.81 mg/dL; P = 0.008), and low-density lipoprotein (WMD: -6.64; 95% CI: -8.65, -4.63 mg/dL; P < 0.00001), whereas no significant change was observed in high-density lipoprotein cholesterol (WMD: -1.39; 95% CI: -3.12, 0.35 mg/dL; P = 0.12), compared with placebo. Additionally, TRT significantly prolonged the exercise time to the onset of 1-mm ST-segment depression during treadmill exercise testing (single-dose to 14 weeks; WMD: 67.37; 95% CI: 55.05, 79.69 s; P < 0.00001), and reduced carotid intima-media thickness (12-36 months; WMD: -0.03; 95% CI: -0.05, -0.02 mm; P = 0.0003). Among nonfatal cardiovascular events, a potential arrhythmia safety signal was observed (6598 participants, OR: 1.58; 95% CI: 1.21, 2.05; P = 0.0007). Conclusion(s): TRT appears to reduce overall cardiovascular risk factors in middle-aged and older men with low or low-normal testosterone levels, but the clinical significance of the observed arrhythmia signal remains uncertain. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <12> Accession Number 2050814764 Title Non-inferiority of a paclitaxel-coated balloon versus a rapamycin-eluting metal stent for de novo non-complex small coronary vessel disease: a prospective randomized controlled trial. Source Postepy w Kardiologii Interwencyjnej. 22(3) (pp 406-416), 2026. Date of Publication: 2026. Author Xu X.; Xiang Y.; Ge K.; Shi H.; Zhang Z.; Zheng J. Institution (Xu, Xiang, Ge, Shi, Zhang, Zheng) Department of Cardiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Kunming City, China Publisher Termedia Publishing House Ltd. Abstract Introduction: While drug-coated balloons (DCB) have demonstrated efficacy for coronary small vessel disease, comparative data between DCB and drug-eluting stents (DES) in de novo coronary lesions remain limited. Aim(s): This study hypothesized that a DCB-only strategy would be non-inferior to DES for angiographic outcomes in de novo small vessel coronary lesions. Material(s) and Method(s): This prospective randomized controlled trial (RCT) enrolled 228 patients with de novo (>= 70% stenosis), non-complex coronary lesions from January 2022 to January 2024. Participants were randomized 1: 1 to paclitaxel-coated balloon or rapamycin-eluting stent (DES). The primary endpoint was late lumen loss (LLL) at 6 and 12 months post-procedure, with a non-inferiority margin of 0.15 mm. Baseline clinical characteristics were compared between groups, with 12-month follow-up assessments including cardiac function, major adverse cardiovascular events (MACE), post-procedural angina, and bleeding events. Quantitative coronary angiography was used to evaluate minimal lumen diameter, percent stenosis, and LLL. Kaplan-Meier analysis was used to assess cumulative survival rates. Result(s): Baseline clinical characteristics were similar between groups (p > 0.05). The DCB group had more Mehran Type I lesions (p < 0.05). Both groups reduced thrombogenic potential (p < 0.05). There were no significant differences in angiographic outcomes, MACE, or BARC >= 3 bleeding (p > 0.05). At 6 and 12 months, the 95% CI upper limits for LLL difference were below 0.15 mm (p for non-inferiority < 0.001). DCB had lower post-procedural angina frequency (p < 0.05) but similar episode duration. Survival rates did not differ significantly (p > 0.05). Conclusion(s): For de novo, non-complex small coronary vessel disease, DCB monotherapy demonstrates comparable long-term efficacy to DES, meeting non-inferiority criteria. Copyright © Termedia Sp. z o. o. <13> Accession Number 2048337656 Title Comparison of Photon-Counting and Energy-Integrating Computed Coronary Tomography Angiography for Coronary Artery Disease: A Systematic Review and Meta-Analysis. Source JACC: Cardiovascular Imaging. 19(11) (pp 1346-1359), 2026. Date of Publication: 01 Nov 2026. Author Kurugalage R.; Bhatia A.; Mukherjee A.; K G.; Figtree G.A.; Bursill C.A.; Dey D.; Wong D.T.L.; Marathe J.A.; Psaltis P.J. Institution (Kurugalage, Bhatia, Mukherjee, K) Flinders School of Medicine and Public Health, Bedford Park, SA, Australia (Figtree) Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia (Figtree) Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Bursill, Marathe, Psaltis) School of Medicine, College of Health, Adelaide University, Adelaide, SA, Australia (Bursill, Marathe, Psaltis) Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia (Dey) Biomedical Imaging Research Institute, Cedars Sinai Medical Center and Cedars Sinai Health Sciences University, Los Angeles, CA, United States (Wong) Victorian Heart Institute, Monash University, Clayton, VIC, Australia (Wong) Victorian Heart Hospital, Monash Health, Clayton, VIC, Australia (Marathe, Psaltis) Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia Publisher Elsevier Inc. Abstract Background: Photon-counting detector (PCD)-computed tomography (CT) offers higher spatial resolution and spectral capability compared with energy-integrating (EID)-CT. In coronary computed tomography angiography (CTA), these features may mitigate calcium blooming, enhance stenosis quantification, limit stenosis overestimation, and reduce low-yield referrals to invasive coronary angiography (ICA). Objective(s): This meta-analysis compared diagnostic outcomes between PCD-CT and EID-CT in adults with stable coronary artery disease undergoing coronary CTA. Method(s): The authors' protocol was preregistered and followed the PRISMA 2020 guidelines. Primary outcomes were vessel-level stenosis reclassification, downstream ICA referral, and revascularization rates among those referred. Where multiple studies with compatible definitions were available, random-effects meta-analysis was performed; otherwise, results were described narratively. Result(s): Fifteen studies (N = 11,350) met inclusion criteria. At the vessel level, PCD-CT down-classified stenosis severity in a pooled absolute proportion of 34.2% of vessels compared with EID-CT (95% CI: 27.3-41.9; P < 0.0001). This was associated with fewer downstream ICA referrals (pooled OR: 0.71; 95% CI; 0.63-0.79; P < 0.0001) and higher rates of revascularization among those undergoing ICA (OR: 1.43; 95% CI: 1.14-1.79; P = 0.0017). Stratified by coronary artery calcium score (CACS), ICA referrals were lower with PCD-CT when CACS was <400 (OR: 0.62; 95% CI: 0.52-0.75; P < 0.0001) and trended lower when CACS >=400 (OR: 0.42; 95% CI: 0.16-1.11; P = 0.08). Conclusion(s): Compared against conventional EID-CT, PCD-CT was associated with down-classification of stenosis severity, translating to fewer referrals for ICA and a greater rate of revascularization when angiography is undertaken. Copyright © 2026 <14> Accession Number 2051066835 Title Protocol for an individual patient data meta-analysis for the assessment of risk factors affecting the development and outcome of functional and structural acute kidney injury after cardiac surgery: the METARIS CS-AKI study. Source BMJ Open. 16(10) (no pagination), 2026. Article Number: e124451. Date of Publication: 01 Oct 2026. Author Albert A.; Vogel F.; Krause L.; Blume L.; Devarajan P.; Pickering J.; Di Somma S.; Hur M.; Kim H.; Park C.M.; Haase M.; Haase-Fielitz A.; Endre Z.H.; Doi K.; Komaru Y.; Introcaso G.; Garcia Alvarez M.; Bojic S.; Gaipov A.; Lange S.; Lauten P.; Costello-Boerrigter L.C.; Bleiziffer S.; Lipcsey M.; Schley G.; Stieger P.; Udzik J.; Wroblewski T.; Zapf A.; Braun-Dullaeus R.C.; Albert C. Institution (Albert, Albert) Department of Nephrology, Central Clinic Bad Berka, Bad Berka, Germany (Vogel, Krause, Zapf) Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Blume, Lange, Stieger, Braun-Dullaeus, Albert) University Clinic for Cardiology and Angiology, Otto von Guericke University Magdeburg, Magdeburg, Germany (Blume) Department of Neonatology, Charite University Medicine Berlin, Berlin, Germany (Devarajan) College of Medicine, University of Cincinnati, Cincinnati, OH, United States (Pickering) Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand (Di Somma) UNAM Sapientiam University La Sapienza and Great Health Science, Rome, Italy (Hur, Kim) Department of Laboratory Medicine, Konkuk University, Gwangjin-gu, Seoul, South Korea (Park) Dongnam Institute of Radiological & Medical Sciences, Konkuk University, Gwangjin-gu, Seoul, South Korea (Haase) Otto von Guericke University Magdeburg, Medical Faculty, Magdeburg, Germany (Haase) Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (Haase-Fielitz) Department of Cardiology, Immanuel Diakonie Bernau, Bernau, Germany (Haase-Fielitz) Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany (Endre) Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia (Doi, Komaru) Department of Emergency and Critical Care Medicine, The University of Tokyo, Bunkyo, Japan (Komaru) Division of Nephrology, Washington University in St. Louis, St. Louis, MO, United States (Introcaso) Laboratorio Clinico, Centro Cardiologico Monzino IRCCS, Milano, Italy (Garcia Alvarez) Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (Bojic) Department of Anaesthesiology, Resuscitation and Intensive Care, Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia (Gaipov) Department of Medicine, Nazarbayev University School of Medicine, Astana, Nur-Sultan, Kazakhstan (Lauten, Costello-Boerrigter) Department of Cardiology and Intensive Care Medicine, Central Clinic Bad Berka, Bad Berka, Germany (Lauten) Philipps University of Marburg, Medical Faculty, Marburg, Germany (Bleiziffer) Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany (Lipcsey) Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden (Schley) Department of Nephrology and Hypertension, University Clinic Erlangen of Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany (Udzik, Wroblewski) Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland Publisher BMJ Publishing Group Abstract In addition to serum creatinine (SCr), a kidney functional biomarker, structural damage biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) may improve identification of patients at risk of adverse outcomes after cardiac surgery. Previous meta-analyses have relied on study-level data, functional acute kidney injury (AKI) definitions and heterogeneous NGAL cut-off concentrations, limiting comparability and clinical interpretation. We will conduct an individual patient data (IPD) meta-analysis of prospective studies investigating NGAL in adult patients undergoing cardiac surgery. Authors of eligible studies will be contacted to provide IPD according to a prespecified data request form. Primary outcomes will be the AKI incidence, initiation of renal replacement therapy and in-hospital mortality after surgery. SCr and NGAL will be analysed both as continuous predictors and using study-specific as well as harmonised IPD-derived cut-off values to characterise AKI phenotypes and predictors of adverse outcomes enabling the quantification of risk across the full spectrum of NGAL and SCr concentrations. Exploratory analyses using mixed-effects logistic regression models will investigate patient-level characteristics that may modify clinical risk for the development of AKI and related adverse outcomes. The study results will be reported in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Individual Participant Data. The findings may improve biomarker-guided risk stratification after cardiac surgery. Ethics approval was obtained for all included studies by the respective ethics committees or institutional review boards. This meta-analysis is exempt from additional ethical approval because it uses anonymised data from previously published studies with informed consent already obtained. Findings will be disseminated through national and international conferences and may be published in separate peer-reviewed articles according to the scope of the analyses. CRD420261336943. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. <15> Accession Number 2044490804 Title The impact of catheter ablation in congenital heart disease and atrial fibrillation: An updated meta-analysis. Source Journal of Interventional Cardiac Electrophysiology. 69(6) (pp 1445-1456), 2026. Date of Publication: 01 Sep 2026. Author Afonso L.M.; Fernandes J.M.; Grillo I.; Gaelzer G.C.; da Hora D.A.B.; de Almeida V.P.; Fabiano R.C. Institution (Afonso) Federal University of Cariri, Ceara, Barbalha, Brazil (Fernandes) Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, Sao Paulo, Brazil (Grillo) University of Buenos Aires, Buenos Aires, Argentina (Gaelzer) Pontifical Catholic University of Parana, Parana, Curitiba, Brazil (da Hora) Federal University of Amazonas, Amazonas, Manaus, Brazil (de Almeida) Federal University of Catalao, Goias, Catalao, Brazil (Fabiano) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States Publisher Springer Abstract Background: Catheter ablation (CA) is a well-established therapy for Atrial Fibrillation (AF). However, the impact of CA on patients with AF and Congenital Heart Disease (CHD) remains unclear. Therefore, we performed a meta-analysis evaluating the safety and efficacy of CA in patients with CHD and AF. Method(s): PubMed, Embase, Cochrane, and Clinical Trials databases were searched for studies evaluating the use of CA in patients with CHD and AF. The search included all records from the beginning of the database to September 2025. Our primary endpoints were AF recurrence and periprocedural complications. We reported the endpoints in proportion (%) and 95% confidence intervals (95% CI). Additionally, a prespecified subanalysis of Atrial Septal Defects (ASD) was performed. Result(s): We included 38 studies, comprising 1,657 patients, of whom 30.2% were female, with a mean age of 55.63 years. ASD was present in 31.6% of patients. The follow-up period ranged from 6 to 49 months. The recurrence rate of AF over a mean follow-up of 24.1 months was 27% (95% CI: 19.0 to 35.0%), and up to 12 months was 19% (95% CI: 14.0 to 24.0%). Moreover, there was a low periprocedural complication rate of 5.0% (95% CI: 2.0% to 7.0%). Our prespecified subanalysis for the ASD cohort had an AF recurrence of 18.0% (95% CI: 10 to 27.0%). Conclusion(s): Our findings suggest that CA in patients with CHD and AF is effective and safe, with results similar to the general population. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <16> Accession Number 2049957486 Title Point-of-Care Ultrasound of Upper Airway Changes During Cardiopulmonary Bypass in Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Source Medicina (Lithuania). 62(10) (no pagination), 2026. Article Number: 1829. Date of Publication: 01 Oct 2026. Author Cetin E.; Gunel B.; Yilmaz M.; Duzyol C.; Kara M.Y.; Yuksek A.; Duman E.; Zeytun F. Institution (Cetin, Gunel, Yilmaz, Kara, Yuksek, Zeytun) Department of Anesthesiology and Reanimation, Kocaeli City Hospital, Kocaeli, Turkey (Duzyol) Department of Cardiovascular Surgery, Kocaeli City Hospital, Kocaeli, Turkey (Duman) Pulmonology Clinic, Balikesir Ataturk City Hospital, Balikesir, Turkey Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Elevated endotracheal tube (ETT) cuff pressure impairs tracheal mucosal perfusion and may contribute to upper airway soft-tissue changes. During cardiopulmonary bypass (CPB), the cuff usually remains inflated although ventilation is suspended, yet the relevance of cuff pressure management during CPB is unclear. We compared two ETT cuff pressure strategies during CPB (0 vs. 20-30 cmH<inf>2</inf>O) on point-of-care ultrasound (POCUS) measurements of upper airway soft tissue in patients undergoing coronary artery bypass grafting (CABG). Material(s) and Method(s): In this single-center, prospective, randomized, observer-blinded trial, 76 patients (ASA III-IV, aged 18-80 years) undergoing elective CABG were randomized 1:1 to a 0 cmH<inf>2</inf>O or 20-30 cmH<inf>2</inf>O ETT cuff pressure strategy throughout CPB (n = 38 per group). Transesophageal echocardiography (TEE) was not used in any patient. POCUS measurements of lateral pharyngeal wall (LPW) thickness, tongue thickness, parapharyngeal distance, midsagittal tongue area, and tongue width were obtained at four time points (T0-T3). The primary analysis was the omnibus group x time interaction for LPW thickness in a generalized estimating equations (GEE) model; the between-group difference in change from T0 to T2 was a planned supporting contrast. Result(s): All 76 randomized patients completed the study and were analyzed. The group x time interaction for LPW thickness was significant (p < 0.001); the between-group difference in the increase in LPW thickness from T0 to T2 was 1.50 mm (95% CI 1.27 to 1.73), and 1.00 mm (95% CI 0.82 to 1.18) at postoperative hour 2. Parapharyngeal distance and tongue thickness showed the same pattern. No multiplicity-adjusted between-group difference in LPW thickness was detected at T0 or T1, and a sensitivity analysis using the pre-intervention time point (T1) as baseline gave consistent results (T2 vs. T1: 1.43 mm, 95% CI 1.30 to 1.57). In an exploratory, unadjusted secondary analysis, difficult extubation occurred in 0/38 vs. 7/38 patients (absolute risk difference 18.4 percentage points, 95% CI 5.4 to 33.4; p = 0.012). Conclusion(s): Complete cuff deflation during CPB was associated with smaller ultrasonographic upper airway soft-tissue changes after CPB. The trial was not powered for clinical outcomes; the lower frequency of difficult extubation is hypothesis-generating, and these data do not support a change in routine practice before confirmation in trials with patient-centered endpoints. Copyright © 2026 by the authors. <17> Accession Number 2048849379 Title SURGELLA: A Scoping Review of Impella-Assisted Hemodynamic Support in High-Risk Non-Cardiac Surgery. Source Artificial Organs. 50(11) (pp 1532-1545), 2026. Date of Publication: 01 Nov 2026. Author Elghazaly H.; Allaf M.; Mian A.; Ahmed H.; Gordon-Weeks A.; Tindale A.; Panoulas V. Institution (Elghazaly) Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom (Elghazaly) William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (Allaf, Tindale, Panoulas) Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Mian, Gordon-Weeks) Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (Mian, Gordon-Weeks) Department of Hepato-Pancreato-Biliary Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom (Ahmed) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (Ahmed) Department of Medicine, University of Cambridge, Cambridge, United Kingdom (Panoulas) National Heart and Lung Institute, Imperial College London, London, United Kingdom Publisher John Wiley and Sons Inc Abstract Background: Patients with advanced heart failure or severe ventricular dysfunction are often considered prohibitively high risk for non-cardiac surgery. Impella may provide temporary perioperative hemodynamic support by augmenting cardiac output and unloading the left ventricle, but evidence for this strategy remains limited and largely case based. Method(s): We conducted a scoping review of Impella use for adult high-risk non-cardiac surgery. MEDLINE and Embase were searched from inception to April 2026, with supplementary hand-searching and citation tracking. Eligible reports were synthesized descriptively, with particular attention to implantation timing, operative context, device strategy, outcomes, and complications. Result(s): Twenty-three publications comprising 36 unique patients were identified. Evidence consisted mainly of case reports and small series. Impella was used across bariatric, abdominal, oncological, endocrine, transplant-related, vascular, orthopedic, and neurosurgical procedures. Clinical strategies included planned pre-emptive support, surgery during established Impella or ECMELLA support, rescue implantation after perioperative deterioration, and combined support strategies. Operative completion was usually reported and 34 of 36 unique published patients survived to hospital discharge; however, this reflects selected published experience rather than a reliable estimate of effectiveness or safety. Conclusion(s): Impella-supported non-cardiac surgery appears technically feasible in highly selected patients treated in specialist centers. Current evidence supports feasibility, not comparative benefit or generalizable safety. Prospective multicenter data with standardized reporting are required before wider adoption can be justified. Copyright © 2026 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <18> Accession Number 2050284080 Title Pooled Analysis of Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Replacement Using the SAPIEN Valve. Source Journal of the American Heart Association. 15(19) (no pagination), 2026. Article Number: e044789. Date of Publication: 2026. Author Kharsa C.; Samimi S.; Agrawal A.; Khan S.U.; Lone A.N.; Zhu Z.; Schleicher M.; Akbar U.A.; Arshad H.B.; Atkins M.D.; Reardon M.J.; Faza N.N.; Little S.H.; Kleiman N.S.; Goel S.S.; Aoun J. Institution (Kharsa, Khan, Zhu, Arshad, Faza, Little, Kleiman, Goel, Aoun) Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States (Samimi) Section of Cardiology, Baylor College of Medicine, Michael E DeBakey VA Medical Center, Houston, TX, United States (Agrawal) Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States (Lone) Division of Cardiology Guthrie Robert Packer Hospital, United States (Schleicher) Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, United States (Akbar) West Virginia University-Camden Clark Medical Center, Parkersburg, WV, United States (Atkins, Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States Publisher American Heart Association Inc. Abstract BACKGROUND: Transcatheter mitral valve replacement (TMVR) using the Sapien (Edwards Lifesciences, Irvine, CA) transcatheter heart valve has become the preferred treatment for high-risk patients with failed mitral bioprosthetic valves or prior surgical mitral valve repairs. Differences in anatomy and procedural complexity between valve-in-valve TMVR (ViV-TMVR) and valve-in-ring TMVR (ViR-TMVR) may influence clinical outcomes. METHOD(S): We systematically searched OVID Medline, Embase, SCOPUS, Web of Science, and Cochrane for studies published between 2015 and 2022 comparing ViV-TMVR and ViR-TMVR. The primary end point was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, stroke, acute kidney injury, major bleeding, reintervention, left ventricular outflow tract obstruction, and device embolization. Random-effects models were used to pool outcomes. RESULT(S): Eight studies including 1947 patients (ViV-TMVR: 1435; ViR-TMVR: 512) were analyzed. Patients undergoing ViV-TMVR were older and had a greater baseline comorbidity burden. No significant differences were observed in 30-day mortality (odds ratio [OR]: 0.70 [95% CI: 0.47-1.05]; I2=0%) or in-hospital mortality (OR: 1.05 [95% CI: 0.34-3.21]; I2=3%). Similarly, stroke, major bleeding, and device embolization did not differ significantly between groups. However, ViV-TMVR was associated with lower rates of left ventricular outflow tract obstruction (OR: 0.30 [95% CI: 0.18-0.51]), reintervention (OR: 0.19 [95% CI: 0.13-0.30]), and acute kidney injury (OR: 0.51 [95% CI: 0.29-0.90]), with no significant heterogeneity. CONCLUSION(S): Compared with ViR-TMVR, ViV-TMVR was associated with lower rates of left ventricular outflow tract obstruction, reintervention, and acute kidney injury, whereas mortality and other major complications were comparable. These findings may inform patient selection and procedural planning for transcatheter mitral valve interventions. Copyright © 2026, The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. <19> Accession Number 2051038760 Title Prehabilitation before thoracic surgery: do we need it, and does it make a difference?. Source Current Opinion in Anaesthesiology. (no pagination), 2026. Date of Publication: 2026. Author Donatelli F.; Yoon S.; Varrassi G. Institution (Donatelli) Department of Anesthesia, Lakeshore General Hospital, CIUSS de l'Ouest de l'Ile de Montreal, Pointe-Claire, Canada (Donatelli) Department of Anesthesia, McGill University, Montreal, QC, Canada (Yoon) Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea (Varrassi) VIBRA Group, Fondazione Paolo Procacci, Rome, Italy (Varrassi) Pain Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Prehabilitation is increasingly used before thoracic surgery to increase physiological reserve, but whether improved functional capacity translates into better postoperative outcomes remains uncertain.This review examines the physiological rationale, recent evidence, and appropriate role of prehabilitation in noncardiac thoracic surgery.Recent findings - Preoperative exercise and multimodal programs consistently improve functional capacity, including 6-min walk distance and cardiopulmonary fitness.Thoracic-specific meta-analyses suggest reductions in postoperative pulmonary complications and hospital stay; however, individual randomized trials remain heterogeneous, and a recent fragility analysis of prehabilitation trials in cancer surgery showed that statistically positive complication outcomes typically hinged on a single event.Functional improvement does not necessarily mediate reductions in complex postoperative morbidity, and similar medium-term recovery may be achievable with postoperative rehabilitation.Optimal patient selection remains uncertain.Summary - Prehabilitation can increase physiological reserve, but it cannot neutralize the multidimensional stress of major noncardiac thoracic surgery.A risk-adapted approach is preferable to universal implementation.Prehabilitation should exploit an existing oncologically acceptable waiting period, avoid delaying definitive surgery, and be integrated with early postoperative rehabilitation. Copyright © 2026 Wolters Kluwer Health, LLC.All rights reserved. <20> Accession Number 2048168842 Title The Effectiveness of Perioperative Respiratory Muscle Exercise in Elderly Cardiac Surgery Patients: A Randomized Controlled Trial. Source Archives of Physical Medicine and Rehabilitation. 107(11) (pp 3196-3204), 2026. Date of Publication: 01 Nov 2026. Author Wang Q.; Shao J.; Peng Y.; Li S.; Chen L.; Lin Y. Institution (Wang, Shao, Peng, Lin) Department of Nursing, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Wang, Li, Chen, Lin) Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Wang) School of Nursing, Fujian Medical University, Fujian, Fuzhou, China Publisher W.B. Saunders Abstract Objective: This study aimed to evaluate the impact of perioperative respiratory muscle training on respiratory muscle strength, pulmonary function, functional capacity, and prognostic outcomes in patients undergoing surgery. Design(s): A randomized controlled trial. Setting(s): Cardiac surgery ward and cardiac surgery intensive care unit of a tertiary Grade A hospital in Fuzhou, China. Participant(s): Eighty-two participants. Intervention(s): Perioperative respiratory muscle exercise. Main Outcome Measure(s): Eighty-two patients were randomly assigned to either the intervention group (n=42), who performed perioperative respiratory muscle training, or the control group (n=40). The intervention group completed respiratory muscle exercise from admission to discharge (except during mechanical ventilation). Respiratory muscle strength was assessed upon admission, the day before surgery, on the third day postintensive care unit transfer, and at discharge. Each patient underwent a lung function test, a 6-minute walk test, a self-efficacy for exercise scale, an anxiety and depression test, and a quality of life questionnaire, before and after intervention. Result(s): Compared to the control group, the intervention group showed significantly greater improvements in maximal inspiratory pressure (57.69+/-10.85 cmH<inf>2</inf>O vs 48.28+/-10.30 cmH<inf>2</inf>O), pulmonary function, functional capacity, postoperative pulmonary complications (38.1% vs 65.0%), inspiratory muscle weakness (42.9% vs 85.0%), duration of mechanical ventilation and intensive care unit stay, level of anxiety and depression, quality of life, and length of postoperative hospitalization. In addition, the incidence of postoperative pulmonary (9.5% vs 22.5%) and rehospitalization within 6 months (9.5% vs 17.5%) was reduced, though not statistically significant. Conclusion(s): Perioperative respiratory muscle training could contribute to improved respiratory muscle strength, pulmonary function, functional capacity, prognostic outcomes, and quality of life in elderly cardiac surgery patients. Continuous activation of the respiratory muscles could provide multiple benefits for these individuals. Copyright © 2026 American Congress of Rehabilitation Medicine <21> Accession Number 2050038056 Title Don't Wait- Ablate! Catheter Ablation in Patients with Advanced Heart Failure and Atrial Fibrillation. Source Current Heart Failure Reports. 23(1) (no pagination), 2026. Article Number: 52. Date of Publication: 01 Dec 2026. Author Moersdorf M.; Sommer P.; Sohns C. Institution (Moersdorf, Sommer, Sohns) Department of Electrophysiology, Heart- and Diabetescenter NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (Moersdorf) Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University, New Orleans, LA, United States (Sommer) Department of Electrophysiology, Heart- and Diabetescenter NRW, University Bielefeld, Medical Faculty OWL, Bad Oeynhausen, Germany Publisher Springer Abstract Purpose of Review: Heart failure (HF) and atrial fibrillation (AF) frequently coexist and mutually accelerate disease progression through complex hemodynamic, neurohormonal, and structural interactions. Although earlier rhythm-control strategies failed to demonstrate mortality benefit, largely due to limitations of antiarrhythmic drug therapy, catheter ablation has fundamentally altered the therapeutic landscape. Recent Findings: The CASTLE-AF trial established catheter ablation as a disease-modifying therapy in patients with AF and HF with reduced ejection fraction (HFrEF), demonstrating reductions in mortality and HF hospitalization. More recently, the CASTLE-HTx trial extended these findings to patients with end-stage HF eligible for heart transplantation (HTx) or left ventricular assist device (LVAD) therapy. Catheter ablation has demonstrated a marked reduction in mortality and the need of an urgent HTx, or LVAD implantation compared with medical therapy alone. Subsequent subanalyses further refined risk stratification and identified patient subsets deriving the greatest benefit. Therefore, catheter ablation has received a class 1 recommendation for patients with AF and HFrEF. Summary: According to recent clinical evidence supporting early rhythm control through catheter ablation in advanced HF, it leads to a paradigm shift in the management of this high-risk population: in selected patients with AF and advanced HF, clinicians should not delay referral-"Don't wait, ablate." Copyright © The Author(s) 2026. <22> Accession Number 2049583173 Title Patent foramen ovale closure versus medical therapy for prevention of recurrent ischemic events in patients with cryptogenic stroke or transient ischemic attack and documented patent foramen ovale: a systematic review and network meta-analysis of randomized controlled trials and observational studies. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Date of Publication: 12 Aug 2026. Author Deng Y.; An D.; Xiong X.; Zhou Z.; Liu X.; Xiang Y. Institution (Deng) The Second Clinical Medical College, Guizhou University of Traditional Chinese Medicine, Guizhou, Guiyang, China (An) The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guizhou, Guiyang, China (Xiong, Zhou, Liu, Xiang) Department of Cardiovascular Internal Medicine, Second Hospital, Guizhou University of Traditional Chinese Medicine, Guizhou, Guiyang, China Publisher Frontiers Media SA Abstract Background - This network meta-analysis (NMA) aimed to compare the efficacy and safety of patent foramen ovale (PFO) closure and medical therapy categories, including antiplatelet therapy, anticoagulation, and mixed medical therapy. Methods - We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to June 22, 2026. Eligible randomized controlled trials and observational studies comparing PFO closure with medical therapy in adult patients with cryptogenic ischemic stroke or transient ischemic attack and confirmed PFO were included. Results - Eighteen studies involving 7, 135 participants, including six randomized controlled trials and 12 observational studies, were included. Four intervention nodes were analyzed: PFO closure, antiplatelet therapy, anticoagulation, and mixed medical therapy. For recurrent cerebrovascular ischemic events, PFO closure was associated with a lower risk than antiplatelet therapy (RR 0.22, 95% CI 0.12-0.41), anticoagulation (RR 0.40, 95% CI 0.19-0.82), and mixed medical therapy (RR 0.51, 95% CI 0.33-0.77). For bleeding events, PFO closure was associated with a significantly lower risk than anticoagulation (RR 0.16, 95% CI 0.06-0.42), while the comparisons with antiplatelet therapy (RR 0.49, 95% CI 0.20-1.23) and mixed medical therapy (RR 0.91, 95% CI 0.46-1.79) did not reach statistical significance. Model-fit assessment showed similar DIC values between the consistency and unrelated mean-effects models. Conclusions - PFO closure showed the most favorable efficacy profile for preventing recurrent cerebrovascular ischemic events and was associated with a significantly lower bleeding risk than anticoagulation. However, safety findings for comparisons with antiplatelet therapy and mixed medical therapy should be interpreted cautiously because bleeding events were sparse and confidence intervals were wide. Systematic Review Registration - CRD420251148908 Copyright © 2026 Deng, An, Xiong, Zhou, Liu and Xiang. <23> Accession Number 2045614060 Title Efficacy of Dexmedetomidine in Preventing Postoperative Delirium in Patients Undergoing Brain Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Neurocritical Care. 45(2) (pp 737-749), 2026. Date of Publication: 01 Oct 2026. Author dos Reis M.A.O.M.; de Assis E.B.T.; Swamy H.K.; Matos B.C.M.; Ferreira M.Y.; Ben-Shalom N.; Polverini J.E.R.; Polverini A.D. Institution (dos Reis, Matos) Faculty of Medicine, Universidad Nacional de Rosario, Santa Fe, Rosario, Argentina (de Assis, Swamy) Faculty of Medicine, Baltic Federal University, Kaliningrad Oblast, Kaliningrad, Russian Federation (Ferreira, Ben-Shalom) Department of Neurosurgery, Northwell Health Hospital, New York, NY, United States (Polverini) Department of Anaesthesiology, Barretos Cancer Hospital, SP, Barretos, Brazil (Polverini) Neurosurgical Oncology Division, Barretos Cancer Hospital, SP, Barretos, Brazil Publisher Springer Abstract Background: Dexmedetomidine (DEX), a selective alpha-2 adrenergic receptor agonist, is widely used in various surgical settings, including cardiac and general surgeries, for its sedative, analgesic, and neuroprotective properties. Patients undergoing brain surgery are particularly susceptible to postoperative delirium (POD). Given the established benefits of dexmedetomidine in other surgical fields, its potential to mitigate delirium in neurosurgery warrants investigation. Method(s): A systematic search of PubMed, Embase, Scopus, and Cochrane databases was conducted from inception to January 2025 and updated in April 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed, and a meta-analysis was performed using Review Manager 5.4.1. Five randomized controlled trials were included, evaluating the efficacy of DEX in preventing POD in adult patients undergoing brain surgery. Result(s): A total of 646 patients were enrolled, with DEX administered with a loading dose ranging from 0.5 to 1 mug/kg over 10 min, followed by a maintenance infusion rate of 0.1 to 0.5 mug/kg/h during the surgical procedure. The pooled risk ratio (RR) for POD with DEX was 0.47 (95% confidence interval (CI): 0.35-0.63; p < 0.00001); reflecting a 53% reduction in the risk of postoperative delirium, with no statistical heterogeneity detected (chi2 = 2.09, degrees of freedom (df) = 4, p = 0.72; I2 = 0%). Subgroup analyses showed similar effect estimates across brain tumor and other cranial procedures. Adverse events were comparable between groups and generally mild. Conclusion(s): This meta-analysis found that perioperative dexmedetomidine was associated with a significant reduction in postoperative delirium risk in neurosurgical patients. Further multicenter trials are needed to confirm these findings and to refine optimal administration strategies. Copyright © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2026. <24> Accession Number 2049202700 Title The role of antifactor Xa monitoring in the dosing and administration of low-molecular-weight heparins in pregnancy: a systematic review and meta-analysis. Source Journal of Thrombosis and Haemostasis. 24(11) (pp 4012-4026), 2026. Date of Publication: 01 Nov 2026. Author Ashraf R.; Mohamed D.; Sayfi S.; Bowen J.M.; Steinberg I.; Shehata N.; Hwang M.; D'Souza R. Institution (Ashraf, Sayfi, D'Souza) Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, Canada (Ashraf, Sayfi, Bowen, D'Souza) Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada (Mohamed) Department of Obstetrics & Gynaecology, McGill University, Montreal, QC, Canada (Bowen) Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada (Bowen) Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Steinberg) Department of Pediatrics, University of Southern California (USC) Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States (Shehata) Division of Haematology, Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (Hwang) Library & Knowledge Services, Trillium Health Partners, Toronto, ON, Canada Publisher Elsevier B.V. Abstract Background Low-molecular-weight heparins (LMWHs) are widely used in pregnancy for prevention and treatment of venous thromboembolism (VTE) and in individuals with mechanical heart valves (MHVs). Objectives Our aim was to determine the risk of thromboembolic complications (TECs) and major bleeding with weight-based, fixed, and anti-Xa-monitored dosing of LMWHs during pregnancy. Methods We conducted a systematic review and searched 6 databases for articles published before August 2024 that reported on LMWH dosing and monitoring during pregnancy. We calculated event rates and 95% confidence intervals (95% CIs) for maternal death, TECs, and major bleeding using a random-effects meta-analysis. We assessed risk of bias using the Quality In Prognosis Studies tool and evaluated the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results We identified 5007 studies, of which 94 (53 case series, 30 cohort studies, and 11 randomized trials) were eligible. For thromboprophylaxis and VTE treatment, fixed, weight-based, and anti-Xa-monitored LMWH doses had overlapping pooled event rates and 95% CIs for TECs and major bleeding. For MHVs, the risk of maternal death, TECs, and major bleeding was 2.7% (95% CI, 0.3%-6.5%), 7.9% (95% CI, 2.8%-14.6%), and 8.4% (95% CI, 2.0%-17.2%), respectively with overlapping pooled single-arm event rates and 95% CIs across different anti-Xa-monitored LMWH dosing regimens. The CoE for all estimates was low to very low, mainly due to imprecision, risk of bias, and publication bias. Conclusion Pooled single-arm event rates and 95% CIs for the main outcomes overlapped across LMWH dosing regimens currently used in pregnancy for thromboprophylaxis, VTE treatment, and anticoagulation in individuals with MHVs. These findings should be interpreted in light of small sample sizes, wide 95% CIs, and low CoE; and not as evidence of comparable effectiveness or safety. Copyright © 2026 The Author(s). <25> Accession Number 2051032142 Title Direct oral anticoagulants vs dual antiplatelet therapy following left atrial appendage closure in atrial fibrillation. Source Heart Rhythm. 23(9) (pp e1947-e1957), 2026. Date of Publication: 01 Sep 2026. Author Kaisaier W.; Xu Z.; Ye M.; Wu Z.; Dong Y.; He J.; Liu C.; Chen Y.; Lip G.Y.H.; Zhu W. Institution (Kaisaier, Ye, Wu, Dong, He, Liu, Chen, Zhu) Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Xu) Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Lip) Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom (Lip) Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (Lip) Department of Cardiology, Lipidology and Internal Medicine, Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland Publisher Elsevier B.V. Abstract Background Percutaneous left atrial appendage closure (LAAC) is an established alternative to oral anticoagulants for preventing thromboembolic events for selected patients with atrial fibrillation (AF). However, optimal post-procedural antithrombotic therapy remains uncertain, particularly regarding the use of direct oral anticoagulants (DOACs) vs dual antiplatelet therapy (DAPT). Objective This meta-analysis aimed to compare the efficacy and safety outcomes of DOACs vs DAPT in the early post-implant period following LAAC in patients with AF. Methods We systematically searched PubMed and Embase until November 2025 to identify randomized controlled trials (RCTs) that compared DOACs with DAPT after LAAC. Efficacy outcomes included device-related thrombosis (DRT), stroke, and all-cause mortality, whereas safety outcomes encompassed major and minor bleeding. Pooled effect estimates were calculated as odds ratios (ORs) with 95% confidence intervals (CIs). Where appropriate, fixed- or random-effects models were applied according to between-study heterogeneity. Results 3 RCTs (ADRIFT, ADALA, ANDES) involving 704 patients (mean age 75.8-78.4 years; 65% males) were included, with 368 assigned to DOAC and 336 to DAPT. Baseline thromboembolic and bleeding risk were high (mean CHA<inf>2</inf>DS<inf>2</inf>-VASc 4.0-4.7; mean HAS-BLED 3.5-3.8). Clinical outcomes were evaluated at 2-3 months. Compared with DAPT, DOACs were associated with significantly lower risks of DRT (OR = 0.16; 95% CI: 0.05-0.57), major bleeding (OR = 0.46; 95% CI: 0.26-0.81) and minor bleeding (OR = 0.59; 95% CI: 0.38-0.92). No significant differences were observed in stroke (OR = 0.46; 95% CI: 0.07-3.13) and all-cause mortality (OR = 0.60; 95% CI: 0.23-1.54). Conclusion In randomized trials of patients with AF undergoing LAAC, short-term DOAC-based regimens were associated with lower rates of DRT and fewer bleeding events than DAPT, without differences in stroke or mortality. These findings support DOACs as a favorable short-term antithrombotic option after LAAC in selected patients. Copyright © 2026 Published by Elsevier Inc. on behalf of Heart Rhythm Society. <26> Accession Number 2050030372 Title Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation: A Comprehensive Evidence Synthesis. Source PACE - Pacing and Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Bashir Z.; Rehman M.A.; Hamza M.; Yang M.; Butt M.O.; Bukhari S. Institution (Bashir, Yang) University of Texas Medical Branch, Galveston, TX, United States (Rehman) Department of Internal Medicine, University of Central Florida, Tallahassee, FL, United States (Rehman) Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN, United States (Hamza) Department of Internal Medicine, Tidal Health, Salisbury, MD, United States (Butt) Department of Internal Medicine, Memorial Satilla Health, Waycross, GA, United States (Bukhari) Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States Publisher John Wiley and Sons Inc Abstract Background: Oral anticoagulation (OAC) remains the cornerstone of stroke prevention in atrial fibrillation (AF) but is limited by bleeding risk. Left atrial appendage occlusion (LAAO) devices offer an alternative; however, recent randomized trials have reported inconsistent efficacy compared with OAC. Method(s): We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing LAAO with OAC through April 1, 2026, using MEDLINE, EMBASE, and Cochrane CENTRAL. Eligible studies enrolled adults (>=18 years) with AF randomized to LAAO or OAC. Primary and secondary outcomes were pooled as risk ratios (RR) with 95% confidence intervals (CIs). Individual patient-level data (IPD) were reconstructed from published Kaplan-Meier curves for time-to-event sensitivity analyses. Result(s): Six RCTs (n = 7,004; mean age 72 years; CHA<inf>2</inf>DS<inf>2</inf>-VASc 3.9; HAS-BLED 1.7; mean follow-up 38 months) were included. LAAO showed no significant difference in ischemic stroke (RR 1.20, 95% CI 0.82-1.76), major bleeding (RR 0.77, 95% CI 0.50-1.17), or all-cause mortality (RR 0.96, 95% CI 0.82-1.13) compared with OAC. Hemorrhagic stroke risk was significantly lower with LAAO (RR 0.53, 95% CI 0.30-0.93). Reconstructed IPD demonstrated similar stroke and bleeding risks (HR 1.24 and 0.84, respectively) but lower all-cause mortality with LAAO (HR 0.70, 95% CI 0.52-0.95). Conclusion(s): LAAO provides comparable ischemic stroke prevention and major bleeding outcomes to OAC and reduces hemorrhagic stroke risk. Reconstructed IPD analyses suggest a possible mortality benefit that warrants further investigation. Future studies using contemporary devices and post-ablation populations are needed to refine patient selection and further characterize the comparative clinical outcomes of LAAO and OAC in AF patients. Copyright © 2026 Wiley Periodicals LLC. <27> Accession Number 2049502881 Title Fractional Flow Reserve in Acute Coronary Syndrome: An Updated Systematic Review and Bayesian Meta-Analysis. Source Journal of the American Heart Association. 15(18) (no pagination), 2026. Article Number: e050265. Date of Publication: 2026. Author Ha E.T.; Shah H.; Zhang C.; Phichaphop A.; Waksman O.; Verma B.; Kobayashi Y.; Waksman R.; Garcia-Garcia H.M. Institution (Ha, Shah, Zhang, Phichaphop, Waksman, Verma, Waksman, Garcia-Garcia) Medstar Washington Hospital Center, Washington, DC, United States (Kobayashi) NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States Publisher American Heart Association Inc. Abstract BACKGROUND: The diagnostic performance of fractional flow reserve (FFR) in the setting of acute coronary syndrome (ACS) remains unclear. We sought to perform an updated systematic review and meta-analysis investigating the performance of FFR-guided revascularization in the setting of ACS. METHOD(S): Two main primary comparisons tested the major adverse cardiac events (MACE) rate at 1-year of patients treated with an FFR-guided strategy in ACS versus chronic coronary syndrome and an FFR-guided versus angiographic-guided strategy in acute coronary syndrome. Treatment effect was defined as the risk difference and was estimated with Bayesian random effect model with a conservative prior of no treatment effect. Kaplan-Meier estimates and their standard deviations were retrieved to maximum accuracy from cumulative incidence function/ survival function plots for studies with censoring. RESULT(S): We found 11 eligible trials (with a total of 13029 patients) in this systematic review. Within the FFR-guided strategy, acute coronary syndrome was associated with an increased risk of MACE at 1year compared with chronic coronary syndrome (risk difference (RD): 1.9%, 95% credible interval [0.2% to 3.6%]). In contrast, among patients with ACS no difference in 1-year MACE rate was observed between angiography-guided versus FFR-guided complete revascularization strategy (RD=0.9%, 95% CI [-1.3 to 3.2]). CONCLUSION(S): FFR-guided strategy of lesions in acute coronary syndrome was associated with worse 1-year MACE compared with FFR-guided revascularization in chronic coronary syndrome reflecting the high-risk nature of acute coronary syndrome patients. No difference in long-term outcomes was seen from a FFR-guided versus angiography-guided approach in acute coronary syndrome. Further studies are needed to better understand and optimize the use of physiology in the ACS setting. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. <28> Accession Number 2049624345 Title Biomarkers associated with post-operative pneumonia: a systematic review and meta-analysis. Source BMC Pulmonary Medicine. 26(1) (no pagination), 2026. Article Number: 455. Date of Publication: 01 Dec 2026. Author Howroyd F.; Sardeli A.V.; Smith F.G.; Veenith T.; Duggal N.A.; Ahmed Z. Institution (Howroyd, Sardeli, Smith, Duggal, Ahmed) Department of Inflammation and Ageing, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom (Howroyd, Smith, Ahmed) University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (Veenith) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom (Veenith) Institute of Acute Care, University of Wolverhampton, Wolverhampton, United Kingdom Publisher BioMed Central Ltd Abstract Background: Post-operative pneumonia is a commonly occurring surgical complication associated with poor patient outcomes. This study aimed to synthesise pre-operative and post-operative blood-based biomarkers associated with post-operative pneumonia. Method(s): Electronic databases were searched up to April 14th, 2026. Primary studies investigating blood-based biomarkers in adults hospitalised after surgery were included. Meta-analysis was performed using the random effects model to compare pooled data for pneumonia and no-pneumonia groups using standardised mean difference. Risk of bias was assessed using the ROBINS-E tool. Result(s): Thirty-seven studies (n = 15,842 patients) were included, with an overall pneumonia rate of 17.8% [15.8-20.0%]. One hundred and fifteen biomarkers were identified. Meta-analysis identified that patients who developed post-operative pneumonia had significantly lower platelet-to-neutrophil ratio (p < 0.0001), red blood cell count (p = 0.001), haemoglobin (p = 0.002), albumin (p = 0.005) and lymphocyte count (p = 0.008) and significantly higher monocyte-to-lymphocyte ratio (p < 0.0001), systemic immune inflammation index (p < 0.001), systemic inflammatory response index (p < 0.0001) and blood urea nitrogen (p = 0.0001) at pre-operative baseline, compared to those without pneumonia. Patients who developed post-operative pneumonia were associated with significantly higher procalcitonin (PCT) at post-operative day one (p = 0.03), two (p = 0.0001), three (p = 0.0004) and six (p < 0.0001); higher C-Reactive Protein (CRP) at day two (p = 0.02), four (p < 0.0001) and five (p < 0.0001); higher interleukin (IL)-6 at day three (p = 0.001) and four (p = 0.0002); and higher white blood cell (WBC) count at day three (p = 0.01) and day four (p = 0.001) post-operatively, compared to those without pneumonia. In addition, pre-operative CRP was associated with mortality within the patients who later developed post-operative pneumonia (r = 0.70, p = 0.0009). Conclusion(s): The results identify blood-based biomarker signals associated with post-operative pneumonia. However, interpretation is limited by heterogeneous pneumonia definitions and inconsistent reporting of diagnosis timing across studies. The certainty of evidence is therefore limited, and thus these biomarkers cannot currently be used for prediction or diagnosis in clinical practice. Further high-quality, prospective studies are required to establish clinically meaningful thresholds. Protocol Registration: PROSPERO: CRD42024570654. Copyright © The Author(s) 2026. <29> Accession Number 2050781013 Title Association Between Rest-Activity Rhythm and Cardiovascular Disease, Cardiovascular Mortality, and All-Cause Mortality: A Systematic Review and Meta-Analysis. Source Journal of the American Heart Association. 15(19) (no pagination), 2026. Article Number: e048656. Date of Publication: 2026. Author Chang F.; Xu J.; Guo M.; Xu H.; Li D.; Covassin N.; Somers V.K.; Wang K.; Wang Y.; Li J. Institution (Chang, Guo) Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China (Xu, Li, Wang, Wang, Li) Cardiovascular Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (Xu) Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China (Covassin, Somers, Li) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States Publisher American Heart Association Inc. Abstract BACKGROUND: Disruption in rest-activity rhythm (RAR) is an emerging risk factor for cardiovascular disease (CVD) and mortality, but the strength of evidence is unclear. Therefore, we conducted a systematic review and meta-analysis to assess associations between RAR characteristics and cardiovascular disease incidence or prevalence, cardiovascular mortality, and all-cause mortality. METHOD(S): A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase for cohort or cross-sectional studies published up to August 2025. The exposure variables were nonparametric RAR parameters, including interdaily stability (describing day-to-day stability of the RAR), intradaily variability (a measure of RAR fragmentation), and relative amplitude (indicating robustness or strength of the RAR). The primary outcomes were cardiovascular mortality and all-cause mortality. The secondary outcomes included cardiovascular disease prevalence and incidence. RESULT(S): Seven studies involving 109 365 participants were included. Pooled results showed that higher intradaily variability was associated with a significantly increased risk of all-cause mortality (hazard ratio [HR], 1.05 [95% CI, 1.02-1.09]) and cardiovascular disease prevalence (odds ratio, 1.73 [95% CI, 1.21-2.47]). Lower relative amplitude was significantly associated with higher cardiovascular mortality (HR, 1.50 [95% CI, 1.13-1.98]) and all-cause mortality (HR, 1.46 [95% CI, 1.27-1.68]). Interdaily stability showed no significant associations with any outcome. CONCLUSION(S): Measures of disrupted rest-activity rhythms were associated with increased cardiovascular mortality, and all-cause mortality. These findings support using RAR metrics as early, noninvasive risk indicators. Future work should investigate whether appropriately timed physical activity and sleep, as well as other interventions targeting RAR can mitigate cardiovascular risk. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. <30> Accession Number 2048122455 Title TRISCEND II: Effect of Transcatheter Tricuspid Valve Replacement on Echocardiographic Measures of Right Heart Remodeling and Function. Source JACC: Cardiovascular Imaging. 19(9) (pp 1027-1039), 2026. Date of Publication: 01 Sep 2026. Author Sannino A.; Grayburn P.A.; Kodali S.K.; Lurz P.; Thourani V.H.; Makar M.; Haeffele C.; Puthumana J.; Lee J.; Flueckiger P.; Chadderdon S.; Padang R.; Sekaran N.K.; Stewart-Dehner T.; Ender J.; Koulogiannis K.; Morsy M.; Miyasaka R.; Havens B.; Ku I.; Silvestry F.; Nabauer M.; Gleason P.; Lindman B.R.; Ho E.; Good M.; Gossler T.; Cohen J.A.; Harris A.; Sengupta P.; Kelly N.; Maksoud A.; Weber M.; Romero S.; Yucel E.; Raghunathan D.; Skolnick D.; Wang L.; Sun Y.-P.; Vainrib A.; Kapila A.; Mackensen G.B.; Aman E.; Mehrkens D.; Ivannikova M.; Smith W.; Abramson S.; Treat S.; Toufan M.; Mack M.J.; Leon M.B.; Hahn R.T. Institution (Sannino, Toufan) Baylor Scott & White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, United States (Sannino) Department of Cardiology, Angiology, and Intensive Care Medicine Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm, Berlin, Germany (Grayburn, Mack) Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, United States (Kodali, Leon, Hahn) Columbia University Irving Medical Center, New York, NY, United States (Lurz, Gosler) University Medical Centre Mainz, Mainz, Germany (Thourani, Flueckiger) Piedmont Heart Institute, Atlanta, GA, United States (Makar) Cedars-Sinai Medical Center, Los Angeles, CA, United States (Haeffele) Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States (Puthumana) Northwestern University, Chicago, IL, United States (Lee) Henry Ford Hospital, Detroit, MI, United States (Chadderdon) Division of Cardiovascular Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, United States (Padang) Mayo Clinic, Rochester, MN, United States (Sekaran) Intermountain Medical Center, Murray, UT, United States (Stewart-Dehner) The Christ Hospital, Cincinnati, OH, United States (Ender) Heart Center Leipzig at Leipzig University, Leipzig, Germany (Koulogiannis) Atlantic Health System Morristown Medical Center, Morristown, NJ, United States (Morsy) Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States (Miyasaka) The Cleveland Clinic Foundation, Cleveland, OH, United States (Havens) St. Vincent Heart Center of Indiana, Indianapolis, IN, United States (Ku) Kaiser San Francisco Medical Center, San Francisco, CA, United States (Silvestry) Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania-Philadelphia, Philadelphia, PA, United States (Nabauer) Klinikum der Universitat Munchen, Munich, Germany (Gleason) Division of Cardiology, Department of Medicine, Emory University-Atlanta, Atlanta, GA, United States (Lindman) Vanderbilt University Medical Center, Nashville, TN, United States (Ho) Montefiore Medical Center, The Bronx, New York, United States (Good) Oklahoma Heart Institute, Tulsa, OK, United States (Cohen) Sentara Norfolk General Hospital, Norfolk, VA, United States (Harris) Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, MI, United States (Sengupta) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States (Kelly) Department of Cardiovascular Medicine/Cardiology, Carolinas Health System, Charlotte, NC, United States (Maksoud) Cardiovascular Research Institute of Kansas, Wichita, KS, United States (Weber) University Hospital Bonn, Bonn, Germany (Romero) Scripps Memorial Hospital La Jolla, La Jolla, CA, United States (Yucel) Massachusetts General Hospital, Boston, MA, United States (Raghunathan) The University of Texas Health Science Center at Houston, Houston, TX, United States (Skolnick) Saint Luke's Hospital of Kansas City, Kansas City, MO, United States (Wang) St. Francis Hospital, Roslyn, NY, United States (Sun) Brigham and Women's Hospital, Boston, MA, United States (Vainrib) New York University Langone Medical Center, New York, NY, United States (Kapila) Florida Heart & Vascular Care-JFK, Atlantis, FL, United States (Mackensen) Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States (Aman) UC Davis Medical Center Sacramento, Sacramento, CA, United States (Mehrkens) University Hospital of Cologne, Cologne, Germany (Ivannikova) Clinic for General and Interventional Cardiology/Angiology, University of Bad Oyenhausen, Bad Oyenhausen, Germany (Smith) The Cardiac & Vascular Institute Research Foundation, Gainesville, FL, United States (Abramson) Lankenau Medical Center, Wynnewood, PA, United States (Treat) UC Health Northern Colorado (Medical Center of the Rockies), Loveland, CO, United States Publisher Elsevier Inc. Abstract Background: The TRISCEND II (EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device) trial demonstrated clinical benefits for transcatheter tricuspid valve replacement (TTVR) with the EVOQUE System over medical therapy for the primary safety and effectiveness endpoint to 1 year. Objective(s): The authors report echocardiographic outcomes at 1 year for the randomized cohort and evaluate hemodynamic and structural changes. Method(s): The multicenter, prospective TRISCEND II trial enrolled 400 patients with severe, symptomatic tricuspid regurgitation (TR) and randomized them in a 2:1 ratio to TTVR (n = 267) or medical therapy (control) (n = 133). The secondary echocardiographic endpoint was reduction in TR severity from baseline to discharge. Echocardiograms were evaluated by an independent echocardiographic core laboratory. Result(s): All patients had severe TR at baseline; at discharge, 95.5% of patients who underwent TTVR had mild TR. On paired analysis from baseline to 1 year, 95.3% of patients who underwent TTVR and 2.3% of control patients achieved mild TR. Between baseline and 1 year, the mean inferior vena cava diameter decreased significantly more for patients who underwent TTVR (normal breathing P < 0.001; forced inhalation P = 0.038). Patients who underwent TTVR experienced greater improvements in diastolic right ventricular (RV) size (P < 0.05) and larger decreases in RV systolic function (P < 0.001), consistent with reduced preload from TR reduction. RV stroke volume and cardiac output increased significantly in patients who underwent TTVR (P < 0.001) but not in control patients. Conclusion(s): One-year echocardiographic outcomes from the TRISCEND II trial demonstrated that near elimination of TR following TTVR is associated with reduced venous congestion, RV reverse remodeling, and significant improvements in forward stroke volume and cardiac output. (EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device [TRISCEND II Pivotal Trial]; NCT04482062) Copyright © 2026 American College of Cardiology Foundation <31> Accession Number 2043092700 Title Outer nuclear layer hyperreflectivity as an optical coherence tomography finding in Danon disease. Source Acta Ophthalmologica. 104(7) (pp e810-e822), 2026. Date of Publication: 01 Nov 2026. Author Emfietzoglou M.; Sakuno G.; Hoyek S.; Vu D.M.; Comander J.; Miller J.B.; Sadda S.R.; Patel N.A.; Vavvas D.G. Institution (Emfietzoglou, Sakuno, Hoyek, Vu, Comander, Miller, Patel, Vavvas) Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States (Sadda) Doheny Eye Institute, University of California, Los Angeles, CA, United States Publisher John Wiley and Sons Inc Abstract Purpose: To describe an optical coherence tomography (OCT) finding that is highly prevalent in Danon disease. Method(s): Retrospective observational case series at a single centre, combined with a systematic literature review of PubMed and EMBASE for genetically confirmed Danon disease patients with available macular OCT images. Fifty-two macular OCT scans from 29 genetically confirmed Danon disease patients (5 from our institution; 24 from 11 published studies) were included. For each patient, a single foveal-centred macular OCT scan per eye was selected for analysis. Two independent reviewers assessed images for the presence of outer nuclear layer (ONL) hyperreflectivity, with discrepancies resolved by consensus. Result(s): Evidence of ONL hyperreflectivity appeared in 39 macular scans (75%). Of the 13 scans without this finding (25%), 10 scans (19%) showed macular atrophy (including bull's-eye maculopathy cases) or cystoid macular oedema that obscured evaluation of outer retinal layers at the fovea, and two scans (4%) used colour-encoded OCT that prevented reliable evaluation of the ONL. In only one scan (2%), ONL hyperreflectivity was absent despite preserved foveal architecture and adequate image quality. Conclusion(s): ONL hyperreflectivity is a highly prevalent OCT finding in Danon disease, most evident in young patients without advanced outer retinal atrophy. This feature may serve as a non-invasive finding of early retinal involvement. Longitudinal studies are warranted to confirm its prognostic value. Copyright © 2026 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd. <32> Accession Number 2048853551 Title Hypoxic preconditioning improves intraoperative oxygenation and postoperative recovery in children undergoing thoracoscopic surgery: a randomized controlled trial. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1801428. Date of Publication: 2026. Author Xiao T.; Wang L.; Pei D.J.; Zhang S.B.; Wang J.H.; Yang G.X.; Qu S.Q. Institution (Xiao, Wang, Pei, Zhang, Qu) Department of Anesthesiology, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Hunan, Changsha, China (Wang, Yang) Department of Thoracic Surgery, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Hunan, Changsha, China Publisher Frontiers Media SA Abstract Background - Hypoxia preconditioning (HPC) and remote ischemic preconditioning (RIPC) are potential lung-protective strategies, but their efficacy in pediatric thoracic surgery remains unclear. This randomized controlled trial aimed to evaluate the effects of HPC, alone or in combination with RIPC, in children undergoing video-assisted thoracoscopic pulmonary resection. Methods - In a single-center, 2x2 factorial randomized trial, 160 children (<18years) undergoing thoracoscopic lung surgery were allocated to four groups: Control (no preconditioning), HPC (three cycles of 5-min hypoxia/ventilation in the non-dependent lung), RIPC (three cycles of 5-min limb ischemia/reperfusion), and combined HPC+RIPC. The primary outcome was the PaO<inf>2</inf>/FiO<inf>2</inf> ratio at 30min of one-lung ventilation (OLV). Secondary outcomes included the duration of postoperative mechanical ventilation, hospital length of stay, and incidence of postoperative pulmonary complications (PPCs). Results - A total of 139 patients were included in the final analysis. Compared with the control group, HPC significantly improved oxygenation at 30min of OLV (PaO<inf>2</inf>/FiO<inf>2</inf>: 256.4+/-60.3 vs. 201.3+/-65.0mmHg; p=0.022), reduced median mechanical ventilation duration (45 vs. 102.5min; p<0.001), and shortened hospital length of stay (7 vs. 11days; p=0.001). HPC also reduced the incidence of PPCs (53% vs. 81%; p=0.021), with the largest reduction observed in pleural effusion. The addition of RIPC did not enhance these outcomes, and RIPC alone had no significant effect. Conclusion - HPC was associated with improved intraoperative oxygenation and enhanced postoperative recovery in children undergoing thoracoscopic pulmonary surgery. These findings suggest that HPC may represent a simple and promising lung-protective strategy in pediatric thoracic anesthesia. Clinical trial registration - Identifier ChiCTR2000038658, https://www.chictr.org.cn/showproj.html?proj=61845. Copyright © 2026 Xiao, Wang, Pei, Zhang, Wang, Yang and Qu. <33> Accession Number 2049256048 Title Sexual Rehabilitation Interventions for Patients with Cardiovascular Disease: A Scoping Review. Source Patient Preference and Adherence. 20 (no pagination), 2026. Article Number: 634991. Date of Publication: 2026. Author Zhang F.; Chen L.; Jiang Y.; Liu M.; Xiong X. Institution (Zhang) Nursing Department, The First Affiliated Hospital of Henan Medical University, Henan, Xinxiang, China (Zhang, Chen, Xiong) Nursing Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, Nan Chang, China (Zhang, Jiang, Liu) School of Nursing, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, China Publisher Dove Medical Press Ltd Abstract Objective: This study systematically synthesizes the types, core components, and implementation characteristics of sexual rehabilitation interventions for patients with cardiovascular disease to inform the integration of sexual rehabilitation into cardiac rehabilitation and guide clinical practice. Method(s): A scoping review methodology was employed, following the framework of Arksey and O'Malley and reported according to PRISMA-ScR guidelines. PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, and Wanfang Data were systematically searched from January 2000 to December 2025. Based on the Population-Concept-Context framework, inclusion and exclusion criteria were applied. Literature screening, data extraction, and evidence mapping were performed. Result(s): A total of 29 studies were included: original research, systematic reviews, guidelines, scientific statements and research protocols. The included evidence primarily focused on patients with myocardial infarction or coronary heart disease and those undergoing percutaneous coronary intervention, with some studies also involving patients' partners. Interventions were categorized into four types: (1) guidance-based interventions centered on sexual education and counseling; (2) psychological and behavioral interventions; (3) couple-based interventions; and (4) comprehensive rehabilitation integrated with cardiac rehabilitation. Most interventions were delivered by nurses or multidisciplinary teams, primarily through face-to-face interactions, with some utilizing remote methods like phone calls, video consultations, and mobile applications. Conclusion(s): Current sexual rehabilitation interventions mainly focus on sexual health education and counseling, while psychological and behavioral interventions and partner-assisted interventions have also been explored, with favorable outcomes reported in some studies. However, sexual rehabilitation remains fragmented and lacks integration into cardiac rehabilitation systems. Future research should promote standardization, explore integrated models, and leverage digital health technologies for individualized care. Copyright © 2026 Zhang et al. <34> Accession Number 2049566118 Title Evolocumab in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis of efficacy and safety. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 883. Date of Publication: 01 Dec 2026. Author Li S.; Zhang C.; Liu Y. Institution (Li, Zhang, Liu) Physical Examination Center, Hebei General Hospital, 348 Heping West Road, Hebei, Shijiazhuang, China Publisher BioMed Central Ltd Abstract Background: Evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, potently reduces low-density lipoprotein cholesterol. However, its effects on hard clinical endpoints and safety in patients with atherosclerotic cardiovascular disease (ASCVD) require updated synthesis, particularly incorporating data from recent long-term extension studies and diverse subpopulations. Objective(s): To systematically evaluate the efficacy and safety of evolocumab in patients with ASCVD. Method(s): PubMed, Embase, Cochrane Library, OVID, China National Knowledge Infrastructure (WANFANG MED ONLINE and CNKI), and ClinicalTrials.gov were systematically searched from January 2014 to March 2026. Randomized controlled trials (RCTs) comparing evolocumab with placebo in patients with ASCVD were included. The primary endpoint was major adverse cardiovascular events (MACE). A random-effects model was used for meta-analysis, with subgroup analyses, meta-regression, sensitivity analyses, and publication bias assessment. Result(s): Eight RCTs comprising 40,658 patients were included. Regarding lipid parameters, evolocumab significantly reduced levels of low-density lipoprotein cholesterol (LDL-C; standardized mean difference [SMD]: -2.546, 95% confidence interval [CI]: -3.024 to -2.067, P < 0.001), total cholesterol (TC; SMD: -1.543, 95% CI: -1.947 to -1.139, P < 0.001), apolipoprotein B (Apo B; SMD: -1.598, 95% CI: -2.169 to -1.027, P < 0.001), and lipoprotein(a) (Lp(a); SMD: -0.713, 95% CI: -0.938 to -0.489, P < 0.001) compared with placebo, but showed no significant effect on high-density lipoprotein cholesterol (HDL-C; SMD: 0.233, 95% CI: -0.058 to 0.524, P = 0.117) or triglycerides (TG; SMD: -0.315, 95% CI: -0.765 to 0.136, P = 0.171). For clinical endpoints, evolocumab significantly reduced the odds of MACE compared with placebo (OR: 0.416, 95% CI: 0.248-0.698, P < 0.001; I2 = 86.7%); however, the 95% prediction interval crossed unity (0.13-1.36), indicating uncertainty about the true effect in future studies. Myocardial infarction (OR: 0.711, 95% CI: 0.661-0.765, P < 0.001), stroke (OR: 0.774, 95% CI: 0.693-0.864, P < 0.001), and coronary revascularization (OR: 0.777, 95% CI: 0.734-0.821, P < 0.001) all showed significant odds reductions. Evolocumab significantly reduced odds of cardiovascular death (OR: 0.771, 95% CI: 0.657-0.904, P = 0.002) and all-cause mortality (OR: 0.852, 95% CI: 0.762-0.953, P = 0.004). Safety analysis indicated that injection site reactions were more common with evolocumab (OR: 1.33, 95% CI: 1.12-1.59, P < 0.01), with no significant differences in serious adverse events, neurocognitive events, muscle-related events, or liver function abnormalities. Conclusion(s): In the context of optimized background therapy, evolocumab significantly reduces the odds of MACE, myocardial infarction, and stroke, and improves multiple atherogenic lipid parameters in patients with ASCVD. Notably, significant reductions in both cardiovascular and all-cause mortality were also observed in this updated analysis. Its overall safety profile is favorable. Copyright © The Author(s) 2026. <35> Accession Number 2049554671 Title The Impact of Cardiac Rehabilitation on Psychosocial Factors, Functional Capacity, and Left Ventricular Function in Patients with Coronary Artery Disease: Systematic Review and Meta-Analysis. Source F1000Research. 13 (no pagination), 2026. Article Number: 575. Date of Publication: 2026. Author Harbi A.S.; Soh D.K.L.; Yubbu D.P.B.; Soh K.G. Institution (Harbi, Soh) School of Nursing, Applied Science Private University, Amman, Jordan (Yubbu) Department of Pediatrics, Universiti Putra Malaysia, Selangor, Serdang, Malaysia (Soh) Department of Sport Studies, Universiti Putra Malaysia, Selangor, Serdang, Malaysia Publisher F1000 Research Ltd Abstract Background: Cardiac rehabilitation is a multifaceted program implemented after adverse events. It aims at facilitating the return to normal life. This review aimed to examine the impact of cardiac rehabilitation on psychosocial risk factors, functional capacity, and left ventricular function. Method(s): The following databases: CINAHL, Scopus, PubMed, and Cochrane Library have been searched to retrieve the randomised controlled trials that investigate the effectiveness of cardiac rehabilitation versus usual care on anxiety, depression, peak oxygen consumption, six-minute walk distance, left ventricular ejection fraction, and left ventricular end-systolic and diastolic dimensions. Filters were set to retrieve trials published in the English Language between 2000 and 2024. Risk of bias was assessed using the Cochrane risk-of-bias tool (Rob2). Data were analysed meta-analytically. Result(s): Twenty-two (22) trials were included, randomised 2283 participants. A significant improvement favouring intervention groups was observed in anxiety SMD = -0.3890 (95% CI: -0.5640 to -0.2140; p0.001), depression SMD = -0.4032 (95% CI: -0.7114 to -0.0950; p= 0.002), peak oxygen consumption MD = 1.2471 (95% CI: 0.3963 to 2.0979; p = 0.004), six-minute walk distance MD = 36.0290 (95% CI: 7.7497 to 64.3082; p = 0.013), and left ventricular ejection fraction MD = 3.0650 (95% CI: 1.1279 to 5.0022; p = 0.001), Although cardiac rehabilitation had no significant effect in decreasing left ventricular end-diastolic dimension MD = -0.0480 (95% CI: -0.2609 to 0.1648; p = 0.658) and left ventricular end-systolic and MD = -0.0670 (95% CI: -0.2829 to 0.1489; p = 0.543) a favourable trend toward intervention group was seen. Risk of bias was high in 1 study and unclear in 7 studies. Conclusion(s): For patients with Coronary Artery Disease, cardiac rehabilitation demonstrated effectiveness in improving psychological symptoms such as anxiety and depression, functional capacity as measured by peak oxygen consumption and six-minute walk test, and left ventricular function. Copyright: © 2026 Harbi AS et al. <36> Accession Number 2050015638 Title Dual antiplatelet therapy versus aspirin alone after coronary artery bypass grafting: a systematic review and meta-analysis. Source General Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Shen B.; Xiang R.; Xie Y.; Wan J.; Jia L.; Zhang Y. Institution (Shen, Xie, Zhang) Department of Neurosurgery, Affiliated Hospital of Chengdu University, Sichuan, Chengdu, China (Shen, Xiang, Zhang) Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Sichuan, Chengdu, China (Xiang, Wan) Clinical Medical College, Affiliated Hospital of Chengdu University, Sichuan, Chengdu, China (Jia) Department of Neurosurgery, Shanxi Provincial People's Hospital, Shanxi, Taiyuan, China Publisher Springer Abstract Objective: To determine whether dual antiplatelet therapy improves survival and major ischemic outcomes, and whether it increases major bleeding, compared with aspirin alone after coronary artery bypass grafting. Method(s): PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to March 2026 for randomized controlled trials comparing aspirin plus a platelet adenosine diphosphate receptor inhibitor with aspirin alone after coronary artery bypass grafting. The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiovascular events, myocardial infarction, stroke, and major bleeding. Risk ratios were pooled with random-effects models. Result(s): Nine randomized trials involving 3,516 patients were included. Eight trials involving 3,496 patients reported all-cause mortality. Dual antiplatelet therapy was not associated with a significant reduction in all-cause mortality (risk ratio 0.77, 95% confidence interval 0.34-1.75), myocardial infarction (risk ratio 0.92, 95% confidence interval 0.56-1.50), stroke (risk ratio 0.68, 95% confidence interval 0.33-1.43), or major adverse cardiovascular events (four trials, 3,054 patients; risk ratio 0.69, 95% confidence interval 0.41-1.16). Major bleeding was increased in the primary analysis (risk ratio 2.28, 95% confidence interval 1.48-3.52), but this association was attenuated after exclusion of the largest contemporary trial. Conclusion(s): In randomized evidence, dual antiplatelet therapy did not clearly reduce mortality or major ischemic events after coronary artery bypass grafting compared with aspirin alone. Routine, unselected use is not supported, and individualized postoperative antiplatelet decisions remain warranted. Copyright © The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery 2026. <37> Accession Number 2045887955 Title Routine cerebral embolic protection during TAVR: A meta-analysis and trial sequential evidence from 11,000 randomized patients. Source Journal of Cardiology. 88(5) (pp 382-392), 2026. Date of Publication: 01 Nov 2026. Author Kholeif Z.; Mohamed A.E.; Elnady M.; Abomohsen M.; Alomari A.; Rashwan R.; Tahhan I.S.; Elnashar M.; Khalafallah M.A.; Sharaf M.; Gadelmawla A.F.; Afify R.; Awashra A.; Ali A.E.; Elkasaby H.; Kietselaer B. Institution (Kholeif, Kietselaer) Cardiology Department, Mayo Clinic, Rochester, MN, United States (Kholeif) Baptist Hospital of Southeast Texas, Beaumont, TX, United States (Mohamed, Sharaf, Afify) New York University, Langone Health, Manhattan, NY, United States (Elnady) Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt (Abomohsen) Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, United States (Alomari) Department of Clinical Medical Sciences, Yarmouk University Faculty of Medicine, Irbid, Jordan (Rashwan) Department of Internal Medicine, NYC Health and Hospitals/Lincoln, Bronx, NY, United States (Tahhan) Department of Internal Medicine, Wellington Regional Medical Center, Wellington, FL, United States (Elnashar) Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States (Khalafallah) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt (Awashra) Department of Medicine, An Najah National University, Nablus, Palestine (Ali) Department of Internal Medicine, Crestwood Medical Centre, Huntsville, AL, United States (Elkasaby) Newgiza University School of Medicine, Giza, Egypt Publisher Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) Abstract Objectives To perform an updated meta-analysis assessing the effect of routine cerebral embolic protection (CEP) use on the incidence of stroke-disabling and non-disabling-following transcatheter aortic valve replacement (TAVR). Methods Electronic databases were systematically searched through August 2025 for eligible randomized controlled trials (RCTs) comparing CEP versus no CEP in TAVR. The primary outcomes were the incidence of overall stroke, disabling stroke, and non-disabling stroke at 2-5 days and 30 days post-procedure. Random-effects model was used to estimate risk ratios (RR) with 95% confidence intervals (CI). Evaluation of the certainty of evidence was done following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Trial sequential analysis was performed to assess the conclusiveness and the reliability of the data. Results Eight RCTs, including 11,692 patients, were analyzed. No statistically significant difference was observed in overall stroke incidence between CEP and control groups at 2-5 days (RR = 0.95; 95% CI: 0.75-1.19; p = 0.64) or at 30 days (RR = 0.93; 95% CI: 0.57-1.53; p = 0.79). Disabling stroke rates were also similar at 2-5 days (RR = 0.70; 95% CI: 0.41-1.18; p = 0.18) and at 30 days (RR = 1.18; 95% CI: 0.36-3.87; p = 0.78). Non-disabling stroke showed no significant difference at either time point. Safety outcomes, including major bleeding, vascular complications, and acute kidney injury, were also not significantly different. Conclusion This updated meta-analysis found that a routine CEP strategy during TAVR was not associated with a statistically significant reduction in overall, disabling, or non-disabling stroke. The neutral effect on safety endpoints suggests a limited role for routine CEP use, although smaller benefits, device-specific effects, or benefits in selected higher-risk patients cannot be excluded. Copyright © 2026 Japanese College of Cardiology. <38> Accession Number 2049894657 Title Continuous-Flow Left Ventricular Assist Devices in Biventricular Configuration: A Systematic Review and Comparative Meta-Analysis of HeartMate 3 and HeartWare Biventricular Assist Devices. Source Artificial Organs. (no pagination), 2026. Date of Publication: 2026. Author Rahimov D.; Jones A.J.; Irondi C.O.; Nam Y.; Siddique F.; Storozynsky E.; Gibson G.T.; Joseph S.M.; Rajagopal K.; Hoopes C.W.; Tchantchaleishvili V. Institution (Rahimov, Jones, Irondi, Nam, Siddique, Rajagopal, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States (Storozynsky, Gibson, Joseph) Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, United States Publisher John Wiley and Sons Inc Abstract Background: Advanced biventricular heart failure may require durable biventricular assist device (BiVAD) support when heart transplantation is not immediately feasible or patients are ineligible for heart transplantation. We aimed to compare baseline characteristics, perioperative features, and clinical outcomes between patients supported with HeartMate 3-BiVAD (HM3-BiVAD) and HeartWare-BiVAD (HW-BiVAD). Method(s): A systematic search was performed in October 2025 across MEDLINE, Embase, Cochrane Library, Scopus, and CINAHL. We identified studies of adult patients supported with dual HeartMate 3 LVAD and HeartWare HVAD continuous-flow pumps in a BiVAD configuration. Study-level data were pooled to compare patients supported with HM3-BiVAD and those with HW-BiVAD. Result(s): The proportion of females was significantly lower among HM3-BiVAD patients [HM3: 4.8% (95% CI: 1.2, 17.1) vs. HW: 22.5% (16.8, 29.4), p = 0.02], whereas patient age was comparable between groups [HM3: 47 (43, 52) years vs. HW: 48 (45, 50) years, p = 0.9]. Chronic kidney disease [HM3: 57.1% (23, 85.6) vs. HW: 10.9% (4.6, 23.6), p = 0.01] was more common among HM3-BiVAD patients. Concomitant right ventricular assist device (RVAD) placement was the predominant approach across both groups [HM3: 66.2% (35.5, 87.4) vs. HW: 78.5% (70.1, 85), p = 0.36]. Right atrium was used more frequently as RVAD implantation site in the HM3-BiVAD group [HM3: 96.7% (63.4, 99.8) vs. HW: 33.9% (19, 52.9), p = 0.01], whereas the right ventricle predominated in the HW-BiVAD group [HM3: 3.2% (0.2, 36.6) vs. HW: 64.5% (45.2, 80.1), p = 0.01]. Overall survival was significantly higher among HM3-BiVAD patients [78.1% (49.3, 92.9)] compared to HW-BiVAD patients [48% (40.6, 55.4); p = 0.05]. The mean follow-up was 274 (200, 349) days in patients with HM3-BiVAD and 210 (143, 277) days in HW-BiVAD patients (p = 0.21). Conclusion(s): Patients with HW-BiVAD were characterized by a higher proportion of females and more frequent use of the RV as the RVAD implantation site, likely both due to the smaller device profile. HM3-BiVAD patients demonstrated higher post-implant survival despite a more severe preimplant clinical profile, suggesting a possible device-related advantage. Copyright © 2026 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <39> Accession Number 2049883615 Title Perioperative Blood Management in General Surgery: Recent Advances, Current Limitations, and the Emerging Role of Artificial Intelligence-A Narrative Review. Source International Journal of General Medicine. 19 (no pagination), 2026. Article Number: 640779. Date of Publication: 2026. Author Zhang L.; Liu G.; Guo S.; Wu Y.; Yu J.; Song X.; Jiang H. Institution (Zhang, Liu, Guo, Wu, Yu, Jiang) Department of General Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Heilongjiang, Mudanjiang, China (Song) Department of Pathology, Mudanjiang Cancer Hospital, Heilongjiang, Mudanjiang, China Publisher Dove Medical Press Ltd Abstract Patient blood management (PBM) is a patient-centered approach to blood use that aligns with modern medical practice. It is based on multidisciplinary collaboration and evidence-based medicine. Its aim is to improve clinical outcomes by correcting preoperative anemia, reducing perioperative blood loss, standardizing transfusion practices, and optimizing the management of coagulation function. Patients undergoing general surgery, particularly complex liver surgery or gastrointestinal cancer surgery, often face preoperative anemia, intraoperative bleeding, increased transfusion requirements, and postoperative coagulation abnormalities. These factors make perioperative blood management more complex. This narrative review searched PubMed, Web of Science, Google Scholar, and the China National Knowledge Infrastructure (CNKI) for relevant studies published over the past 10 years. It summarizes recent advances, current limitations, and challenges in the clinical translation of perioperative blood management in general surgery. This review focuses on the assessment and management of preoperative anemia, bleeding control and hemostatic strategies, transfusion management, coagulation monitoring, and thrombotic risk management. It also discusses recent advances and current limitations in the use of artificial intelligence (AI) and machine learning (ML) for risk prediction, clinical decision support, and individualized management. Current evidence suggests that PBM may help optimize perioperative care in general surgery. AI/ML may also support clinical decision-making by predicting bleeding risk, estimating transfusion requirements, and stratifying thrombotic risk. However, studies specifically focusing on general surgery patients remain limited. Most available evidence comes from cardiac surgery, orthopedics, or other surgical populations. In addition, current prediction models still have several limitations, including insufficient external validation, a lack of prospective evaluation, and limited interpretability. Therefore, these models should currently be used only as tools to support clinical judgment. Therefore, future studies should include more multicenter prospective research in general surgery populations. AI/ML-assisted decision support should also be further explored within standardized PBM pathways to improve the precision and standardization of perioperative blood management in general surgery. Copyright © 2026 Zhang et al. <40> Accession Number 2050880348 Title Optimizing Saphenous Vein Grafts: From Workhorse to an Evidence-Based Conduit Strategy. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Zhou Z.; Zhao J.; Wang Y.; Wu W. Institution (Zhou, Zhao, Wang, Wu) Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, China Publisher SAGE Publications Ltd Abstract Objective: The saphenous vein graft (SVG) remains the most common conduit in coronary artery bypass grafting (CABG) but suffers from inferior long-term patency compared with arterial grafts. This review evaluates the concept of viewing the SVG not as an inherently flawed conduit but as one that can be systematically optimized through evidence-based strategies. Method(s): A narrative review was conducted to address the following clinical question: "In patients undergoing CABG, how do contemporary surgical harvesting techniques, intraoperative preservation methods, and postoperative pharmacologic strategies interact to optimize the long-term patency of saphenous vein grafts?" We synthesized evidence from recent landmark randomized controlled trials and meta-analyses to define a comprehensive optimization strategy. Result(s): SVG failure is a cascade initiated by surgical trauma and propagated by hemodynamic stress. The "no-touch" harvesting technique, which preserves protective perivascular tissue, has demonstrated superior long-term patency in classic trials, although recent evidence has sparked debate regarding its universal reproducibility. Intraoperative preservation with endothelial-sparing solutions and aggressive postoperative pharmacotherapy-including high-intensity statins and tailored antiplatelet strategies-provide crucial secondary protection. Notably, when graft failure occurs, recent randomized evidence challenges the dogma of a strict "native vessel first" approach, supporting instead an individualized, anatomy-driven strategy that balances early procedural hazard against long-term durability. Conclusion(s): The SVG is an optimizable conduit. A modern, integrated approach-combining meticulous harvesting, biological preservation, and aggressive secondary prevention-can substantially improve graft durability. By shifting focus from simple conduit selection to comprehensive conduit optimization and appropriate patient-specific target selection, the Heart Team can significantly improve long-term cardiovascular outcomes. Copyright © The Author(s) 2026 <41> Accession Number 2050621569 Title Abbreviated Dual Antiplatelet Therapy in Patients With High Bleeding Risk Undergoing PCI of Bifurcation Lesions: A Prespecified Substudy of the MASTER DAPT Trial. Source Circulation: Cardiovascular Interventions. 19(10) (pp e016222), 2026. Date of Publication: 01 Oct 2026. Author Chevalier B.; Cao D.; Smits P.C.; Brunel P.; Frigoli E.; Heg D.; Higuchi Y.; Kauer F.; Landi A.; Lopes R.D.; Mainar V.; Mamas M.; Mateev H.; McDonald J.; McFadden E.P.; Mulassari A.; Munir S.; Polad J.; Reimers B.; Sardella G.; Ungi I.; von Birgelen C.; Weidinger F.; Paradies V.; Valgimigli M. Institution (Chevalier) Institut Cardiovasculaire Paris-Sud, Hopital Prive Jacques Cartier, Ramsay-Sante, Massy, France (Cao) Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy (Cao) Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy (Smits, Paradies) Department of Cardiology, Maasstad Hospital, Rotterdam, Netherlands (Brunel) Cardiology Department, Hopital Prive Dijon-Bourgogne, Dijon, France (Frigoli, Landi, Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland (Heg) Department of Clinical Research, University of Bern, Bern, Switzerland (Higuchi) Cardiovascular Division, Osaka Keisatsu Hospital, Japan (Kauer) Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, Netherlands (Landi, Valgimigli) Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (Lopes) Duke University Medical Center, Durham, NC, United States (Mainar) Hospital General Alicante, Spain (Mamas) Keele Cardiovascular Research Group, School of Medicine, Keele University, United Kingdom (Mateev) Department of Interventional Cardiology, National Heart Hospital, Sofia, Bulgaria (McDonald) Department of Cardiology, East Lancashire Hospitals National Health Service Trust, Royal Blackburn Hospital, Lancashire, Blackburn, United Kingdom (McFadden) Interventional Cardiology, Cork University Hospital, Ireland (Mulassari) The Madras Medical Mission Hospital, Chennai, India (Munir) Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom (Polad) Department of Cardiology, Jeroen Bosch Hospital, Den Bosch, Netherlands (Reimers) Cardio Center, Humanitas Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano-Milan, Italy (Sardella) Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy (Ungi) Division of Invasive Cardiology, Department of Internal Medicine, Center of Cardiology, University of Szeged, Hungary (von Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands (von Birgelen) Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands (Weidinger) 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria (Valgimigli) University of Bern, Switzerland Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Coronary stenting of bifurcation lesions has been associated with an increased risk of thrombotic events. However, the optimal duration of dual antiplatelet therapy (DAPT) after treatment of bifurcations, particularly among patients with high bleeding risk, is unknown. We aimed to evaluate the safety and efficacy of abbreviated DAPT in patients with high bleeding risk undergoing percutaneous coronary intervention (PCI) of bifurcation lesions. METHOD(S): - The MASTER DAPT trial (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Standard DAPT Regimen) randomized patients with high bleeding risk who were free from ischemic or bleeding events after 1 month of PCI to discontinue DAPT (abbreviated regimen) or continue DAPT for a minimum of 2 additional months (standard regimen). Coprimary outcomes were net adverse clinical outcomes events, major adverse cardiac and cerebral events, and BARC (Bleeding Academic Research Consortium) type 2, 3, or 5 bleeding at 335 days after randomization. This prespecified substudy evaluates the outcomes of abbreviated versus standard DAPT according to treatment of bifurcation lesions. RESULT(S): - Of the 4579 patients randomized, 976 (21.2%) underwent bifurcation PCI. Net adverse clinical event and major adverse cardiac and cerebral events did not differ between abbreviated and standard DAPT in both patients with (hazard ratio [HR], 0.98 [95% CI, 0.73-1.17] and HR, 0.92 [95% CI, 0.63-1.54], respectively) and without bifurcation PCI (HR, 1.14 [95% CI, 0.67-1.93] and HR, 0.96 [95% CI, 0.74-1.25]; P interaction=0.803 and 0.563, respectively). Abbreviated DAPT consistently reduced BARC 2, 3, or 5 bleeding in patients with (HR, 0.83 [95% CI, 0.53-1.30]) or without (HR, 0.65 [95% CI, 0.51-0.82]) bifurcation (P interaction=0.321). CONCLUSION(S): - Among patients with high bleeding risk with or without bifurcation PCI, abbreviated DAPT was associated with lower bleeding risk without an excess of ischemic or net adverse events compared with standard DAPT. REGISTRATION: - URL: https://www.clinicaltrials.gov; Unique identifier: NCT03023020. Copyright © 2026 American Heart Association, Inc. <42> Accession Number 2049882755 Title Drug-coated balloons in coronary disease: meta-analysis comparing sirolimus- and paclitaxel-coated technologies. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 965. Date of Publication: 01 Dec 2026. Author Ibraheem M.; Abouslima A.; Ebrahim A.; Ahmed S.; Elbahnasawy S.E.; Gamal M.H.; Ramadan N.; Adel M.; Elhady M.M. Institution (Ibraheem) Internal Medicine Trainee, University Hospitals Birmingham, Birmingham, United Kingdom (Abouslima) ACCS IM Trainee, Newcastle Upon Tyne, Lead Employer Trudom, Stella House, Goldcrest Way, Newburn Riverside, United Kingdom (Ebrahim) Cardiology Registrar, Ninewells Hospital, Dundee, United Kingdom (Ahmed) Acute Medicine, University Hospitals of Birmingham, Birmingham, United Kingdom (Elbahnasawy) Department of Diagnostic Radiology, Menofia University Hospital, Menofia, Egypt (Gamal) Faculty of Pharmacy, Tanta University, Gharbia, Egypt (Ramadan) Teaching assistant of medical biochemistry and molecular biology - Faculty of Medicine, Benha University, Qalubiya, Egypt (Adel) Faculty of Clinical Pharmacy, Tanta University, Gharbia, Egypt (Elhady) Faculty of Medicine, Benha University, Qalyubia, Egypt (Elhady) Cardiology Department, National Heart Institute, Giza, Egypt Publisher BioMed Central Ltd Abstract Background and aim: Drug-coated balloons (DCBs) are a key alternative to drug-eluting stents for coronary artery interventions, offering the advantage of drug delivery without permanent implants. Both paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs) are valuable treatment options. This systematic review and meta-analysis compare the efficacy and safety of sirolimus-coated versus paclitaxel-coated balloon catheters in patients with coronary artery disease. Method(s): We conducted a systematic review and meta-analysis following PRISMA guidelines, searching five databases. We exclusively included RCTs. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals were calculated using fixed-effects or random-effects models, with sensitivity analysis performed in cases of heterogeneity. Result(s): Eight trials involving 1043 patients were included. The meta-analysis demonstrated no significant difference between SCB and PCB for late lumen loss (MD 0.06, 95% CI [-0.02 to 0.14]). Only two outcomes showed statistically significant differences favoring PCB: reducing late lumen enlargement (RR 0.66, 95% CI [0.49-0.87], P = 0.004) and, after sensitivity analysis, lowering binary restenosis rates in de novo lesions Conclusion(s): This meta-analysis shows SCB and PCB have similar safety and efficacy in coronary artery interventions, with no significant differences in most outcomes. However, PCB outperforms late lumen enlargement and binary restenosis rates in de novo lesions. Similar outcomes across sirolimus formulations indicate other factors influence success. Both balloon types appear safe and effective, though PCB may retain certain advantages in specific scenarios. Larger, longer-term studies are needed to establish the optimal drug-coated balloon strategy for different patient populations. Clinical trial number: not applicable. Copyright © The Author(s) 2026. <43> Accession Number 2049885983 Title Closed Versus Open Vent Port Techniques and the Disconnection Technique for Optimizing Lung Collapse With Bronchial Blockers in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial. Source Clinical Respiratory Journal. 20(10) (no pagination), 2026. Article Number: e70235. Date of Publication: 01 Oct 2026. Author Yao J.; Chen Y.-J.; Shen F.-M.; Xie J.; Yang J.-J.; Huang L.-X.; Tan X.-X.; Yang Y.; Sun J. Institution (Yao, Chen, Shen, Xie, Yang, Huang, Tan, Yang, Sun) Department of Anesthesiology, Surgery and Pain Management, Zhongda Hospital, Southeast University, Jiangsu, Nanjing, China (Sun) Jiangsu Provincial Key Laboratory of Critical Care Medicine, Jiangsu, Nanjing, China Publisher John Wiley and Sons Inc Abstract Introduction: For patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer or other pulmonary lesions, effective one-lung ventilation (OLV) is essential to provide surgical exposure. Bronchial blockers (BBs) are increasingly used for OLV, but the optimal management of their vent port to accelerate lung collapse remains unclear. Method(s): In this prospective, randomized, controlled trial, 75 patients were allocated to three groups (n = 25 each): Group 1-BB with vent port closed; Group 2 (control)-BB with vent port open; Group 3-BB with the disconnection technique. Primary outcome was the time to complete lung collapse, which was scored according to the video clips obtained during the operation. Secondary outcomes included intraoperative hypoxemia, blood gas analysis, blocker malposition, perioperative complications, and surgeon satisfaction. Result(s): A total of 72 patients were included in the modified intention-to-treat analysis, with 24 patients in each group. Median time to complete lung collapse was 15 min (95% CI: 10-15) in Groups 1 and 3 but was not reached in Group 2 (15/24, 62.5% had not achieved complete collapse by 30 min). In an exploratory 30-min restricted mean survival time (RMST), complete collapse occurred on average 14.17 min earlier in Group 1 (95% CI: 11.10-17.23) and 12.50 min earlier in Group 3 (95% CI: 9.62-15.38) than in Group 2, with no difference between Groups 1 and 3 (1.67 min, 95% CI: -1.85 to 5.19); time-averaged hazard ratios were consistent (Group 1 vs. 2, 9.80 [4.22-22.73]; Group 3 vs. 2, 7.63 [3.36-17.31]; Group 1 vs. 3, 1.20 [0.67-2.16]). No significant differences were detected in hypoxemia, blocker malposition, or complications across groups; however, the trial was not powered for safety outcomes. Conclusion(s): In patients aged 18-65 years with ASA I-II and normal pulmonary function undergoing thoracic surgery, the closure of the BB vent port results in a more rapid lung collapse compared to maintaining the vent port open. However, there was no statistically significant difference observed between the vent port closure technique and the disconnection technique regarding the time required for complete lung collapse. Trial Registration: ChiCTR identifier: ChiCTR2000039896. Copyright © 2026 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd. <44> Accession Number 2050339323 Title Percutaneous left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation: A pragmatic meta-analysis of randomized trials within the DOAC era. Source American Heart Journal Plus: Cardiology Research and Practice. 71 (no pagination), 2026. Article Number: 100942. Date of Publication: 01 Nov 2026. Author Kuniyoshi G.M.; Campane R.Z.; Patil N.; de Oliveira A.C.V.; Araujo B.; Kuniyoshi R.R. Institution (Kuniyoshi) Department of Medicine, Escola Superior de Ciencias da Santa Casa de Misericordia de Vitoria (EMESCAM), 2190 Nossa Senhora da Penha Avenue, Vitoria, Brazil (Campane) Department of Medicine, Hospital Regional Hans Dieter Schimidt, 330 Xavier Arp Street, Joinville, Brazil (Patil) Hospitalist Department, Cape Fear Valley Health, 1638 Owen Drive, Fayetteville, NC, United States (de Oliveira) Department of Medicine, Universidade Federal de Lavras, Trevo Rotatorio Professor Edmir Sa Santos, Lavras, Brazil (Araujo) Department of Medicine, Universidade Nove de Julho, 90 Dom Jaime de Barros Camara Avenue, Sao Bernardo do Campo, Brazil (Kuniyoshi) Department of Cardiac Arrhythmias, Centrocor, 60 Alfeu Alves Pereira Street, Vitoria, Brazil (Kuniyoshi) Department of Cardiac Arrhythmias, Vitoria Apart Hospital, 591 Governador Mario Covas, Serra, Brazil (Kuniyoshi) Department of Electrophysiology, Hospital Universitario Cassiano Antonio Moraes (HUCAM), Universidade Federal do Espirito Santo (UFES), 1355 Marechal Campos Avenue, Vitoria, Brazil Publisher Elsevier Inc. Abstract Background: Percutaneous left atrial appendage occlusion (LAAO) is an established alternative to oral anticoagulation (OAC). However, its safety and efficacy boundaries remain incompletely defined in dedicated comparisons against direct oral anticoagulants (DOACs). Objective(s): This study applied a pragmatic framework to evaluate the comparative efficacy and safety of LAAO versus OAC in a DOAC-predominant setting. Method(s): PubMed, Embase, and Cochrane Library were searched for randomized controlled trials comparing LAAO with OAC, restricted to a DOAC-predominant comparator. Risk ratios (RR) with 95% confidence intervals (CI) were calculated via a Mantel-Haenszel random-effects model. Result(s): Four trials comprising 5890 patients were included (96.4% of controls assigned to DOACs). Overall stroke (RR 1.18, 95% CI 0.87-1.60; p = 0.28), systemic embolism (RR 1.09, 95% CI 0.29-4.08; p = 0.89), major bleeding (RR 0.98, 95% CI 0.81-1.19; p = 0.85), hemorrhagic stroke (RR 0.82, 95% CI 0.45-1.51; p = 0.53), and all-cause mortality (RR 1.00, 95% CI 0.85-1.17; p = 0.99) did not differ significantly. Ischemic stroke presented numerical asymmetry favoring OAC that approached statistical significance (RR 1.36, 95% CI 0.99-1.89; p = 0.06). Conversely, within available protocol-defined datasets, LAAO significantly reduced nonprocedural clinically relevant bleeding (RR 0.50, 95% CI 0.43-0.60; p < 0.01). Conclusion(s): In a pragmatic analysis of the DOAC era, randomized data show no statistically significant differences for hard individual endpoints, though broad confidence intervals reflect precision limits. A numerical asymmetry for ischemic stroke favored OAC, while LAAO reduced nonprocedural clinically relevant bleeding. Current evidence remains non-definitive, warranting shared clinical decision-making to balance individual thromboembolic risks against long-term bleeding susceptibility. Copyright © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/ <45> Accession Number 2038725816 Title Inspiratory Muscle Strength After Threshold Inspiratory Muscle Training Versus Incentive Spirometry in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Source Natural Resources for Human Health. 6(13S) (pp 1236-1246), 2026. Date of Publication: 11 Sep 2026. Author Hadju M.F.; Warliani M.; Aritonang S.E.; Zainuddin A.A.; Waluyo Y.; Kusumanegara J. Institution (Hadju, Warliani, Aritonang, Waluyo) Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, South Sulawesi, Makassar, Indonesia (Zainuddin) Department of Public Health, Faculty of Medicine, Hasanuddin University, South Sulawesi, Makassar, Indonesia (Kusumanegara) Department of Thoracic, Cardiac, and Vascular Surgery, Faculty of Medicine, Hasanuddin University, South Sulawesi, Makassar, Indonesia Publisher Visagaa Publishing House Abstract Respiratory dysfunction after coronary artery bypass grafting (CABG) may reduce inspiratory muscle strength and affect health-related quality of life. This single-center, assessor-blinded randomized controlled trial compared threshold inspiratory muscle training (IMT) with incentive spirometry (IS) in 30 adults undergoing elective CABG. Participants were randomized 1:1 to IMT or IS. IMT was performed for five preoperative days and IS for two days; both interventions were resumed after extubation and continued until discharge. Preoperative Strength Index (S-Index) was analyzed using ANCOVA adjusted for baseline values, while SF-12 Physical and Mental Component Summary scores were assessed at baseline, discharge, and 30 days. After baseline adjustment, preoperative S-Index was significantly higher with IMT than IS (85.85 vs 75.48 cmHO; adjusted mean difference 10.37 cmHO, 95% CI 2.52-18.22; p=0.012; partial eta2=0.214). PCS-12 and MCS-12 changed significantly over time (both p<0.001), but time-by-group interactions were not significant (p=0.621 and p=0.174, respectively). Hospital stay (9.60 vs 11.93 days; p=0.004) and ICU stay [median 2.0 vs 4.0 days; p=0.027] were shorter with IMT, although these were exploratory outcomes. Threshold IMT produced greater short-term preoperative improvement in dynamic inspiratory muscle strength than IS, while health-related quality-of-life trajectories did not differ between groups. Copyright © 2026, Visagaa Publishing House. All rights reserved. <46> Accession Number 2050732994 Title Long-term outcomes of myocardial revascularization using I-graft and no-touch saphenous vein grafting: results of a randomized controlled trial. Source Clinical and Experimental Surgery. 14(3) (pp 23-32), 2026. Date of Publication: 2026. Author Makaev A.G.; Khvan D.S.; Sirota D.A.; Zhulkov M.O.; Agaeva K.A.; Bogachev-Prokophiev A.V.; Semagin A.A.; Aminov V.V.; Bazylev V.V.; Tungusov D.S.; Zotov A.S.; Sakharov E.R.; Shelest O.O.; Semchenko A.N.; Kovliakov V.A.; Rosseikin E.V. Institution (Makaev, Khvan, Sirota, Zhulkov, Agaeva, Bogachev-Prokophiev) Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation (Sirota) Novosibirsk State Medical University, Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation (Semagin, Aminov) Federal Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Chelyabinsk, Russian Federation (Bazylev, Tungusov) Federal Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation (Penza), Penza, Russian Federation (Zotov, Sakharov, Shelest) Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological Agency of Russia, Moscow, Russian Federation (Semchenko, Kovliakov, Rosseikin) Federal Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Khabarovsk, Russian Federation Publisher Geotar Media Publishing Group Abstract Aim. To evaluate the long-term outcomes of myocardial revascularization using I-grafts and no-touch saphenous vein grafting within a randomized controlled trial, assessing graft patency, the incidence of major adverse cardiac and cerebrovascular events (major adverse cardiovascular and cerebrovascular events, MACCE), leg wound complications, and mortality at 6- and 12-month follow-up. Material and methods. This prospective multicenter randomized study included 106 patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) at five federal centers between 2023 and 2024. Patients were randomized using the envelope method into two groups: in the first group (I-graft, n = 53), revascularization of the right coronary artery was performed using an I-composite graft based on the internal thoracic artery and a no-touch saphenous vein; in the second group (Conv, n = 53), a free no-touch saphenous vein graft with a proximal anastomosis to the aorta was used. The primary endpoint was graft patency at 12 months based on multislice computed tomography data. Secondary endpoints included MACCE incidence, mortality, and leg wound complications at 6 and 12 months of follow-up. Results. At 6 months post-CABG, no myocardial infarctions or repeat revascularizations were recorded. In the I-graft group, 2 strokes (4.3%) occurred, compared to none in the Conv group (p = 0.23); mortality was 0% in both groups. There were no statistically significant differences between groups regarding discomfort or numbness at the vein harvesting site. At 12 months, high graft patency rates were maintained: 91.9% in the Conv group and 89.1% in the I-graft group (p = 0.73). No myocardial infarctions or repeat revascularizations were identified. Mortality was 4.1% (n = 2) in the I-graft group and 2.3% (n = 1) in the Conv group (p = 1.0). The incidence of local complications at the vein harvesting site also showed no statistical difference between the studied groups. Conclusion. Within 12 months after surgery, the I-graft technique and the free no-touch saphenous vein graft demonstrated comparable clinical efficacy and high patency. Thus, the composite I-graft can be considered a safe and reliable alternative to traditional aortocoronary venous grafting for multivessel myocardial revascularization. Copyright All articles in our journal are distributed under the CC BY-NC-ND 4.0 (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) https://creativecommons.org/licenses/by/4.0/deed.en <47> Accession Number 2049913642 Title Fully biodegradable ventricular septal defect occluders: from biomaterials to clinical translation. Source Cardiovascular Intervention and Therapeutics. (no pagination), 2026. Date of Publication: 2026. Author Yang L.; Pang G.-Y.; Wang X.-J.; Wang R.-Q.; Bai Z.-X.; Zhang S.; Liu S.-F.; Song J.-W.; Lu T.-Y.; Shan X.-H.; Bai Y.; Guo Z.-F.; Qin Y.-W.; Zhu N. Institution (Yang, Pang, Wang, Wang, Liu, Song, Lu, Shan, Bai, Guo, Qin, Zhu) Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai, China (Bai, Zhang) Department of Clinical Medicine, Naval Medical University, 800 Xiangyin Road, Shanghai, China Publisher Springer Abstract Ventricular septal defect (VSD) is the most prevalent congenital heart disease (CHD), which is approximately 20% of all congenital cardiac defects. Although transcatheter closure of VSD is a favorable alternative to traditional open-heart surgery, conventional nitinol-based occluders carry permanent risks of atrioventricular conduction disturbances, device erosion, and nickel allergy, which precluded regulatory approval in the United States for perimembranous VSD. Fully biodegradable occluders represent an attractive solution, offering equivalent closure efficacy while eliminating the long-term risks due to a permanent metallic implant. Owing to favorable endothelization-degradation kinetics, biocompatibility, and mechanical performance, polydioxanone (PDO) and poly-L-lactic acid (PLLA) have emerged as the superior framework and membrane materials, respectively. Clinical evidence from case series, retrospective cohort studies, and a multicenter randomized controlled trial suggests high procedural success and favorable short- to mid-term safety, with a low incidence of conduction disturbances following biodegradable VSD occluder implantation. In 2022, the National Medical Products Administration (NMPA) of China has granted regulatory approval for the MemoSorb device, which represents the first clinical available fully biodegradable VSD occluder. This review focuses on biomaterials science, structural design principles, preclinical animal studies, and the emerging clinical evidence of fully biodegradable VSD occluder. Copyright © The Author(s) under exclusive licence to Japanese Association of Cardiovascular Intervention and Therapeutics 2026. <48> Accession Number 2050953793 Title Transcatheter versus surgical closure of CHDs in predominantly pediatric populations: a systematic review of comparative and single-arm evidence. Source Cardiology in the Young. (pp 1-22), 2026. Date of Publication: 2026. Author Majed A.; Kmeid P.; Safa A.; Kahwaji H.; Naamani A.E.R.; El-Atat M.; Ossaily A.; Ghanem G. Institution (Majed, Kmeid, Safa, Kahwaji, Naamani, El-Atat) LAU Gilbert and Rose-Marie Chagoury School of Medicine, Lebanon (Ossaily, Ghanem) Lebanese American University Medical Center-Rizk Hospital, Lebanon Publisher Cambridge University Press Abstract Background: - Transcatheter closure increasingly replaces surgery for congenital heart defects (CHDs), but comparative evidence comes almost entirely from atrial septal defect. We asked whether its trade-offs hold for other lesions in predominantly pediatric cohorts. Method(s): - We searched PubMed, Embase, and Cochrane CENTRAL to June 2026 for cohorts with mean or median age under 18 years (PRISMA 2020). Only direct comparisons informed comparative conclusions. Narrative synthesis was stratified by lesion, with sensitivity analyses for mixed-age cohorts and adverse-event definitions. Result(s): - Six of eleven studies compared both approaches (1, 158 transcatheter, 490 surgical patients), in atrial septal defect, patent ductus arteriosus, and coronary artery fistula; none addressed muscular ventricular septal defect. Procedural success was high with both. Hospital stay was shorter after transcatheter closure in all six (2.4-4.4 days in atrial septal defect), the most consistently observed finding. Major adverse events were less frequent after transcatheter closure in atrial septal defect, but arms differed in age and weight, and the difference was inconsistent in wholly pediatric cohorts; in coronary artery fistula, one study at serious risk of bias found them over twice as frequent after transcatheter closure. Where both arms were followed, reintervention was uncommon in each. GRADE certainty was low for hospital stay and procedural success, otherwise very low. Conclusion(s): - Shorter hospital stay after transcatheter closure is the most consistently observed finding, at low certainty. Neither approach is shown to be safer: safety findings differed between lesions and, beyond atrial septal defect, rest on single studies. Lesion anatomy determines which approach applies. Copyright © The Author(s), 2026. Published by Cambridge University Press <49> Accession Number 2049163773 Title Long-Term Outcomes Following Bilateral vs Single Internal Thoracic Artery Grafts: A Secondary Analysis of a Randomized Clinical Trial. Source JAMA Cardiology. 11(10) (pp 925-931), 2026. Date of Publication: 14 Oct 2026. Author Taggart D.P.; Gaudino M.; Gerry S.; Jasinski M.; Lees B.; Gray A.M.; Zamvar V.; Deja M.; Seevanayagam S.; De Moraes Neto F.R.; Konstanty-Kalandyk J.; Pawlaczyk R.; Sajja L.R.; Actis Dato G.; Guazzelli A.; Cook J.; Wallis C.; Benedetto U.; Puskas J.D.; Flather M.; Wos S.; Mehta D.; O'Keefe P.; Trivedi U.; Clark S.; Bochenek A.; Hasan R.; Keenan D.; Deshpande R.; Desai J.; Garner L.; Choong C.; Nair S.; Sudarshan C.; Cale A.; Zakkar M.; Spyt T.; Gaer J.; Sadowksi J.; Kapelak B.; Gaweda B.; Petrou M.; Pepper J.; Chandrasekaran V.; Mannam G.; Briffa N.; Casabona R.; Kuduvali M.; Dihmis W.; Anisimowicz L.; Podesser B.; Meharwal Z.; Trehan N.; Hrapkowicz T.; Widenka K. Institution (Taggart, Lees, Wallis) Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States (Gerry) Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, United Kingdom (Jasinski) Department of Cardiac Surgery, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland (Jasinski) Department of Pediatric Cardiothoracic Surgery, Children Memorial Health Institute, Warsaw, Poland (Gray) Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (Zamvar) Department of Cardiac Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom (Deja) Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland (Deja) Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland (Seevanayagam) Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Melbourne, VIC, Australia (De Moraes Neto) Department of Cardiac Surgery, Federal University of Pernambuco, Recife, Brazil (Konstanty-Kalandyk) Department of Cardiovascular Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland (Pawlaczyk) Department of Cardiac Surgery, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland (Sajja) Division of Cardiothoracic Surgery, STAR Hospitals, Hyderabad, India (Actis Dato) Department of Cardiac Surgery, Mauriziano Hospital, Turin, Italy (Guazzelli, Cook) Surgical Intervention Trials Unit (SITU), Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom (Benedetto) Division of Cardiac Surgery, University G.d'Annunzio Chieti-Pescara, SS Annunziata Hospital, Chieti, Italy (Puskas) Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, United States (Flather) Norwich Medical School, University of East Anglia and Norfolk, Norwich University Hospital, Norwich, United Kingdom (Wos, Bochenek) Medical University of Silesia, Katowice, Poland (Mehta, O'Keefe) University Hospital of Wales, Cardiff, United Kingdom (Widenka) Szpital Wojewodzki 2, Rzeszow, Poland (Trivedi) Royal Sussex County Hospital, Brighton, United Kingdom (Clark) Freeman Hospital, Newcastle, United Kingdom (Hasan, Keenan) Royal Infirmary of Manchester, Manchester, United Kingdom (Deshpande, Desai) King's College Hospital, London, United Kingdom (Hrapkowicz) Silesian Centre for Heart Disease, Zabrze, Poland (Garner, Choong, Nair, Sudarshan) Royal Papworth Hospital, Cambridge, United Kingdom (Meharwal, Trehan) Escorts Heart Institute, New Delhi, India (Podesser) Landesklinikum, St Polten, Center for Biomedical Research, Medical University of Vienna, Vienna, Austria (Anisimowicz) Szpital Uniwersytecki, Bydgoszcz, Poland (Cale) Castle Hill Hospital, Hull, United Kingdom (Zakkar, Spyt) Glenfield Hospital, Leicester, United Kingdom (Kuduvali, Dihmis) The Cardiothoracic Centre, Liverpool, United Kingdom (Gaer) Harefield Hospital, London, United Kingdom (Sadowksi, Kapelak, Gaweda) John Paul II, Krakow, Krakow, Poland (Casabona) Ospedale Mauriziano, Turin, Italy (Briffa) Northern General Hospital, Sheffield, United Kingdom (Petrou, Pepper) Royal Brompton Hospital, London, United Kingdom (Chandrasekaran) St George's Hospital, London, United Kingdom (Mannam) Care Hospital, Hyderabad, India Publisher American Medical Association Abstract Importance: Bilateral internal thoracic artery grafting has been proposed to improve survival compared to standard single internal thoracic artery grafting during coronary artery bypass graft (CABG) surgery, but any survival benefit may emerge only with longer-term follow-up. Objective(s): To report 15-year extended follow-up of a randomized clinical trial of bilateral vs single internal thoracic artery grafting for CABG. Design, Setting, and Participant(s): This is a secondary analysis of an unblinded randomized clinical trial that took place at 28 cardiac surgery centers in 7 countries between June 2004 and December 2007, with 15-year follow-up reported after 2025. Patients scheduled for CABG on clinical grounds were eligible. Those requiring only single grafts or concomitant valve surgery, as well as those with a history of previous CABG, were excluded. All 3102 patients in the original trial provided data for this analysis, while 3042 completed the full 15-year follow-up. Data were analyzed from January to March 2026. Intervention(s): If patients fulfilled all the eligibility criteria and provided written informed consent, they were randomly assigned to bilateral or single internal thoracic artery grafts with vein or radial artery grafts used in both groups as clinically indicated. Main Outcomes and Measures: All-cause mortality at 15 years. The composite of all-cause mortality, myocardial infarction, or stroke was a secondary outcome. Result(s): A total of 1548 patients were randomized to bilateral internal thoracic artery grafts and 1554 to single internal thoracic artery grafts. The mean (SD) age was 64 (9) years and 446 (15%) were female. In the bilateral graft group, 215 (14%) received only a single arterial graft, while in the single graft group, 359 (23%) also received a radial artery graft. At 15 years, vital status was known for 3039 patients (98%). There were 585 deaths (37.8%) in the bilateral graft group and 584 (37.6%) in the single graft group (hazard ratio [HR], 1.00; 95% CI, 0.89-1.12; P =.97). Secondary outcome event rates were 43.9% and 45.8%, respectively (HR, 0.94; 95% CI, 0.85-1.05). Conclusions and Relevance: There was no difference in all-cause mortality at 15 years between patients undergoing CABG who were randomized to bilateral vs single internal thoracic artery grafts in an intention-to-treat analysis. Given the high rate of potential postrandomization confounders (eg, crossovers and use of radial arteries), the multiple arterial graft hypothesis still needs to be tested in randomized clinical trials. Copyright © 2026 American Medical Association. <50> Accession Number 2049881146 Title Clinical prediction models in cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis. Source Critical Care. 30(1) (no pagination), 2026. Article Number: 540. Date of Publication: 01 Dec 2026. Author Lasa-Berasain P.; Torrecilla Ugarte A.; Juarez-Vela R.; Ibanez-Beroiz B.; Ansotegui Hernandez A.; Sadaba R.; Barado Hualde J. Institution (Lasa-Berasain) Department of Intensive Care Medicine, Reina Sofia Hospital, Navarre, Tudela, Spain (Lasa-Berasain, Sadaba, Barado Hualde) Public University of Navarre (UPNA), Navarre, Pamplona, Spain (Torrecilla Ugarte) Department of Internal Medicine, Garcia Orcoyen Hospital, Navarre, Estella, Spain (Juarez-Vela) Faculty of Health Sciences, GRUPAC Research Group, University of La Rioja, La Rioja, Spain (Ibanez-Beroiz) Methodology Unit, Navarrabiomed-UPNA, Navarre, Spain (Sadaba) Cardiovascular Translational Research, Navarrabiomed (Fundacion Miguel Servet); Instituto de Investigacion Sanitaria de Navarra (IdiSNA); University Hospital of Navarre, Navarre, Spain (Ansotegui Hernandez, Barado Hualde) Department of Intensive Care Medicine, University Hospital of Navarre, Navarre, Pamplona, Spain Publisher BioMed Central Ltd Abstract Purpose: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent postoperative complication associated with substantial morbidity and mortality. Clinical prediction models (CPM) may identify high-risk patients enabling targeted preventive interventions and improved outcomes. The objective of the study was to identify available CPMs for the risk of developing CSA-AKI and summarize their performance. Method(s): A systematic search of studies published in Pubmed, Scopus, the Chocrane Library and Web of Science was conducted, including studies that developed or validated CPMs for CSA-AKI in adult patients undergoing cardiac surgery with cardiopulmonary bypass. Data were extracted by two independent reviewers. Summary measures of diagnostic performance were calculated when feasible using random-effects models. Calibration and sensitivity analyses were also performed. Result(s): The pooled incidence of CSA-AKI was 26.3% (95% CI, 26.0-26.4), whereas CSA-AKI requiring renal replacement therapy (CSA-AKI RRT) occurred in 2.2% of patients (95% CI, 2.1-2.2). Among validated CPMs, Thakar 2005 demonstrated the best predictive performance for CSA-AKI RRT: pooled AUC 0.80 (95% CI, 0.77-0.82), sensitivity of 0.87, and a specificity of 0.49 at a threshold of >= 3 points. Calibration analyses indicated underestimation of risk. The Mehta 2006 and Wijeysundera 2007 models also demonstrated good discrimination. Discrimination for the prediction of milder stages of CSA-AKI was poorer, but newer models such as the Demirjian 2022 model showed promising performance. Conclusion(s): Accurate and well-validated CPMs can facilitate risk stratification for CSA-AKI which can influence clinical practice and research. Thakar 2005 demonstrated very good discrimination for predicting CSA-AKI RRT, whereas more validation studies for the prediction of milder stages of CSA-AKI are warranted. Copyright © The Author(s) 2026. <51> Accession Number 2049898298 Title SGLT2 inhibitor therapy following aortic valve intervention for aortic stenosis: a systematic review and meta-analysis of mortality, heart failure, rhythm, renal, and valve-related outcomes. Source Journal of Cardiothoracic Surgery. 21(1) (no pagination), 2026. Article Number: 838. Date of Publication: 01 Dec 2026. Author Megantara H.P.; Dakota I.; Taofan T.; Indrian S.; Aurora R.G.; Adiarto S. Institution (Megantara) Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia (Megantara, Dakota, Taofan, Indrian, Aurora, Adiarto) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia Publisher BioMed Central Ltd Abstract Background: Residual mortality and heart-failure events remain common after aortic valve intervention for severe aortic stenosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in heart-failure, diabetes, and chronic kidney disease populations, but their role following transcatheter or surgical aortic valve intervention remains uncertain. Method(s): PubMed, Scopus, ScienceDirect, Cochrane Library, citation tracking, and manually identified eligible studies were screened through June 2026 for randomized and observational studies comparing SGLT2i with usual care or no SGLT2i after aortic valve intervention. The review was registered in PROSPERO (CRD420251059332). Eligible populations included TAVR, SAVR, and bioprosthetic aortic valve evidence where available. Adjusted hazard ratios (HRs) were pooled using random-effects models while non-HR estimates and non-comparable endpoints were summarized narratively. Result(s): Twelve eligible reports were included, comprising one randomized trial and 11 observational studies. Most time-to-event estimates were reported from TAVR cohorts; two SAVR-only studies and one mixed bioprosthetic AVR study added complementary surgical and valve-durability data. In the pooled time-to-event analysis, SGLT2i use was associated with lower all-cause mortality (HR 0.69, 95% CI 0.60-0.79; I2=5%; p < 0.001). The study-defined composite clinical outcome was also lower (HR 0.68, 95% CI 0.53-0.89; I2=57%; p = 0.005), although component definitions differed across studies. Estimates for heart-failure hospitalization or exacerbation, atrial fibrillation, and acute kidney injury were not statistically significant. Conclusion(s): SGLT2i use after aortic valve intervention was associated with lower all-cause mortality in pooled time-to-event analysis. SAVR data were clinically informative but were not sufficiently homogeneous for separate quantitative pooling. Findings for composite, heart-failure, rhythm, renal, and valve-related outcomes remain less certain. Dedicated randomized trials are needed to confirm whether the observed association reflects a treatment effect and to define patient selection, treatment timing, and peri-procedural safety. Copyright © The Author(s) 2026. <52> Accession Number 2048182122 Title Coronary Artery Bypass Grafting Based on Computed Tomography-Derived Fractional Flow Reserve vs Angiography (CABG-COREA trial): Early Results. Source Annals of Thoracic Surgery. 122(5) (pp 1233-1241), 2026. Date of Publication: 01 Nov 2026. Author Kim M.-S.; Ryu A.-J.; Kim J.W.; Lee C.H.; Hwang S.W.; Kim K.-B. Institution (Kim, Kim, Lee, Hwang, Kim) Cardiovascular Center, Myongji Hospital, Gyeonggido, South Korea (Kim) Hanyang University College of Medicine, Seoul, South Korea (Ryu) AiMEDiC, Seoul, South Korea Publisher Elsevier Inc. Abstract Background This randomized trial was designed to compare 1-year outcomes in patients who received revascularization on the basis of computed tomography-derived fractional flow reserve (CT-FFR) vs quantitative coronary angiography (QCA). In this early analysis, early angiographic and clinical outcomes were compared. Methods A total of 106 patients were randomized to undergo coronary artery bypass grafting on the basis of CT-FFR (n = 53) or QCA (n = 53). Complete revascularization was achieved for coronary arteries with CT-FFR <=0.78 (CT-FFR group) or those with QCA stenosis (>70% stenosis for left and >=90% stenosis for right coronary artery territories; QCA group). Angiography was performed at median 1 (1-1) postoperative day in all patients. Angiographic findings of graft flow were categorized as perfectly patent, competitive (bidirectionally or unidirectionally competitive), or occluded. Results There were no differences in patient characteristics between the groups. The average number of revascularized coronary arteries per patient was 3.7 +/- 0.8 in the CT-FFR group and 3.5 +/- 0.7 in the QCA group ( P = .089). The median difference in expected anastomosis sites was 2 (1-3). There was no operative mortality and no difference in morbidities between the groups. The number of perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts was 167 (85.2%), 10 (5.1%), and 19 (9.7%), respectively, in the CT-FFR group (n = 196) and 133 (72.7%), 23 (12.6%), and 27 (14.8%), respectively, in the QCA group (n = 183). There was a significant difference in the number of perfectly patent grafts between the groups ( P = .007). Conclusions The average number of distal anastomoses was similar between the groups. However, the number of competitive grafts was significantly reduced in the CT-FFR group compared with the QCA group. Copyright © 2026 The Society of Thoracic Surgeons. <53> Accession Number 2049886989 Title Randomized pilot trial of intraoperative hemoadsorption in clopidogrel treated patients undergoing urgent coronary artery bypass grafting. Source Journal of Cardiothoracic Surgery. 21(1) (no pagination), 2026. Article Number: 837. Date of Publication: 01 Dec 2026. Author Jahangirifard A.; Mirtajani S.B.; Al-Aamri I.; Al-Lawati K.; Hosseinzadeh M.; Wendt D.; Deliargyris E.N.; Mandegar M.H. Institution (Jahangirifard) National Heart Center, Royal Hospital, Muscat, Oman (Jahangirifard, Mirtajani, Hosseinzadeh) Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Al-Aamri, Al-Lawati) Cardiac anesthesia consultant, National Heart Centre, Royal hospital, Muscat, Oman (Al-Lawati) McMaster University, Hamilton, ON, Canada (Wendt) CytoSorbents Europe GmbH, Muggelseedamm 131, Berlin, Berlin, Germany (Wendt) University Hospital Essen, Hufelandstr. 55, Essen, Germany (Deliargyris) CytoSorbents Inc, 305 College Road, Princeton, NJ, United States (Mandegar) Department of Cardiac Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher BioMed Central Ltd Abstract Background: Patients receiving clopidogrel who undergo urgent CABG before the recommended 5-day washout period are at increased risk of perioperative bleeding. This study evaluated whether intraoperative hemoadsorption can reduce bleeding in such patients. Method(s): Patients undergoing CABG within 24 h of clopidogrel discontinuation were randomized 1:1 to intraoperative hemoadsorption (Group 1) or control (Group 2). In the intervention group, the device was incorporated into the cardiopulmonary bypass (CPB) circuit. Efficacy was assessed by 24-hour chest tube drainage (CTD), blood product transfusions and surgical revisions for bleeding control. Result(s): A total of 50 patients were randomized (mean age 64 +/- 8.6 years, 82% male). There were no differences in baseline characteristics between groups. Group 1 showed significantly reduced median 24-hr CTD of 300mL [250-400] vs. 500mL [400-700], p = 0.0003, transfusions of packed red blood cells 0 [0-1] vs. 1 [0-2] units, p = 0.047), fresh frozen plasma 0 [0-0] vs. 2 [2-3] units, p < 0.0001) and platelets 0 [0-0] vs. 2 [1-3] units, p < 0.0001 compared with Group 2. One revision for bleeding control occurred in Group 2 (4.0%). No device-related serious adverse events were observed. Conclusion(s): In this cohort of clopidogrel-treated patients undergoing CABG within 24 h of discontinuation, intraoperative hemoadsorption was associated with lower postoperative bleeding and transfusion requirements. Copyright © The Author(s) 2026. <54> Accession Number 2049891386 Title Pneumothorax rates following cardiac surgery with versus without continuous serratus anterior plane catheters: a secondary analysis of trial data with propensity score matching to a historic cohort. Source Canadian Journal of Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Saeed H.; Kang S.; Uppal V.; Ho L.; Herman C.; Bailey J.G. Institution (Saeed) Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Saskatchewan, Saskatoon, SK, Canada (Kang, Uppal, Ho, Bailey) Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada (Herman) Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada Publisher Springer Abstract Purpose: Moderate to severe pain is common after cardiac surgery, especially in the first two postoperative days. Inadequate pain control may prolong intensive care unit (ICU) stay, may increase cost, and contributes to chronic pain. Enhanced Recovery After Cardiac Surgery (ERACS) protocols prioritize multimodal analgesia, including regional anesthesia techniques. In a recent randomized trial with continuous serratus anterior plane (SAP) catheters, we found unexpectedly high pneumothorax rates. To address this, we aimed to design a propensity-score-matched comparison using patients from the same institution to control for institutional practice patterns, surgical techniques, and patient demographics that could confound comparisons with published literature rates from other centres. Method(s): We conducted a secondary analysis of RCT data with propensity score matching to a historic cohort. We compared the pneumothorax rates in patients receiving continuous SAP catheters in our previous Cardiac-Serratus Anterior Plane (Cardiac-SAP) trial with those in a retrospective institutional database cohort of patients receiving standard care undergoing cardiac surgery via sternotomy. The two groups were propensity score matched in a 1:20 ratio based on age, sex, smoking status, surgery type, and pre-existing respiratory disease. We analyzed univariate comparisons using Fisher's exact test or the percentile bootstrapping method. Result(s): We matched 50 patients from the Cardiac-SAP trial to 989 retrospective cohort patients. After matching, the SAP catheter group was associated with a significantly higher risk of pneumothorax (12% vs 3%; odds ratio, 5.3; 95% confidence interval, 2.1 to 13.6; P < 0.001). There were no significant differences for other outcomes, including ICU readmissions, length of ventilation, and length of ICU or hospital stay. Patients who developed a pneumothorax had longer ventilation time and longer hospital stays. Conclusion(s): Our data suggest that SAP catheter use as a part of a randomized trial for cardiac surgery was associated with a higher rate of pneumothorax in trial participants than in a historic cohort of a similar population, though causality is unclear. Differences in monitoring within the trial and the inherent risks in this population may have contributed. Copyright © Canadian Anesthesiologists' Society 2026. <55> Accession Number 2041703974 Title Thoracic Ultrasound-Guided Regional Nerve Blockade for Pain Management Following Open Heart Surgery in Children: A Systematic Review and Network Meta-analysis of Analgesic Efficacy and Impact on Postoperative Opioid Requirements. Source Pediatric Cardiology. 47(8) (pp 3210-3222), 2026. Date of Publication: 01 Dec 2026. Author Abdelhady E.; Elmitwalli I.; Saber A.; Elhamrawy A.; Tobias J.D. Institution (Abdelhady, Tobias) Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States (Elmitwalli) Department of Pediatrics, University of Oklahoma Children's Hospital, Oklahoma City, OK, United States (Saber) Department of Cardiology, Minia Cardiothoracic University Hospital, New Minya, Egypt (Elhamrawy) Detroit Medical Center, Wayne State University, Detroit, MI, United States (Tobias) Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, United States Publisher Springer Abstract A new era of multimodal opioid-sparing pain management strategies has begun, aiming to control pain while limiting the use of opioids and their associated adverse effects. Peripheral nerve blockade, either single-shot or continuous catheter techniques, constitute an important cornerstone of these strategies. This systematic review and network meta-analysis aimed to compare and evaluate the effects of different single-shot ultrasound-guided regional anesthetic techniques on pain control following open cardiac surgical procedures in pediatric patients. A systematic review and comprehensive search were conducted to retrieve available randomized clinical trials focusing on the use of ultrasound-guided regional anesthesia nerve blockade as part of a multimodal analgesia approach in pediatric patients undergoing open cardiac surgery through median sternotomy. Our search was conducted in major databases, including MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials. The main outcomes of interest were perioperative opioid consumption and postoperative pain scores. A total of 1,511 articles were retrieved for the initial screening of titles, with 16 RCTs deemed eligible and included after full-text screening. Eleven different regional nerve blocks were assessed in the studies, including erector spinae plane block (ESPB), thoracic paravertebral block (PVB), deep parasternal block (DPB), superficial parasternal block (SPB), thoracic retrolaminar paravertebral block (TRLB), pectoral nerve block type II (PECS II), and multiple injection costotransverse block (MICB). Compared to no intervention, parasternal blocks particularly DPB and SPB were associated with a significant reduction in both intraoperative and 24-h postoperative fentanyl consumption. Postoperatively, fentanyl consumption was reduced by -4.92 microg/kg (95% CI: [-6.58 to -3.26]) with DPB, -2.54 microg/kg (95% CI: [-4.16 to -0.91]) with SPB, and -5.6 microg/kg (95% CI: [-8.31 to -2.89]) with TRLB. Intraoperatively, SPB reduced fentanyl use by -5.12 microg/kg (95% CI: [-6.8 to -3.43]) and DPB by -4.31 microg/kg (95% CI: [-5.9 to -2.71]). No significant postoperative opioid-sparing effect was observed with other blocks, such as ESPB, PVB, MICB, or PECS II. The pooled estimates showed considerable heterogeneity, with I2 values of 90.9% for intraoperative and 94.7% for postoperative fentanyl consumption. Ultrasound-guided regional anesthesia-particularly parasternal blocks-may offer superior opioid-sparing effects and enhanced recovery in children undergoing open-heart surgery, making them promising adjuncts to multimodal analgesia. In contrast, blocks such as ESPB, PVB, and MICB showed limited benefit for median sternotomy pain. Given the substantial heterogeneity in the current evidence, the routine use of these techniques should be guided by institutional experience and individualized patient factors. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025. <56> Accession Number 2038744201 Title Low-molecular-weight heparin vs rivaroxaban for venous thromboembolism prevention after surgery: a systematic review and meta-analysis. Source Angiologia. 78(5) (pp 232-240), 2026. Date of Publication: 01 Sep 2026. Author Gonzalez-Sagredo A.; Hospedales J.; Villoria J.; Lopez-Sobrino T.; Videla S. Institution (Gonzalez-Sagredo, Hospedales) Department of Angiology, Vascular and Endovascular Surgery, Hospital Quironsalud del Valles, Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitari Sagrat Cor, Sabadell, Spain (Villoria) Department of Design and Biometrics, Medicxact, Alpedrete, Spain (Lopez-Sobrino) Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain (Videla) Department of Pharmacology, Therapeutics and Toxicology, Universitat Autonoma de Barcelona, Neuropharmacology & Pain Group, Neuroscience Program, Bellvitge Biomedical Research Institute, Clinical Research Support Area, Hospital Universitari Germans Tries i Pujol, Barcelona, Spain Publisher ARAN Ediciones S.L Abstract Objective: to determine whether rivaroxaban is comparable to low-molecular-weight heparin (LMWH) in terms of efficacy in preventing venous thromboembolism (VTE) after surgery and safety. Method(s): this meta-analysis was registered in PROSPERO (CRD420261293821) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethical approval was not required for this study. The inclusion criteria were randomized controlled trials (RCTs) comparing LMWH vs rivaroxaban for VTE prevention after surgery. The MEDLINE and Scopus electronic databases were searched. Common-effect and random-effects estimates of the overall effects were calculated using the Mantel-Haenszel method. The confidence intervals for the random-effects estimates were calculated using the Hartung-Knapp method. The efficacy outcome was VTE incidence, and the safety outcome was major bleeding. Result(s): of the 1063 records identified, 985 were excluded based on title and abstract screening. Of the remaining 78 records, 6 trials met the inclusion criteria: 4 in orthopedic surgery, 1 in thoracic surgery, and 1 in gynecology. Patients receiving rivaroxaban had a significantly lower incidence of VTE than those receiving LMWH (OR, 0.54; 95 %CI, 0.30-0.98) and a nonsignificantly higher incidence of bleeding (OR, 1.72; 95 %CI, 0.75-3.94). Conclusion(s): rivaroxaban appears to be more effective than LMWH in preventing postoperative VTE and may be considered an appropriate option in patients at low risk of bleeding. In contrast, LMWH should be considered in patients at higher bleeding risk, such as those with advanced renal disease, liver disease, a history of gastrointestinal bleeding, hematological disorders, or concomitant antiplatelet therapy. Copyright © 2026 S. <57> [Use Link to view the full text] Accession Number 2045941568 Title Association Between CTSG Variants and Persistent Postoperative Pain After Cardiac Surgery. Source Anesthesia and Analgesia. 143(5) (pp 1116-1125), 2026. Date of Publication: 01 Nov 2026. Author Garcia N.; Diaz-Arias J.; Chiminazzo V.; Alvarez V.; Valle-Garay E.; Asensi V. Institution (Garcia) Anaesthesiology Service, Hospital Universitario Central de Asturias, Oviedo, Spain (Diaz-Arias, Valle-Garay, Asensi) Microbiology and Infectious Diseases Group, FINBA-ISPA, Oviedo, Spain (Chiminazzo) Biostatistics and Epidemiology Unit, FINBA-ISPA, Oviedo, Spain (Alvarez) Molecular Genetics Unit, Nephrology Research Institute, Hospital Universitario Central de Asturias, FINBA-ISPA, Oviedo, Spain (Valle-Garay) Biochemistry and Molecular Biology, Oviedo University School of Medicine, Oviedo, Spain (Asensi) Infectious Diseases Unit, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Oviedo, Spain Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Cathepsin G (CTSG) is a neutrophil-derived serine protease implicated in inflammatory pain modulation. Genetic variation in CTSG may influence postoperative pain susceptibility. This study evaluated the association between CTSG polymorphisms, CTSG plasma concentration and enzymatic activity, and long-term pain after cardiac surgery. METHOD(S): - We conducted a prospective cohort study including 255 Caucasian adults undergoing elective cardiac surgery via median sternotomy. CTSG single nucleotide polymorphisms (SNPs) rs2070697, rs2236742, and rs45567233 were genotyped. A random subsample of 107 patients underwent measurement of CTSG plasma concentration and enzymatic activity. Pain intensity (visual analogue scale [VAS]) at rest and with movement was assessed at 24 hours, 1 month, 6 months, and 12 months. Ordinal logistic regression was used to analyze associations between CTSG variants and pain. Mendelian randomization evaluated the causal effect of CTSG activity on pain. RESULT(S): - Overall, 16/250 patients (6.4%) reported moderate to severe postsurgical pain during movement at 6 months, and 6/178 patients (3.3%) at 12 months. At 1 month, pain was associated with higher BMI (P =.016); at 12 months, it was more frequent in women (P <.001) and in patients using antidepressants (P =.022). The rs2070697 AA genotype was associated with reduced pain at 1 month at rest (GA vs AA: OR = 4.329, 95%CI = 1.523-12.310, P =.006), 6 months at rest and in movement (GA vs AA at rest: OR = 4.642, 95%CI = 1.535-14.040, P =.007; GA vs AA in movement: OR = 3.509, 95%CI = 1.169-10.530, P =.025), and 12 months in movement (GA vs AA: OR = 5.754, 95%CI: 1.492-22.200, P =.011). In contrast, the rs2236742 AA genotype was associated with increased pain at all three time points (P <.05). Carriers of rs2236742 AA also reported greater preoperative informational anxiety (GG vs AA: OR = 0.193, 95%CI: 0.049-0.758, P =.018). CTSG activity was lower in rs2070697 A-allele carriers (P =.03). CTSG activity and pain showed no causal association. No significant relationships were found for rs45567233. CONCLUSION(S): - Variants appear to modulate susceptibility to prolonged post-sternotomy pain. These findings warrant validation in larger multi-ethnic cohorts to clarify mechanisms and potential implications for personalized perioperative pain management. Copyright © 2026 International Anesthesia Research Society <58> Accession Number 2044250064 Title Trial emulation of percutaneous left atrial appendage occlusion versus direct oral anticoagulants. Source Journal of Interventional Cardiac Electrophysiology. 69(7) (pp 1789-1801), 2026. Date of Publication: 01 Oct 2026. Author Ruzieh M.; Du F.; Foy A.J.; Blotner M.; Naccarelli G.V.; Lian Y.; Shao H.; Mandrola J.; Jiao T. Institution (Ruzieh) Feinberg School of Medicine, Northwestern University, Chicago, IL, United States (Du, Jiao) Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1889 Museum Road, Rm 6301, Gainesville, FL, United States (Foy) Beebe Hospital, Lewes, DE, United States (Blotner) Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, United States (Lian) Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Shao) Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States (Mandrola) Baptist Health Louisville, Louisville, KY, United States (Naccarelli) Penn State University Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA, United States Publisher Springer Abstract Background: The use of percutaneous left atrial appendage occlusion (pLAAO) has increased in the past several years, as an alternative to oral anticoagulants in patients with atrial fibrillation (AF). The pivotal trials that led to pLAAO approval had small sample size and their populations differ from real-world patients who undergo pLAAO. Objective(s): To compare pLAAO to direct oral anticoagulants (DOACs) in Medicare beneficiaries with AF. Design(s): We created a retrospective cohort to emulate a target trial, from Jan 1st, 2015 to Dec 31st, 2020. Patients were identified from a 15% nationally representative sample of Medicare beneficiaries. We mimicked randomization using propensity score matching, and assigned patients to receive pLAAO or DOACs in a 1:3 ratio. The primary efficacy composite outcome was stroke, transient ischemic attack (TIA), or systemic thromboembolism. The primary safety outcome was bleeding events leading to hospital admission. Result(s): After matching, we included 3,692 patients in the pLAAO group and 11,076 in the DOACs group. The mean age of patients was 78.5 years and 46.6% were women. The mean follow-up time was 2.4 years. The rate of the primary composite endpoint was not significantly different between pLAAO and DOACs (0.66/100 person-year vs. 0.47/100 person-year, HR: 1.38, 95% CI: 0.98 - 1.95). Bleeding events leading to hospitalization were significantly more common with pLAAO (5.30/100 person-year vs. 3.25/100 person-year, HR: 1.58, 95% CI: 1.38 - 1.79). Conclusion(s): In Medicare patients with AF, the rate of stroke, TIA or systemic thromboembolism was not significantly different between pLAAO and DOACs. Bleeding outcomes should be interpreted with caution, as residual confounding and variations in medication use over time may have influenced these findings. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <59> Accession Number 2049685061 Title Psychiatric and Identity Reconstruction Following Organ Transplantation: A Review of Patient-Attributed Donor-Related Experiences. Source Transplantation Proceedings. 58(9) (pp 1869-1876), 2026. Date of Publication: 01 Nov 2026. Author Burianek A.; De La Cruz S.; Touchette G.; Kim J.; Dyson C. Institution (Burianek, Touchette, Kim, Dyson) NYIT College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR, United States (De La Cruz) University of Chicago, Chicago, Illinois, United States Publisher Elsevier Inc. Abstract Organ transplantation has increasingly been associated with significant psychological and psychiatric sequelae following surgery. While psychiatric conditions such as anxiety and depression are well documented, some transplant recipients also report changes in personality, behavior, or identity that they attribute to the controversial concept of "cellular memory." This narrative review evaluates reported psychiatric and psychological changes following organ transplantation and examines explanatory models beyond the concept of "cellular memory." A narrative review of literature published between 1997 and 2025 was conducted using the ScienceDirect, PubMed, and SciLit databases. Studies describing posttransplant psychiatric symptoms, personality changes, or identity reconstruction were included. A total of six studies met inclusion criteria and were analyzed. Reported phenomena included mood disturbances, identity changes, altered preferences, and memory-like experiences that recipients attributed to donor characteristics. These reported experiences were primarily subjective, inconsistently reproduced, and derived from low-level evidence. No empirically supported biological mechanism for the transfer of memory or personality through organ transplantation was identified. Although current evidence does not support "cellular memory" as a biological phenomenon, recipient-reported psychological experiences remain clinically relevant. These findings highlight the importance of addressing psychiatric symptoms as part of comprehensive posttransplant care and support integration of psychiatric screening and counseling into posttransplant care. Copyright © 2026 Elsevier Inc. <60> [Use Link to view the full text] Accession Number 2050141854 Title Periprocedural Brain Health: The Scope of the Problem and the Neurologist's Role. Source Neurology. 105(12) (no pagination), 2025. Article Number: e214427. Date of Publication: 23 Dec 2025. Author Hassani S.; Gorelick P.B. Institution (Hassani, Gorelick) From the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States Publisher Lippincott Williams and Wilkins Abstract In this article, we highlight a relatively underaddressed topic in the field of neurology-periprocedural brain health. After reviewing the scope of the problem, we call upon neurologists to join multidisciplinary efforts to realize the goal of reducing the rate of periprocedural stroke, cognitive impairment, and mortality and outline a roadmap of the work that lies ahead to achieve optimal periprocedural brain health. Copyright © 2025 American Academy of Neurology <61> Accession Number 2050643225 Title Transcatheter aortic valve replacement in failed transcatheter versus failed surgical bioprostheses: a systematic review with exploratory meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (pp 1-16), 2026. Article Number: 1870804. Date of Publication: 18 Sep 2026. Author Ghannam M.; Abomohsen M.; Idries I.Y.; Shamoon F.; Ghallab M.; Zghyer F.; Gonzalez A.V.; Ahmad A.; Habib H.A.; Vasudev R. Institution (Ghannam, Abomohsen, Idries) Brookdale University Hospital and Medical Center, Brooklyn, NY, United States (Shamoon, Ahmad, Habib, Vasudev) St. Joseph's University Medical Center, Paterson, NJ, United States (Ghallab) Department of Cardiovascular Medicine, Creighton University, Omaha, NE, United States (Zghyer) Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States (Gonzalez) Department of Cardiology, Heart Failure Division, University of Alabama at Birmingham, Birmingham, AL, United States Publisher Frontiers Media SA Abstract Background - With the expanding use of transcatheter aortic valve replacement (TAVR) in younger patients, the need for reintervention on failed bioprostheses is rising. Comparative evidence between redo TAVR for failed transcatheter valves (TAV-in-TAV) and TAVR for failed surgical valves (TAV-in-SAV) is limited. Objective - To systematically review and meta-analyse the clinical, haemodynamic, and safety outcomes of TAV-in-TAV versus TAV-in-SAV. Methods - PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase were searched from inception to April 2026. Studies directly comparing TAV-in-TAV with TAV-in-SAV and reporting original data with >=10 patients per group were included. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed for 30-day mortality, 1-year mortality, mean transvalvular gradient at 30 days, and new permanent pacemaker (PPM) implantation. Results - Four observational studies, including 705 patients in the extracted comparative cohorts, met the inclusion criteria. Two full-text studies contributed to the primary quantitative analyses. TAV-in-TAV was not associated with a statistically significant difference in 30-day mortality compared with TAV-in-SAV (OR 0.71, 95% CI 0.25-2.00), nor in 1-year mortality (OR 1.02, 95% CI 0.47-2.18). TAV-in-TAV was associated with lower mean transvalvular gradients at 30 days (MD -2.71 mmHg, 95% CI -4.07 to -1.34). A non-significant trend toward higher new permanent pacemaker implantation was observed after TAV-in-TAV (OR 1.85, 95% CI 0.94-3.65). Conclusion - Current comparative evidence between TAV-in-TAV and TAV-in-SAV remains limited and observational. No definitive mortality difference was identified, but clinically meaningful benefit or harm cannot be excluded. TAV-in-TAV shows a consistent early haemodynamic signal with lower gradients, while the possible increase in pacemaker implantation remains exploratory. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261369410, PROSPERO CRD420261369410. Copyright © 2026 Ghannam, Abomohsen, Idries, Shamoon, Ghallab, Zghyer, Gonzalez, Ahmad, Habib and Vasudev. <62> Accession Number 2044357345 Title The additive value of preprocedural cardiac computed tomography angiography (CCTA) planning in percutaneous left atrial appendage occlusion: a systematic review and meta-analysis. Source Journal of Interventional Cardiac Electrophysiology. 69(7) (pp 2071-2084), 2026. Date of Publication: 01 Oct 2026. Author Balbaa E.; Rakab M.S.; Gadelmawla A.F.; Amin A.M.; Tawfik A.M.; Elgendy A.; AL-Ihribat A.R.; Turkmani M.; Altobaishat O.; Elgendy M.S.; Shubietah A.; Abuelazm M. Institution (Balbaa, Tawfik) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Rakab, Amin, Elgendy) Faculty of Medicine, Mansoura University, Mansoura, Egypt (Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt (AL-Ihribat) Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine (Turkmani) Faculty of Medicine, Michigan State University, East Lansing, MI, United States (Turkmani) Division of Pulmonary and Critical Care, University of Toledo, Toledo, OH, United States (Altobaishat) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Elgendy, Abuelazm) Faculty of Medicine, Tanta University, Tanta, Egypt (Shubietah) Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States Publisher Springer Abstract Background: Cardiac computed tomography angiography (CCTA) is increasingly used to guide left atrial appendage occlusion (LAAO) by providing a detailed anatomical assessment. However, its incremental value over conventional planning methods, such as transesophageal echocardiography or fluoroscopy, remains uncertain. This study evaluated the additive value of CCTA-guided planning in percutaneous LAAO. Method(s): A systematic review and meta-analysis conducted using PubMed, Embase, CENTRAL, Scopus, and Web of Science, up to September 2024 (updated in July 2025). Dichotomous outcomes were pooled as risk ratios (RR), while continuous outcomes were pooled as mean differences (MD) along the corresponding 95% confidence intervals (CI). PROSPERO ID: CRD42024600363. Result(s): Six studies comprising 978 patients with follow-up periods of up to 90 days were included. The CCTA-guided group had significant higher device implantation success [RR: 1.06; 95% CI (1.01, 1.11), P = 0.028], a lower device resizing [RR: 0.42; 95% CI (0.26, 0.66), P = 0.0002], and a lower procedure time [MD: -13.29 min; 95% CI (-23.72, -2.86), P = 0.01]. There was no significant difference between the two groups in device-related embolization [P = 0.38], peri-device leakage [P = 0.16], radiation dose [P = 0.84], and contrast utilization [P = 0.96]. Conclusion(s): Adding CCTA to preoperative planning for LAAO as a complementary modality can increase implantation success rate, improve device selection accuracy, and shorten procedure time without increasing adverse events or contrast use with substantial heterogeneity and divergent subgroups. However, limited follow-up restricts long-term safety conclusions. Further large-scale, long-term randomized trials are needed to validate these findings. Copyright © The Author(s) 2026. <63> Accession Number 2049027135 Title Percutaneous Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Bayesian Meta-analysis. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(10) (no pagination), 2026. Article Number: 105625. Date of Publication: 01 Oct 2026. Author Rai A.; Kandala A.; Bola H.; Schurr J.; Singh M.; Ahmad Y.; Fanaroff A.; Hu R.; Malik N.; Frankel D.S.; Markman T.; Nazarian S.; Giri J.; Shah T.; Nathan A. Institution (Rai) Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States (Rai, Bola) Faculty of Medicine, Imperial College London, London, United Kingdom (Kandala) Faculty of Medicine, University College London, London, United Kingdom (Schurr, Fanaroff, Hu, Malik, Frankel, Markman, Nazarian, Giri, Shah, Nathan) Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States (Singh) Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States (Ahmad) Division of Cardiology, University of California San Francisco, San Francisco, CA, United States Publisher Elsevier B.V. Abstract Background Conflicting randomized trial results have generated uncertainty regarding percutaneous left atrial appendage occlusion (LAAO) vs oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF). Thus, the objective of this study is to estimate the posterior probability that LAAO confers clinically meaningful excess ischemic stroke risk relative to OAC. Methods A Bayesian hierarchical meta-analysis was performed of RCT comparing LAAO with OAC in nonvalvular AF. The primary outcome was ischemic stroke, analyzed using Bayesian random-effects Poisson regression under a vague (primary), skeptical, and enthusiastic prior specification. Results Six RCT (7004 patients, +18,000 patient-years) were included. Ischemic stroke incidence rate ratio (IRR) was 1.34 (95% credible interval [CrI], 0.91-1.97; P [IRR > 1.0] = 94%). The probability of exceeding 0.5 and 1.0 excess events/100 patient-years was 12% and 0.5%, respectively. The effect on any-stroke was smaller (IRR, 1.09; 95% CrI, 0.76-1.56; P [IRR > 1.0] = 70%; P [absolute rate difference >0.5%/y] = 4.7%), because of a reduction in hemorrhagic stroke (IRR, 0.55; 95% CrI, 0.23-1.18; P [IRR < 1.0] = 94.5%). The decrease in hemorrhagic stroke was attenuated among trials using direct oral anticoagulants for medical management (IRR, 0.80; 95% CrI, 0.33-1.75). Conclusions In AF, there is a high posterior probability that LAAO is associated with a higher rate of any-stroke, driven by an increase in ischemic stroke relative to OAC. However, the 95% CrI for ischemic stroke crossed unity, and the estimated absolute excess is small. This possible excess must be weighed against a substantial reduction in the risk of hemorrhagic stroke. Copyright © 2026 . <64> Accession Number 2049830828 Title The Effect of Sodium Bicarbonate on Renal Injury in Patients Undergoing Major Surgery: Evidence Predominantly from Cardiac Surgery. Source Current Anesthesiology Reports. 16(1) (no pagination), 2026. Article Number: 38. Date of Publication: 01 Dec 2026. Author Han Z.; Zhang T.; Zhu N.; Yang Y.; Zheng Q.; Chandler C.; Zhang Y. Institution (Han, Zhang) Department of Anesthesiology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China (Han, Zhang) Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China (Zhang, Zhu, Yang, Zheng, Zhang) Anhui Medical University, Hefei, China (Chandler) Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, United States Publisher Springer Abstract Background: Acute kidney injury (AKI) is a common postoperative complication with no established pharmacologic prevention. Sodium bicarbonate (NaHCO) has been studied extensively for its renoprotective potential, but evidence is conflicting. Its influence depends on the patient's prior renal function and the type of renal injury. We performed an updated meta-analysis to evaluate the efficacy and safety of perioperative intravenous NaHCO for preventing renal injury after major surgery. Method(s): We searched PubMed, Embase, Web of Science, and Cochrane Library for randomized controlled trials comparing perioperative NaHCO with control in adult patients undergoing major surgery (9 cardiac surgery trials and 1 orthotopic liver transplantation trial). Primary outcome was AKI incidence; secondary outcomes included serum creatinine change at 48 h, need for renal replacement therapy (RRT), and all-cause mortality. Random-effects models were used. Result(s): Ten randomized controlled trials involving 1,544 patients were included. Perioperative NaHCO did not reduce AKI incidence compared with control therapy (RR = 1.02, 95% CI 0.86-1.21, P = 0.81) or improve 48-h serum creatinine change (MD = - 0.66 micromol/L, 95% CI - 15.53 to 14.21). No significant effects were observed on RRT requirement or all-cause mortality. Subgroup analyses showed no consistent effect modification by surgical type, timing, or infusion duration, although high-dose NaHCO showed a borderline signal of potential harm. Conclusion(s): Perioperative intravenous sodium bicarbonate was not associated with a reduction in AKI incidence. The confidence interval does not exclude a small benefit or harm. Routine use solely for AKI prophylaxis is not supported. Copyright © The Author(s) 2026. <65> Accession Number 2050116458 Title Systematic review, meta-analysis of cusp-overlap vs. three-cusp coplanar approaches in self-expandable transcatheter aortic valve replacement. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1870774. Date of Publication: 2026. Author Ghannam M.; Abomohsen M.; Idries I.Y.; Shamoon F.; Vasudev R.; Moghib K.; Ghallab M.; Zghyer F.; Gonzalez A.V.; Ahmad A.; Habib H.A. Institution (Ghannam, Abomohsen, Idries) Brookdale University Hospital and Medical Center, Brooklyn, NY, United States (Shamoon, Vasudev, Ahmad, Habib) St. Joseph's University Medical Center, Paterson, NJ, United States (Moghib) Faculty of Medicine Kasralainy Cairo University, Cairo, Egypt (Ghallab) Department of Cardiovascular Medicine, Creighton University, Omaha, NE, United States (Zghyer) Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States (Gonzalez) Department of Cardiology, Heart Failure Division, University of Alabama at Birmingham, Birmingham, AL, United States Publisher Frontiers Media SA Abstract Background - The cusp-overlap technique (COT) is an alternative fluoroscopic approach to the standard three-cusp technique (ST) in self-expandable transcatheter aortic valve replacement (TAVR). It may improve implantation depth and reduce conduction disturbances, but its overall clinical benefit remains unclear. Objectives - To compare the safety and efficacy of COT vs. ST in terms of mortality, conduction disturbances, permanent pacemaker implantation (PPI), and cerebrovascular accidents (CVA). Methods - This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Cochrane, Scopus, Embase, and Web of Science were searched up to October 2025. Studies comparing COT and ST were included. Data extraction and risk-of-bias assessment were performed independently. Meta-analysis was conducted using R with fixed- and random-effects models. Outcomes included mortality (by follow-up), conduction disturbances, PPI, and CVA. The protocol was registered in PROSPERO (CRD420251156402). Results - Eighteen studies were analyzed, with patient numbers varying by outcome (mortality: 5, 984 patients; conduction disturbances: 7, 200 patients; PPI: 5, 712 patients; CVA: 4, 066 patients). COT significantly reduced mortality compared with ST (OR: 0.60, 95% CI: 0.40-0.88; p = 0.010; I2 = 0%), with the strongest effect observed at 30 days. Conduction disturbances were also lower with COT (OR: 0.62, 95% CI: 0.48-0.82; p = 0.0006; I2 = 77.7%), driven by reductions in both complete atrioventricular block and left bundle branch block. The risk of PPI was markedly reduced with COT (OR: 0.50, 95% CI: 0.39-0.63; p < 0.0001; I2 = 23.0%). In contrast, there was no significant difference in CVA between groups (random-effects OR: 1.05, 95% CI: 0.73-1.51; p = 0.78; I2 = 0%). Conclusion - COT in self-expandable TAVR is associated with lower rates of conduction disturbances and PPI, and reduced short-term mortality, without increasing cerebrovascular risk. While these findings are consistent and clinically plausible, the overall certainty of evidence is limited. COT appears to be a promising procedural refinement, but further randomized studies are needed to confirm long-term benefits. Systematic Review Registration - identifier CRD420251156402. Copyright © 2026 Ghannam, Abomohsen, Idries, Shamoon, Vasudev, Moghib, Ghallab, Zghyer, Gonzalez, Ahmad and Habib. <66> Accession Number 2049543299 Title Routine Versus Deferred Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis With Reconstructed Individual Patient Data. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(10) (no pagination), 2026. Article Number: 105566. Date of Publication: 01 Oct 2026. Author Balata M.; Badran A.S.; Gbreel M.I.; Hassan M.; Ebeid I.; Abdelrahman A.A.; Robinson D.; Bodanowitz J.; Valenta S.; Valenta C.; Kochev P.; Ince H.; Ortak J. Institution (Balata, Robinson, Bodanowitz, Valenta, Valenta, Kochev, Ince, Ortak) Department of Cardiology, University Hospital of Rostock, Rostock, Germany (Badran) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Gbreel) Department of Cardiology, Ahmed Maher Teaching Hospital, Cairo, Egypt (Hassan) Theodor Bilharz Research Institute, Giza, Egypt (Ebeid) Department of Cardiology, National Institute of Diabetes and Endocrinology, Cairo, Egypt (Abdelrahman) Emergency Department, King's College Hospital, London, United Kingdom Publisher Elsevier B.V. Abstract Background The optimal management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) remains controversial. Whether routine percutaneous coronary intervention (PCI) before TAVR provides clinical benefit compared to a strategy of deferral is unclear. Methods We performed a meta-analysis of randomized controlled trials (RCT) comparing routine PCI before TAVR with a strategy of PCI deferral. The primary end points were a composite of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality. Secondary end points included myocardial infarction, stroke, revascularization, and major bleeding. We applied a random-effects model to calculate hazard ratios (HR) and 95% CI. We also performed a pooled time-to-event analysis using reconstructed individual patient data. Results We included 3 RCT (ACTIVATION, NOTION-3, and PRO-TAVI) comprising a total of 1156 patients. The pooled cohort had a median age exceeding 81 years and exhibited low anatomic coronary complexity (median SYNTAX score <=10). Routine PCI did not significantly reduce the risk of MACCE (HR, 0.84; 95% CI, 0.62-1.13; P = .25) or all-cause mortality (HR, 0.88; 95% CI, 0.67-1.17; P = .38). Pooled Kaplan-Meier analysis confirmed no difference in all-cause mortality over 48 months (HR, 0.89; 95% CI, 0.68-1.17; P = .41). Although routine PCI was associated with a significant reduction in any revascularization (HR, 0.24; 95% CI, 0.06-0.89; P = .03) and urgent revascularization (HR, 0.33; 95% CI, 0.12-0.87; P = .02), it was associated with increased bleeding events (HR, 1.96; 95% CI, 1.28-3.00; P < .01). No significant differences were observed regarding myocardial infarction or stroke. Conclusions Routine PCI before TAVR did not reduce mortality or MACCE compared to a deferral strategy. Although routine PCI lowered the risk of subsequent urgent revascularization, it significantly increased the risk of major bleeding. Copyright © 2026 The Author(s). <67> Accession Number 2050879183 Title Comparison of oral and intravenous methadone for postoperative analgesia after cardiac surgery: a pilot randomized clinical trial. Source Regional Anesthesia and Pain Medicine. (no pagination), 2026. Article Number: rapm-2026-108588. Date of Publication: 2026. Author Ramanujan K.S.; Grate J.C.; Khan F.; Paul J.; D'Souza R.S.; Lemahieu A.M.; Wittwer E.D. Institution (Ramanujan, Grate, Paul, D'Souza, Wittwer) Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States (Khan) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States (Lemahieu) Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, United States Publisher BMJ Publishing Group <68> Accession Number 2048566227 Title Cardioprotective effects of remimazolam in elderly hypertensive patients undergoing gastrointestinal tumor surgery: A randomized controlled trial. Source World Journal of Gastrointestinal Oncology. 18(8) (no pagination), 2026. Article Number: 121785. Date of Publication: 15 Aug 2026. Author Ma T.-T.; Tong J.; Liu M.-Y. Institution (Ma) Department of Anesthesiology, Yizheng Hospital of Nanjing Drum Tower Hospital Group, Jiangsu Province, Yangzhou, China (Tong) Department of General Surgery, Yizheng Hospital of Nanjing Drum Tower Hospital Group, Jiangsu Province, Yangzhou, China (Liu) Department of Anesthesiology, Jiangdu People's Hospital Affiliated to Yangzhou University, Jiangsu Province, Yangzhou, China Publisher Baishideng Publishing Group Inc Abstract BACKGROUND Elderly patients with hypertension undergoing gastrointestinal tumor surgery are at increased risk of perioperative cardiovascular complications, particularly myocardial injury after non-cardiac surgery (MINS). Anesthetic management plays a crucial role in maintaining hemodynamic stability and reducing cardiac stress in this vulnerable population. Remimazolam, a novel ultra-short-acting benzodiazepine, has shown potential advantages in cardiovascular stability compared with conventional anesthetic agents, however, its cardioprotective effects in high-risk surgical patients remain insufficiently explored. AIM To evaluate the cardioprotective effects and safety of remimazolam-based general anesthesia compared with conventional anesthesia in elderly hypertensive patients undergoing gastrointestinal tumor surgery, with a particular focus on myocardial injury markers, hemodynamic stability, postoperative recovery, and the incidence of MINS. METHODS A total of 80 elderly hypertensive patients who underwent gastrointestinal tumor surgery at Yizheng Hospital of Nanjing Drum Tower Hospital Group between bApril 2024 and August 2025 were selected. Patients were randomly divided into a control group (P group) and an experimental group (R group) using the envelope method. P group received conventional general anesthesia, while R group received remimazolam-based general anesthesia. Perioperative serum biomarkers, arterial blood gas indices, postoperative pain, incidence of postoperative complications, surgical indicators, and adverse events within 30 days of follow-up were compared between the two groups. Patients were further divided into non-MINS and MINS groups based on the occurrence of MINS. Differences in clinical indicators between the two groups were analyzed. Binary logistic regression was used to identify risk factors for MINS, and a predictive model was constructed and validated based on these factors. RESULTS At T0, creatine kinase (CK) levels were significantly lower and lactate levels significantly higher in P group compared with R group (P < 0.05). At T1, systolic and diastolic blood pressures were significantly lower in P group than in R group (P < 0.05). At T6, CK-MB levels were significantly higher in P group (P < 0.05). At T7, High-Sensitivity Troponin (hs-cTn), CK-MB, and aspartate aminotransferase were significantly higher in P group (P < 0.05). At T8, CK-MB and N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in P group (P < 0.05). Visual Analog Scale scores at T7 and T8 were significantly higher in P group (P < 0.05). Postoperative agitation scores and incidence were significantly higher in P group (P < 0.05), as was the incidence of MINS (P < 0.05). Intraoperatively, colloid use was significantly lower, while crystalloid and norepinephrine use were significantly higher in P group (P < 0.05). There was no significant difference in the incidence of adverse events within 30 days postoperatively between the two groups (P?> 0.05). Compared with the MINS group, the non-MINS group had significantly lower proportions of colon cancer and conventional general anesthesia, as well as lower levels of hs-cTn, CK-MB, NT-proBNP at T6-T8, and shorter operative time (P < 0.05). Multivariate analysis showed that tumor type, anesthesia method, NT-proBNP at T7, and NT-proBNP at T8 were independent risk factors for MINS. The area under the curve for NT-proBNP at T8 and the predictive model was?> 0.7. CONCLUSION The use of remimazolam for general anesthesia in elderly hypertensive patients undergoing gastrointestinal tumor surgery can reduce myocardial injury and the incidence of MINS. It helps stabilize perioperative blood pressure, alleviates postoperative pain, reduces the risk of postoperative agitation, and decreases intraoperative norepinephrine requirements. It is safe and does not increase postoperative complications or adverse events within 30 days. Tumor type, anesthesia method, and postoperative NT-proBNP levels can help predict the risk of MINS, providing a reference for prevention and treatment strategies. Copyright © Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc. <69> Accession Number 2049562987 Title Cognitive impairment in heart transplantation: prevalence, trajectories, and prognostic impact - a systematic review. Source Aging Clinical and Experimental Research. 38(1) (no pagination), 2026. Article Number: 199. Date of Publication: 01 Dec 2026. Author Parrotta I.; Valente M.; Piazzalunga E.; Scarpa E.; Mantini D.; Danesin L.; Rossi C.; Borgese L.; Golfieri L.; Burgio F.; Potena L. Institution (Parrotta, Piazzalunga, Scarpa, Danesin, Burgio) IRCCS San Camillo Hospital, Venice, Italy (Valente, Rossi, Borgese, Golfieri, Potena) IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Parrotta, Mantini) Movement Control and Neuroplasticity Research Group, Leuven, Belgium (Piazzalunga) Department of Cognitive Brain Sciences, University School for Advanced Studies IUSS Pavia, Pavia, Italy Publisher Springer Science and Business Media Deutschland GmbH Abstract Background/Aim: Heart transplantation (HTx) represents the definitive treatment for patients with end-stage heart failure (HF). Neurological complications, particularly cognitive impairment (CI), may influence prognosis, thereby affecting the overall benefits of HTx. CI in HF is associated with disease severity, extracardiac dysfunction, and peri- or intra-operative factors such as prolonged ventilation, cerebral hypoperfusion, and systemic inflammation. However, existing studies on CI in HTx candidates are highly heterogeneous, limiting comparability and highlighting the need for a clearer understanding of its impact in both candidates and recipients. Method(s): This systematic review was registered with PROSPERO (CRD42024549051) and conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Embase were searched for studies published between 2013 and June 2025. Eligible studies assessed cognitive function in adult HF patients undergoing HTx. Result(s): Of 1188 records screened, eight studies met the inclusion criteria. Most cognitive studies employed the Montreal Cognitive Assessment (MoCA), while two used comprehensive neuropsychological batteries. Evidence confirmed that CI is common among HF and HTx populations. Incorporating cognitive status into frailty assessments enhanced prediction of adverse outcomes, including prolonged hospitalization and reduced survival. Cognitive decline was frequently observed in the immediate post-transplant period, often linked to high-dose immunosuppressive therapy and anemia, while long-term improvements were reported in attention, memory, and executive function. Conclusion(s): Cognitive assessment is essential in HTx candidates, as CI has a major impact on survival. Further studies are needed to clarify long-term cognitive trajectories and the role of immunosuppressive therapy in shaping outcomes. Copyright © The Author(s) 2026. <70> Accession Number 2038742620 Title Risk of Short-Term Stroke in Non-High-Risk Patients Undergoing Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Source Reviews in Cardiovascular Medicine. 27(10) (no pagination), 2026. Article Number: 49672. Date of Publication: 01 Oct 2026. Author Liu H.; Xiao Z.; Zou J.; Peng X. Institution (Liu, Zou, Peng) Department of Cardiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China (Liu, Zou, Peng) Jiangxi Hypertension Research Institute, Nanchang, China (Xiao) Jiangxi Medical College, Nanchang University, Nanchang, China Publisher IMR Press Limited Abstract Background: To compare the incidence of stroke at 1 and 2 years following transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), aiming to inform clinical decision-making regarding the safety and effectiveness of these interventions. Method(s): A random-effects meta-analysis was conducted including 9 randomized controlled trials (RCTs) with a total of 9865 patients. The primary endpoint was the incidence of stroke at 1 and 2 years post-procedure. Result(s): At 1 year, TAVR was associated with a lower incidence of stroke compared with SAVR (odds ratio (OR), 0.77 95% confidence interval (CI), 0.61-0.98 p = 0.03). No significant difference was observed at 2 years (OR, 0.87 95% CI, 0.65-1.17 p = 0.37). Conclusion(s): TAVR significantly reduces the risk of stroke within 1 year post-procedure compared with SAVR however, this effect was not maintained at 2 years. These findings highlight the early benefit of TAVR, while the long-term advantage requires further investigation. The PROSPERO Registration: This study has been registered with PROSPERO, registration number: CRD42025636191, https://www.crd.york.ac.uk/PROSPERO/view/C RD42025636191. Copyright © 2026 The Author(s). <71> Accession Number 2050566239 Title Expanding indications for transcatheter aortic valve implantation: time for valve-in-valve in mechanical prosthesis? A systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1920900. Date of Publication: 2026. Author Ruiz-Ruiz J.; Jain A.; Garcia Gomez M.; Stepanenko A.; Pensotti F.; Rodriguez M.; Real C.; Cortes Villar C.; Galan-Arriola C.; De Prada Martin B.; Carrasco Moraleja M.; Alcantara R.W.A.; San Roman A.; Ibanez B.; Amat-Santos I. Institution (Ruiz-Ruiz, Jain, Garcia Gomez, Stepanenko, Pensotti, Rodriguez, Cortes Villar, Carrasco Moraleja, San Roman, Amat-Santos) Cardiology Department, University Clinic Hospital of Valladolid, Spain (Real, Galan-Arriola, Ibanez, Amat-Santos) Centro Nacional de Investigacion Cardiovascular (CNIC), Madrid, Spain (Cortes Villar, Galan-Arriola, San Roman, Ibanez, Amat-Santos) Centro de Investigacion Biomedica en Red (CIBERCV), Madrid, Spain (De Prada Martin) Anesthesiology Department, University Clinic Hospital of Valladolid, Spain (Alcantara) Clinica Aurus, Oliveira, Brazil (Alcantara) Interventional Cardiology Unit, Hospital Sao Judas Tadeu, Oliveira, Brazil (Ibanez) Cardiology Department, Fundacion Jimenez Diaz, Madrid, Spain Publisher Frontiers Media SA Abstract Aims - Following the recent first-in-human experience of Valve in Mechanical Valve (ViMech), interest has emerged in understanding how frequently such an approach might be required in clinical practice. We performed an exploratory meta-analysis to characterize the long-term burden of valve-related complications and reintervention after mechanical aortic valve replacement. Methods - Systematic literature search identified studies reporting outcomes of the five most used mechanical aortic valve models (Medtronic/ATS, St. Jude, Carbomedics, Bicarbon, On-X). Descriptive analysis and random-effects meta-analysis assessed late all-cause and valve-related mortality and complications (bleeding, thromboembolism, valve thrombosis, endocarditis, paravalvular leak, reintervention), expressed per 100 patient-years. Results - Thirty-two studies encompassing 24,960 patients undergoing mechanical valve replacement were assessed. Isolated mechanical aortic valve replacement was reported in all 32 studies (13,890 patients; 98,987 patient-years; mean follow-up 7.1 years); mean age at implantation was 57.9 years (95% CI 56.3-59.6) and 43% (38-49) were female. Pooled all-cause mortality was 2.39 per 100 patient-years (95% CI 1.92-2.99) and valve-related mortality was 0.55 (0.41-0.73) per 100 patient-years. Bleeding (0.22 [0.16-0.30]) and thromboembolic events (0.18 [0.12-0.25]) were the leading causes of valve-related death. Thromboembolic events (0.94 [0.77-1.14]) and bleeding (0.85 [0.65-1.10]) were the most frequent non-fatal complications, considerably more common than reintervention (0.36 [0.28-0.48] per 100 patient-years). All-cause mortality and complication rates were broadly similar across valve models. Conclusions - Mechanical aortic valves show excellent long-term durability with low reintervention rates. Nevertheless, valve-related complications, mainly bleeding and thromboembolism, suggest a small but clinically relevant population in whom redo surgery may carry substantial risk, providing epidemiological context for emerging Valve in Mechanical Valve strategies. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002419, identifier CRD420251002419. Copyright © 2026 Ruiz-Ruiz, Jain, Garcia Gomez, Stepanenko, Pensotti, Rodriguez, Real, Cortes Villar, Galan-Arriola, De Prada Martin, Carrasco Moraleja, Alcantara, San Roman, Ibanez and Amat-Santos. <72> Accession Number 2049878212 Title Predictors of recurrent stroke among patients with lacunar stroke receiving intensive blood pressure control: a secondary analysis of the secondary prevention of small subcortical strokes trial. Source Neurological Research. (no pagination), 2026. Date of Publication: 2026. Author Shakir M.; Huang Y.; Gomez C.R.; Qureshi A.I. Institution (Shakir, Huang, Qureshi) Zeenat Qureshi Stroke Institute, Columbia, MO, United States (Shakir, Gomez) Department of Neurology, University of Missouri, Columbia, MO, United States Publisher Taylor and Francis Ltd. Abstract Background: Intensive systolic blood pressure (SBP) lowering to <130 mm Hg is recommended in contemporary secondary stroke prevention guidelines; however, it did not significantly reduce overall recurrent ischemic stroke in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. In this post hoc secondary analysis of participant-level SPS3 trial data, we sought to identify baseline predictors of recurrent ischemic stroke among patients with lacunar stroke assigned to the lower SBP target in SPS3. Method(s): This post hoc secondary analysis included SPS3 participants randomized to the lower SBP target (<130 mm Hg). The primary outcome was centrally adjudicated recurrent ischemic or hemorrhagic stroke. Candidate predictors were evaluated with multivariable Cox proportional hazards regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Result(s): Among 1501 participants (41.1% aged >= 65 years; 60.8% were men), 120 (8.0%) experienced recurrent ischemic stroke over a median follow-up of 3.49 years (interquartile range, 1.80-5.08), corresponding to an incidence rate of 2.43 events per 100 person-years. In unadjusted comparisons, recurrent ischemic stroke was associated with diabetes mellitus (44.2% vs 34.2%; p =.036), coronary artery bypass grafting/coronary stent (9.2% vs 4.1%; p =.018), Black race (24.2% vs 14.4%; p =.007), elevated serum creatinine (14.2% vs 7.7%; p =.022), aspirin or clopidogrel use at the qualifying lacunar stroke (44.2% vs 28.5%; p <.001), large-vessel atherosclerosis (29.3% vs 17.9%; p =.004), and lower prevalence of a subcortical qualifying stroke (21.7% vs 46.1%; p <.001). In multivariable analysis, aspirin or clopidogrel use at the qualifying lacunar stroke (HR, 1.69; 95% CI, 1.14-2.50; p =.009) and large-vessel atherosclerosis (HR, 1.63; 95% CI, 1.08-2.413; p =.020) were independently associated with recurrence. Randomization to aspirin plus clopidogrel was not associated with recurrent ischemic stroke (HR, 1.09; 95% CI, 0.75-1.57; p =.661). Conclusion(s): In SPS3 participants assigned to intensive SBP control, 8.0% experienced recurrent ischemic stroke. Aspirin or clopidogrel use at the qualifying lacunar stroke and large-vessel atherosclerosis remained independent predictors of recurrence. These findings may help identify patients who require preventive strategies beyond intensive SBP lowering. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <73> Accession Number 2049877499 Title Left atrial appendage occlusion for stroke prevention in atrial fibrillation: recent evidence, catheter ablation, and future trials. Source Expert Review of Cardiovascular Therapy. (no pagination), 2026. Date of Publication: 2026. Author Samaras A.; Nair D.G.; Nielsen-Kudsk J.E.; Tzikas A. Institution (Samaras) School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece (Nair) St. Bernards Healthcare & Arrhythmia Research Group, Jonesboro, AR, United States (Nielsen-Kudsk) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Tzikas) Second Department of Cardiology, General Hospital "Hippokration", Thessaloniki, Greece (Tzikas) Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece Publisher Taylor and Francis Ltd. Abstract Introduction: Oral anticoagulation (OAC) remains the standard for stroke prevention in atrial fibrillation (AF), but bleeding, non-persistence and thromboembolism despite treatment create important unmet needs. Catheter ablation and left atrial appendage occlusion (LAAO) address distinct mechanisms and do not reproduce systemic anticoagulation. Areas covered: This narrative review covers randomized anticoagulation-withdrawal studies after ablation, trials and pooled evidence on LAAO, patients unable to sustain anticoagulation, procedural imaging and healing, post-implant antithrombotic therapy, and future trial design. Targeted searches of PubMed/MEDLINE and ClinicalTrials.gov were supplemented by citation screening and review of contemporary congress reports, for evidence spanning 2005-10 October 2026. Expert opinion: The completed randomized LAAO program mainly tests substitution where OAC remains feasible. Precision source control should be investigated as rescue when OAC cannot be sustained and as a potential dose-sparing complement in selected patients, while addressing residual ischemic risk and verifying durable closure. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <74> Accession Number 652079563 Title Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis. Source The New England journal of medicine. 395(16) (pp 1600-1609), 2026. Date of Publication: 22 Oct 2026. Author Bundgaard H.; Pries-Heje M.; Hjulmand J.; Hasselbalch R.; Jorgensen P.G.; Fano S.; Kober N.; Tuxen C.; Kader N.; Seven E.; Rasmussen L.E.; Wienberg M.; Bruun N.E.; Tofterup M.; Rasmussen M.; Baden L.R.; Woolley A.; Lange T.; Helweg-Larsen J.; Povlsen J.A.; Fosbol E.; Moser C.; Iversen K. Institution (Bundgaard, Pries-Heje, Hjulmand, Hasselbalch, Kader, Fosbol) Department of Cardiology, Copenhagen University Hospital-Hjertecentret and Rigshospitalet, Copenhagen, Denmark (Bundgaard, Seven, Bruun, Fosbol, Iversen) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Hasselbalch, Jorgensen, Fano, Iversen) Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Copenhagen, Denmark (Hasselbalch, Iversen) Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark (Hasselbalch) Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark (Kober, Tuxen) Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark (Seven) Department of Cardiology, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark (Rasmussen) Department of Cardiology, Godstrup Regional Hospital, Denmark (Wienberg) Department of Cardiology, Copenhagen University Hospital-North Zealand, Denmark (Bruun) Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (Bruun) Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark (Tofterup) Department of Cardiology, Odense University Hospital, Odense, Denmark (Rasmussen) Department of Infectious Diseases, Skane University Hospital, Lund, Sweden (Rasmussen) Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden (Baden, Woolley) Harvard Medical School, Boston, United States (Baden) Dana-Farber Cancer Institute, Boston, United States (Baden, Woolley) Division of Infectious Diseases, Brigham and Women's Hospital, Boston, United States (Lange) Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Helweg-Larsen) Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (Povlsen) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Moser) Department of Clinical Microbiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (Moser) Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark Abstract BACKGROUND: In patients with infective endocarditis on the left side of the heart, the current recommendation of up to 6 weeks of antibiotic therapy is based largely on expert consensus opinion. Whether a clinical response-tailored antibiotic management strategy can shorten treatment duration without compromising safety is unclear. METHOD(S): In this international, open-label, randomized trial, we assigned adults in stable condition with infective endocarditis caused by Staphylococcus aureus, Enterococcus faecalis, or streptococcus species to receive either response-tailored or standard-duration antibiotic therapy. Before randomization, all the patients received at least the prespecified 2 to 4 weeks of therapy and met criteria for clinical stabilization. After randomization, patients in the tailored-therapy group discontinued antibiotics and those in the standard-therapy group continued standard treatment (total duration, 4 to 6 weeks). The primary efficacy end point was days alive without antibiotic treatment for infective endocarditis or bacteremia within 6 months after randomization (tested for superiority). The primary safety end point was a composite of death from any cause, unplanned cardiac surgery, or symptomatic embolic events within 6 months after randomization (tested for noninferiority; margin, 7.5 percentage points). Relapse of bacteremia or infective endocarditis was a key secondary end point. RESULT(S): A total of 508 patients underwent randomization, with 255 assigned to response-tailored therapy and 253 to standard-duration therapy. The median time alive without antibiotic treatment was 183 days (interquartile range, 181 to 183) with tailored therapy and 169 days (interquartile range, 166 to 171) with standard therapy (Hodges-Lehmann estimated difference, 13 days; 95% confidence interval [CI], 12 to 13; P<0.001 for superiority). A primary safety end-point event occurred in 21 patients (8.2%) with tailored therapy and in 27 patients (10.7%) with standard therapy (absolute between-group difference, -2.4 percentage points; 95% CI, -7.7 to 2.7; P<0.001 for noninferiority), indicating noninferiority. Relapse occurred in 13 patients (5.1%) with tailored therapy and in 4 patients (1.6%) with standard therapy (P = 0.04). CONCLUSION(S): Among patients with infective endocarditis on the left side of the heart, the use of a response-tailored antibiotic strategy resulted in a longer time alive without antibiotic therapy than standard-duration therapy and met the criterion for noninferiority with respect to safety but was associated with a higher incidence of relapse of bacteremia or infective endocarditis. (Funded by Sygeforsikringen "danmark" and others; POET II ClinicalTrials.gov number, NCT03851575.). Copyright © 2026 Massachusetts Medical Society. <75> Accession Number 2051003581 Title Effect of perioperative opioid-sparing multimodal analgesia on early postoperative sleep disturbance in adults undergoing elective non-cardiac, non-obstetric surgery under general anaesthesia: protocol for a systematic review and meta-analysis. Source BMJ Open. 16(10) (no pagination), 2026. Article Number: e121506. Date of Publication: 01 Oct 2026. Author Shi Y.; Cai H.; Du J.; Fu Z.; Zhao J.; Liu X. Institution (Shi, Cai, Du, Fu) Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Shi, Cai, Du, Fu, Zhao, Liu) Department of Anaesthesiology, China-Japan Friendship Hospital, Beijing, China Publisher BMJ Publishing Group <76> Accession Number 2050734911 Title Tricuspid Transcatheter Edge-to-Edge Repair in Patients With Transvalvular Cardiac Implantable Electronic Device Leads: A Systematic Review and Meta-Analysis. Source American Journal of Cardiology. 280 (pp 5-11), 2026. Date of Publication: 01 Dec 2026. Author Moscato L.; Stabile F.; Vadala G.; Samad N.S.; Hakkeem B.; Madaudo C.; Corrado E.; Novo G.; Galassi A.R. Institution (Moscato, Stabile, Vadala, Madaudo, Corrado, Novo, Galassi) Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy (Samad) College of Arts and Science, New York University, New York, NY, United States (Hakkeem) Government Medical College Kozhikode, Kerala, India Publisher Elsevier Inc. Abstract Severe tricuspid regurgitation (TR) is associated with adverse outcomes, particularly in patients with cardiac implantable electronic devices (CIEDs), in whom transvalvular leads may contribute to valve dysfunction. Evidence supporting tricuspid transcatheter edge-to-edge repair (T-TEER) in this population remains limited. We performed a systematic review and meta-analysis to evaluate whether the presence of transvalvular CIED leads is associated with differences in procedural success, early safety, or mid-term outcomes after T-TEER. PubMed, Scopus, and Cochrane Library databases were systematically searched for studies comparing T-TEER outcomes in patients with and without CIEDs. Prespecified analyses focused on procedural success, early safety, functional status, residual TR, and 1-year all-cause mortality. Pooled mean differences and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight observational studies were included, comprising 2,779 patients, of whom 820 (29.5%) had transvalvular CIED leads. Procedural success was comparable between groups (RR 1, 95% CI 0.95 to 1.04). No significant differences were observed in early safety outcomes or functional status at 30 days. At 1-year follow-up, no significant differences were observed in residual TR <=2+ (RR 0.95, 95% CI 0.88 to 1.02), while all-cause mortality was higher in patients with CIEDs (RR 1.33, 95% CI 1.03 to 1.72). In conclusion, in this meta-analysis, T-TEER demonstrated comparable procedural success and early safety in patients with and without transvalvular CIED leads. Despite similar TR reduction at 1 year, patients with CIEDs exhibited higher midterm mortality, suggesting a possible discordance between valve-level technical success and patient-level clinical outcomes. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <77> Accession Number 2049800670 Title Continuous intra-arterial versus noninvasive blood pressure monitoring for preventing hypotension during anesthesia induction in patients aged >= 75 years undergoing noncardiac surgery: a randomized controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 625. Date of Publication: 01 Dec 2026. Author Li Y.; Liang S.; Zhang Y.; Ye Z.; Guo Q.; Zou W. Institution (Li, Liang, Zhang, Ye, Guo, Zou) Department of Anesthesiology, Xiangya Hospital, Central South University, Hunan Province, Changsha, China (Zou) National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, Changsha, China (Zou) Outcomes Research Consortium, Houston, TX, United States Publisher BioMed Central Ltd Abstract Background: Hypotension is common during the period after induction of general anesthesia and before surgical incision, particularly in older patients. The objective of this study was to compare the effectiveness of continuous intra-arterial pressure monitoring with that of noninvasive blood pressure monitoring in preventing hypotension during anesthesia induction in older patients (>= 75 years) undergoing noncardiac surgery. Method(s): In this single-center, randomized controlled trial, 82 older patients who were scheduled for elective noncardiac surgery under general anesthesia were randomly assigned to the continuous intra-arterial pressure monitoring group or the noninvasive blood pressure monitoring group. The primary outcome was the area under the curve for mean arterial pressure (MAP) < 65 mmHg during the first 15 min after induction, based on invasive blood pressure measurements. Result(s): The area under the curve for mean arterial pressure < 65 mmHg was significantly lower in the continuous intra-arterial pressure monitoring group (median (interquartile range), 0 (0-6.09) mmHg.min) than in the noninvasive group (3.67 (0-26.45) mmHg.min; P = 0.008). The continuous intra-arterial pressure monitoring group also had a shorter duration of MAP < 65 mmHg (0 (0-1.42) vs. 0.87 (0-3.88) minutes; P = 0.010), received lower doses of propofol (16.67 (13.34-24.15) vs. 30 (24.17-40.83) mg; P = 0.011) and remifentanil (25.34 (16.67-40.00) vs. 34.18 (25.00-57.00) microg; P = 0.045), and received vasoactive drugs earlier (0.87 (0.67-1.00) vs. 2.33 (1.87-3.33) minutes; P < 0.001) and at higher doses in the continuous intra-arterial pressure monitoring group. Conclusion(s): Compared with noninvasive blood pressure monitoring, continuous intra-arterial pressure monitoring initiated before induction was associated with reduced the incidence, severity, and duration of hypotension during anesthesia induction in older patients (>= 75 years) undergoing noncardiac surgery. Trial registration: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400088505) on August 20, 2024 (https://www.chictr.org.cn/). Copyright © The Author(s) 2026. <78> Accession Number 2047861217 Title Safety and Efficacy of Transcatheter Aortic Valve Implantation at Centres With Versus Without On-Site Cardiac Surgery: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. 35(10) (pp 1382-1394), 2026. Date of Publication: 01 Oct 2026. Author Elettreby A.M.; El-Sayed O.S.; Al-Hawari N.E.M.; Alqeeq B.F.; Gadelmawla A.F.; Abo Elnaga A.A.; Abushanap M.M.; Alkasasbeh J.A.; Jreisat L.; Alkhawaldeh I.M.; Bisht O. Institution (Elettreby, Abo Elnaga) Faculty of Medicine, Mansoura University, Mansoura, Egypt (El-Sayed) Faculty of Medicine, Zagazig University, Sharqia, Zagazig, Egypt (Al-Hawari) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Alqeeq) Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine (Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt (Abushanap, Jreisat) The Hashemite University, Zarqaa, Jordan (Alkasasbeh, Alkhawaldeh) Faculty of Medicine, Mutah University, Al-Karak, Jordan (Bisht) Evanglisches Herzzentrum Coswig, Coswig, Germany Publisher Elsevier Ltd Abstract Background: Aortic stenosis (AS) is the most common heart valve disorder causing significant complications. While transcatheter aortic valve implantation (TAVI) offers a less invasive alternative to surgery, debate remains about whether it should require on-site cardiac surgery backup. This systematic review and meta-analysis evaluate existing literature comparing outcomes of TAVI performed at centres with versus without on-site cardiac surgery, aiming to guide optimal patient management and institutional decision-making. Method(s): A comprehensive literature search was conducted in multiple databases up to May 2025 to retrieve relevant studies. Random-effects meta-analyses pooled risk ratios (RR) or mean differences. Because definitions of surgical backup varied across studies, backup organisation was extracted for each study. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Result(s): Six observational cohort studies (n=6,109 patients) were included. No statistically significant differences were observed for in-hospital mortality (four studies; n=3,463; RR= 0.94), 30-day mortality (five studies; n=4,880; RR= 0.87), or emergent conversion to open-heart surgery (four studies; n=4,136; RR= 0.78). Most secondary outcomes were likewise not statistically different, but several had substantial heterogeneity or unstable leave-one-out results. In one matched registry study from the included studies, in-hospital mortality among patients requiring emergent cardiac surgery after intraprocedural complications was high in both settings (50% vs 62.5%). Conclusion(s): This observational meta-analysis did not detect statistically significant differences in short-term mortality, emergent conversion, or major complications between centres with and without on-site cardiac surgery. However, the absence of statistically significant differences does not establish safety equivalence. Certainty of evidence was low to very low, and findings should be interpreted cautiously in light of residual confounding, publication bias, and variation in backup models. Accordingly, future high-quality studies are needed to validate these findings. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) <79> Accession Number 2026748415 Title Impact of Complete Revascularization in the ISCHEMIA Trial. Source Journal of the American College of Cardiology. 82(12) (pp 1175-1188), 2023. Date of Publication: 19 Sep 2023. Author Stone G.W.; Ali Z.A.; O'Brien S.M.; Rhodes G.; Genereux P.; Bangalore S.; Mavromatis K.; Horst J.; Dressler O.; Poh K.K.; Nath R.K.; Moorthy N.; Witkowski A.; Dwivedi S.K.; Bockeria O.; Chen J.; Smanio P.E.P.; Picard M.H.; Chaitman B.R.; Berman D.S.; Shaw L.J.; Boden W.E.; White H.D.; Fremes S.E.; Rosenberg Y.; Reynolds H.R.; Spertus J.A.; Hochman J.S.; Maron D.J. Institution (Stone, Shaw) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Ali) St Francis Hospital, Roslyn, NY, United States (Ali, Horst, Dressler) Cardiovascular Research Foundation, New York, NY, United States (O'Brien, Rhodes) Duke Clinical Research Institute, Durham, NC, United States (Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, United States (Bangalore, Reynolds, Hochman) NYU Grossman School of Medicine, New York, NY, United States (Mavromatis) Emory University School of Medicine, Atlanta, GA, United States (Poh) National University Heart Center Singapore and the Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Nath) Dr Ram Manohar Lohia Hospital, New Delhi, India (Moorthy) Sri Jayadeva Institute of Cardiovascular Sciences and Research, Karnataka, Bangalore-Karnataka, India (Witkowski) National Institute of Cardiology, Warsaw, Poland (Dwivedi) King George Medical University, Lucknow Up, India (Bockeria) National Research Center for Cardiovascular Surgery, Moscow, Russian Federation (Chen) Guangdong Provincial People's Hospital, Guangdong, China (Smanio) Instituto Dante Pazzanese de Cardiologia e Fleury Medicina e Saude, Sao Paulo, Brazil (Picard) Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States (Chaitman) St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St Louis, MO, United States (Berman) Cedars-Sinai Medical Center, Los Angeles, CA, United States (Boden) Boston University School of Medicine, Boston, MA, United States (White) Auckland City Hospital Green Lane Cardiovascular Services and University of Auckland, Auckland, New Zealand (Fremes) University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (Rosenberg) National Heart, Lung, and Blood Institute, Washington, DC, United States (Spertus) Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Kansas City, MO, United States (Maron) Department of Medicine, Stanford School of Medicine, Stanford, CA, United States Publisher Elsevier Inc. Abstract Background: Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported. Objective(s): Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management. Method(s): ACR and FCR in the INV group were assessed at an independent core laboratory. Multivariable-adjusted outcomes of CR were examined in INV patients. Inverse probability weighted modeling was then performed to estimate the treatment effect had CR been achieved in all INV patients compared with CON management. Result(s): ACR and FCR were achieved in 43.4% and 58.4% of 1,824 INV patients. ACR was associated with reduced 4-year rates of cardiovascular death or MI compared with incomplete revascularization. By inverse probability weighted modeling, ACR in all 2,296 INV patients compared with 2,498 CON patients was associated with a lower 4-year rate of cardiovascular death or MI (difference -3.5; 95% CI: -7.2% to 0.0%). In comparison, the event rate difference of cardiovascular death or MI for INV minus CON in the overall ISCHEMIA trial was -2.4%. Results were similar but less pronounced with FCR. Conclusion(s): The outcomes of an INV strategy may be improved if CR (especially ACR) is achieved. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522) Copyright © 2023 American College of Cardiology Foundation <80> Accession Number 2051133255 Title Cost-effectiveness of catheter ablation in end-stage heart failure with atrial fibrillation: Insights from CASTLE-HTx. Source Heart Rhythm. (no pagination), 2026. Date of Publication: 2026. Author Boettger P.; Moersdorf M.; Sommer P.; Marrouche N.F.; Costard-Jaeckle A.; Crijns H.J.G.M.; Bergau L.; Fox H.; Hindricks G.; Dagres N.; Schramm R.; Fink T.; Khalaph M.; Sciacca V.; Didenko M.; Konietschke F.; Rudolph V.; Gummert J.; Tijssen J.G.P.; Sossalla S.; Sohns C. Institution (Boettger) Department of Cardiology,Angiology and Critical Care Medicine, Justus Liebig University of Giessen, Giessen, Germany (Boettger) Department of Health Policy, London School of Economics and Political Science, London, United Kingdom (Moersdorf, Sommer, Bergau, Fink, Khalaph, Sciacca, Didenko, Sohns) Department of Electrophysiology.Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Moersdorf, Marrouche, Gummert) Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States (Costard-Jaeckle, Fox, Schramm) Clinic for Thoracic and Cardiovascular Surgery,Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany (Costard-Jaeckle, Fox, Schramm) Heart Failure Department,Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany (Crijns) Department of Cardiology and CARIM, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands (Hindricks, Dagres) Department of Cardiology,Angiology and Intensive Care Medicine, German Heart Center of the Charite-University Medicine Berlin, Charite Campus Mitte, Germany (Konietschke) Institute of Biometry and Clinical Epidemiology, Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany (Rudolph) Clinic for General and Interventional Cardiology/Angiology,Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Tijssen) Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Sossalla) Department of Cardiology,Angiology and Critical Care Medicine, University of Giessen & Kerckhoff Heart Center, Bad Nauheim/DZHK (Partner Site RheinMain), Germany Publisher Elsevier B.V. Abstract Background The CASTLE-HTx (Catheter Ablation for Atrial Fibrillation in patientS With End-sTage Heart Failure and Eligibility for Heart Transplantation; ClinicalTrials.gov identifier NCT04649801) trial showed that the combination of catheter ablation and guideline-directed medical therapy (GDMT) was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or heart transplantation (HTx) in patients with end-stage heart failure (HF) and atrial fibrillation (AF). Objective This analysis evaluates the cost-effectiveness of catheter ablation plus GDMT vs medical therapy alone in patients with end-stage HF and AF referred for HTx evaluation. Methods In CASTLE-HTx, we randomized 194 patients in end-stage HF and AF to receive catheter ablation and GDMT (n = 97) or medical therapy alone (n = 97). Details of study design, outcome definitions, and results have been published. A cohort-based Markov model projected lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) from the perspective of the German statutory health insurance system using 3-year outcomes from CASTLE-HTx. Results In lifetime projections, the combination of AF ablation and GDMT was associated with a mean survival gain of ~1.7 LYs per patient at an incremental cost of ~12,000, yielding an incremental cost-effectiveness ratio of ~7300 per LY gained. The incremental cost-effectiveness ratios per QALY in lifetime projections (8600) and at 36 months (30,400) were below 50,000 per QALY, indicating cost-effectiveness at contemporary thresholds. Within 36 months, this survival benefit resulted in a gain of 0.34 LYs, reflecting prevention of death and worsening HF. The long-term benefit emerged early and remained consistent across sensitivity analyses. Conclusion The combination of catheter ablation and GDMT is cost-effective and economically favorable in patients with end-stage HF and AF who are referred for HTx evaluation. Copyright © 2026 Heart Rhythm Society. <81> Accession Number 2051118125 Title Transcatheter atrioventricular valve-in-valve re-replacement with balloon-expandable prostheses: contemporary clinical relevance and place among redo valve interventions. Source Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 30(2) (pp 77-81), 2026. Date of Publication: 2026. Author Gorbatykh A.V. Institution (Gorbatykh) Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg, Russian Federation Publisher Meshalkin National Medical Research Center Abstract Introduction: The steadily increasing number of patients with structural degeneration of bioprosthetic heart valves necessitates the search for alternatives to redo open surgery, which is associated with high operative risk due to resternotomy, adhesions, repeat cardiopulmonary bypass, and an unfavorable comorbidity profile. In this context, transcatheter valve-in-valve re-replacement has emerged as one of the key management strategies for this patient population, especially in the technically most challenging atrioventricular positions. Objective(s): To assess the contemporary clinical relevance of transcatheter atrioventricular re-replacement and define its place in the structure of redo interventions based on the clinical case series reported by R.S. Tarasov et al. and current international literature. Result(s): This article reviews the technical and clinical aspects of mitral and tricuspid re-replacement using balloon-expandable prostheses. Recent meta-analyses have shown that the valve-in-valve technique is non-inferior to surgical re-replacement in terms of survival, while being associated with significantly lower rates of stroke, bleeding, and acute kidney injury. Particular attention is paid to the role of multislice computed tomography in preventing left ventricular outflow tract obstruction during mitral interventions, to the principles of balloon-expandable prosthesis positioning in the atrioventricular position, and to the possibility of minimizing anesthetic support during tricuspid re-replacement. At the same time, the limitations of the current evidence base and several unresolved issues are emphasized, including implanted device durability, the risk of residual gradients, and paravalvular regurgitation. Conclusion(s): At present, transcatheter valve-in-valve re-replacement in atrioventricular positions should be regarded not merely as an alternative for patients at prohibitive risk, but as a clinically justified component of the contemporary treatment strategy capable of substantially reducing procedural burden and accelerating rehabilitation. Nevertheless, the definitive determination of its role requires prospective studies with long-term outcome assessment. Copyright © 2026 Gorbatykh <82> Accession Number 2051095718 Title Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Implantation in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Source Cardiology in Review. (no pagination), 2026. Date of Publication: 2026. Author Bacha Z.; Shahbaz H.; Yasir A.; Afridi H.; Rashad A.; Muneer H.; Gohar F.; Khan M.; Chaudhary M.A.; Rehman A.; Abid M.; Afridi M.S.; Naqvi M.; Khan F.M.; Rahat S.; Rafi F.; Hassanabad A.F. Institution (Bacha, Gohar) From the Department of Medicine, Khyber Medical College (KMC), Peshawar, Pakistan (Yasir, Afridi, Rashad, Khan, Khan) Department of Medicine, Khyber Girls Medical College (KGMC), Peshawar, Pakistan (Shahbaz) Department of Medicine, Ayub Medical College (AMC), Abbottabad, Pakistan (Muneer, Rahat) Department of Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan (Rafi) Department of Medicine, Sharif medical and dental college, Lahore, Pakistan (Chaudhary) Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Rehman) Department of Medicine, Kabir medical college, Peshawar, Pakistan (Abid, Naqvi) Department of Medicine, Dow Medical College, Karachi, Pakistan (Afridi) Department of Medicine, Pak International Medical College, Peshawar, Pakistan (Hassanabad) Division of Cardiac Surgery, Department of Surgery, Columbia University Irving Medical Center, Columbia University, New York, NY, United States Publisher Lippincott Williams and Wilkins Abstract Concomitant coronary artery disease affects 40-75% of patients undergoing transcatheter aortic valve implantation (TAVI). Three recent randomized trials yielded conflicting findings: NOTION-3 demonstrated reduced composite events with pre-TAVI percutaneous coronary intervention (PCI), whereas PRO-TAVI showed non-inferiority of PCI deferral with less bleeding; neither demonstrated mortality benefit. No previous meta-analysis combined all 3 trials with observational evidence, applied design-stratified GRADE certainty, or explored cardiovascular mortality heterogeneity. We performed a systematic review and meta-analysis of 16 studies (3 randomized trials, 13 observational cohorts; 8,207 patients). Ten prespecified outcomes were pooled using Mantel-Haenszel random-effects risk ratios (RRs) with 95% confidence intervals (CIs); 30-day all-cause mortality was primary. GRADE certainty was assessed separately for randomized and observational evidence. Prespecified design-based subgroup and leave-one-out sensitivity analyses were performed. Pre-TAVI PCI was not associated with significant differences in 30-day all-cause mortality (RR 1.26, 95% CI 0.90-1.77; I2 = 32%) or 1-year mortality (RR 1.00, 95% CI 0.87-1.15; I2 = 0%). Major bleeding (RR 1.19, 95% CI 0.98-1.44) and major vascular complications (RR 1.48, 95% CI 0.95-2.30) showed borderline non-significant trends favoring PCI deferral (both I2 = 0%). Excluding Griese et al. 2014, the principal driver of harm and heterogeneity, reduced cardiovascular mortality heterogeneity (RR 0.91; I2 = 24%). No significant differences occurred in stroke, myocardial infarction, acute kidney injury, pacemaker implantation, or rehospitalization. Routine pre-TAVI PCI confers no mortality benefit and may increase bleeding and vascular complications; PCI should be individualized according to coronary complexity, lesion significance, and bleeding risk. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <83> Accession Number 2051223186 Title Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: An Updated Meta-Analysis of RCTs Using Reconstructed Individual Patient Data. Source American Journal of Cardiology. 280 (pp 95-106), 2026. Date of Publication: 01 Dec 2026. Author Otaal A.; Coylewright M.; Alkhouli M.; Patel N.K.; Kolte D. Institution (Otaal, Patel, Kolte) Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States (Coylewright) Heart and Vascular Center, Essentia Health, Duluth, MN, United States (Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States Publisher Elsevier Inc. Abstract Left atrial appendage closure (LAAC) is a reasonable alternative to oral anticoagulation (OAC) in selected patients with atrial fibrillation (AF). We conducted an updated meta-analysis of randomized controlled trials comparing LAAC versus OAC in patients with AF. The primary efficacy endpoint was a composite of all stroke, systemic embolism, or cardiovascular/all-cause death. The primary safety endpoint was major bleeding. Secondary endpoints included net adverse clinical events, all-cause death, nonprocedure-related bleeding, and ischemic stroke. Reconstructed individual patient data meta-analysis using a 2-stage approach and study-level meta-analysis using random-effects models were performed. Six trials enrolling 7,004 patients randomized to LAAC (n = 3,681) or OAC (n = 3,323) were included. There were no significant differences between LAAC versus OAC for the primary efficacy endpoint (difference in restricted mean survival time [RMST] -0.006 years, 95% confidence interval [CI] -0.027 to 0.015 years, p = 0.56) or primary safety endpoint (RMST 0.004 years, 95% CI -0.025 to 0.034 years, p = 0.77) at 3 years. Nonprocedure-related bleeding was significantly lower with LAAC versus OAC (RMST 0.162 years, 95% CI 0.104 to 0.220 years, p <0.001) with no difference in all-cause death (RMST 0.029 years, 95% CI -0.031 to 0.089 years, p = 0.34). In a study-level meta-analysis, ischemic stroke was not significantly different with LAAC versus OAC (risk ratio 1.32, 95% CI 0.94 to 1.86, p = 0.09). In conclusion, the trade-off between a statistically significant lower risk of nonprocedure-related bleeding and a numerically, but not statistically, higher risk of ischemic stroke with LAAC versus OAC necessitates individualized risk assessment and shared decision-making for patients with AF at elevated risk of stroke. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <84> Accession Number 652530096 Title Lifetime Management of Aortic Stenosis: Expert Review of Evidence and Consensus Guidelines. Source The Annals of thoracic surgery. (no pagination), 2026. Date of Publication: 26 Oct 2026. Author Centofanti P.; Rinaldi M.; Di Eusanio M.; D'Onofrio A.; Gerosa G.; Lodo V.; Pacini D.; Salizzoni S.; Stefano P.; Pilato M. Institution (Centofanti, Lodo) Cardiac Surgery Unit, AO Ordine Mauriziano Hospital, Turin, Italy (Rinaldi, Salizzoni) Cardiac Surgery Unit, AOU Citta della Salute e della Scienza University Hospital, Turin, Italy (Di Eusanio) Cardiac Surgery Unit, Ospedali Riuniti University Hospital, Ancona, Italy (D'Onofrio) Cardiac Surgery Unit, Policlinico Tor Vergata University Hospital, Rome, Italy (Gerosa) Cardiac Surgery Unit, University Hospital of Padua, Padua, Italy (Pacini) Cardiac Surgery Unit, Policlinico Sant'Orsola-Malpighi University Hospital, Bologna, Italy (Stefano) Cardiac Surgery Unit, Careggi University Hospital, Florence, Italy (Pilato) Cardiac Surgery Unit, Palermo, Italy Abstract BACKGROUND: The 2025 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines introduced a Class I recommendation for transfemoral transcatheter aortic valve implantation (TAVI) in selected patients aged 70 years or older with tricuspid aortic stenosis and suitable anatomy, while surgical aortic valve replacement (SAVR) remains recommended in younger low-risk patients. In patients with long expected survival, this framework requires careful consideration of valve durability, future reintervention, and patient preferences. This expert review, developed by the Italian Cardiac Surgery Working Group, examines contemporary evidence and consensus recommendations from a lifetime-management perspective. METHOD(S): We performed a narrative, evidence-based synthesis of randomized trials, trial-based meta-analyses, and propensity-matched real-world registries comparing transfemoral TAVI and SAVR, with primary emphasis on low-risk patients. Lower-intermediate-risk evidence was included only when directly relevant to lifetime management, durability, or reintervention. RESULT(S): Evidence suggests that treatment effects are time-dependent: early non-inferiority of TAVI may attenuate with longer follow-up, particularly in patients with substantial life expectancy. Randomized durability data remain limited, whereas propensity-matched real-world registries have suggested possible higher late mortality after TAVI in younger, lower-risk populations. Reintervention after a transcatheter-first strategy may be associated with increasing technical complexity and procedural risk over time. CONCLUSION(S): This review supports appropriate application of current guidelines through a pragmatic framework for individualized, Heart Team-based decision-making. Transfemoral TAVI is often appropriate in patients with limited life expectancy or recognized high surgical risk when anatomically feasible. In patients with long expected survival, SAVR should retain a central role as an important reference strategy. Copyright © 2026. Published by Elsevier Inc. <85> Accession Number 2049925274 Title Effect of Preoperative Intranasal Dexmedetomidine on Postoperative Myocardial Injury in Patients Undergoing Coronary Artery Bypass Grafting. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 644667. Date of Publication: 2026. Author Li Q.; Hu S.; Fu Y.; Shen L.; Xiong B.; Qi D. Institution (Li, Hu, Fu, Shen, Xiong, Qi) Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Jiangsu, Xuzhou, China (Li, Hu, Fu, Shen, Xiong, Qi) Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, China Publisher Dove Medical Press Ltd Abstract Purpose: To evaluate the effects of preoperative intranasal dexmedetomidine on postoperative myocardial injury biomarkers in patients undergoing on-pump coronary artery bypass grafting (CABG). Patients and Methods: In this randomized, double-blind, placebo-controlled trial, 70 patients undergoing on-pump CABG were assigned to receive intranasal dexmedetomidine (1 mug/kg) or saline 30 min before bedtime on the night before surgery and again 30 min before anesthesia induction. The primary outcome was serum high-sensitivity cardiac troponin T (hs-cTnT) at 24 h after surgery. Secondary outcomes included perioperative cardiac biomarkers, preoperative sleep quality, postoperative delirium, and adverse events. Result(s): For the prespecified primary outcome, hs-cTnT concentrations at 24 h after surgery were significantly lower in the dexmedetomidine group than in the control group (estimated marginal means, 170.29 vs 357.29 ng/L; P < 0.001). Postoperative creatine kinase-MB (CK-MB) concentrations were also lower in the dexmedetomidine group (all P < 0.05). N-terminal pro-B-type natriuretic peptide showed a significant group-by-time interaction (P = 0.030), although between-group differences at individual postoperative time points were not significant. The dexmedetomidine group had higher Leeds Sleep Evaluation Questionnaire scores (62 [60-64] vs 44 [41-50]; P < 0.001) and a lower incidence of postoperative delirium (14.3% vs 37.1%; P = 0.029). Adverse events, mechanical ventilation duration, and intensive care unit (ICU) length of stay did not differ significantly between groups. Conclusion(s): In this single-center trial, two-dose preoperative intranasal dexmedetomidine was associated with lower postoperative hs-cTnT and CK-MB concentrations, better subjective preoperative sleep quality, and a lower observed incidence of postoperative delirium. These findings are preliminary and require confirmation in larger, adequately powered multicenter randomized trials to determine whether the biomarker reductions translate into clinically meaningful cardiovascular benefits. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2500111431. Copyright © 2026 Li et al. <86> Accession Number 2038825013 Title Impact of Preoperative Versus Intraoperative and Postoperative Intra-Aortic Balloon Pump Insertion on Mortality and Clinical Outcomes in High-Risk Coronary Artery Bypass Grafting Patients: A Systematic Review and Meta-Analysis. Source Cor et Vasa. 68(5) (pp 546-554), 2026. Date of Publication: 2026. Author Hutabarat M.C.B.A.P.; Limanto D.H.; Rizki M.; Sembiring Y.E. Institution (Hutabarat, Limanto, Rizki, Sembiring) Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia (Hutabarat, Limanto, Sembiring) Department of Thoracic, Cardiac and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Publisher Czech Society of Cardiology Z.S Abstract Introduction: The optimal timing of intra-aortic balloon pump (IABP) insertion in high-risk coronary artery bypass grafting (CABG) remains controversial. While preoperative IABP may provide early hemodynamic stabilization, intraoperative or postoperative insertion is typically performed as rescue therapy after hemodynamic deterioration. This study aimed to evaluate the impact of preoperative versus intraoperative/ postoperative IABP insertion on mortality and clinical outcomes in high-risk CABG patients. Method(s): A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed and ScienceDirect were searched for studies published between January 2000 and January 2025. Eligible studies included adult high-risk CABG patients directly comparing preoperative and delayed (intra operative/postoperative) IABP insertion. The primary endpoint was short-term mortality (in-hospital or 30-day). Secondary outcomes included major adverse cardiac events (MACE), prolonged mechanical ventilation, ICU stay, hospital stay, and duration of IABP support. Random-effects meta-analysis was performed using RevMan 5.4. Result(s): Ten studies comprising 49,557 patients were included. Preoperative IABP insertion was associated with significantly reduced in-hospital mortality (OR 0.52; 95% CI 0.33-0.81; p = 0.004) and 30-day mortality (OR 0.12; 95% CI 0.05-0.31; p <0.001). Major adverse cardiac events were also significantly lower (OR 0.54; 95% CI 0.39-0.76; p <0.001). Prolonged mechanical ventilation was reduced (OR 0.38; 95% CI 0.15-0.96; p = 0.04). No significant differences were observed in ICU stay, hospital stay, ventilation duration, or IABP support duration. Conclusion(s): Preoperative IABP insertion is associated with improved short-term survival and reduced perioperative complications in high-risk CABG patients, supporting a proactive rather than rescue strategy in carefully selected individuals. Copyright © 2026, CKS. <87> Accession Number 2049616146 Title Current status of minimally invasive surgery for thoracic esophageal diverticula: systematic review and meta-analysis. Source Surgical Endoscopy. (no pagination), 2026. Date of Publication: 2026. Author Tamburri G.; Cammarata F.; Bistagnino F.; Bonitta G.; Simic A.; Skrobic O.; Schoppmann S.F.; Ayazi S.; Elshafei M.; Popa C.; Bona D.; Bonavina L.; Gutschow C.A.; Aiolfi A. Institution (Aiolfi, Tamburri, Cammarata, Bistagnino, Bonitta, Bona) Department of General Surgery, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy (Simic, Skrobic) Department of Surgery, School of Medicine University of Belgrade, Hospital for Digestive Surgery, University Clinical Center of Serbia, Belgrade, Serbia (Gutschow) Upper-GI Unit, Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland (Schoppmann) Surgical Oncology, Department of Surgery, Upper-GI-Service, Medical University of Vienna, Vienna, Austria (Ayazi) Department of Surgery, Drexel University, Philadelphia, PA, United States (Elshafei) Department of General and Visceral Surgery, Marien Hospital Mainz, Mainz, Germany (Popa) Regional Institute of Gastroenterology and Hepatology O. Fodor Cluj-Napoca, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Croitorilor 19-21, Cluj-Napoca, Romania (Bona) Department of Biomedical Science for Health, University of Milan, Milan, Italy (Bonavina) Department of Pharmacy, Health and Nutrition Sciences, University of Calabria, Rende, Cosenza, Italy (Bonavina) Division of General and Foregut Surgery, Azienda Ospedaliera di Cosenza, University of Calabria, Cosenza, Italy Publisher Springer Abstract Introduction: Thoracic esophageal diverticula, including epiphrenic and parabronchial types, are rare clinical entities representing about 30% of all esophageal diverticula. Thoracic diverticula of the pulsion type have traditionally been associated with motility disorders and treated by stapled diverticulectomy with or without myotomy/fundoplication in patients experiencing disabling symptoms of dysphagia, regurgitation or pulmonary aspiration. Purpose of this study was to review the existing literature and estimate outcomes of minimally invasive surgery. Method(s): Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. The search was last updated on April 20, 2026. Outcomes were staple-line leak, overall complications, in-hospital mortality, and symptoms improvement. Result(s): Twenty-one observational studies including 390 patients were analyzed. The age of the patients ranged from 23 to 83 years. Dysphagia (86%), regurgitation (73.4%), and respiratory symptoms (31.2%) were common indications for surgery. The size of the diverticula ranged from 2 to 11 cm. Preoperative use of standard or high-resolution esophageal manometry was reported in 18 studies. Achalasia (49.2%) was the most commonly associated motility disorder. Laparoscopic (61.9%), thoracoscopic (30.6%), or combined (6.7%) minimally invasive approaches were described. Adjunctive procedures were esophagomyotomy (87%) and Dor (34.6%) or Toupet (17.7%) fundoplication. The estimated pooled prevalence of staple-line leak was 9.8% (95% CrI 7.1-13.4%; I2 = 0.0). Exploratory unadjusted subgroup analyses did not identify statistically supported differences in staple-line leak according to myotomy (RR = 0.67; 95% CrI 0.17-3.52) or surgical approach (RR = 0.72; 95% CrI 0.22-3.39). The estimated pooled prevalence of overall complications, in-hospital mortality, and study-reported symptom resolution/improvement was 21.6% (95% CrI 16.1-28.4%), 1.3% (95% CrI 0.5-2.9%), and 92.1% (95% CrI 87.7-95%), respectively. Conclusion(s): Current evidence reporting outcome for minimally invasive midesophageal and epiphrenic diverticulectomy is limited by study design and treatment heterogeneity. Future well-designed multicenter studies are required to assess the effect of surgical approach and esophageal myotomy on short-term morbidity, symptomatic outcomes, and recurrence rate. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <88> Accession Number 2051097287 Title Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation in infants undergoing cardiac procedures (NasoVISI): a multicentre, randomised controlled trial. Source The Lancet Child and Adolescent Health. (no pagination), 2026. Date of Publication: 2026. Author Garcia-Marcinkiewicz A.G.; Gottlieb E.A.; Twite M.; Zabala L.M.; Kuntz M.T.; Waberski A.T.; Zhang B.; Nicolson S.C. Institution (Garcia-Marcinkiewicz, Zhang, Nicolson) The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States (Gottlieb) Dell Children's Medical Center, The University of Texas at Austin Dell Medical School, Austin, TX, United States (Twite) Children's Hospital Colorado, Aurora, CO, United States (Twite) Nemours Children's Health, Wilmington, DE, United States (Zabala) Children's Medical Center Dallas, UT Southwestern Medical Center, Dallas, TX, United States (Kuntz) Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, United States (Waberski) Children's National, Washington, DC, United States Publisher Elsevier B.V. Abstract Background: Nasotracheal intubation is a common procedure for infants undergoing surgery, and successful intubation at first attempt reduces the risk of complications. First-attempt success is improved with videolaryngoscopy compared with direct laryngoscopy in infants requiring orotracheal intubation, but the value of videolaryngoscopy in infants requiring nasotracheal intubation is unknown. We aimed to compare first-attempt success of nasotracheal intubation by videolaryngoscopy and direct laryngoscopy in infants undergoing cardiac procedures. Method(s): In this multicentre, parallel group, randomised controlled trial across eight paediatric cardiac centres in the USA, we enrolled infants aged 365 days or younger without anticipated difficult airways requiring nasotracheal intubation for elective cardiothoracic surgery or cardiac catheterisation. Patients were randomly assigned (1:1) to videolaryngoscopy or direct laryngoscopy using permuted block randomisation stratified by site. The primary outcome was first-attempt intubation success rate. Analysis was by modified intention to treat using generalised estimating equations to account for clustering within intubating clinicians. Complications associated with first attempt and across all attempts were compared between groups with the same marginal models as the primary outcome analysis. This trial is registered with ClinicalTrials.gov (NCT05433155) and is closed to new participants. Finding(s): Between July 1, 2022, and March 31, 2024, 684 infants were randomly assigned, of whom 673 were included in the primary outcome analysis: 340 in the videolaryngoscopy group and 333 in the direct laryngoscopy group. 311 (46%) participants were female, 362 (54%) were male, and 457 (68%) were White. The median age was 14.04 weeks (IQR 1.48-22.89) and the mean weight was 4.77 kg (SD 1.74). First-attempt success was higher in the videolaryngoscopy group than in the direct laryngoscopy group (281 [83%] vs 249 [75%]; adjusted risk difference 8.2% [95% CI 2.0-14.3], p=0.0093). First-attempt complications occurred in 85 (13%) participants overall, with similar incidences between groups (45 [13%] vs 40 [12%]; 0.4% [-3.5 to 4.3], p=0.83). Considering all attempts cumulatively, any complication occurred in 94 (14%) participants overall, with similar incidences between groups (46 [14%] vs 48 [14%]; -1.9% [-6.0 to 2.3], p=0.38). No cases of cardiac arrest or death occurred in either group. Interpretation(s): Improved first-attempt success rates with videolaryngoscopy for nasotracheal intubation in infants undergoing cardiac procedures add to growing evidence favouring videolaryngoscopy as the first-line technique for tracheal intubation in infants. Key remaining questions for ongoing research include whether this benefit extends to infants with difficult airways and at non-specialist centres or urgent settings, and how clinician training should evolve as videolaryngoscopy becomes standard practice. Funding(s): Anesthesia Patient Safety Foundation and The Children's Hospital of Philadelphia. Copyright © 2026 Elsevier Ltd <89> Accession Number 2051136130 Title Intravenous and intra-arterial thrombolysis for acute ischemic stroke following interventional cardiac procedures: A systematic review and narrative synthesis. Source Therapeutic Advances in Neurological Disorders. 19 (no pagination), 2026. Date of Publication: 01 Jan 2026. Author D'Anna L.; Prandin G.; Abu-Rumeileh S.; Favruzzo F.; Surcinelli A.; Simonetti R.; Ornello R.; Colantuono P.; Sacco S.; Di Sante F.; Di Pietro M.; Sensi S.L.; Tomassini V.; Strano S.; Toni D.; Miserocchi L.M.; Balducci G.; Piacaglia M.G.; Otto M.; Simister R.; Caulo M.; Zimarino M.; Meinel T.R.; Korompoki E.; Veltkamp R.; Bax F.; Valente M.; Gigli G.; Merlino G.; Russo M.; Foschi M. Institution (D'Anna, Korompoki, Veltkamp) Department of Brain Sciences, Imperial College London, London, United Kingdom (D'Anna) Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom (Prandin) Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy (Abu-Rumeileh, Otto) Department of Neurology, Martin-Luther-University Halle-Wittenberg, (Saale), Halle, Germany (Favruzzo) Comprehensive Stroke Center, Ospedale dell'Angelo, Azienda ULSS 3 Serenissima, Mestre, Italy (Surcinelli, Miserocchi, Balducci, Piacaglia, Foschi) Department of Neurosciences, Stroke Unit - Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy (Simonetti) Unidad de Ictus, Hospital Universitario Vall d'Hebron, Barcelona, Spain (Ornello, Colantuono, Sacco) Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy (Di Sante, Di Pietro, Sensi) Department of Neurosciences, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (Tomassini) Department of Neurosciences, Imaging and Clinical Sciences, Centre for Disability, Rehabilitation and Sport Medicine (CARES), Institute of Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (Strano) Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University, Rome, Italy (Toni) Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy (Simister) Comprehensive Stroke Service, University College London Hospital, London, United Kingdom (Caulo) Department of Neuroscience and Clinical Sciences, University of Chieti, Chieti, Italy (Zimarino, Russo) Department of Cardiology, SS. Annunziata Hospital, ASL2 Abruzzo, Chieti, Italy (Zimarino) Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele d'Annunzio" University of Chieti-Pescara, Chieti, Italy (Meinel) Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland (Korompoki) Department of Clinical Therapeutics, National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece (Veltkamp) Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany (Veltkamp) Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany (Bax, Valente, Gigli, Merlino) Clinical Neurology, Udine University Hospital, Department of Medicine (DAME), University of Udine, Udine, Italy (Merlino) Department Head, and Neurosciences, SOSD Stroke Unit, Udine University Hospital, Udine, Italy (Russo) Department1 of Cardiology, F. Renzetti Hospital, ASL2 Abruzzo, Lanciano, Italy Publisher SAGE Publications Ltd Abstract Background: Acute ischemic stroke is a rare but potentially devastating complication of interventional cardiac procedures, and evidence on thrombolysis remains limited. Objective(s): To systematically review intravenous and intra-arterial thrombolysis (IVT and IAT) for ischemic stroke during or after cardiac procedures, focusing on neurological, functional, mortality, and haemorrhagic outcomes. Design(s): Systematic review and narrative synthesis. Method(s): The review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420261287481). PubMed, Scopus, and EMBASE were searched from inception to January 2026. Studies reporting periprocedural ischemic stroke treated with IVT and/or IAT were included. Prespecified outcomes were favourable functional outcome (modified Rankin Scale score 0-2 at approximately 90 days), all-cause mortality, and symptomatic intracranial haemorrhage; neurological improvement/recovery was additionally summarised post hoc. Result(s): Twenty-four studies including 85 thrombolysis-treated patients were included, predominantly case reports and small case series. Exact age was available for 38 patients (median 72 years, IQR 61.3-78.8) and sex for 69 (59.4% male). TAVI/TAVR was the most frequent setting (33/85, 38.8%). Stroke occurred during or immediately after the intervention in 21/38 patients (55.3%) with precise timing; large-vessel occlusion was identified in 33/47 (70.2%) with extractable vascular imaging data. Favourable functional outcome was reported in 11/18 patients (61.1%) with compatible approximately 90-day mRS data. Post-hoc neurological improvement/recovery was separately ascertainable in 43 patients and was reported in 33/43 (76.7%). All-cause mortality occurred in 9/68 (13.2%), major or clinically significant bleeding in 8/85 (9.4%), intracranial haemorrhage/haemorrhagic transformation in 6/85 (7.1%), and symptomatic intracranial haemorrhage in 1/35 (2.9%). Conclusion(s): Thrombolysis has been reported across heterogeneous cardiac procedural settings, but case-report predominance and substantial clinical and outcome heterogeneity preclude reliable estimates of effectiveness and safety. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). <90> Accession Number 2051222524 Title Left Atrial Appendage Occlusion Among Cancer Patients With Atrial Fibrillation: A Systematic Review and Updated Meta-Analysis. Source American Journal of Cardiology. 280 (pp 118-124), 2026. Date of Publication: 01 Dec 2026. Author Afonso L.M.; Gava G.D.B.; da Silva Pires H.; Fiuza E.F.; Goldwasser B.T.T.; Rogelin M.; de Sant Anna Melo E. Institution (Afonso) Department of Medicine, Federal University of Cariri, Ceara, Barbalha, Brazil (Gava) Department of Medicine, Federal University of Santa Maria, Rio Grande do Sul, Santa Maria, Brazil (da Silva Pires) Department of Medicine, City University of Sao Paulo (UNICID), Sao Paulo, Sao Paulo, Brazil (Fiuza) Department of Medicine, Nove de Julho University (UNINOVE), Sao Paulo, Sao Paulo, Brazil (Goldwasser) Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Rogelin) Department of Cardiology, Santa Catarina Institute of Cardiology, Santa Catarina, Sao Jose, Brazil (de Sant Anna Melo) Department of Medicine, Albert Einstein Israelite Hospital, Sao Paulo, Sao Paulo, Brazil Publisher Elsevier Inc. Abstract Left atrial appendage occlusion (LAAO) is a well-established therapy for atrial fibrillation in patients with contraindications to oral anticoagulation. However, the clinical outcomes of LAAO in patients with cancer remain poorly defined. Therefore, we performed an updated meta-analysis to evaluate the safety and efficacy of LAAO in patients with cancer. PubMed, Embase, and Cochrane databases were systematically searched for studies evaluating LAAO in patients with atrial fibrillation and cancer. Our end points of interest were long-term stroke, bleeding, and all-cause mortality. We reported the end points as hazard ratios (HRs), odds ratios ,and 95% confidence intervals (CIs). Additionally, a prespecified subgroup analysis comparing patients with active and history of cancer was performed. Heterogeneity was assessed using the I2 statistic. We included 9 studies with 209,325 patients, of whom 39.3% were female and had a mean age of 77 years. Cancer was significantly associated with higher long-term all-cause mortality (HR 1.64, 95% CI 1.20 to 2.23, p = 0.002). However, no significant associations were observed for long-term stroke (HR 0.59, 95% CI 0.30 to 1.15, p = 0.12) or long-term bleeding (HR 1.02, 95% CI 0.57 to 1.83, p = 0.94). No significant difference was observed between active and history of cancer subgroups (p = 0.146). In this meta-analysis, cancer was associated with higher long-term mortality in patients who underwent LAAO. Nevertheless, there was no difference between cancer and noncancer groups' risk for thromboembolic or bleeding events. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <91> Accession Number 2038813629 Title Effectiveness of Pediatric Respiratory Therapist-Led Early Pulmonary Rehabilitation on Post-Thoracic Surgery Lung Function: A Systematic Review and Meta-Analysis. Source Natural Resources for Human Health. 6(19s) (pp 504-516), 2026. Date of Publication: 06 Oct 2026. Author Abdat I.; Alnumiere A.; Khaddour M.; Alkweider M.; Ebrahim H.A.; Zafir T.F.; Alajmi A.; Al-Salami M.I.A. Institution (Abdat) Ministry of Health (MOH), Research Participation and Scientific Collaboration, Saudi Arabia (Alnumiere) Children's Hospital in Damascus, Syrian Arab Republic (Khaddour, Alkweider, Ebrahim) University Children's Hospital, Damascus University, Syrian Arab Republic (Ebrahim) Damascus Hospital, Syrian Arab Republic (Zafir) King Abdulaziz University (Alajmi) KFMC, Saudi Arabia (Al-Salami) Umm Al-Qura University, Saudi Arabia Publisher Visagaa Publishing House Abstract Background: Early pulmonary rehabilitation (PR) following adult thoracic and cardiac surgery is well established, yet the effectiveness of Respiratory Therapist (RT)-led early PR specifically on postoperative lung function after pediatric thoracic surgery has not been systematically evaluated. This review asks: what is the effectiveness of RT-led early PR on lung function in children undergoing thoracic surgery, and, where direct pediatric thoracic-surgical evidence is absent, what can be inferred indirectly from the broader pediatric surgical/respiratory literature and the adult thoracic/cardiac surgery PR evidence base. Method(s): A systematic, transparently-scoped search of relevant literature was completed (PubMed/MEDLINE, ClinicalTrials.gov, PMC, Frontiers, Google Scholar), using a fixed date range through August 2026, explicitly searching for RT-delivered as well as other provider-delivered early PR. Eligible designs included randomized controlled trials, non-randomized comparative studies and single-arm cohort studies, published 2020-2026, reporting pulmonary function, respiratory-muscle strength or functional exercise outcomes following facilitated mobilization, respiratory physiotherapy or structured PR. No study was identified that evaluated RT-led early PR specifically after pediatric thoracic surgery; studies were therefore organized as direct evidence (pediatric thoracic and general surgical, and pediatric non-surgical respiratory populations) and indirect comparative evidence (adult thoracic/cardiac surgical populations), used only to contextualize the size of the direct pediatric evidence gap. Risk of bias was assessed using RoB 2 for randomized studies and ROBINS-I logic for non-randomized/single-arm studies. Result(s): Fifteen studies were identified (n=8 direct pediatric evidence; n=7 indirect adult thoracic/cardiac evidence). No study evaluated RT-led early PR after pediatric thoracic surgery specifically; the pediatric evidence base was instead drawn from general/abdominal pediatric surgery and non-surgical pediatric respiratory disease, and was overwhelmingly delivered by physiotherapists rather than Respiratory Therapists. A quantitative, descriptive meta-analytic synthesis was performed for the two studies with extractable mean/SD comparative pulmonary data (Bezgin et al., 2025; Kim et al., 2024); the remaining 13 studies were evaluated narratively (Synthesis Without Meta-analysis, SWiM approach), as pooling across such heterogeneous, mostly non-thoracic-surgical populations was not statistically defensible. In the pediatric literature, early rehabilitation was associated with improvements in respiratory muscle strength and functional exercise parameters, while effects on lung volumes were more variable. The indirect adult thoracic/cardiac surgical evidence suggests greater efficacy for integrated, multi-modal PR protocols over single-mode mobilization, with more consistent improvements in FEV1%/FVC% and reductions in postoperative pulmonary complications. Conclusion(s): No study has yet evaluated the effectiveness of RT-led early PR on lung function after pediatric thoracic surgery, and this review's most clinically actionable finding is the existence of that gap itself. Indirect evidence from broader pediatric surgical and respiratory populations, and from the far more extensive adult thoracic/cardiac surgery literature, suggests benefit from structured, multi-component PR delivered by a dedicated provider rather than mobilization alone. Pediatric thoracic-surgery-specific randomized trials directly comparing RT-led to standard (typically PT-led) delivery are required before firm clinical recommendations can be made for this population. Copyright © 2026, Visagaa Publishing House. All rights reserved. <92> Accession Number 2038825020 Title The Effect of Sodium Dodecyl Sulfate Concentration on the Integrity of Bovine Jugular Veins for Decellularized Pulmonary Xenografts: A Systematic Review. Source Cor et Vasa. 68(5) (pp 600-604), 2026. Date of Publication: 2026. Author Nurrahmah A.; Soebroto H.K.; Utamayasa K.A.; Hakim A.R.; Puruhito I. Institution (Nurrahmah) Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia (Soebroto, Hakim, Puruhito) Department of Thoracic, Cardiac and Vascular Surgery, Dr Soetomo General Academic Hospital, Surabaya, Indonesia (Utamayasa) Department of Child Health, Cardiology Division, Dr. Soetomo General Hospital, Surabaya, Indonesia Publisher Czech Society of Cardiology Z.S Abstract Objective: The aim of this study was to thoroughly examine the data regarding how SDS concentration affects the extracellular matrix preservation, biocompatibility, biomechanical integrity, and decellularization effectiveness of bovine jugular veins used as pulmonary xenograft prototypes. Method(s): We looked for studies on SDS decellularization of bovine jugular veins in PubMed, Scopus, and Google Scholar until July 2025. Eligible studies comprised in vitro, in vivo, and translational research evaluating SDS concentrations (0.5-1%). The outcomes extracted encompassed DNA removal, extracellular matrix preservation, biomechanical testing, cytotoxicity, and graft patency. Narrative synthesis was conducted because of heterogeneity. Result(s): There were fourteen studies in total. SDS at 0.5-1% successfully accomplished decellularization. SDS 0.5% kept collagen and elastin better, however it could have left some cells behind. SDS 1% cleared more DNA, but it also depleted glycosaminoglycans and made it harder for growth factors to stay in place. Biomechanical tests showed that the tensile strength was the same, but too much exposure made the constructs weaker. In vitro, cell viability diminished on 1% SDS scaffolds. Limited in vivo trials indicated satisfactory short-term patency but emphasized dangers of calcification and thrombosis. Conclusion(s): SDS is effective for bovine jugular vein decellularization. Concentrations of 0.5-1% balance cellular clearance with matrix preservation, but neither is optimum. Future study should refine procedures, include enzymatic detergents, and evaluate long-term in vivo outcomes. Copyright © 2026, Czech Society of Cardiology Z.S. All rights reserved. <93> Accession Number 2051222494 Title Enhanced recovery after surgery pathways in pediatric thoracic surgery: A scoping review. Source Journal of Pediatric Surgery. (no pagination), 2026. Article Number: 163540. Date of Publication: 2026. Author Ataman Yildiz G.; Taylan S.; Eti Aslan F. Institution (Ataman Yildiz, Eti Aslan) Faculty of Health Sciences, Nursing Department Bahcesehir University, Istanbul, Turkey (Taylan) Faculty of Health Sciences, Nursing Department Mediterrenian University, Antalya, Turkey Publisher W.B. Saunders Abstract Background: Pediatric thoracic surgery is a field with a high risk of postoperative complications and a complex recovery process, requiring effective care models that support rapid and safe patient recovery. Objective(s): This study aims to systematically map the existing literature on ERAS (Enhanced Recovery After Surgery) protocols in pediatric thoracic surgery, to identify the reported protocol components and outcome measures, and to determine knowledge gaps for future research. Method(s): A scoping review was conducted according to the six-stage framework of the Joanna Briggs Institute and reported in line with the PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, Web of Science, and Scopus databases in February 2026. Studies examining ERAS protocols in pediatric thoracic surgery and reporting clinical and psychosocial outcomes were included. Two researchers independently extracted the data and synthesized them using thematic analysis. Result(s): A total of 7 studies were included in the scoping review. The most frequently evaluated components of ERAS protocols were early mobilization, multimodal analgesia, and early feeding, and these practices were important for shortening hospital length of stay, optimizing pain control, and supporting clinical efficiency without increasing complication rates. Although most studies were retrospective and single-center, ERAS was shown to be feasible when implemented through multidisciplinary teams and safe in terms of short-term clinical outcomes. However, patient-reported and long-term psychosocial outcomes remain limited. Conclusion(s): ERAS protocols in pediatric thoracic surgery are feasible and safe in terms of short-term clinical outcomes and can be effective with multidisciplinary team coordination. Future multicenter, prospective, and standardized studies are needed to evaluate patient-reported and long-term outcomes. Copyright © 2026 Elsevier Inc. <94> Accession Number 2051118132 Title Structural degeneration of biological conduits: an analytical review of calcification mechanisms. Source Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 30(2) (pp 20-33), 2026. Date of Publication: 2026. Author Nichay N.R. Institution (Nichay) Meshalkin National Medical Research Center, Novosibirsk, Russian Federation Publisher Meshalkin National Medical Research Center Abstract Introduction: In congenital heart surgery, pulmonary valve replacement remains the most common valve substitution procedure. Pulmonary valved conduit implantation is essential for correcting most complex congenital heart defects and is performed five times more frequently than other valve replacements in children. However, all pulmonary valved conduits lack growth potential and inevitably undergo structural valve degeneration (SVD), limiting their long-term durability. Calcification constitutes the principal manifestation and predominant pathophysiological process of SVD. Objective(s): To provide a comprehensive overview of the factors contributing to pathological calcification and their role in the pathogenesis of mineralization in biological conduits. Materials: Literature sources, including both clinical and experimental studies, were analyzed. Result(s): This narrative review examines the key drivers of pathological calcification, including recipient metabolic and immune factors, biomaterial structure and composition, and mechanical stress on the implant. Conclusion(s): Understanding the basic mechanisms of biomaterial mineralization is essential for addressing early prosthesis dysfunction. Strategies targeting these mechanisms could underpin the development of next-generation conduits with greater resistance to tissue mineralization and improved long-term durability. Copyright © 2026 Nichay <95> Accession Number 2038749705 Title COMPARATIVE STUDY OF PROPOFOL VS KETAMINE-MIDAZOLAM IN CARDIAC PATIENTS UNDERGOING NON-CARDIAC SURGERY. Source International Journal of Medicine and Public Health. 16(4) (pp 42-51), 2026. Date of Publication: 01 Oct 2026. Author Naveed H.; Ahmad A.; Fiza G.; Tariq H.; Tahir M.Z. Institution (Naveed, Ahmad, Fiza, Tahir) Ghurki Trust Teaching Hospital, Lahore, Pakistan (Tariq) Govt. Muhammad Nawaz Sharif Hospital, Yakki Gate, Lahore, Pakistan Publisher Pink Petals Publications Pvt Ltd Abstract Background: The aim is to compare the hemodynamic effects and safety profile of propofol versus the combination of ketamine and midazolam as induction agents in cardiac patients undergoing non-cardiac surgery. Study Duration: March 2025 to March 2026. Study Place: Department of Anaesthesia in collaboration with departments of General Surgery, Urology and Gynaecology, Ghurki Trust Teaching Hospital Lahore, Pakistan Material(s) and Method(s): This quasi-experimental study was conducted on 120 cardiac patients (ASA class II-III) scheduled for elective non-cardiac surgery. Patients were allocated into two equal groups: Group P (n=60) received propofol 2 mg/kg for induction, while Group M (n=60) received ketamine 1 mg/kg combined with midazolam 0.05 mg/kg. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2) were recorded at baseline, immediately post-induction, and at 1, 3, 5, and 10 minutes after intubation. Perfusion index (PI) was measured using a pulse oximeter probe. Data were analyzed using SPSS version 26, with independent t-tests for continuous variables and chi-square tests for categorical variables. A p-value <0.05 was considered statistically significant. Result(s): Post-induction mean SBP was significantly higher in Group M (124.8 +/- 11.6 mmHg) compared to Group P (118.3 +/- 12.4 mmHg, p=0.008). Mean MAP post-induction was 73.5 +/- 9.8 mmHg in Group M versus 69.7 +/- 10.2 mmHg in Group P (p=0.04). Perfusion index was significantly higher in Group M (1.85 +/- 0.38) compared to Group P (1.62 +/- 0.29, p=0.001). The incidence of hypotension (SBP <90 mmHg) was 18.3% in Group P versus 6.7% in Group M (p=0.04). Recovery time was comparable between groups (p=0.32). Conclusion(s): Induction with ketamine-midazolam provides superior hemodynamic stability and better peripheral perfusion compared to propofol in cardiac patients undergoing non-cardiac surgery, with a lower incidence of hypotension. Both agents demonstrated comparable safety profiles and recovery times. Copyright © 2026, Pink Petals Publications Pvt Ltd. All rights reserved. <96> Accession Number 652497518 Title The Efficacy of Ultrasound Guided Bilateral Transversus Thoracic Plane Block for Postoperative Pain Control in Cardiac Surgery. Source QJM: An International Journal of Medicine. Conference: 43rd Annual Ain Shams Medical Congress. Cairo Egypt. 117(Supplement 1) (pp i13), 2024. Article Number: hcae070.029. Date of Publication: 01 Jun 2024. Author Fahim J.N.Z.; Hassan B.E.E.; Abd-Elsalam E.H.; EL-Shourbagy M.S. Institution (Fahim, Hassan, Abd-Elsalam, EL-Shourbagy) Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Egypt Publisher Oxford University Press Abstract Background: Cardiothoracic surgeries are associated with significant pain. Optimal analgesia is a vital part of strategies intended to improve patients' experience and outcomes. Traditionally, analgesia in these types of surgeries has depended on large doses of I.V. opioids. Aim of the Work: The aim of the study was to evaluate the effect of postoperative bilateral US guided TTPB block on postoperative pain control in patients undergoing cardiac surgery through mid-line sternotomy compared to systemic analgesia. Patients and Methods: This study is a randomized clinical trial study at Ain-shams University Hospitals, Cairo, Egypt. In our study, patients were randomly allocated into two groups with 40 patients in each group. Group 1 (study group) received TTP block., whereas Group 2(control group) received systemic analgesics. The two groups were compared regarding their demographic data (age, sex, body weight and height), A numerical rating scale (NRS) for sternal pain, morphin consumption during 24 hours after extubation and time of first rescue analgesia, heart rate and blood pressure in icu, time of extubation, ICU length of stay, total length stay of the hospital. Result(s): Our study showed that when compared to general anesthesia with systemic opioids, TTPB block is associated with significantly better postoperative pain control. Conclusion(s): Tranversus thoracic plaine block is technically simple, safe and very effective technique and can be used as a part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and satisfaction and also helps in superior pulmonary rehabilitation, thus assisting in better outcome and less unwanted side effects of systemic analgesics. <97> Accession Number 652513608 Title Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation in infants undergoing cardiac procedures (NasoVISI): a multicentre, randomised controlled trial. Source The Lancet. Child & adolescent health. (no pagination), 2026. Date of Publication: 27 Oct 2026. Author Garcia-Marcinkiewicz A.G.; Gottlieb E.A.; Twite M.; Zabala L.M.; Kuntz M.T.; Waberski A.T.; Zhang B.; Nicolson S.C. Institution (Garcia-Marcinkiewicz) Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States (Gottlieb) Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, TX, United States (Twite) Children's Hospital Colorado, Aurora, CO, USA; Nemours Children's Health, Wilmington, DE, USA (Zabala) Children's Medical Center Dallas, UT Southwestern Medical Center, Dallas, TX, United States (Kuntz) Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, United States (Waberski) Children's National, WA, United States (Zhang, Nicolson) Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States Abstract BACKGROUND: Nasotracheal intubation is a common procedure for infants undergoing surgery, and successful intubation at first attempt reduces the risk of complications. First-attempt success is improved with videolaryngoscopy compared with direct laryngoscopy in infants requiring orotracheal intubation, but the value of videolaryngoscopy in infants requiring nasotracheal intubation is unknown. We aimed to compare first-attempt success of nasotracheal intubation by videolaryngoscopy and direct laryngoscopy in infants undergoing cardiac procedures. METHOD(S): In this multicentre, parallel group, randomised controlled trial across eight paediatric cardiac centres in the USA, we enrolled infants aged 365 days or younger without anticipated difficult airways requiring nasotracheal intubation for elective cardiothoracic surgery or cardiac catheterisation. Patients were randomly assigned (1:1) to videolaryngoscopy or direct laryngoscopy using permuted block randomisation stratified by site. The primary outcome was first-attempt intubation success rate. Analysis was by modified intention to treat using generalised estimating equations to account for clustering within intubating clinicians. Complications associated with first attempt and across all attempts were compared between groups with the same marginal models as the primary outcome analysis. This trial is registered with ClinicalTrials.gov (NCT05433155) and is closed to new participants. FINDINGS: Between July 1, 2022, and March 31, 2024, 684 infants were randomly assigned, of whom 673 were included in the primary outcome analysis: 340 in the videolaryngoscopy group and 333 in the direct laryngoscopy group. 311 (46%) participants were female, 362 (54%) were male, and 457 (68%) were White. The median age was 14.04 weeks (IQR 1.48-22.89) and the mean weight was 4.77 kg (SD 1.74). First-attempt success was higher in the videolaryngoscopy group than in the direct laryngoscopy group (281 [83%] vs 249 [75%]; adjusted risk difference 8.2% [95% CI 2.0-14.3], p=0.0093). First-attempt complications occurred in 85 (13%) participants overall, with similar incidences between groups (45 [13%] vs 40 [12%]; 0.4% [-3.5 to 4.3], p=0.83). Considering all attempts cumulatively, any complication occurred in 94 (14%) participants overall, with similar incidences between groups (46 [14%] vs 48 [14%]; -1.9% [-6.0 to 2.3], p=0.38). No cases of cardiac arrest or death occurred in either group. INTERPRETATION: Improved first-attempt success rates with videolaryngoscopy for nasotracheal intubation in infants undergoing cardiac procedures add to growing evidence favouring videolaryngoscopy as the first-line technique for tracheal intubation in infants. Key remaining questions for ongoing research include whether this benefit extends to infants with difficult airways and at non-specialist centres or urgent settings, and how clinician training should evolve as videolaryngoscopy becomes standard practice. FUNDING: Anesthesia Patient Safety Foundation and The Children's Hospital of Philadelphia. Copyright © 2026 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies. <98> Accession Number 652497618 Title Three years' registry on myocardial perfusion imaging patients in Ain shams university nuclear cardiology unit. Source QJM: An International Journal of Medicine. Conference: 43rd Annual Ain Shams Medical Congress. Cairo Egypt. 117(Supplement 1) (pp i58), 2024. Article Number: hcae070.131. Date of Publication: 01 Jun 2024. Author Alzebak O.; Mansour H.; Rayan M.; Adel A. Institution (Alzebak, Mansour, Rayan, Adel) Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt Publisher Oxford University Press Abstract Background: The development in nuclear myocardial perfusion imaging (MPI) has provided diagnostic and prognostic implications in CAD patients, leading to an explosive increase in the performanceofthesestudies. Thisexpansionofimagingspectrumisassociatedwithwidespread concern regarding imaging utilization and increased healthcare costs. There is no comparative data that guide the use of these modalities with respect to appropriateness and patients' benefit. Targeted data collection, through registry studies, enable analysis of both quality and outcomes with big advantages of reflecting real world daily practice and identifying the gaps in care which may not otherwise be feasible in high-quality randomized control trials. Objective(s): To explore the extent to which stress myocardial perfusion imaging (MPI) studies met published appropriate use criteria (AUC), and the real world practice in the nuclear cardiology unit of Ain shams University. Patients and Methods: It was a retrospective cohort study that included 2598 patients who underwent myocardial perfusion imaging in Ain Shams university nuclear cardiology unit throughout the period from January 2017 to December2019. All patients were subjected to thorough demographic data, history of cardiovascular risk factors (arterial hypertension, diabetes mellitus, smoking, family history of premature cardiovascular diseases), indication of the test, preprocedural ECG, ejection fraction by echocardiography, previous coronary angiography and PCI or CABG, calculation of pretest probability and Framingham risk score, determination of appropriateness use criteria and stress-rest Tc 99m imaging to detect the presence of ischemia and one day Tc 99m imaging to detect viability. Result(s): The study included 2598 patients with mean age of 57.76 years, with male predominance (68.1%), 38.2% were diabetics and 53% had hypertension. The most common indications to undergo MPI was the exclusion of CAD as a cause of chest pain in 38.8% of patients followed by the evaluation of symptomatic post PCI patients in 21.9%. Moreover 63.8% of patients showed appropriate tests, while 18.6% of patients showed uncertain tests. Whereas 17.6% of patients had inappropriate studies. 81% of appropriate tests showed positive results of SPECT. Whereas in the inappropriate and the uncertain category, the negative test for ischemia predominated. Conclusion(s): We have established that appropriateness criteria are effective in identifying appropriateness of SPECT in a university center located in Cairo. Also, we concluded that in our unit the appropriate tests were more prominent than inappropriate and unclassified tests. Most of the appropriate studies were positive for ischemia. While, most of the inappropriate and uncertain tests were normal and the commonest cause of referral for MPI was exclusion of CAD as a cause of chest pain. <99> Accession Number 652513618 Title Efficacy of Ultrasound-Guided Pectointercostal Fascial Block Versus Control and Alternative Regional Techniques in Cardiac Surgery: A Systematic Review and Meta-Analysis with Dose-Response Analysis. Source Medicina (Kaunas, Lithuania). 62(10) (no pagination), 2026. Date of Publication: 29 Sep 2026. Author Elnahas M.; Zidan M.; Abusamra Y.; Hassan M.; Saravi B.; Hochrein S.; Lang P. Institution (Elnahas, Hochrein, Lang) Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, Sozialstiftung Bamberg, Bamberg, Germany (Zidan) Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, United Kingdom (Abusamra) Department of Anaesthesia, Manchester University NHS Foundation Trust, United Kingdom (Hassan) Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital, Wuerzburg, Germany (Saravi) Department of Oral, Maxillofacial and Facial Plastic Surgery, Medical Faculty and University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Germany Abstract Background and Objectives: Ultrasound-guided pectointercostal fascial block (USG-PIFB) is increasingly used for post-sternotomy analgesia, but its efficacy remains uncertain. Prior meta-analyses pooled ultrasound-guided blocks with surgeon-performed infiltration, introducing heterogeneity. We aimed to determine the analgesic efficacy of USG-PIFB in adult cardiac surgery by restricting inclusion to ultrasound-guided techniques. Material(s) and Method(s): Six databases were searched through December 2025, with an update search of open sources and trial registries in September 2026, for randomized controlled trials comparing USG-PIFB with control (Comparison 1) or with an alternative regional technique (Comparison 2) in adults undergoing sternotomy. The primary outcome was 24-h opioid consumption in intravenous morphine milligram equivalents. Random-effects meta-analysis (REML, Knapp-Hartung), subgroup, sensitivity and meta-regression analyses, an exploratory trial sequential analysis and GRADE assessment were performed. Result(s): Twenty-nine trials (2664 participants) were included: 24 in Comparison 1 and eight in Comparison 2. In 13 trials (902 participants), USG-PIFB reduced 24-h opioid consumption (mean difference -6.60 mg; 95% CI, -10.92 to -2.27; I2 = 97.7%), but the 95% prediction interval (-22.24 to 9.04 mg) included no effect and small-study effects could not be excluded. Pain scores were lower by 0.8 to 1.4 points at rest (extubation, 12 and 24 h) and during movement (12 h). Extubation was earlier and intensive care stay shorter, with extreme heterogeneity. No dose-response relationship was detected, and the difference from deep parasternal techniques was near zero. No local anesthetic systemic toxicity or block-attributable pneumothorax was reported; one block-site hematoma occurred in a USG-PIFB recipient. Certainty of evidence was low for rescue analgesic use and block-related complications and very low for all other outcomes. Conclusion(s): USG-PIFB may modestly reduce 24-h opioid consumption, but the magnitude and reproducibility of this effect across clinical settings remain uncertain. It is best regarded as one component of multimodal analgesia, and adequately powered multicentre trials are needed. <100> Accession Number 652497504 Title Short-term outcomes of complete coronary revascularization compared to staged revascularization during primary percutaneous coronary intervention in patients with multivessel coronary artery disease: Presenting with ST segment elevation myocardial infarction. Source QJM: An International Journal of Medicine. Conference: 43rd Annual Ain Shams Medical Congress. Cairo Egypt. 117(Supplement 1) (pp i54), 2024. Article Number: hcae070.122. Date of Publication: 01 Jun 2024. Author Alnashar I.A.; Almissiri A.M.; Guindy R.R.; Zahran M. Institution (Alnashar) National Heart Institute, Giza, Cairo, Egypt (Almissiri, Guindy, Zahran) Department of Cardiology, Ain Shams University, Cairo, Egypt Publisher Oxford University Press Abstract Background: Complete revascularization has been recently popularized for management of ST-Segment-Elevation Myocardial Infarction (STEMI) patients with multivessel disease scheduled for Primary Percutaneous Coronary Intervention (PPCI). We assessed the three months outcomes of Compete Revascularization (CR) compared to staged revascularization in patients with multivessel disease undergoing PPCI. Material(s) and Method(s): We conducted a randomized, open-label, comparative trial on STEMI patients with multivessel disease indicated for PPCI in the setting of STEMI. Patients were randomly assigned to undergo PCI revascularization of the non-culprit lesions during the index procedure, Complete Revascularization (CR) or within 30 days later after discharge, Staged Revascularization (SR). The primary endpoint was the composite of all-cause mortality, re-infarction, Heart Failure (HF), recurrence of angina symptoms, cerebrovascular stroke, and need for revascularization. Result(s): A total of 100 patients were randomized in 1:1 ratio. The primary end point occurred in 24% of the patients in CR and 20% in SR group (p = 0.62). The incidence of HF (14% vs. 12%; p = 0.76), repeated revascularization (4% in each group), persistent angina (8% vs. 2%, p = 0.16), all-cause mortality (2% in each group), MI (4% in each group), stent thrombosis (0% vs. 4%; p = 0.15), and cerebrovascular accident (0% vs. 2%; p = 0.32). Conclusion(s): Staged revascularization provided comparable short-term benefits to complete revascularization in STEMI patients with multivessel disease undergoing PPCI. The present trial demonstrated that complete revascularization was associated with a trend towards higher incidence of stent thrombosis and CVA than staged revascularization. <101> Accession Number 2038819243 Title Comment on Hemostasis Using Prothrombin Complex Concentrate in Patients Undergoing Cardiac Surgery: Systematic Review with Meta-Analysis. Source Brazilian Journal of Cardiovascular Surgery. 41(4) (no pagination), 2026. Article Number: e20250302. Date of Publication: 2026. Author Zwaag S.V.; Kukel I.; Fassl J. Institution (Zwaag, Kukel, Fassl) Institute of Cardiac Anesthesiology, TUD Dresden University of Technology, Dresden, Germany Publisher Sociedade Brasileira de Cirurgia Cardiovascular <102> Accession Number 652497290 Title Levosimendan versus Milrinone in Improving Pulmonary Hypertension after Cardiac Surgery. Source QJM: An International Journal of Medicine. Conference: 43rd Annual Ain Shams Medical Congress. Cairo Egypt. 117(Supplement 1) (pp i7), 2024. Article Number: hcae070.015. Date of Publication: 01 Jun 2024. Author Abd El Aziz Fahmy N.M.; Abd Elmalek Marcos F.A.; Hassan Gouda H.S.; Malky Senada M.G. Institution (Abd El Aziz Fahmy, Abd Elmalek Marcos, Hassan Gouda, Malky Senada) Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Egypt Publisher Oxford University Press Abstract Background: Pulmonary hypertension is a multifactorial disease with a high morbidity and mortality, right ventricular function is the most important predictor of morbidity and mortality in patients suffering from pulmonary hypertension. Milrinone, a phosphodiesterase III inhibitor is commonly used during post cardiopulmonary bypass (CPB) period in combination with adrenaline or noradrenaline to decrease pulmonary artery pressure and to provide synergistic positive inotropic effect. Levosimendan is a calcium sensitizing agent with inotropic, pulmonary vasodilatory, and cardioprotective properties. This study compared levosimendan with milrinone in improving pulmonary hypertension after cardiac surgeries. Objective(s): To compare between levosimendan and milrinone in improving pulmonary hypertension after cardiac surgeries. Patients and Methods: In this study 40 Patients were assigned randomly by using a computer - generated table of random numbers, placing them in sealed envelopes, into two groups: Group M: 20 Patients were received milrinone Group L:20 Patients were received levosimandan. Result(s): In this study we compared levosimendan vs milrinone, in levosimendan group there was more significant increase of post operative TAPSE, in milrnone group there was more significant decrease of PAP and RVSP. There was statistically significant difference groups received milrinone in pre, post operative AST, ALT as there was increase in post operative AST and ALT, groups were compared in demographic data (in terms of age, sex, weight and height) and there was no statistically significant difference between groups, were compared as regard CPB and type of surgery and there was no statistically significant difference between groups, were compared in post operative data (in terms of systolic, diastolic blood pressure, heart rate, SPO2, CVP, UOP and extubation time), there was no statistically significant difference between groups, were compared in kidney function (in term of pre and post operative serum creatinine), there was no statistically significant difference between groups, were compared in acid base data (in term of post operative PH), there was no statistically significant difference between groups, were compared in weaning from ventilators (within 24 hours post operative) and there was no statistically significant difference between groups. Conclusion(s): We concluded that in levosimendan group there was more significant increase in post operative TAPSI, in milrinone group there was more significant decrease of PAP and RVSP and in milrinone group there was increase in post operative AST/ALT. <103> Accession Number 652497786 Title Use of Corticosteroids on Prophylaxis of New-Onset Atrial Fibrillation after Cardiac Surgery. Source QJM: An International Journal of Medicine. Conference: 43rd Annual Ain Shams Medical Congress. Cairo Egypt. 117(Supplement 1) (pp i39-i40), 2024. Article Number: hcae070.091. Date of Publication: 01 Jun 2024. Author Abdelsattar M.; Radwan A.; Nashed S.W.; Elagamy A.E.; Elshaer E.M.H. Institution (Abdelsattar, Radwan, Nashed, Elagamy, Elshaer) Intensive Care Department, Faculty of Medicine, Ain Shams University, Egypt Publisher Oxford University Press Abstract Background: Most cardiac operations are performed under cardiopulmonary bypass(CPB); however, it is well known that cardiopulmonary bypass often causes systemic inflammatory response syndrome (SIRS). Cardiac tissue inflammation induced by the CPB and surgical trauma has been previously hypothesized to cause POAF. The relationship between inflammation and atrial fibrillation after cardiac surgery is further strengthened by studies that showed that corticosteroid (CS) prophylaxis can reduce the occurrence of atrial fibrillation after cardiac surgery. Aim of the Work: to determine the efficacy of corticosteroids in prophylaxis of POAF and shorten length of intensive care unit (ICU) and hospital stay. Patients and Methods: This is randomized controlled clinical trial on 84 patients who underwent their first elective cardiac surgery under cardiopulmonary bypass in Ain Shams University Hospitals. Patients were randomized into two equal groups (n 1/4 42 each) as the control group who underwent a standard cardiopulmonary bypass without any additional medication which was performed under the supervision of a specialized elite and experts in their specialization, and the Methylprednisolone (MP) group who was given 1 g of methylprednisolone (divided into 250 mg every 6h once in the ICU), The primary outcome is the overall occurrence of postoperative AF during the first 72 hours after cardiac surgery. Secondary outcomes are the length of hospital stay, and intensive care unit (ICU) stay. Result(s): This study revealed that using corticosteroids effective in reducing the incidence of POAF without increasing the incidence of postoperative complications and adverse effects due to corticosteroids therapy. This study showed decreased risk of developing AF in patients undergoing cardiac surgery. The incidence of POAF was found be significant lower in MP group 16.7% (7 patients developed AF) versus 35.7% in the control group (15 patients developed AF) (p 0.047). Conclusion(s): Use of Corticosteroids is effective in prophylaxis of POAF in patients undergoing elective cardiac surgery in terms of reducing its incidence and decreasing the length of ICU and hospital stay. <104> Accession Number 2050991542 Title The Effect of Intranasal Dexmedetomidine on Hemodynamic Responses during Double-Lumen Tube Insertion: A Randomized Controlled Trial. Source Annals of Cardiac Anaesthesia. 29(4) (pp 510-515), 2026. Date of Publication: 01 Oct 2026. Author Gilbert R.P.; Kumar S.N.; Panchanathan I.; Thomas A.K.; Dhanaboopathy K.; Kuppuswamy B.; Benjamin S.R.; Kuruvila K.T.; Rao V.M.; David N. Institution (Gilbert) Department of Anaesthesia, Christian Medical College, Tamil Nadu, Vellore, India (Kumar, Panchanathan, Kuppuswamy) Department of Cardiac Anaesthesia, Christian Medical College, Tamil Nadu, Vellore, India (Thomas, Dhanaboopathy) Department of Anaesthesia, Believers Church Medical College and Hospital, Kerala, Thiruvalla, India (Benjamin, Kuruvila, Rao, David) Department of Cardiothoracic Surgery, Christian Medical College, Tamil Nadu, Vellore, India Publisher Wolters Kluwer Medknow Publications Abstract ABSTRACT - Background: - Thoracic surgeries require controlled lung collapse for optimal visualization, achieved through Double-Lumen Tube (DLT) intubation for one-lung ventilation (OLV). DLT insertion triggers significant sympathetic activation, potentially causing cardiovascular complications and cerebrovascular events. This study aimed to investigate the efficacy of intranasally administered Dexmedetomidine in attenuating hemodynamic perturbations associated with laryngoscopy and DLT placement. Method(s): - This randomized controlled study was done in a tertiary care center in South India. Patients coming for thoracic surgery requiring DLT insertion were recruited and randomized into Group A and Group B (n = 25). Group A received 1 mcg/kg Intranasal Dexmedetomidine, and Group B received Intranasal Normal saline 45 minutes prior to induction of anaesthesia using a mucosal atomizer device. Hemodynamic parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR), were recorded at different time points up to 30 minutes after intubation. Result(s): - Patients in the dexmedetomidine group had a lower heart rate before intubation (84.92 +/- 0.0349) than those in the placebo group (96.48 +/- 0.0349). A statistically significant reduction in heart rate was observed in Group A at intubation (T0) and at subsequent time points (T1, T2, T3, T20, T25, and T30). SBP and DBP decreased before intubation, after which subsequent readings showed a statistically significant difference (P = 0.000). Patients in Group A required significantly less Propofol to maintain BP within 20% of baseline. Conclusion(s): - Administering a single dose of intranasal dexmedetomidine at 1 mcg/kg before induction effectively manages the hemodynamic response during laryngoscopy. Copyright © 2026 Annals of Cardiac Anaesthesia <105> Accession Number 2051096103 Title Subxiphoid uniportal video-assisted thoracoscopic surgery: a scoping review of technical evolution, clinical applications, and future perspectives. Source Journal of Thoracic Disease. 18(10) (no pagination), 2026. Article Number: 1148. Date of Publication: 30 Oct 2026. Author Wang S.; Song Z. Institution (Wang, Song) Department of Thoracic Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70 Heping Road, Huancui District, Weihai, China Publisher AME Publishing Company Abstract Background: Subxiphoid uniportal video-assisted thoracoscopic surgery (SU-VATS) has attracted increasing attention as a minimally invasive strategy that avoids intercostal nerve damage, a frequent drawback of conventional intercostal VATS. This scoping review maps the existing literature to answer three questions: how the technique has evolved, for which thoracic procedures it has been applied and with what outcomes, and what innovations and evidence gaps will shape its future. Method(s): PubMed was searched from January 2010 through 6 June 2026 (primary search) and the search strategy was refined and re-executed on 6 September 2026 to verify the selection process, using combinations of "subxiphoid", "infrasternal", "uniport*", "single-port", "single-incision", "VATS", and "thoracoscopic" terms, supplemented by backward citation searching. Two authors independently screened records and charted the data; 71 studies were included. Result(s): SU-VATS has been employed across a broad spectrum of thoracic operations: lobectomy, segmentectomy, thymectomy for anterior mediastinal pathology, bilateral pulmonary resection, and thoracic sympathectomy. In most comparisons-almost all observational and unblinded-SU-VATS was associated with lower postoperative pain ratings [visual analogue scale (VAS)/numeric rating scale (NRS)] than intercostal uniportal VATS (IU-VATS), although one study reported greater incisional discomfort after bilateral procedures. A distinctive benefit is management of bilateral disease through one incision without repositioning. Nonetheless, SU-VATS entails a longer learning curve, extended operative times during early adoption, and greater difficulty accessing upper lobe or posterior mediastinal targets. Recent innovations-including sternal elevation devices, articulating instruments, three-dimensional (3D) thoracoscopy, indocyanine green (ICG) fluorescence, and robotic platforms-have been introduced to address these spatial constraints. Conclusion(s): SU-VATS constitutes a meaningful addition to the minimally invasive thoracic surgeon's toolkit, with observational comparisons suggesting advantages in analgesia and bilateral operability. Current data support its safety and feasibility for appropriately selected cases, but oncologic equivalence has not been established, and multicenter randomized trials with standardized endpoints are required to define its optimal position. Evidence strength differs by procedure-most substantial for thymectomy and least mature for sympathectomy. Robotic systems and image-based navigation are expected to broaden its indications further. Copyright This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/ <106> Accession Number 2051131907 Title 2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS expert consensus statement update on cardiovascular implantable electronic device lead management and extraction. Source Heart Rhythm. 23(8) (pp e1716-e1792), 2026. Date of Publication: 01 Aug 2026. Author Cha Y.-M.; El-Chami M.F.; Liu C.F.; Andreychuk L.J.; Beaver T.M.; Bergen K.M.; Berul C.I.; Birgersdotter-Green U.M.; Breitenstein A.; Epstein L.M.; Gross J.N.; Jackson L.R.; Karim S.; Krahn A.D.; Kusumoto F.; Lever N.; Linton-Frazier L.N.; Love C.J.; Mah D.Y.; Mason P.K.; Maynard M.T.; Maytin M.; Montgomery J.A.; Ngai J.; Parkash R.; Patton K.K.; Pothineni N.V.K.; Rojel-Martinez U.; Sohail M.R. Institution (Cha) Mayo Clinic, Rochester, MN, United States (El-Chami) Emory University, Atlanta, GA, United States (Liu) Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY, United States (Andreychuk) Sault Area Hospital, Sault Ste Marie, ON, Canada (Beaver) University of Florida College of Medicine, Gainesville, FL, United States (Bergen) CaroMont Heart & Vascular, Gastonia, NC, United States (Berul) Children's National, Washington, DC, United States (Birgersdotter-Green) University of California, La Jolla, San Diego, CA, United States (Breitenstein) University Heart Center, University Hospital Zurich, Zurich, Switzerland (Epstein) Northwell Health, Manhasset, NY, United States (Gross) Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States (Jackson) Duke University Medical Center, Durham, NC, United States (Karim) Case Western Reserve University, Mercy Medical Center, Cincinnati, OH, United States (Krahn) University of British Columbia, Vancouver, BC, Canada (Kusumoto) Mayo Clinic Jacksonville, Jacksonville, FL, United States (Lever) Auckland City Hospital, Auckland, New Zealand (Linton-Frazier) Indiana Regional Medical Center, Indiana, PA, United States (Love) Johns Hopkins Hospital, Baltimore, MD, United States (Mah) Boston Children's Hospital, Boston, MA, United States (Mason) University of Virginia, Charlottesville, VA, United States (Maynard) Colorado State University, Fort Collins, CO, United States (Maytin) Brigham & Women's Hospital, Boston, MA, United States (Montgomery) Vanderbilt University Medical Center, Nashville, TN, United States (Ngai) NYU Langone, New York, NY, United States (Parkash) QEII Health Sciences Center, Halifax, NS, Canada (Patton) University of Washington, Seattle, WA, United States (Pothineni) Kansas City Heart Rhythm Institute, Overland Park, KS, United States (Rojel-Martinez) South Medical Center, Puebla, Mexico (Sohail) Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States Publisher Elsevier B.V. Abstract Aim The "2026 HRS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction"provides updated recommendations to guide clinicians in the management of cardiovascular implantable electronic device (CIED) leads. Background Since the publication of the "2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction,"the field has evolved quickly. New evidence on CIED lead management and the blooming development of new CIED technologies, including leadless pacing and implantable cardioverter-defibrillator leads implanted outside the vascular system and new lumenless pacing leads and lead extraction tools, have contributed to the field's rapid evolution. Methods and Results A comprehensive literature search was conducted in accordance with the Institute of Medicine standards. The writing committee reviewed evidence gathered through electronic literature searches encompassing clinical trials, original studies, and meta-analyses conducted on human subjects published in English from MEDLINE, PubMed, Embase, and the Cochrane Library up to December 2024. The comprehensive literature review supports each evidence-based recommendation and is compiled in the evidence tables. A predefined threshold of >70% approval for each recommendation was required, with a quorum of two-thirds of the writing committee. The final mean consensus of 108 recommendations was 93.61%. Discussion The recommendations from the "2017 Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction"have been updated with new evidence to guide clinicians. The new recommendations address the latest CIED technologies with the advantages over transvenous leads; new evidence supporting diagnosis, treatment, and prevention for CIED infection; appropriate lead management in transcatheter tricuspid valve replacement for tricuspid regurgitation; and standardization of transvenous lead extraction approach, protocol, and facilities to improve the outcomes of CIED lead management and extraction. Copyright © 2026 Published by Elsevier Inc. on behalf of Heart Rhythm Society. <107> Accession Number 2051031363 Title COMPARISON OF EFFICACY AND SAFETY OF SUGAMMADEX VS NEOSTIGMINE AS A REVERSAL AGENT IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA UNDERGOING MAJOR ABDOMINAL AND THORACIC SURGERIES - A PROSPECTIVE RANDOMIZED CONTROL STUDY. Source International Journal of Academic Medicine and Pharmacy. 8(5) (pp 735-739), 2026. Date of Publication: 2026. Author Moturi P.K.; Subhalakshmi S.; Tungana S.; Dhivakaran A. Institution (Moturi) Department of Anesthesiology, Andhra Medical College, India (Subhalakshmi) JR Medical College and Hospital, Andhra Medical College, India (Tungana) Andhra Medical College, India (Dhivakaran) Department of Anaesthesiology, Andhra Medical College, India Publisher Society for Healthcare and Research Development Abstract Background: Patients with obstructive sleep apnoea (OSA) face a heightened risk of postoperative respiratory complications. Residual neuromuscular blockade (rNMB) significantly contributes to airway obstruction and hypoventilation during the perioperative period. While Neostigmine, the traditional reversal agent, shows variable efficacy and is linked to cholinergic side effects, Sugammadex offers a rapid and predictable reversal of steroidal neuromuscular blockade, potentially improving postoperative respiratory outcomes. Objective(s): This study aims to compare the safety and efficacy of Sugammadex and Neostigmine regarding neuromuscular blockade recovery, postoperative pulmonary complications, adverse events, and recovery profile in OSA patients undergoing significant abdominal and thoracic surgeries. Material(s) and Method(s): In a prospective randomized controlled study, approved by the Institutional ethics committee, 120 adult patients with OSA undergoing major abdominal and thoracic surgeries under general anaesthesia were assigned to receive either Sugammadex (n=60) or Neostigmine with an anticholinergic (Glycopyrrolate) (n=60) for the reversal of Vecuronium-induced neuromuscular blockade. Quantitative train-of-four (TOF) monitoring was employed. The primary outcome was the time to achieve a TOF ratio of >=0.9. Secondary outcomes included postoperative pulmonary complications, adverse events, extubation time, and PACU stay. Result(s): The time to reach TOF >=0.9 was significantly shorter with Sugammadex (2.3 +/- 0.9 min) compared to Neostigmine (11.2 +/- 4.1 min) (p < 0.001). Composite pulmonary complications were observed in 10% of the Sugammadex group versus 28.3% in the Neostigmine group (p = 0.01). Adverse events were significantly fewer with Sugammadex (11.7% vs 40%, p < 0.001). Both PACU stay and extubation time were notably reduced. Conclusion(s): Sugammadex offers a faster and more reliable reversal of neuromuscular blockade and is linked to fewer respiratory and cholinergic complications compared to Neostigmine in OSA patients. Its preferential use in this high-risk group is clinically advantageous. Copyright © 2026, Society for Healthcare and Research Development. All rights reserved. <108> Accession Number 2051058619 Title Transcatheter versus surgical aortic valve replacement in low- to intermediate-risk patients: Do DEDICATE trial outcomes translate to real-world populations?. Source Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Daeter E.J.; Roefs M.M.; Post R.A.J.; Berg J.T.; Tonino P.A.L.; Van Veghel D.; Klautz R.; Takkenberg J.J.M.; Veen K.M. Institution (Daeter, Berg) Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands (Roefs, Van Veghel) Netherlands Heart Registration, Utrecht, Netherlands (Post) Department of Biostatistics, Erasmus MC, Rotterdam, Netherlands (Post) Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands (Tonino) Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands (Klautz) Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands (Klautz) Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands (Takkenberg, Veen) Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, Rotterdam, Netherlands Publisher Elsevier Inc. Abstract Objective: To assess the transportability of the randomized DEDICATE (Randomized, Multicenter, Event-Driven Trial of TAVI versus SAVR in Patients with Symptomatic Severe Aortic-Valve Stenosis) trial results, comparing surgical aortic valve replacement (SAVR) with transcatheter aortic valve replacement (TAVR) in low- to intermediate-risk patients, with an external Dutch population derived from the Netherlands Heart Registration. Method(s): Data sources included the DEDICATE-RCT data (TAVR-trial, SAVR-trial cohorts) and the Netherlands Heart Registration (SAVR-registry cohort). The primary end point was composite of all-cause mortality or stroke at 1 year; secondary end points were mortality and stroke. As-treated TAVR-trial and SAVR-trial patients were propensity-score (PS) matched to SAVR-registry patients. Model-based and weighting-based transportability analyses were performed. Result(s): After we applied trial criteria, 3389 patients from the SAVR registry were eligible and 1211 patients from the trial (654 TAVR; 557 SAVR) were included. Patients from the SAVR registry who were eligible for the trial were younger and had fewer comorbidities. PS matching of TAVR-trial to SAVR-registry cohorts yielded 1150 patients, and matching of the SAVR-trial to SAVR-registry cohorts yielded 892 patients. In PS-matched cohorts, SAVR-trial patients experienced more composite events (hazard ratio [HR], 1.63; 1.02-2.62, P = .04) and strokes (HR, 2.96; 1.37-6.37, P = .01) than SAVR-registry patients, with comparable mortality (HR, 1.15; 0.65-2.02, P = .63). TAVR-trial (vs SAVR-registry) patients had lower 1-year mortality (HR, 0.46; 0.24-0.87, P = .02). Transported absolute risk reduction (ARR) of 1-year mortality of TAVR was attenuated when the trial was reweighted to resemble the registry (ARR<inf>transported</inf>: 2.2% [0.1-4.2]; ARR<inf>trial</inf>: 3.7% [1.4-6.7]). Conclusion(s): In PS-matched analyses, patients from the SAVR registry showed lower combined mortality/stroke and stroke rates than participants in the SAVR trial, suggesting caution in transporting trial-derived relative effects to this population. For mortality, the relative trial effects could be reproduced, but absolute benefit of TAVR was diminished in the registry population. Copyright © 2026 The Authors <109> Accession Number 2051130276 Title Catheter ablation in end-stage heart failure with atrial fibrillation: an hierarchical endpoint analysis of the CASTLE-HTx trial. Source European Journal of Heart Failure. 28(4) (pp 755-761), 2026. Date of Publication: 01 Apr 2026. Author Moersdorf M.; Verbeeck J.; Marrouche N.F.; Costard-Jaeckle A.; Crijns H.J.G.M.; Bergau L.; Fox H.; Hindricks G.; Dagres N.; Sossalla S.; Schramm R.; Fink T.; Meynen F.; Sciacca V.; Didenko M.; Konietschke F.; Rudolph V.; Gummert J.; Tijssen J.G.P.; Sommer P.; Sohns C. Institution (Moersdorf, Bergau, Fink, Sciacca, Didenko, Sommer, Sohns) Department of Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany (Verbeeck, Meynen) Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), University of Hasselt, Hasselt, Belgium (Marrouche) Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States (Costard-Jaeckle, Fox, Schramm, Gummert) Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany (Costard-Jaeckle, Fox, Schramm) Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Med. Fakultat OWL (Universitat Bielefeld), Bad Oeynhausen, Germany (Crijns) Department of Cardiology and CARIM, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands (Hindricks, Dagres) Department of Cardiology, Angiology and Intensive Care Medicine, Charite Campus Mitte, German Heart Center of the Charite-University Medicine Berlin, Berlin, Germany (Sossalla) Department of Cardiology and Angiology, University of Giessen & Kerckhoff Heart Center, DZHK (Partner Site RheinMain), Bad Nauheim, Germany (Konietschke) Institute of Biometry and Clinical Epidemiology, Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany (Rudolph) Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Tijssen) Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands Publisher Oxford University Press Abstract Background: The CASTLE-HTx trial (NCT04649801) showed that the combination of catheter ablation and guideline-directed medical therapy (GDMT) was associated with a lower likelihood of a composite of death from any cause, implantation of a left-ventricular assist device (LVAD), or heart transplantation (HTx) in patients with end-stage heart failure (HF) and atrial fibrillation (AF). Aim(s): This is an ancillary analysis with the generalized pairwise comparison methodology of the main outcomes of CASTLE-HTx. Method(s): In CASTLE-HTX, 194 patients were randomized to catheter ablation and GDMT (n = 97) or medical therapy alone (n = 97). The first hierarchical outcome was a composite of (1) death from any cause, (2) urgent HTx, (3) implantation of an LVAD, and (4) frequency of hospitalizations for worsening HF. Secondary analysis also included AF burden and left-ventricular ejection fraction improvement. Treatment effects are reported as net treatment benefit (NTB) and win odds, with corresponding confidence intervals (CIs). Result(s): Patients randomized to ablation had more wins with respect to death from any cause (28.4%/12.4%), HTx (4.3%/2.1%), LVAD implantation (4.2%/0.6%), and hospitalizations for worsening HF (24.8%/11.3%). 61.6% of pairs favoured ablation, 26.4% medical therapy, and 12.0% were tied. This resulted in a restricted NTB at 3 years of 35.3% (95% CI, 19.8-49.0, P < .001) favouring ablation (win odds: 2.09; 95% CI, 1.49-2.92). In the secondary analysis, 67.0% of pairs favoured ablation against 28.6% of pairs favouring medical therapy. The restricted NTB was 38.4% (95% CI, 22.8-52.0, P < .001) in favour of ablation (win odds: 2.25; 95% CI, 1.59-3.17). Conclusion(s): This pairwise analysis of CASTLE-HTx confirms the clinical benefits of early catheter ablation in addition to GDMT among AF patients in end-stage HF. The treatment benefit was primarily driven by mortality and HF hospitalizations. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <110> Accession Number 2051038167 Title Comparative Efficacy of Pecto-Intercostal Facial Plane Block vs Transversus Thoracic Facial Plane Block Combined with Rectus Sheath Block for Post-Sternotomy Analgesia: A Prospective Randomized Controlled Trial. Source Annals of Cardiac Anaesthesia. 29(4) (pp 577-586), 2026. Date of Publication: 2026. Author Gupta P.; Pula R.; Polapally V.; Gooty S.; Krosuri V.; Thakur N.; Gopinath R. Institution (Gupta, Pula, Polapally, Gooty, Krosuri, Thakur, Gopinath) Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Telangana, Hyderabad, India Publisher Wolters Kluwer Medknow Publications Abstract Background: - Ultrasound-guided facial plane blocks are central to enhanced recovery after cardiac surgery (ERACS) protocols, yet evidence comparing pecto-intercostal facial plane block (PIFB) and transversus thoracic facial plane block (TTPB) with rectus sheath block (RSB) remains limited. Method(s): - This prospective, randomized, controlled trial enrolled 100 adult patients (ASA II-III) undergoing elective median sternotomy at a tertiary care hospital in South India. Patients received standardized general anesthesia and were randomized to bilateral PIFB or TTPB (20 mL 0.25% bupivacaine + 4 mg dexamethasone per side) with RSB after cardiopulmonary bypass. The primary outcome was 24-hour postoperative fentanyl consumption. Secondary outcomes included visual analog scale (VAS) pain scores at 0, 3-, 6-, 12-, and 24-hours post-extubation, rescue analgesia, extubation timing, ICU/hospital stay, and complications. Result(s): - A total of 96 patients completed analysis (PIFB: n = 47; TTPB: n = 49). Mean 24-hour fentanyl consumption was 267.23 +/- 92.54 microg (PIFB) vs 297.18 +/- 88.09 microg (TTPB), mean difference - 29.95 microg (95% confidence interval: -66.60 to 6.70; P = 0.108). VAS scores showed no significant between-group differences (P > 0.05). Rescue analgesia rates were similar, with 84% and 90% not requiring additional opioids. Four PIFB patients (8%) stayed intubated >24 hours due to cardiac issues, vs none in the TTPB group (P = 0.121). Conclusion(s): - This trial found no significant difference in opioid consumption or pain scores between PIFB + RSB and TTPB + RSB for post-sternotomy analgesia. Both techniques were safe within ERACS protocols. Larger noninferiority trials are needed before establishing equivalence or recommending one technique over another. Copyright © 2026 Annals of Cardiac Anaesthesia <111> Accession Number 2051140156 Title Evolution of diagnostic reference levels in paediatric cardiac interventional procedures: a narrative review. Source Applied Radiation and Isotopes. 239 (no pagination), 2027. Article Number: 113057. Date of Publication: 01 Jan 2027. Author Ubeda C.; Cabanas A.; Nocetti D.; Cubillos Y.; Miranda P.; Franco M.C.; Donoso-Aguirre S. Institution (Ubeda, Nocetti, Donoso-Aguirre) Medical Technology Department, Health Sciences Faculty, LABODOP, Universidad de Tarapaca, Arica, Chile (Cabanas) Physics Department, Faculty of Medicine, Universidad de Tarapaca, Arica, Chile (Cubillos) Library System, Universidad de Tarapaca, Arica, Chile (Miranda) Dr. Luis Calvo Mackenna Children's Hospital, Antonio Varas 360, Santiago, Chile (Franco) Department of Pediatric Cardiology, Zambrano Hellion Hospital, Tecnologico de Monterrey, School of Medicine and Health Sciences, Nuevo Leon, Monterrey, Mexico Publisher Elsevier Ltd Abstract The goal of this narrative review was to identify and synthesise publications reporting radiation dose values for paediatric cardiac interventional procedures (PCIP), organised according to four DRL-related benchmarking levels used in this review: typical values, local DRLs, national DRLs and regional DRLs. These procedures can deliver high radiation doses to markedly radiosensitive patients. DRLs are an important tool for optimising these exposures. Publications from 2010 to 2025 were searched, and twenty-five studies met the eligibility criteria, with reported kerma-area product (P<inf>KA</inf>) taken as a common comparator. Reported P<inf>KA</inf> spanned more than two orders of magnitude, from below 1 Gy cm2 in patients under 5 kg to above 100 Gy cm2 for complex therapeutic procedures in larger children. Within a single DRL category, procedural complexity alone drove differences exceeding one order of magnitude, while procedure-specific stratification converged on a narrow 1-5 Gy cm2 band in the youngest patients. National DRLs showed the widest inter-study dispersion and regional DRLs the narrowest. The variability in reported dose values was primarily driven by differences in categorisation schemes and procedural complexity rather than by inconsistencies in the DRL concept itself. The available evidence reflects an evolution from early local initiatives towards national and regional frameworks characterised by increasing methodological maturity and international collaboration. Future developments are expected to move towards complexity-based DRLs supported by large multicentre datasets, automated dose monitoring and artificial intelligence for real-time optimisation, while coordinated regional initiatives and shared registries may enable continuous DRL updating and stronger radiation protection for PCIP. Copyright © 2026 Elsevier Ltd <112> Accession Number 2049994304 Title Dexmedetomidine Versus Dexamethasone in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: An Exploratory Randomized Controlled Trial of Inflammatory Biomarkers and Opioid Consumption. Source Healthcare (Switzerland). 14(20) (no pagination), 2026. Article Number: 3468. Date of Publication: 01 Oct 2026. Author Salama M.A.; Al Dammas F.K.; AlDhuwaihy A.; Alanezi K.; Alshuwaier F.; Almedlej N.; AbdelTwab H.; ElTantawi N.; Sabri R.A.; Alaidy A.; Jamous Y.F. Institution (Salama, Alaidy) Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Al Dammas) Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia (AlDhuwaihy, Alanezi, Alshuwaier, Almedlej) College of Medicine, King Saud University, Riyadh, Saudi Arabia (AbdelTwab) Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt (ElTantawi) Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Sabri) Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Jamous) Wellness and Preventive Medicine Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response in children undergoing congenital heart surgery. Although dexmedetomidine has been proposed as an alternative to corticosteroids, the two agents have not previously been directly compared in a pediatric randomized trial. This study aimed to compare the effects of dexmedetomidine and dexamethasone on inflammatory biomarkers and analgesic outcomes in children undergoing congenital heart surgery with CPB. Method(s): In this prospective, randomized, controlled exploratory trial, 50 children aged 6 months to 18 years undergoing elective congenital heart surgery with CPB were randomized 1:1 to dexamethasone (n = 25) or dexmedetomidine (n = 25), using institutional regimens that were not equipotent anti-inflammatory doses. Serum interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured at baseline, immediately after separation from CPB (post-CPB), and 12 h postoperatively. The primary endpoint was IL-6 at the two postoperative time points; IL-8 was a secondary biomarker outcome. Secondary outcomes also included Face, Legs, Activity, Cry, Consolability (FLACC) pain scores, fentanyl consumption, and time to first rescue analgesia. Effect estimates included Hodges-Lehmann (HL) median differences with 95% confidence intervals (CIs); a post hoc baseline-adjusted mixed-effects model of log-transformed concentrations served as a sensitivity analysis. Secondary and exploratory analyses were not adjusted for multiple comparisons. Result(s): All 50 randomized children were analyzed. Median IL-6 was lower in the dexmedetomidine group at 12 h (50 vs. 178 pg/mL; HL difference 86 pg/mL, 95% CI 59 to 144; p < 0.001); the post-CPB difference (46 vs. 77 pg/mL; HL difference 34 pg/mL, 95% CI 0 to 112; p = 0.045) was imprecise and not significant after post hoc Bonferroni correction for the two primary comparisons. In the post hoc baseline-adjusted sensitivity model, the ratio of geometric mean IL-6 concentrations (dexmedetomidine/dexamethasone) was 0.35 (95% CI 0.22 to 0.58; p < 0.001). Among secondary and exploratory outcomes, for which p-values are nominal, IL-8 was also lower post-CPB (159 vs. 381 pg/mL; p = 0.001) and at 12 h (120 vs. 311 pg/mL; p = 0.002). Dexmedetomidine was associated with lower intraoperative (83.0 +/- 30.7 vs. 142.6 +/- 51.7 microg; p < 0.001) and cumulative 24-h fentanyl consumption (53.8 +/- 17.4 vs. 105.4 +/- 32.8 microg; p < 0.001), analyzed in absolute units with incompletely documented intraoperative doses, and a longer time to first rescue analgesia (4.68 +/- 0.73 vs. 1.84 +/- 0.23 h; p < 0.001). Time to extubation did not differ significantly (median 2 vs. 1 h; p = 0.204). Intensive care unit length of stay, an exploratory outcome recorded in days, was distributed toward shorter stays with dexmedetomidine (median 2 [interquartile range 1-2] vs. 2 [2-3] days; p = 0.007). No pre-specified adverse events occurred in either group, although the trial was too small to exclude clinically important safety differences. Conclusion(s): In this exploratory trial of two non-equipotent institutional regimens, dexmedetomidine was associated with lower early postoperative IL-6 and IL-8 concentrations and lower opioid consumption than dexamethasone. These hypothesis-generating biomarker and analgesic signals do not demonstrate therapeutic superiority or patient-centered clinical benefit and require confirmation in larger, adequately powered multicenter trials. Copyright © 2026 by the authors. <113> Accession Number 2051038159 Title Response to Comments on Comparison of Analgesic Efficacy of Intrathecal Morphine and Ultrasound - Guided Bilateral Erector Spinae Plane Block in Patients Undergoing Open Heart Surgery with Midline Sternotomy: An Open Label Randomized Control Trial. Source Annals of Cardiac Anaesthesia. 29(4) (pp 661-662), 2026. Date of Publication: 2026. Author Karuppiah V.; Kumar R.; Mohammed S.; Chouan A.; Chhabra S.; Kamal M.; Sharma A. Institution (Karuppiah) Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India (Kumar, Mohammed, Chouan, Chhabra, Kamal) Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Rajasthan, Jodhpur, India (Sharma) Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Rajasthan, Jodhpur, India Publisher Wolters Kluwer Medknow Publications <114> Accession Number 2050991546 Title Impact of Erector Spinae Block on Postoperative Analgesia and Hospital Recovery in Coronary Artery Bypass Surgery: A Systematic Review with Meta-analysis, Meta-Regression, and Sequential Trial Analysis. Source Annals of Cardiac Anaesthesia. 29(4) (pp 481-493), 2026. Date of Publication: 01 Oct 2026. Author Aureliano de Carvalho J.P.; dos Reis Requiao H.; Vieira R.M.; de Sousa Ferreira P.; da Silva Neto E.B.; Torres de Araujo Azi L.M.; Modolo N.S.P.; Alves R.L. Institution (Aureliano de Carvalho, dos Reis Requiao, de Sousa Ferreira, da Silva Neto, Torres de Araujo Azi, Alves) Federal University of Bahia, Salvador, Brazil (Vieira, Modolo, Alves) Botucatu School of Medicine, Paulista State University, Botucatu, Brazil Publisher Wolters Kluwer Medknow Publications Abstract ABSTRACT - The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed. ESPB significantly reduced the morphine milligram equivalent consumption at 24 h (mean difference (MD) -19.05 mg; 95% confidence interval (CI) [-22.50 to -15.61]; P < 0.001; high certainty) and 48 h (MD -19.42 mg; 95% CI [-28.75 to -10.09]; P < 0.001; moderate certainty). Pain scores, by the Numerical Rating Scale, were lower within 12 h (MD -0.93; P < 0.001; moderate certainty) and at 24 h (MD -0.58; P = 0.016; low certainty). ESPB shortened extubation time (MD -2.50 h; high certainty) and ICU stay (MD -12.55 h; moderate certainty). TSA confirmed robust evidence for opioid reduction, early pain relief, and extubation benefits. ESPB provides effective early analgesia, reduces perioperative opioid requirements, and accelerates recovery in CABG, representing a fundamental complement to conventional isolated intravenous analgesia. Future research should investigate continuous techniques. Copyright © 2026 Annals of Cardiac Anaesthesia <115> Accession Number 2050064887 Title Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units. Source Critical Care. 30(1) (no pagination), 2026. Article Number: 553. Date of Publication: 01 Dec 2026. Author Anushapreethi S.; Chhotray P.; Samal S.; Panda S.; Patnaik R.; Mishra S.B. Institution (Anushapreethi, Samal, Panda, Mishra) Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Odisha, Bhubaneswar, India (Chhotray) Department of Respiratory Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Odisha, Bhubaneswar, India (Patnaik) Department of Critical Care Medicine, Medeor 24x7 Hospital, Abu Dhabi, United Arab Emirates Publisher BioMed Central Ltd Abstract Background: Chlorhexidine (CHX) has been a long-standing component of oral-care bundles for preventing ventilator-associated pneumonia (VAP), but recent evidence has questioned its benefit in non-cardiac-surgery ICU. We evaluated whether adding 0.12% CHX to standardized oral-care bundle provides incremental benefit in a mixed medical ICU. Method(s): We conducted a prospective, pragmatic cluster-randomized crossover (AB/BA) trial in six adult medical ICUs of a single tertiary-care academic hospital in Bhubaneswar, India. ICUs were randomized as three ICUs of two Period of 9 months with the multicomponent oral-care bundle without chlorhexidine and three with the same bundle plus 0.12% chlorhexidine with a 1-month wash-in and re-training interval. Consecutive adults ventilated for >= 48 h were included. The primary outcome was VAP incidence density (Clinical Pulmonary Infection Score (CPIS) > 6) as per 1,000 ventilator-days. Secondary outcomes were 28-day all-cause mortality, duration of mechanical ventilation, ICU length of stay, 28- day ventilator-free days, Beck Oral Assessment Scale (BOAS) and Critical-Care Pain Observation Tool (CPOT) scores. The primary model was a population-averaged Poisson generalized estimating equation (GEE) and adjustment for treatment, period, sequence, age, sex, APACHE II, and SOFA. Result(s): A total of 1,035 patients (637 No CHX, 398 CHX) accrued 10,024 ventilator-days (5,918 vs. 4,106). Groups were well balanced at baseline (mean age = 55 years; APACHE II = 19.6; SOFA = 13.4). VAP occurred in 100/5,918 ventilator-days (16.9 per 1,000) vs. 77/4,106 (18.8 per 1,000) (No CHX vs. CHX). The adjusted Poisson incidence rate ratio was 1.08 (95% CI 0.84-1.38; p = 0.56). 28-day mortality was 28.7% vs. 26.4% (no CHX vs. CHX) (adjusted OR 0.87, 95% CI 0.65-1.15; p = 0.33). ICU length of stay was longer in the CHX arm (adjusted mean difference + 0.89 days, 95% CI + 0.19 to + 1.58; p = 0.013). BOAS and CPOT scores did not differ. Conclusion(s): In this trial, adding 0.12% chlorhexidine to a standardized oral-care bundle did not reduce VAP incidence density or 28-day mortality and was associated with a modest increase in ICU length of stay. Routine CHX use provided no clear incremental benefit in a mixed medical ICU population. Trial registration: Clinical Trials Regisrty- India (CTRI) identifier [CTRI/2024/02/062201], registered [01 February 2024]. Copyright © The Author(s) 2026. <116> Accession Number 2050014248 Title Rethinking Postoperative Pain in the Era of Robotic Thoracic Surgery: A Surgeon's Perspective on Functional Recovery and Potential Oncologic Implications. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 7843. Date of Publication: 01 Oct 2026. Author Miyazaki T.; Doi R.; Matsumoto K. Institution (Miyazaki, Doi, Matsumoto) Division of Thoracic and Pelvic Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Persistent postoperative pain remains an incompletely resolved problem after minimally invasive thoracic surgery, despite expectations that robot-assisted thoracic surgery (RATS) would meaningfully outperform video-assisted thoracoscopic surgery (VATS) in analgesia. This narrative review synthesizes evidence from randomized trials, cohort studies, and meta-analyses comparing acute and chronic pain outcomes between VATS and RATS, examines mechanisms and surgically modifiable risk factors underlying intercostal nerve injury and pain chronification, and evaluates the emerging concept of Return to Intended Oncologic Treatment (RIOT) as a perioperative endpoint linking pain control to oncologic recovery. Across randomized and propensity-matched comparisons, RATS has generally failed to demonstrate superior pain outcomes relative to VATS, and several studies suggest multiport robotic platforms may produce greater early pain than uniportal thoracoscopic approaches. Port number, operative time, and drainage duration emerge as modifiable surgical predictors of chronic pain, while inadequately controlled acute pain compromises functional recovery and is associated with delayed RIOT; direct evidence that pain independently influences RIOT or long-term survival remains limited, and this link should currently be regarded as a plausible, testable hypothesis rather than an established causal pathway. We conclude that, on the comparative evidence available to date, robotic instrumentation has not shown a consistent, clinically meaningful reduction in pain burden relative to VATS, and that pain management should be reframed as a shared surgical-anesthetic target relevant to oncologic recovery rather than a comfort-oriented endpoint alone. Emerging robotic platforms warrant evaluation against this expanded outcome set. Copyright © 2026 by the authors. <117> Accession Number 2050008174 Title Clinical Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: A Systematic Review and Meta-Analysis. Source Journal of Cardiovascular Development and Disease. 13(10) (no pagination), 2026. Article Number: 486. Date of Publication: 01 Oct 2026. Author Ke H.; Wang S.; Li J.; Zhong G. Institution (Ke, Wang, Zhong) Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (Li) Department of Cardiology, The First Affiliated Hospital of Guilin Medical University, Guilin, China Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Aortic valve regurgitation is a common valvular heart disease. Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are the principal therapeutic modalities, while the comparative efficacy of these two approaches remains controversial. Method(s): This systematic review and meta-analysis was prospectively registered on PROSPERO (registration number: CRD420261411339). We systematically searched Web of Science, PubMed, EMBASE, and the Cochrane Library databases for relevant studies from their inception to 26 July 2026. RevMan 5.4 software was used to conduct this analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate the outcomes. Result(s): We assessed in-hospital outcomes and post-discharge 30-day outcomes. The primary outcomes were length of hospital stay, perioperative complications, and valve condition. Secondary outcomes included all-cause mortality, cardiovascular mortality, new-onset atrial fibrillation (AF), and new permanent pacemaker implantation (PPI). Nine articles involving 28,811 patients were included. Compared with SAVR, TAVR reduced length of hospital stay [mean difference (MD) = -4.49, 95% confidence interval (CI): -4.98, -4.01, p < 0.00001, I2 = 80%], perioperative complications [Odds ratios (OR): 0.55, 95% CI: 0.50 to 0.60, p < 0.00001, I2 = 62%) and new-AF(OR: 0.50, 95% CI: 0.43 to 0.59, p < 0.00001 I2 = 30%). However, there was a significant increase in perivalvular leakage (OR: 17.13, 95% CI: 4.13 to 71.13, p < 0.0001 I2 = 29%) and new PPI (OR: 2.63, 95% CI: 2.13 to 3.25, p < 0.00001 I2 = 80%). There was no significant difference observed in all-cause mortality (OR: 0.91, 95% CI: 0.69-1.20, p = 0.49, I2 = 69%). Conclusion(s): Compared with SAVR, TAVR reduced length of hospital stay, perioperative complications, and new AF. However, it was associated with an increase in perivalvular leakage and new PPI. These findings suggest that TAVR may represent a better strategy for patients with pure native aortic regurgitation. Copyright © 2026 by the authors. <118> Accession Number 2050055067 Title Utilization of Microaxial Mechanical Circulatory Support Among the Pediatric Population: A Systematic Review. Source Artificial Organs. (no pagination), 2026. Date of Publication: 2026. Author Jones A.J.; Rahimov D.; Smoot D.; Mustafa M.; Mallur K.; Rajab T.K.; Hoopes C.W.; Tchantchaleishvili V. Institution (Jones, Rahimov, Mustafa, Mallur, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States (Smoot) Drexel University College of Medicine, Philadelphia, PA, United States (Rajab) Department of Cardiovascular Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR, United States Publisher John Wiley and Sons Inc Abstract Background: Utilization of microaxial pumps for temporary mechanical circulatory support in children has increased in recent years. However, data on patient selection, implantation techniques, and outcomes remain limited. Method(s): A systematic literature search was conducted in July 2025 to identify case reports and case series reporting the use of microaxial pumps in patients aged 18 years or less. Forty-four studies comprising 100 patients were identified, and patient-level data were extracted for analysis. Result(s): The median age of the patients was 14 [IQR, 11.5-16] years, with a median weight of 52 [40-73] kg and median body surface area of 1.59 [1.35-1.85] m2. The most common diagnoses were cardiomyopathy (29%), heart allograft rejection (26%), and myocarditis (21%). Impella CP was the most frequently used device (48%), followed by Impella 2.5 and Impella 5.5 (each 21%). Access was predominantly obtained via the femoral artery (47%). Percutaneous implantation was performed in 47% of patients. Patients were weaned from microaxial support for cardiac recovery (42%) or heart transplantation (31%). Fourteen patients (14%) died prior to discharge, with significantly higher mortality among patients supported with ECPella (29%) compared with microaxial pump alone (6%; p = 0.01). The median duration of support was 6 [4-13] days. At the median follow-up of 119 [23-180] days overall survival was 84%. Conclusion(s): Microaxial pumps represent an important addition to temporary mechanical circulatory support in pediatric patients and can serve as an alternative to VA-ECMO in selected cases. Outcomes were less favorable when used in tandem configurations such as ECPella, reflecting the greater severity of illness in these patients. Copyright © 2026 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <119> Accession Number 2049983355 Title Coenzyme Q10 for Acute Stanford Type A Aortic Dissection: Protocol for a Prospective, Randomized, Double-Blind, Placebo-Controlled, Single-Center Feasibility Trial. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 8103. Date of Publication: 01 Oct 2026. Author Dai L.; Wang S.-P.; Zhu Y.-F.; Wu H.-T.; Zheng B.-F.; Li H.-Y.; Jiang W.-J.; Zhang H.-J. Institution (Dai, Wang, Zhu, Wu, Zheng, Li, Jiang, Zhang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Dai, Wang, Zhu, Wu, Zheng, Li, Jiang, Zhang) Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Acute Stanford type A aortic dissection (TAAD) is a catastrophic cardiovascular emergency. Emergency surgery is the standard life-saving treatment, but some patients decline operative repair, and no established pharmacological therapy has been shown to stabilize acute TAAD. Preclinical work by our team implicates mitochondrial dysfunction and smooth muscle cell phenotypic switching in aortic dissection and suggests that coenzyme Q10 may reduce dissection-related injury. This study aims to determine the feasibility of a future definitive randomized trial and to obtain preliminary safety and exploratory efficacy information. Method(s): This prospective, randomized, double-blind, placebo-controlled, single-center feasibility trial will enroll 60 adults with CTA-confirmed Stanford type A aortic dissection within 24 h of symptom onset who decline emergency surgical repair after standard surgical counseling. Participants will be randomized 1:1 to oral coenzyme Q10 100 mg three times daily or matched placebo for 14 days, in addition to the same guideline-directed supportive medical care. The primary feasibility outcome is recruitment feasibility, defined as randomization of 60 participants within 12 months after recruitment initiation. Secondary feasibility outcomes include treatment adherence, follow-up completion, dropout, missingness, outcome-assessment feasibility, and candidate endpoint event rates. The primary exploratory clinical outcome is 14-day all-cause mortality; additional exploratory outcomes include aortic rupture death, false-lumen thrombosis, cardiac tamponade, worsening pericardial effusion, and organ malperfusion syndromes. Safety outcomes include adverse events, serious adverse events, adverse drug reactions, suspected unexpected serious adverse reactions, and prespecified laboratory indices. Result(s): The trial is designed to establish whether recruitment, blinded treatment delivery, follow-up, outcome collection, and safety monitoring are operationally feasible and to provide estimates for planning a larger confirmatory trial. Conclusion(s): This feasibility trial will inform the design and conduct of future definitive evaluation of coenzyme Q10 in acute TAAD. Trial registration: Chinese Clinical Trial Registry, ChiCTR2600123230. Copyright © 2026 by the authors. <120> Accession Number 2050056379 Title The effect of virtual reality glasses used during chest tube removal following open-heart surgery on pain and hemodynamic parameters: a randomized controlled trial. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 993. Date of Publication: 01 Dec 2026. Author Yanik T.C.; Gulsen M.; Ugras G.A.; Arslan S.; Ozdemir F.E. Institution (Yanik) Faculty of Nursing, Surgical Nursing Department, Mersin University, Mersin, Turkey (Gulsen) Faculty of Health Sciences, Surgical Nursing Department, Cukurova University, Adana, Turkey (Ugras) Faculty of Nursing, Surgical Nursing Department, Professor, Mersin University, Mersin, Turkey (Arslan) Faculty of Health Sciences, Surgical Nursing Department, Professor, Cukurova University, Adana, Turkey (Ozdemir) Cardiovascular Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey Publisher BioMed Central Ltd Abstract Background: Chest tube removal (CTR) following open-heart surgery is a painful procedure that may adversely affect patients' hemodynamic parameters. Purpose(s): This study aimed to determine the effect of virtual reality glasses (VRG) used during chest tube removal after open-heart surgery on pain levels and hemodynamic parameters. Method(s): This prospective, two-arm (1:1), randomized controlled trial included 82 patients undergoing open-heart surgery. Patients in the VRG group (n = 41) were exposed to relaxing forest-walk-themed virtual reality content starting five minutes before CTR and continuing for five minutes after the procedure. The control group (n = 41) received routine care without any additional intervention. Pain levels were assessed using the Visual Analog Scale (VAS), and hemodynamic parameters-systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2)-were recorded before CTR, immediately after, and at 5, 15, and 30 min post-procedure. Result(s): A significant group x time interaction was observed for pain (p = 0.003). After adjustment for baseline pain and multiple comparisons, pain was significantly lower in the VRG group than in the control group immediately after CTR (adjusted mean difference [VRG - Control]: -1.26, 95% CI: -1.85 to - 0.68; adjusted p < 0.001), whereas no significant between-group differences were observed at 5, 15, or 30 min. A significant group x time interaction was also observed for SpO2 (p < 0.001), with significantly higher SpO2 in the VRG group immediately after CTR (adjusted mean difference: 2.70, 95% CI: 1.88 to 3.53; adjusted p < 0.001). No significant group x time interactions were observed for SBP, DBP, HR, or RR. Conclusion(s): VRG use during CTR was associated with lower pain immediately after the procedure and higher SpO2 immediately after CTR. No significant effects were observed for SBP, DBP, HR, or RR. These findings suggest that VRG may be a useful non-pharmacological adjunct for short-term pain management during CTR following open-heart surgery. Further studies are needed to confirm its effects on oxygenation and other hemodynamic parameters. Trial registration: ClinicalTrials.gov (NCT05585853) first submitted on October 12, 2022, and first posted on October 19, 2022. Copyright © The Author(s) 2026. <121> Accession Number 2050014923 Title Heart Transplantation: A Review of Recent Advancements in Pre-, Peri, and Post-Transplant Screening and Management. Source Biomedicines. 14(10) (no pagination), 2026. Article Number: 2384. Date of Publication: 01 Oct 2026. Author Ringor M.; Nguyen D.; Boumelhem F.; Joseph Y.; Sharma D.; Dugal J. Institution (Ringor, Nguyen, Boumelhem, Joseph, Sharma, Dugal) Department of Internal Medicine, University of Nevada, Las Vegas, NV, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Heart transplantation (HT) remains a critical treatment for patients with end-stage heart failure who remain unresponsive to optimized guideline-directed medical therapy. This review examines recent advancements in pre-, peri-, and post-transplant screening and management aimed at improving patient selection, transplant accessibility, and clinical outcomes. Pre-transplant strategies include comprehensive HT candidate evaluation, risk stratification, donor selection, allocation policies that priotize critically ill patients, and mechanical circulatory support (MCS) to stabilize patients awaiting transplantation. Peri-transplant advances focus on strategies to maintain hemodynamic stability, minimize ischemic injury, and maintain graft viability immediately after HT. Post-transplant management emphasizes individualized immunosuppressive regimens, cardiac allograft rejection surveillance, and the prevention and management of complications to improve graft survival and long-term patient outcomes. Despite substantial progress, significant challenges remain, particularly the shortage of suitable donor organs and the risk of immune-mediated graft rejection. Emerging approaches, including artificial intelligence, xenotransplantation, and regenerative medicine, offer promising opportunities to expand the donor pool, enhance clinical decision-making, and improve HT outcomes. This review examines the research that influences the current policies and practices involved in HT, featuring the pivotal findings as well as any shortcomings present among these studies. Ultimately, continued research and multidisciplinary collaboration in each phase of HT are essential to improve the short and long-term health outcomes of transplant candidates. By integrating established evidence-based practices with emerging technologies, clinicians may further improve equitable access, survival, and quality-of-life for patients with end-stage heart failure. Copyright © 2026 by the authors. <122> Accession Number 2050012207 Title The Emerging Phenotype of HFpEF in Cardiac Allografts: A Review of Pathophysiology, Diagnosis, and Management. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 8130. Date of Publication: 01 Oct 2026. Author Shankara S.B.; Premananthan S.; Rajapreyar I.; Sparks A. Institution (Shankara, Premananthan) Division of Internal Medicine, Tufts Medical Center, Boston, MA, United States (Rajapreyar) Division of Cardiology, Tufts Medical Center, Boston, MA, United States (Sparks) Division of Cardiac Surgery, Tufts Medical Center, Boston, MA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Advances in donor selection, organ preservation technologies, donation after circulatory death, and broader geographic sharing have expanded access to heart transplantation but have also introduced new challenges that affect allograft function. The transplanted heart is exposed to multiple insults, including donor brain death, ischemia-reperfusion injury, acute and chronic rejection, and cardiac allograft vasculopathy. Increasingly, heart failure with preserved ejection fraction (HFpEF) is being recognized as a distinct manifestation of cardiac allograft dysfunction that may contribute to late graft failure. Diastolic dysfunction occurs frequently after heart transplantation and may develop early as a consequence of ischemia-reperfusion injury, primary graft dysfunction, and/or rejection. Cardiac allograft vasculopathy, chronic immune-mediated injury, metabolic comorbidities, and aging of the donor heart further contribute to the HFpEF phenotype. Although the process is multifactorial and can be variable, progressive abnormalities in myocardial relaxation, compliance, microvascular function, and extracellular matrix remodeling may lead to restrictive physiology and then the clinical syndrome of heart failure with low cardiac output and end-organ dysfunction despite preserved left ventricular ejection fraction. However, the epidemiology, diagnostic criteria, and natural history of HFpEF in transplant recipients remain incompletely characterized. As a result, the goal of this paper is to consolidate the current understanding of the pathophysiology, epidemiology, diagnostic evaluation, and management of HFpEF in cardiac allografts, while identifying current gaps in understanding to guide future research. Copyright © 2026 by the authors. <123> Accession Number 2050012596 Title Acute Kidney Injury After Percutaneous Left Atrial Appendage Occlusion: Incidence, Risk Factors, Clinical Impact, and Contrast-Sparing Strategies-A Systematic Review. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 7919. Date of Publication: 01 Oct 2026. Author Radic J.; Becic T.; Vuckovic M.; Radic M.; Jukic I.; Vukovic J.; Fabijanic D. Institution (Radic, Vuckovic) Department of Internal Medicine, Division of Nephrology, Dialysis and Arterial Hypertension, University Hospital of Split, Split, Croatia (Radic, Radic, Vukovic) Department of Internal Medicine, School of Medicine, University of Split, Split, Croatia (Becic, Fabijanic) Department of Cardiovascular Diseases, University Hospital of Split, Split, Croatia (Radic) Department of Internal Medicine, Division of Rheumatology, Allergology and Clinical Immunology, University Hospital of Split, Split, Croatia (Jukic, Vukovic) Department of Internal Medicine, Division of Gastroenterology, University Hospital of Split, Split, Croatia (Jukic) Faculty of Health Sciences, University of Split, Split, Croatia (Fabijanic) Department of Clinical Propedeutics, School of Medicine, University of Split, Split, Croatia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Acute kidney injury (AKI) is a clinically relevant complication following percutaneous left atrial appendage occlusion (LAAO). This systematic review evaluated its incidence, predictors, and clinical impact while separately examining the procedural feasibility and renal outcomes of contrast-sparing and zero-contrast LAAO strategies. Method(s): PubMed, Web of Science, Scopus, and Cochrane CENTRAL were searched from database inception through 6 October 2026. Eighteen studies met the eligibility criteria. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively, with AKI-focused evidence considered separately from contrast-sparing procedural studies. Result(s): Four studies primarily evaluated AKI following conventional LAAO. Three creatinine-based cohorts reported AKI incidences ranging from 5.3% to 13.7%, whereas one large administrative database study reported coded AKI in 5.3% of index hospitalizations; these estimates were not considered directly comparable. Pre-existing renal dysfunction was the most consistent marker of AKI susceptibility, and AKI was associated with adverse clinical outcomes. Fourteen studies evaluated contrast-sparing or zero-contrast approaches and generally demonstrated high procedural success. However, renal outcomes were inconsistently assessed; several studies did not systematically report AKI, and AKI occurred even after zero-contrast implantation. Conclusion(s): Available evidence supports the procedural feasibility of contrast-sparing and zero-contrast LAAO but does not establish that contrast avoidance prevents AKI or provides a proven nephroprotective benefit. A renal-tailored framework remains hypothesis-generating and requires prospective comparative validation using standardized renal endpoints. Copyright © 2026 by the authors. <124> Accession Number 2050008186 Title Preoperative respiratory muscle strength, muscle mass, and respiratory sarcopenia as predictors of postoperative pulmonary complications after thoracic and cardiac surgery: A systematic review and meta-analysis. Source Clinical Nutrition ESPEN. 76 (no pagination), 2026. Article Number: 105204. Date of Publication: 01 Dec 2026. Author Mizusawa H.; Toyama S.; Okura K.; Shiraishi M.; Noguchi M.; Kanki K.; Natsume H.; Higashimoto Y. Institution (Mizusawa, Shiraishi, Noguchi, Kanki, Natsume) Department of Rehabilitation, Kindai University Hospital, Osaka Prefecture, Japan (Toyama) Department of Rehabilitation, Shizuoka Cancer Center Hospital, Prefecture, Shizuoka, Japan (Okura) Department of Rehabilitation, Akita University Hospital, Akita Prefecture, Japan (Higashimoto) Department of Rehabilitation Medicine, Faculty of Medicine, Kindai University, Osaka Prefecture, Japan Publisher Elsevier Ltd Abstract Background & aims Postoperative pulmonary complications (PPCs) are common after thoracic and cardiac surgery and are associated with adverse outcomes. Respiratory sarcopenia (RS), characterized by coexisting reductions in respiratory muscle mass and strength, may represent a clinically relevant prognostic phenotype, but its prognostic value remains uncertain. This systematic review and meta-analysis aimed to assess whether low preoperative respiratory muscle mass, reduced strength, or their coexistence as RS or probable RS predicts PPCs after thoracic and cardiac surgery. Methods We searched PubMed, Embase, Web of Science, and CENTRAL from January 1990 to February 2026 for studies relating preoperative respiratory muscle mass, strength or flow, or RS to PPCs. Risk of bias was assessed using the Quality In Prognosis Studies tool. Adjusted odds ratios (ORs) were pooled using random-effects models after harmonizing effect directions such that ORs >1 denoted higher risk. Results Sixteen studies were included; all involved thoracic or cardiac surgery, and none included an upper abdominal cohort. Cutoff-based respiratory muscle strength or flow impairment was associated with increased odds of PPCs (OR 2.25, 95% confidence interval [CI] 1.50-3.37; I2 = 51.2%), with the most consistent association observed for percent-predicted peak expiratory flow (PEF) (OR 2.03, 95% CI 1.43-2.90; I2 = 0%). Continuous PEF was associated with PPCs, whereas ultrasound-based diaphragm indices showed smaller, non-significant associations. RS or probable RS was associated with PPCs (OR 2.08, 95% CI 1.33-3.26; I2 = 0%). Conclusions Preoperative functional respiratory muscle impairment, particularly reduced PEF, and RS or probable RS were associated with PPCs. Given that the evidence was limited, heterogeneous, and predominantly derived from thoracic surgery, prospective confirmation is needed. Copyright © 2026. Published by Elsevier Ltd. <125> Accession Number 2050014259 Title Takotsubo Syndrome in Solid Organ Transplant Recipients: Current Evidence, Clinical Challenges, and Future Perspectives-A Narrative Review. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 8167. Date of Publication: 01 Oct 2026. Author Kosek-Nikolajczuk M.; Piatkowski R.; Grabowski M.; Budnik M. Institution (Kosek-Nikolajczuk, Piatkowski, Grabowski, Budnik) 1st Department of Cardiology, Medical University of Warsaw, Stefana Banacha 1a, Warsaw, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Takotsubo syndrome (TTS) is an acute and usually reversible form of myocardial dysfunction associated with emotional or physical stress. Solid organ transplantation (SOT) combines several potential triggers, including major surgical stress, hemodynamic instability, systemic inflammation, and exposure to exogenous catecholamines. Respiratory failure, calcineurin inhibitor toxicity, and altered cardiac innervation may also contribute. This narrative review summarizes current evidence on organ-specific timing, potential triggers, diagnostic challenges, management, and outcomes of TTS in SOT recipients. Reported cases predominantly occur early after liver and kidney transplantation, whereas presentations after heart transplantation range from the immediate postoperative period to years later. After heart transplantation, distinguishing TTS from early graft dysfunction and considering donor-side TTS are particularly important. Diagnostic certainty varies among published cases because formal criteria and the exclusion of competing diagnoses are inconsistently documented. Management largely follows recommendations for the general TTS population, with temporary mechanical circulatory support used in selected severe cases. Although ventricular function usually recovers, cardiogenic shock, arrhythmias, and multiorgan dysfunction may complicate the acute course, and persistent ventricular impairment has been associated with poorer long-term outcomes after liver transplantation. Comparisons with the general TTS population suggest a high proportion of severe presentations among reported transplant-associated cases; however, publication and ascertainment bias preclude firm conclusions about differences in incidence or severity. Evidence remains dominated by case reports, small series, and retrospective studies, underscoring the need for standardized reporting and prospective multicenter research. Copyright © 2026 by the authors. <126> Accession Number 2050092116 Title Elevated Lipoprotein(a) Predicts Recurrent Myocardial Infarction in Diabetic Patients Following Acute Coronary Syndromes. Source Clinical Cardiology. 49(11) (no pagination), 2026. Article Number: e70480. Date of Publication: 01 Nov 2026. Author Echeverria-Ortegon E.; Torres-Chavez M.C.; Tejeda A.P.-T.; Caballero-Osorno P.; Pastor-Cervantes J.; Laviada-Molina H. Institution (Echeverria-Ortegon, Caballero-Osorno, Laviada-Molina) School of Health Sciences, Universidad Marista de Merida, Yucatan, Merida, Mexico (Torres-Chavez) Facultad de Medicina Mexicali, Universidad Autonoma de Baja California, Baja California, Mexicali, Mexico (Tejeda) Memorial Healthcare System, Hollywood, FL, United States (Pastor-Cervantes) Department of Cardiovascular Disease, Memorial Healthcare System, Hollywood, FL, United States Publisher John Wiley and Sons Inc Abstract Background: Patients with type 2 diabetes mellitus (T2DM) who experience acute coronary syndromes (ACS) remain at high risk for recurrent ischemic events despite secondary prevention. Lipoprotein(a) [Lp(a)] contributes to residual cardiovascular risk, but its prognostic impact on recurrent myocardial infarction (MI) and repeat revascularization in diabetic patients after ACS or percutaneous coronary intervention (PCI) remains unclear. Hypothesis: We hypothesized that elevated Lp(a) is associated with increased risk of recurrent MI and repeat coronary revascularization in patients with diabetes after ACS or PCI. Method(s): We conducted a PRISMA-guided systematic review and meta-analysis. PubMed, EBSCOhost, and Cochrane Library were searched for studies evaluating Lp(a) and recurrent cardiovascular outcomes in patients with diabetes after ACS or PCI. Observational studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) were included. Pooled HRs were calculated using random-effects models. Result(s): Seven studies comprising 7887 patients with diabetes and prior ACS or PCI were included. Elevated Lp(a) was associated with increased risk of recurrent MI (pooled HR 2.17, 95% CI 1.02-4.62; I2 = 75%) but not repeat coronary revascularization (pooled HR 1.68, 95% CI 0.79-3.57; I2 = 78%). Conclusion(s): Elevated Lp(a) was associated with increased risk of recurrent MI in patients with diabetes after ACS or PCI. Findings should be interpreted considering the observational study designs, substantial heterogeneity, and limited evidence for repeat revascularization. These findings support Lp(a) as a contributor to residual cardiovascular risk and its potential role in post-ACS risk stratification. Trial Registration: This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420261296821). Copyright © 2026 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC. <127> Accession Number 2049983345 Title Rapidly Reversible Monitored Anesthesia Care with Remimazolam and Flumazenil Reversal for Transcatheter Aortic Valve Replacement: A Randomized Controlled Trial. Source Journal of Clinical Medicine. 15(20) (no pagination), 2026. Article Number: 7880. Date of Publication: 01 Oct 2026. Author Kitaura A.; Mino T.; Yoshino Y.; Sakamoto H.; Matsushima M.; Nakayama Y.; Nakajima Y. Institution (Kitaura, Mino, Sakamoto, Matsushima, Nakayama, Nakajima) Department of Anesthesiology, Faculty of Medicine, Kindai University, Osaka, Sakai, Japan (Yoshino) Department of Anesthesiology, Nagoya University, Aichi, Nagoya, Japan (Nakajima) Department of Anesthesiology, Center for Outcomes Research, University of Texas Health Science Center, Houston, TX, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Monitored anesthesia care (MAC) is increasingly used for transcatheter aortic valve replacement (TAVR), where rapid recovery of consciousness may facilitate early postoperative neurological assessment. Remimazolam provides sedation that can be pharmacologically reversed with flumazenil. We compared emergence from sedation between a remimazolam-flumazenil-based MAC strategy and a conventional dexmedetomidine-based strategy in patients undergoing transfemoral TAVR. Method(s): In this single-center randomized controlled trial, 84 patients undergoing transfemoral TAVR were randomized 1:1 to remimazolam-remifentanil (R group) or dexmedetomidine-propofol-remifentanil (D group) MAC. Flumazenil was administered at the initiation of the postoperative awakening attempt in the R group. The primary outcome was arousal time, assessed using two prespecified measures: time from discontinuation of all anesthetic infusions to arousal and time from initiation of the postoperative awakening attempt to arousal. Arousal was defined as a Modified Observer's Assessment of Alertness/Sedation score of 5. Result(s): Eighty-three patients were included in the analysis (R group, n = 42; D group, n = 41). The time from discontinuation of all anesthetic infusions to arousal was shorter in the R group than in the D group (19.05 [15.77-23.59] vs. 24.09 [19.25-34.78] min; p = 0.0045). The time from initiation of the awakening attempt to arousal was also shorter (0.60 [0.33-1.00] vs. 1.00 [0-4.72] min; p = 0.0117). No patient in the R group required rescue propofol. No significant between-group differences were observed in major procedural or postoperative outcomes. Conclusion(s): A remimazolam-based MAC strategy with flumazenil reversal provided faster and more reliable emergence from sedation than a conventional dexmedetomidine-based strategy during transfemoral TAVR. These findings suggest that a reversible sedation strategy may facilitate rapid recovery of consciousness when early postoperative assessment is desired, although its impact on neurological or other clinical outcomes remains to be established. Copyright © 2026 by the authors. <128> Accession Number 652488321 Title Immediate Complete Revascularization During Index Admission in Older Patients With ST-Segment Elevation Myocardial Infarction. Source JACC. Cardiovascular interventions. (no pagination), 2026. Date of Publication: 22 Oct 2026. Author Cho K.H.; Kim M.C.; Ahn J.H.; Hyun D.Y.; Lim Y.; Lee S.H.; Park S.; Oh S.; Sim D.S.; Hong Y.J.; Kim J.H.; Jeong M.H.; Cho J.H.; Lee S.-R.; Kang D.O.; Hwang J.-Y.; Youn Y.J.; Lee J.-H.; Jeong Y.-H.; Ahn J.-H.; Kim D.-B.; Choo E.H.; Kim C.J.; Kim W.; Rhew J.Y.; Park J.-I.; Yoo S.-Y.; Ahn Y. Institution (Cho) Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea; Victorian Heart Institute, Monash University, Melbourne, Australia (Kim, Ahn, Hyun, Lim, Lee, Oh, Sim, Hong, Kim) Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (Park) Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea; Mokpo Hankook Hospital, Mokpo, Republic of Korea (Jeong) Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea; Gwangju Veterans Hospital, Gwangju, Republic of Korea (Cho) St Carollo General Hospital, Suncheon, South Korea (Lee) Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea (Kang) Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea (Hwang) Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea (Youn) Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea (Lee) Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea (Jeong) CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea (Ahn) Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea (Kim) Division of Cardiology, Department of Internal Medicine, Bucheon St Mary's Hospital, Catholic University of Korea, Seoul, South Korea (Choo) Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, Catholic University of Korea, Seoul, South Korea (Kim) Division of Cardiology, Department of Internal Medicine, Uijeongbu St Mary's Hospital, Catholic University of Korea, South Korea (Kim) Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea (Rhew) Presbyterian Medical Center, Jeonju, South Korea (Park) Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, South Korea (Yoo) Good Morning Hospital, Pyeongtaek, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea (Ahn) Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea Abstract BACKGROUND: Whether age affects the comparative treatment effect of immediate complete revascularization (CR) vs staged CR during the index admission in patients with ST-segment elevation myocardial infarction and multivessel disease remains unknown. OBJECTIVE(S): This study aimed to assess how age influences clinical outcomes in patients with with ST-segment elevation myocardial infarction and multivessel disease randomized to immediate or in-hospital staged CR. METHOD(S): This is a secondary analysis of the OPTION-STEMI (Optimal Timing of Fractional Flow Reserve-Guided Complete Revascularization for Non-Infarct-Related Artery in ST-Segment Elevation Myocardial Infarction with Multivessel Disease) trial, which included 994 patients randomized to immediate or in-hospital staged CR. The primary endpoint at 1 year, defined as a composite of all-cause death, nonfatal myocardial infarction, or any unplanned revascularization, was analyzed according to age and CR strategy. RESULT(S): A significant interaction was found between age, as a continuous variable, and CR strategy for the primary endpoint (interaction P = 0.015). The HR for the primary endpoint was initially higher in the staged CR arm until approximately 67 years, after which it increased steadily in the immediate CR arm. In the binary analysis, a significantly higher incidence of the primary endpoint was observed in the immediate CR arm compared with the staged CR arm in patients >=70 years (45 of 202 [22.3%] vs 29 of 210 [13.8%]; HR: 1.68; 95% CI: 1.06-2.69; log-rank P = 0.029), but not in patients <70 years (20 of 296 [6.8%] vs 24 of 286 [8.4%]; HR: 0.80; 95% CI: 0.45-1.45; log-rank P = 0.470) (multiplicative interaction P = 0.054; relative excess risk due to interaction P = 0.016). CONCLUSION(S): This post hoc analysis of the OPTION-STEMI trial demonstrates that older patients experience significantly worse clinical outcomes with immediate CR than with in-hospital staged CR. These findings suggest that age modifies the treatment effect of the CR strategy and warrant confirmation in adequately powered trials (Timing of FFR-guided PCI for Non-IRA in STEMI and MVD [OPTION-STEMI]; NCT04626882). Copyright © 2026. Published by Elsevier Inc. <129> Accession Number 652490473 Title Comparative Outcomes of Self-Expanding Versus Balloon-Expandable Valves in Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Source Cardiology in review. (no pagination), 2026. Date of Publication: 26 Oct 2026. Author Elazab A.; Ali A.H.G.; Elbataa A.; Mansour A.; Hammad N.; Galal A.; Abdelaziz O.A.; Sayed M.S.; Elkasaby M.H.; Shaaban M.; Hassanin M.S.; Mousa A.I.A.; Elgendy I.Y.; Alharasees M.; Aly A.; Alali A.K.A.; Frishman W.H.; Aronow W.S. Institution (Elazab, Shaaban) From the Department of Medicine, Faculty of Medicine, Qena University, Qena, Egypt (Ali) Department of Medicine, Institute of Medicine, National Research Mordovia State University, Saransk, Russian Federation (Elbataa, Mansour, Galal, Elkasaby, Hassanin) Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Hammad) Department of Medicine, Faculty of Medicine, Port Said University, Port Said, Egypt (Abdelaziz) Department of Medicine, Faculty of Medicine, Misr University of Science and Technology, Giza, Egypt (Sayed) Department of Medicine, Faculty of Medicine, Beni-Suef University, Egypt (Mousa) Department of Pharmacy, Faculty of Pharmacy, Badr University in Cairo (BUC), Cairo, Egypt (Elgendy) Department of Medicine, Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, United States (Alharasees) Department of Medicine, Faculty of Medicine, Mutah University, Jordan (Aly) Department of Medicine, Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, United States (Alali) Department of Medicine, Faculty of Medicine, Yarmouk University, Irbid, Jordan (Frishman, Aronow) Departments of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY, United States Abstract Abstract: Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis, with self-expanding valves (SEV) and balloon-expandable valves (BEV) representing the two major platforms. However, their comparative clinical and hemodynamic performance remains uncertain. We systematically searched four electronic databases through August 2026 for studies comparing SEV and BEV in patients undergoing TAVR. The primary outcomes were permanent pacemaker implantation (PPI) and change in mean pressure gradient (MPG), while secondary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), stroke, paravalvular leakage (PVL), heart failure hospitalization, coronary obstruction, and prosthesis-patient mismatch (PPM). Twenty-three studies involving 21,609 patients were included. Compared with BEV, SEV was associated with a significantly greater reduction in MPG (MD -4.48, 95% CI -5.29 to -3.67; P < 0.0001) and lower risks of moderate (RR 0.56, 95% CI 0.42-0.75) and severe PPM (RR 0.33, 95% CI 0.25-0.44). Conversely, SEV was associated with higher risks of PPI (RR 1.40, 95% CI 1.14-1.72; P < 0.0001), moderate-to-severe PVL (RR 2.28, 95% CI 1.65-3.14; P < 0.0001), and a small but significant increase in all-cause mortality. No significant differences were observed in MACE, stroke, heart failure hospitalization, or coronary obstruction.. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <130> Accession Number 2050918242 Title Safety and Efficacy of Acute Normovolemic Hemodilution in Female Patients: A Secondary Analysis of the ANH Trial. Source JAMA Surgery. (no pagination), 2026. Date of Publication: 2026. Author Pruna A.; Scandroglio A.M.; Lei C.; Oriani A.; Di Fazio A.; Pontillo D.; Santonocito C.; Bonizzoni M.A.; Comis M.; Calabro M.G.; Kadantseva K.; Barucco G.; Guarracino F.; Giardina G.; Ajello V.; Di Prima A.L.; Osinsky R.; Oliva F.M.; Efremov S.; Mucchetti M.; Vandyck K.B.; Franco A.; Arangino C.; Nardelli P.; Ranucci M.; D'Amora M.; Wang L.; Zhang H.; Lorsomradee S.; Hajjar L.A.; Ti L.K.; McNeil J.S.; Pieri M.; Bove T.; Gurcu M.E.; Rocco M.; Landoni G.; Paternoster G.; Zangrillo A.; Monaco F. Institution (Pruna, Scandroglio, Oriani, Pontillo, Bonizzoni, Calabro, Barucco, Giardina, Di Prima, Oliva, Mucchetti, Franco, Nardelli, Pieri, Landoni, Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (Lei, Wang, Zhang) Department of Anesthesiology and Perioperative Medicine, Anesthesia Clinical Research Center, Xijing Hospital, Xi'an, China (Di Fazio) Regional Complex Intercompany Institute of Legal Medicine, San Carlo Hospital, Potenza, Italy (Santonocito) Anesthesia and Intensive Care Medicine III, Policlinico University Hospital G. Rodolico - San Marco, Catania, Italy (Comis) S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine Mauriziano Umberto I, Turin, Italy (Kadantseva) Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation (Kadantseva) A. Loginov Moscow Scientific Clinical Center, Moscow, Russian Federation (Guarracino) University Gabriele d'Annunzio Chieti Pescara, Department of Medical, Dental and Biotechnological Sciences, Chieti, Italy (Ajello) Department of Cardiothoracic and Vascular Surgery, Tor Vergata University Hospital, Rome, Italy (Osinsky) Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation (Efremov) Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation (Vandyck) Department of Anesthesiology, University of Oklahoma, Oklahoma City, United States (Arangino) Anestesia e Terapia Intensiva Cardiochirurgica, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (Ranucci) Department of Cardiac Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (D'Amora) Department of Cardiac, Thorac. and Vasc. Anaesthesia, Univ. Hospital San Giovanni di Dio e Ruggi D Aragona, Salerno, Italy (Lorsomradee) Chiang Mai University, Chiang Mai, Thailand (Hajjar) Hospital das Clinicas, HCFMUSP, Faculdade de Medicina da USP, Sao Paulo, Brazil (Ti) Department of Anaesthesia, National University Hospital, Singapore, Singapore (McNeil) University of Virginia School of Medicine, Charlottesville, United States (Pieri, Landoni, Zangrillo) School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (Bove) Department of Basic Biotechnological Sciences, Intensive Care Peri-Operative Clinics, Universita Cattolica Del Sacro Cuore, Rome, Italy (Bove) Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (Gurcu) Kosuyolu Heart Center, Istanbul, Turkey (Rocco) Department of Medical and Surgical Science and Translational Medicine, Sapienza University of Rome, Rome, Italy (Rocco) UOC Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria sant'Andrea, Rome, Italy (Paternoster) Department of Health Sciences, University of Basilicata, Potenza, Italy (Paternoster) Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy (Monaco) Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy (Monaco) Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy Publisher American Medical Association Abstract Importance: Female patients undergoing cardiac surgery have a higher transfusion burden, yet they remain underrepresented in randomized clinical trials. Although the ANH trial showed no significant reduction in the proportion of patients receiving allogeneic blood transfusions with acute normovolemic hemodilution, evidence regarding its efficacy and safety specifically in female patients remains limited. Objective(s): To evaluate the efficacy and safety of acute normovolemic hemodilution (ANH) compared with usual care in female patients undergoing elective cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participant(s): This was a post hoc secondary analysis of the multicenter, randomized ANH trial, which was conducted at 32 centers in 11 countries from April 2019 to December 2024. Of 2010 patients in the original ANH trial, 405 were women and were included in this analysis; 219 had been randomized to receive ANH and 186 to usual care. This secondary analysis was conducted from August 2025 to January 2026. Intervention(s): Withdrawal of at least 650 mL whole blood with crystalloids replacement and reinfusion after cardiopulmonary bypass. Main Outcomes and Measures: The primary outcome was the occurrence of at least 1 allogeneic packed red blood cell (pRBC) transfusion during the index hospitalization. Safety outcomes included intraoperative hypotension, intensive care unit (ICU) length of stay, hospital length of stay, mortality, and other perioperative complications. Result(s): The median (IQR) age of the participants was 62 (54-69) years. The occurrence of allogeneic pRBC transfusion was similar in the ANH and usual care groups (38.8% vs 44.6%, respectively; relative risk [RR], 0.87; 95% CI, 0.69-1.10; P =.24). Intraoperative hypotension occurred more frequently with ANH (16.0% vs 4.8% in usual care; RR, 3.30; 95% CI, 1.62-6.74; P =.02). Patients receiving ANH also had longer ICU stays (mean difference, 21.13 hours; 95% CI, 1.89-40.38; P =.03) and hospital stays (mean difference, 1.92 days; 95% CI, 0.14-3.70; P =.04). No significant differences were observed in mortality or other postoperative complications. Conclusions and Relevance: In this post hoc secondary analysis of a randomized clinical trial, ANH was not associated with a reduction in allogeneic pRBC transfusion among women undergoing cardiac surgery and was associated with more frequent intraoperative hypotension and longer ICU and hospital stay. These exploratory findings warrant confirmation in adequately powered studies specifically designed to evaluate female patients undergoing cardiac surgery. Copyright © 2026 American Medical Association. All rights reserved, including those for text and data mining, AI training, and similar technologies. <131> Accession Number 2050918329 Title Mental Health Factors in Cardiothoracic Surgery Risk Prediction Models: A Systematic Review. Source Journal of the American Heart Association. 15(20) (no pagination), 2026. Article Number: e052512. Date of Publication: 2026. Author Rios-Monterrosa J.; Artunduaga M.C.; Rasheed N.; Aguiar C.; Jr Castro S.; Jaime M.; Lang E.; Woodward A.; Sun L.Y. Institution (Rios-Monterrosa, Rasheed, Jr Castro, Sun) Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, United States (Artunduaga) Universidad de los Andes, Bogota, Colombia (Aguiar) California Northstate University College of Medicine, Elk Grove, CA, United States (Jaime) Kaiser Permanente Bernard J, Tyson School of Medicine, Pasadena, CA, United States (Lang) University of Central Florida College of Medicine, Orlando, FL, United States (Woodward) Lane Medical Library, Stanford University School of Medicine, Stanford, CA, United States Publisher American Heart Association Inc. Abstract BACKGROUND: Mental health disorders are associated with substantial morbidity and death in cardiovascular disease, yet their role in perioperative risk stratification remains unclear in patients undergoing cardiothoracic surgery. We evaluated how mental health disorders are currently incorporated into cardiothoracic surgery risk prediction models. METHOD(S): We conducted a Preferred Reporting Items for Systemic Reviews and Meta-Analysis-concordant systematic review of PubMed and Embase on September 11, 2025 (International Prospective Register of Systematic Reviews: CRD420251274958). We included studies that developed or validated risk models predicting postoperative outcomes in adults undergoing cardiothoracic surgery that either included a mental health disorder as a covariate or validated a model in patients with such disorders. Model characteristics were extracted using the Checklist for Critical Appraisal and Data Extraction for Systemic Reviews of Prediction Modeling Studies, and risk of bias and applicability were assessed using the Prediction Model Risk of Bias Assessment Tool+Artificial Intelligence. Findings were synthesized qualitatively. RESULT(S): Of 17 986 articles screened, 9 studies met inclusion criteria and described 17 unique models. No study validated a model specifically in patients with mental health disorders. Depression was the most frequently included mental health covariate (8 models). When incorporated, mental health disorders had associations comparable to established clinical risk factors. The most frequently modeled outcomes were hospital readmission and postoperative depression. Three studies had a high risk of bias. Covariate selection and modeled outcomes varied substantially. CONCLUSION(S): Mental health disorders are rarely incorporated into cardiothoracic surgery risk models despite potentially important prognostic associations. Future studies should evaluate their incremental predictive value, validate models in patients with mental health disorders, and examine intersections with sociodemographic risk factors. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. <132> Accession Number 652475856 Title Bromocriptine for Myocardial Recovery in Peripartum Cardiomyopathy: Design and Rationale of the REBIRTH Trial. Source JACC. Heart failure. (pp 103376), 2026. Date of Publication: 21 Oct 2026. Author Wang T.; Ibarra A.J.; Simpson D.; Kirsch J.; Koczo A.; Briller J.E.; Abebe K.Z.; McNamara D.; Givertz M.M. Institution (Wang, Kirsch, Abebe) Center for Biostatistics and Qualitative Methodology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States (Ibarra) Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States (Simpson, Koczo, McNamara) Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Briller) Division of Cardiology, University of Illinois Chicago, Chicago, IL, United States (Givertz) Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States Abstract BACKGROUND: There is evidence suggesting that bromocriptine potentially improves outcomes among women with peripartum cardiomyopathy (PPCM); however, there is currently no randomized controlled trial comparing bromocriptine vs placebo on top of guideline-directed medical therapy (GDMT) in a diverse, multiethnic cohort in North America. OBJECTIVE(S): The REBIRTH trial will enroll 200 women with PPCM to evaluate whether the addition of oral bromocriptine to GDMT is superior to placebo for improving myocardial function and event-free survival. In addition to the randomized trial, REBIRTH will enroll 50 women with PPCM excluded from randomization because of breastfeeding into an observational cohort. METHOD(S): The principal inclusion criteria are >=18 years of age, within 5-months postpartum, and left ventricular ejection fraction (LVEF) <=40%. The primary endpoint is LVEF at 6 months postrandomization. Secondary endpoints include LVEF at 12 months, survival free from major events (ie, death, heart transplantation, or implantation of a durable left ventricular assist device), and survival free from heart failure hospitalization for up to 3 years. RESULT(S): The study is currently enrolling women in both the randomized trial and observational breastfeeding cohort. Primary results are expected to be reported in 2027. CONCLUSION(S): REBIRTH will determine whether the addition of bromocriptine to GDMT for heart failure with reduced ejection fraction improves postpartum myocardial recovery and clinical outcomes in a diverse cohort of women with PPCM. (Randomized Evaluation of Bromocriptine in Myocardial Recovery Therapy for PPCM [REBIRTH]; NCT05180773). Copyright © 2026 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. <133> Accession Number 2051032596 Title Outcomes of left atrial appendage closure vs oral anticoagulation after catheter ablation among patients with higher and lower stroke risk: A subanalysis of the OPTION clinical trial. Source Heart Rhythm. (no pagination), 2026. Date of Publication: 2026. Author Healey J.S.; Doshi R.; Nair D.G.; Reddy V.Y.; Piccini J.; Das M.; Chaudhry M.; Mittal S.; Gonzalez I.C.; Joyner C.; Boveda S.; Loureiro R.E.; Kim J.; Reiss J.A.; Sanchez C.E.; Holshouser J.W.; Heaslop J.; Mikealian B.; Gopinathannair R.; Gharib W.; Schuler B.T.; Jaber W.; Mansour M.; Tondo C.; Natale A.; Phillips K.P.; Boersma L.; Leger K.; Sutton B.; Stein K.; Christen T.; Wazni O.M. Institution (Healey) Population Health Research Institute, McMaster University, Hamilton, ON, Canada (Doshi) Scottsdale Healthcare, Scottsdale, AZ, United States (Nair) St Bernards Medical Centre and Research Group, Jonesboro, AR, United States (Reddy) Cardiac Electrophysiology, Mount Sinai Fuster Heart Hospital School of Medicine, New York, NY, United States (Piccini) Duke University School of Medicine, Durham, NC, United States (Das) Methodist Hospital of Indianapolis, Indianapolis, United States (Chaudhry) Lahey Hospital and Medical Centre, Burlington, MA, United States (Mittal) Valley Health System, Paramus, NJ, United States (Gonzalez) University Hospital of Salamanca, Institute of Biomedical Research, Salamanca, Spain (Joyner) Levinson Heart Hospital at Chippenham, Johnston Willis Medical Center, Richmond, VA, United States (Boveda) Clinique Pasteur, Toulouse, France (Loureiro) University Hospital Alvaro Cunqueiro, Spain (Kim) Cardiovascular Specialists of New England, Londonderry, NH, United States (Reiss) PeaceHealth Southwest Medical Center, Vancouver, WA, United States (Sanchez) Ohio Health Doctors Hospital, Riverside Methodist Hospital, Columbus, OH, United States (Holshouser) Sanger Health and Vascular Institute, Atrium Health Carolinas Medical Center, Charlotte, NC, United States (Heaslop) St. Alphonsus Health System, Boise, ID, United States (Mikealian) UC Health Memorial Hospital, Colorado Springs, CO, United States (Gopinathannair) Kansas City Heart Rhythm Institute, Overland Park, KS, United States (Gharib) Monongalia General Hospital, Morgantown, WV, United States (Schuler) WellSpan York Hospital, York, PA, United States (Jaber, Wazni) Cleveland Clinic, Cleveland, OH, United States (Mansour) Massachusetts General Hospital, Boston, MA, United States (Tondo) Centro Cardiologico Monzino, Milan, Italy (Tondo) Department of Biomedical, Surgery and Dental Sciences, University of Milan, Milan, Italy (Natale) St. David's Medical Center, Austin, TX, United States (Phillips) Greenslope's Private Hospital, Brisbane, Australia (Boersma) St. Antonius Ziekenhuis, Nieuwegein, Netherlands (Leger, Sutton, Stein, Christen) Boston Scientific, Minneapolis, MN, United States Publisher Elsevier B.V. Abstract Background The OPTION trial demonstrated that, after atrial fibrillation ablation, left atrial appendage closure (LAAC) reduced nonprocedural bleeding and was noninferior to oral anticoagulation (OAC) with respect to death, stroke, or systemic embolism. Objective This study aimed to evaluate event rates in relation to patients' baseline stroke risk. Methods The primary safety endpoint was nonprocedural major or clinically relevant nonmajor bleeding, and the primary efficacy endpoint was a composite of death, stroke, or systemic embolism, measured at 3 years. Patients were stratified based on a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of >=4 vs <=3. Results The trial enrolled 1600 patients aged 70 +/- 8 years, with 738 and 862 patients having CHA<inf>2</inf>DS<inf>2</inf>-VASc scores of >=4 and <=3, respectively. The primary efficacy outcome was similar for the OAC and LAAC arms both among patients with a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of >=4 (9.4% vs 7.8%; P =.37) and those with a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of <=3 (2.7% vs 3.3%; P =.59). Patients with a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of <=3 had an annual risk of ischemic stroke of 0.3% with LAAC and 0.1% with OAC (P =.19). Bleeding was more frequent with OAC for CHA<inf>2</inf>DS<inf>2</inf>-VASc scores of >=4 (18.4% vs 11.5%; P <.01) and <=3 (17.9% vs 6.0%; P <.01). Conclusion After ablation of atrial fibrillation, the rates of cardiovascular events are low among individuals with a CHA<inf>2</inf>DS<inf>2</inf>-VASc score of <=3 who were treated with either LAAC or OAC, and their annual risk of ischemic stroke is <=0.3% with either treatment. Bleeding risk with OAC is similar for patients with high and low CHA<inf>2</inf>DS<inf>2</inf>-VASc and significantly lower with LAAC for both groups. Copyright © 2026 Heart Rhythm Society. <134> Accession Number 652489955 Title Solid organ transplantation: How racial and ethnic differences impact wait times and transplant outcomes. Source Human Immunology. Conference: ASHI 52nd Annual Meeting. Montreal Canada. 87(Supplement) (pp 50), 2026. Article Number: 111949. Date of Publication: 01 Nov 2026. Author Masterson E.; Bettinotti M.P.; Gareau A.J. Institution (Masterson, Bettinotti) Johns Hopkins School of Medicine, Baltimore, MD, United States (Gareau) University of Wisconsin- Madison, Madison, WI, United States Publisher Elsevier Inc. Abstract Aim This systematic review investigated how ethnic and racial differences in the organ donation system impact wait time and transplant outcomes. Potential solutions to promote a more equitable transplantation system were also identified through a comprehensive and thorough literature review. Methods This study utilized data from 61 published data sources, including research studies, clinical webpages, and databases. The published data sources were collected through Google Scholar, which was further screened to only include papers published within the last five years unless still scientifically relevant, as well as data from the Organ Procurement and Transplantation Network (OPTN). Results End-stage kidney disease (ESKD) is more prevalent in Black individuals, who are more than four times likelier to be diagnosed compared to white individuals. Of note, the prevalence of ESKD among Hispanic, Asian, and Native American individuals was almost twice as high compared to white individuals. Despite this, white patients with ESKD had the highest transplantation rates (United States Renal Data System, 2023). With respect to thoracic transplantation, white individuals were 23% more likely to receive a lung transplant compared to their non-white counterparts even after adjusting for clinical and demographic factors (Florissi et al., 2024). Of note, Black and Hispanic patients have a disproportionately high prevalence of heart failure compared to other racial groups, yet the transplantation rate for these racial groups has declined from 82.0 to 69.2 and 90.2 to 80 per 100 waitlist-years, respectively (Lewsey and Breathett, 2021). Additionally, Black candidates are more likely to experience pre- and post-transplant mortality and an increased likelihood of being delisted while waiting for a heart transplant (Lewsey and Breathett, 2021). Conclusion This research highlights the significant inequities that persist in the organ transplant system. Further study into ways to increase transplant access for non-white patients, including building medical trust and removing financial barriers, creating local programs to address community-specific needs, and increasing diversity in the donor pool are needed to improve transplant accessibility for all patients. <135> Accession Number 2050936505 Title Impact of social determinants of health on perioperative and interstage outcomes in congenital heart surgery a systematic review. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1881839. Date of Publication: 2026. Author Sakowitz S.; Nelson J.S.; Robinson J.; Rossi C.S.; Shahian D.M.; Cooke D.T.; Jacobs J.P.; Aughtman S.; Schultz M.; Nathan M.; Beaty C.; Shafer M.; Kozik D.; Pelletier G.J. Institution (Sakowitz) Department of Surgery, University of California, Los Angeles, CA, United States (Nelson) Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL, United States (Nelson) Department of Surgery, University of Central Florida College of Medicine, Orlando, FL, United States (Robinson) Division of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, United States (Rossi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States (Shahian) Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Cooke) Division of General Thoracic Surgery, University of California, Davis, Sacramento, CA, United States (Jacobs) Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, United States (Aughtman) Department of Surgery, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, United States (Schultz) Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States (Nathan) Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States (Nathan) Department of Surgery, Harvard Medical School, Boston, MA, United States (Beaty) Nemours Children's Health, Delaware Valley, Wilmington, DE, United States (Shafer) Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, United States (Kozik) Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, United States (Pelletier) Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford, CA, United States Publisher Frontiers Media SA Abstract Importance - Social determinants of health (SDoH)- conditions in which patients live, grow, and age, -are increasingly recognized to influence the health of patients with congenital heart disease (CHD). Objective - To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery. Evidence review - A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria incorporated prior systematic reviews and meta-analyses, secondary analyses of prospectively collected trial data, and prospective or retrospective cohort studies. Subsequent reference searches identified 39 related articles. SDoH included patient and neighborhood level metrics. Two independent reviewers screened studies for full-text review, with data extraction by an expert panel. Findings - Among 1, 224 studies identified, 157 articles underwent full-text review and 121 were ultimately selected for data extraction. Eighty-Five articles did not address acute postoperative outcomes and were excluded. Thirty-six studies focused on acute or interstage outcomes following congenital heart surgery and served as the source information. The remainder were retrospective cohort studies using various databases. The number of study participants ranged from 98 to 174, 352 (median = 6, 979). Factors found to be linked with greater likelihood of in-hospital mortality included Black race, Hispanic/Latino ethnicity, Medicaid insurance, and lower neighborhood socioeconomic status. Both individual and neighborhood level determinants were associated with longer interstage periods, higher complication rates, as well as greater resource utilization and hospital readmissions. Two critical timespans for intervention to reduce inequities in care were the neonatal period and young adulthood. Conclusions and relevance - SDoH impact both acute and interstage outcomes in patients following surgery for CHD. Developing interventions to increase access to and engagement with quality care and out-of-hospital support may improve both short-term outcomes and reduce systems-level financial burden. Systematic Review Registration: Copyright © 2026 Sakowitz, Nelson, Robinson, Rossi, Shahian, Cooke, Jacobs, Aughtman, Schultz, Nathan, Beaty, Shafer, Kozik and Pelletier. <136> Accession Number 652478188 Title Indocyanine green dosing and imaging conditions for intraoperative fluorescence assessment during coronary artery bypass grafting: A systematic review. Source Surgery. (pp 110684), 2026. Date of Publication: 24 Sep 2026. Author Aleman R.; Napoli F.; Jamroz T.; Ahmadi S.; Dip F.; Norese M.; Navia J.; Brozzi N. Institution (Aleman, Napoli, Navia, Brozzi) Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, FL, United States (Jamroz, Ahmadi) Department of Anesthesia, Cleveland Clinic Florida, Weston, FL, United States (Dip, Norese) Department of General Surgery, University of Buenos Aires, Buenos Aires, Argentina Abstract BACKGROUND: Intraoperative indocyanine green fluorescence is used to assess graft filling and myocardial perfusion during coronary artery bypass grafting, although dosing and imaging protocols vary. This review evaluated dose, imaging conditions, visualization, technical abnormality detection, revision, quantitative perfusion, and safety. METHOD(S): Ovid MEDLINE, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched. Three reviewers selected studies and extracted data. Overlapping reports were reconciled into clusters. Doses were normalized to milligrams per injection. Risk of bias was assessed with design-appropriate instruments and certainty with the Grading of Recommendations Assessment, Development, and Evaluation framework. Findings were synthesized by application and imaging method. RESULT(S): Twenty-seven reports represented 20 clusters. Fluorescence appeared within 2-20 seconds. Fluorescence was detected in 525 of 533 conduits, and 379 of 507 grafts were fully analyzable. Indocyanine green findings prompted correction or revision in 5 of 348 conduits and 6 of 289, 8 of 533, and 4 of 107 grafts, with restored fluorescence or confirmed patency after intervention. In 139 grafts assessed against angiography, indocyanine green identified stenosis or occlusion with 83.3% sensitivity and 100% specificity. One randomized study reported normal indocyanine green findings in all 8 grafts meeting combined revision criteria. Quantitative fluorescence identified reduced intensity in 5 of 6 graft failures. Perfusion thresholds were met in 275 of 359 and 63 of 75 myocardial territories. Fixed doses ranged from 0.0125 to 6.25 mg per injection, without direct evidence defining an optimal regimen. CONCLUSION(S): Indocyanine green fluorescence supports rapid visualization of graft filling and may assist intraoperative reassessment during coronary artery bypass grafting. This review defines the reported dose range and identifies the exposure, acquisition, outcome, and safety variables required for more consistent comparison and interpretation. Copyright © 2026 Elsevier Inc. All rights reserved. <137> Accession Number 2051096040 Title Ethical considerations in the management of complications after lung resection: a narrative review. Source Journal of Thoracic Disease. 18(10) (no pagination), 2026. Article Number: 1151. Date of Publication: 30 Oct 2026. Author Zacharias G.; Joshi P.; Burki S.; Tompkins A.K.; Erkmen C.P. Institution (Zacharias, Joshi, Tompkins, Erkmen) Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States (Burki, Erkmen) Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States Publisher AME Publishing Company Abstract Background and Objective: Complications following lung resection present complex clinical, ethical and interpersonal challenges that extend beyond technical management. Although substantial literature addresses the prevention and treatment of complications after lung resection, there is limited guidance regarding the ethical principles that should shape clinical decision-making as complications evolve. This review proposes a practical ethical framework for the management of complications following lung resection. Method(s): Recommendations were developed based on clinical expertise and relevant published sources. A narrative literature search was conducted using PubMed/MEDLINE and Embase, supplemented by targeted searches of relevant clinical resources and reference lists. English-language literature published within the last fifteen years was considered, with more recent evidence prioritized alongside foundational literature. Where lung resection-specific evidence was limited, related thoracic surgery, critical care, perioperative medicine, and surgical ethics literature was incorporated. Key Content and Findings: The developed framework is focused on six foundational ethical principles spanning patient-centered and provider-/systems-centered domains. Patient-centered principles include autonomy, shared decision-making and proportionate goal-concordant care, which help define patient values and integrate those values with clinical expertise to align treatment strategies with meaningful outcomes. Provider-/systems-centered principles include beneficence, nonmaleficence, justice, transparency and accountability, all of which guide professional responsibility, equitable care, honest communication and collaboration throughout recovery. The application of these principles is examined across the preoperative, intraoperative and postoperative phases of care. Conclusion(s): This framework emphasizes aligning treatment decisions with patient-defined goals, while balancing the potential benefits and burdens of intervention. Overall, these six ethical principles provide a structured and durable framework for navigating complications following lung resection. Copyright This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), https://creativecommons.org/licenses/by-nc-nd/4.0/. <138> Accession Number 2051099375 Title Effects of Pharmacological and Surgical Treatments on Mitral Regurgitation Regression and Left Heart Structures: A Meta-Analysis. Source Cardiovascular Innovations and Applications. 11(Supplement 1) (no pagination), 2026. Article Number: 37. Date of Publication: 2026. Author Li H.; Wang S.; Liu W.; Liu J.; Peng Y.; Chen Q. Institution (Li, Wang) Department of Cardiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China (Chen, Liu, Peng) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China (Liu) Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China (Chen) Department of Cardiology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Publisher Compuscript Ltd Abstract Background: An integrated evaluation of medical therapy and surgical intervention for mitral regurgitation (MR) regression is necessary. Method(s): Eligible studies in five electronic databases were screened by two independent reviewers. Relative risk (RR) was calculated for an echocardiographic MR grade <= 2+, and the standard mean difference (SMD) was calculated for the percentage change in MR severity and left ventricular/atrial volume with random-effects models. Result(s): A total of 24 RCTs including 3711 patients were collected. Overall medical therapy decreased MR area (SMD = -1.13) and volume (SMD = -0.76), whereas angiotensin receptor and neprilysin inhibitors (SMD = -0.49) and sodium glucose cotransporter-2 inhibitors (SMD = -0.70) had better performance, on the basis of decreased left atrial volume. Transcatheter mitral valve repair (TMVr) performed similarly to mitral valve surgery (MVS) (RR = 0.99) but better than nonsurgical controls (RR = 3.02), according to 12-month MR grade <= 2+. The addition of MVS to coronary artery bypass grafting was associated with more <= 2+ MR (RR = 1.66) and lower left ventricular volume (SMD = -0.49) (all P < 0.05). A network meta-analysis supported the 12-month benefits of TMVr and MVS for nonrecurrent MR. Conclusion(s): TMVr and MVS were associated with nonrecurrent MR, and medical therapy also decreased MR. The combination of medication and surgery might potentially be beneficial to reduce left heart size and to preserve its output. Copyright © 2026 The Authors <139> Accession Number 652453853 Title Impact of perioperative beta-blocker discontinuation on mortality and MACE in non-cardiac surgery. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Alexandru M.; Rehberg S.; Patrick N.; Guarracino F.; Chousterman B.; Mebazaa A.; Sessler D.; Scholz S. Institution (Alexandru, Rehberg, Patrick, Scholz) Department of Anaesthesiology and Intensive Care, University Hospital of Bielefeld, Campus Bethel, Bielefeld, Germany (Guarracino) University "G. d'Annunzio" of Chieti-Pescara, Italy, Department of Medical, Oral and Biotechnological Sciences, Pisa, Italy (Chousterman, Mebazaa) Department of Anesthesia and Critical Care, AP-HP Universite Paris Cite, Hopital Lariboisiere, Paris, France (Sessler) The University of Texas Health Science Center at Houston (UTHealth Houston), Center for Outcomes Research, Department of Anesthesiology, Cleveland, United States Publisher Springer Nature Abstract Introduction: Recommendation for beta-blockers use in perioperative setting have evolved over several decades, based upon new available evidence. New randomized clinical trials and meta-analysis helped to identify clinical situations and profiles of patients more likely to benefit or be harmed by perioperative beta-blockade, as well as dose and timing in relation with risk-benefit balance. One recommendation that did not vary since early guidelines, relates to the continuation of chronic beta-blockade, that is still Class-I recommendation, mostly based upon retrospective cohorts [1-5]. Objective(s): A meta-analysis was conducted to explore the robustness of data supporting this statement and discussed its relevance regarding patients undergoing non-cardiac surgery. Method(s): A pre-defined protocol was registered at the international PROSPERO Database. Literature search included the Cochrane Library, PubMed, Web of Science and ClinicalTrials.gov. The patient population consisted of adult patients (>= 18 years) undergoing non-cardiac surgery procedures. Studies not able to provide data on mortality, risk of myocardial infarction or ischemic stroke were excluded. The Risk of Bias tool provided by Review Manager was used to assess the risk of BIAS. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Mortality served as primary endpoint, secondary endpoints analyzed the risk of myocardial infarction and ischemic stroke. The effects of the intervention were investigated by assessing the Odds Ratio (OR) and confidence intervals (CI) between the betablocker and control groups and were determined and presented using Forests plots. The presence of relevant statistical heterogeneity was determined based of an I2-value>=50%. A random-effects model was used to pool the data and estimate the results, since relevant statistical heterogeneity was present. All statistical analyses were performed using Review Manager. Result(s): A total of seven studies totalizing 79,631 patients fulfilled the predefined criteria and were included [6-8]. Pooled mortality (longest period of data on mortality) was significantly impacted by betablocker continuation when compared to withdrawal (OR, 2,01 [95% CI 1,25-3,23], p<0,05, I2=83%), as well as the short-term mortality (OR, 4,16 [95% CI 1,54-11,26], p<0,05, I2=76%, Fig. 1). Contrary, the long-term mortality was not statistically significant (OR, 1,22 [95% CI 0,58-2,56], p=0,59, I2=86% Fig. 2). We could not find any significant difference favoring betablocker continuation or withdrawal regarding major adverse cardiovascular events (MACE) (1,63 [95% CI 0,98-2,70], p=0,06, I2=81%, Fig. 3). Conclusion(s): The results of this meta-analysis support the recommendation to continuing beta-blockers based upon the associated higher pooled and short-term risk of mortality. Notably, this risk was not significant for long-term mortality and discontinuation was not associated with an increased probability of MACE. Given the high heterogeneity and the absence of randomized trials, further research may be warranted to confirm this. (Figure presented). <140> Accession Number 652462186 Title Systematic Review of Devices, Designs, and Trials for the Treatment of Deep Venous Reflux. Source Journal of vascular surgery. Venous and lymphatic disorders. (pp 102643), 2026. Date of Publication: 19 Oct 2026. Author Ofori K.A.; Li S.; Grimshaw A.A.; Chaer R.; Ochoa Chaar C.I. Institution (Ofori) Department of Surgery, Yale School of Medicine, New Haven, CT, United States (Li) Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States (Grimshaw) Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States (Chaer) Division of Vascular and Endovascular Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States (Ochoa Chaar) Department of Surgery, Yale School of Medicine, New Haven, CT, United States Abstract OBJECTIVE: Chronic venous insufficiency (CVI) is driven primarily by venous reflux and affects nearly one-third of adults. While superficial reflux is effectively treated with ablation, therapeutic options for deep venous reflux (DVR) remain limited. Despite decades of innovation, no prosthetic or bioprosthetic venous valve has achieved U.S. regulatory approval. We systematically reviewed device strategies, clinical and hemodynamic outcomes, complications, and barriers to translation for devices designed to treat DVR. METHOD(S): We conducted a PROSPERO-registered systematic review (CRD420251101761) of six databases from inception through February 2026, including in vivo animal and human studies evaluating prosthetic or bioprosthetic devices for DVR. Studies of native valve repair or autotransplantation were excluded. The primary outcome for human studies was clinical improvement, and secondary outcomes included patency, procedural complications, valvular function, and thrombosis. RESULT(S): Of 516 records identified, 15 met inclusion criteria: 8 human and 7 animal studies. Two principal strategies were identified: intraluminal valve restoration (VR) and external compression (EC), with approximately 40% of devices delivered percutaneously or endovenously. In human studies, technical success ranged from 87.7%-100%, patency from 67%-100%, and perioperative complication rates from 0%-44%, consisting primarily of bleeding, wound infection, and valve thrombosis. Valve occlusion occurred in up to 28% of animal implants and 18%-22% of select human cohorts. Two perioperative deaths occurred in animal studies; none were reported in human studies. Among human studies, valve competency assessment methods varied substantially. Reported competency ranged from 0%-92%, reflecting heterogeneity in imaging modalities and definitions. Discordance between anatomic patency, duplex-derived reflux reduction, and clinical improvement was frequently observed. In contemporary multicenter trial data, fewer than half of patients met predefined reflux-reduction endpoints despite high device patency and substantial clinical improvement, highlighting discordance between anatomic, hemodynamic, and patient-centered outcomes. By one year, pain had improved in 75%-97% of patients; rVCSS decreased by 37%-81%, with clinically meaningful (>=3-point) improvement in up to 84.6%; and ulcer healing ranged from 67%-100%. Longer follow-up extended to 2 years in animal studies and up to 11 years in human series with various outcomes reported. CONCLUSION(S): Several devices developed for DVR have demonstrated technical feasibility and symptom improvement. However, the risk of thrombosis, the marginal impact on valvular function, and the lack of standardization and selection of adequate endpoints in the measurement of results remain major barriers to regulatory approval. Standardized composite endpoints integrating objective hemodynamic measures with patient-centered outcomes are essential to advance durable DVR device development and clinical translation. Copyright © 2026. Published by Elsevier Inc. <141> Accession Number 652460810 Title Hemoadsorption to prevent acute kidney injury in elective cardiac surgery: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Source Anaesthesia, critical care & pain medicine. (pp 101931), 2026. Date of Publication: 21 Oct 2026. Author Abou-Arab O.; Beyls C.; Ibrahima A.; Appa A.; Alshatri H.Y.; Colombel J.; Kamel S.; Moussa M.D.; Besnier E.; Saleh K.; Mahjoub Y.; Mallat J. Institution (Abou-Arab, Beyls, Ibrahima, Alshatri, Colombel, Mahjoub) Department of Anesthesia and Critical Care, Amiens University Hospital, Amiens, France (Appa) Department of Cardiac Surgery, Amiens University Hospital, Amiens, France (Kamel) CURS, Universite de Picardie Jules Verne, Amiens, France (Moussa) Department of Anesthesiology and Critical Care Medicine, CHU Lille, Lille, France (Besnier) Department of Anesthesiology and Critical Care, University of Rouen Normandy, CHU Rouen, Rouen, France (Saleh) Respiratory Division, Integrated Hospital Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (Mallat) Critical Care Division, Integrated Hospital Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States; Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina Abstract BACKGROUND: This meta-analysis aimed to evaluate whether intraoperative hemoadsorption during cardiopulmonary bypass (CPB) improves postoperative outcomes compared with the standard of care. METHOD(S): We systematically searched EMBASE, PubMed, and the Cochrane Library for randomized controlled trials (RCTs) comparing hemoadsorption versus standard care in patients undergoing cardiac surgery with CPB. Data were analyzed using a frequentist approach and trial sequential analysis (TSA). The primary outcome was the incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) within 7 days after surgery. The protocol was prospectively registered in PROSPERO (CRD42025634991). RESULT(S): A total of six RCTs comprising 798 patients were included. Four RCTs (n = 723; 355 hemoadsorption, 368 control) reported CSA-AKI incidence, which did not significantly differ between groups (RR = 0.93 [95% CI: 0.71-1.21], p = 0.57; I2 = 42.0%). Hemoadsorption was not associated with significant differences in secondary outcomes: interleukin-6, tumor necrosis factor, 28-day mortality, SOFA score, and ICU length of stay. CONCLUSION(S): Hemoadsorption during CPB was not associated with a reduction in CSA-AKI or with improvement in secondary clinical outcomes in elective patients undergoing cardiac surgery. However, the accrued sample represented only 48% of the heterogeneity-adjusted required information size (1,491 patients), and the cumulative Z-curve crossed neither the monitoring nor the futility boundary. REGISTRATION: PROSPERO International Register of Systematic Reviews (CRD42025634991; January 31, 2025). Copyright © 2026. Published by Elsevier Masson SAS. <142> Accession Number 652453630 Title Impact of an intravenous infusion of amino acid on insulin sensitivity during cardiac surgery: a post-hoc analysis. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Rousseau A.F.; Predescu O.; Schricker T. Institution (Rousseau, Predescu, Schricker) Department of Anesthesia, McGill University, Montreal, Canada Publisher Springer Nature Abstract Introduction: Surgical stress induces acute insulin resistance, which is associated with adverse postoperative outcomes. Perioperative amino acids (AA) supplementation is increasingly used to attenuate catabolism and support organ function. However, AA influence glucose metabolism, and their impact on insulin sensitivity (IS) during surgery remains unclear. Objective(s): To assess the effect of intravenous AA infusion on IS and glucose kinetics in non-diabetic patients undergoing cardiac surgery. Method(s): We performed a post-hoc analysis of a randomized controlled trial including non-diabetic patients undergoing elective cardiac surgery (NCT02549443). During surgery, patients received either intravenous AA (at an amount equivalent to 20% of the patient basal energy expenditure, measured by indirect calorimetry) or an equivalent volume of normal saline. IS was assessed using the normoglycemic-hyperinsulinemic clamp (NHC), with steady-state glucose 20% infusion rate (GIR) as the primary outcome. Endogenous glucose production was measured using stable isotope tracer methodology: priming intravenous doses of [6,6-2H2]glucose (22 micromol/kg) were administered followed by three-hour infusions of [6,6-2H2]glucose (0.22 micromol.kg-1.min-1). Blood samples were taken at 150, 160, 170 and 180 min to determine metabolites enrichment (i.e. rate of glucose appearance). Plasma glucose was analyzed by electron-impact ionization gas chromatography-mass spectrometry. Result(s): Twelve patients (n=6 per group) were included: age 62 +/- 9 years, 92% male, body mass index 27.0 +/- 3.6 kg/m2, HbA1c 5.75 +/- 0.2%, surgical time 261 +/- 33 min. Baseline fasting blood glucose and insuline were comparable between groups. At the end of surgery, IS was significantly lower in the AA group compared with controls (2.3 +/- 1.1 vs 3.9 +/- 1.7 mg.kg-1.min-1; p=0.042). Endogenous glucose production was similarly suppressed in both groups, with no significant difference observed. Conclusion(s): Perioperative intravenous AA infusion was associated with a significant reduction in IS during cardiac surgery in non-diabetic patients. Importantly, these findings were obtained under NHC conditions, a controlled but non-physiological metabolic setting that may influence substrate utilization. While AA supplementation may provide anabolic and organ-protective benefits, these findings highlight the need to better characterize its metabolic effects in the perioperative setting. Further studies are needed to determine the clinical relevance of this effect and to optimize perioperative nutritional strategies. <143> Accession Number 652453862 Title Patient-centered ventilator settings to reduce respiratory acidosis after cardiac surgery. a randomized controlled trial. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Roch R.; Bouchard P.A.; Gendron A.; Bertrand-Bureau C.; Couture E.; Lellouche F. Institution (Roch, Bouchard, Gendron, Bertrand-Bureau, Couture, Lellouche) Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada Publisher Springer Nature Abstract Introduction: In patients after cardiac surgery, tidal volumes (Vt) of less than 10 ml/kgPBW are associated with less organ injury (1). However, respiratory acidosis may arise if the respiratory rate (RR) is not properly adjusted and there are no clear indication on how to set this parameter. Acidosis is common after cardiac surgery and may precipitate pulmonary hypertension and hemodynamic consequences (2). We recently showed in a retrospective study that the VentilO algorithm (www.VentilO.ca), a clinical-support system, proposes a higher minute ventilation than expert clinicians at bedside and may reduce the rate of respiratory acidosis (3). However, prospective validation of this algorithm is required. Objective(s): To evaluate whether VentilO reduces the incidence of respiratory acidosis compared with usual clinician-directed ventilation in patients after cardiac surgery Methods: We conducted a RCT in patients after cardiac surgery. Patient signed consent was obtained before surgery. Adult patients admitted in the ICU after cardiac surgery were included. Main exclusion criteria was the presence of triggered breath at ICU arrival. Patients were randomized in the intervention group (Vt and RR set with VentilO) or in standard practice group where ventilatory parameters were determined by expert clinicians. VentilO proposes Vt and RR based on several parameters (3). Primary outcome was the rate of respiratory acidosis defined as a pH < 7.35 associated with PaCO2 > 45 mmHg (15), with severe acidosis defined as pH < 7.30. Secondary outcomes included time of mechanical ventilation, time to spontaneous ventilation, use of vasoactive medication, ventilator-associated complications, ICU mortality and length of stay in ICU. Result(s): We present the data of the first 80 included patients without difference for main baseline characteristics (mean age 65+/-11 years, 80% male, 66% of CABG). The rate of acidosis was lower in the group using VentilO algorithm (29% vs 56%, p=0.02). There was a non statistically significant difference in the rate of respiratory acidosis between both group (17% vs 31%, p = 0.15) (Fig. 1). There was a non statistically significant differences in the total time of mechanical ventilation (189 vs 230 min, p=0.11), ICU length of stay (32.9 vs 39.9 hours, p=0.13) or pulmonary hypertension (PAPS 31.2 vs 30.4 mmHg, p=0.65) between VentilO and Clinician arms. The number of interventions by the RTs to modify Vt or RR was significantly reduced in the VentilO arm (14 vs. 28 intervention, or 0.34+/-0.62 vs. 0.72+/-0.97 intervention/patient, P<0.001). Conclusion(s): The use of VentilO algorithm to set RR and Vt reduces the rate of acidosis in patients after cardiac surgery and reduce the number of interventions after initial settings. (Figure presented). <144> Accession Number 652453412 Title Impact of landiolol bolus administration on heart rate control and hemodynamic stability in postoperative cardiac surgery patients. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Hrazdilova O. Institution (Hrazdilova) Departement of anesthesia, Center of Cardiovascular and Transplant Surgery, Brno, Czechia Publisher Springer Nature Abstract Introduction: Postoperative atrial fibrillation (POAF) and supraventricular tachycardias are frequent complications following cardiac surgery, often requiring rapid heart rate (HR) control to prevent hemodynamic deterioration. Landiolol, an ultra-short-acting and highly B 1-selective antagonist, is an ideal candidate for these patients due to its rapid metabolism. However, the optimal loading bolus dose-balancing efficacy against the risk of hypotension-remains to be established in clinical practice. Objective(s): The Bolus Landiolol Trial aims to compare the efficacy and safety of two initial bolus doses (0.1 mg/kg vs. 0.3 mg/kg). Specifically, the study evaluates whether bolus administration facilitates a more rapid therapeutic effect in achieving acute heart rate control compared to standard infusion protocols. Method(s): This is a preliminary report of an ongoing prospective, randomized trial. To date, 10 patients (N=10) with new-onset POAF or SVT (HR > 120 bpm) have been enrolled in the pilot phase and randomized 1:1. Group A (low-dose) received a 0.1 mg/kg bolus over 60 s, while Group B (high-dose) received 0.3 mg/kg, both followed by a continuous infusion of 10 microg/kg/min. The primary endpoint is successful HR control (HR < 100 bpm or > 20% reduction) within 10 min. Result(s): Initial data from the first 10 patients demonstrate the feasibility and safety of the study protocol. Preliminary observations suggest that successful HR control was achieved in both groups within the target timeframe. While the 0.3 mg/kg dose (Group B) showed a trend toward faster HR reduction, the 0.1 mg/kg dose (Group A) appeared to maintain greater hemodynamic stability with no significant episodes of hypotension (MAP < 60 mmHg) requiring intervention. No serious adverse events or treatment failures were observed. Conclusion(s): These pilot findings confirm that the our study protocol is safe and feasible for implementation in the intensive care setting. Recruitment is ongoing to reach the powered sample size of 100 patients, which will provide definitive evidence on the optimal bolus strategy to achieve a rapid therapeutic effect while ensuring hemodynamic safety in postoperative patients. <145> Accession Number 2051042710 Title Neuroprotective Effects of Dexmedetomidine in Pediatric Open-heart Surgery with Cardiopulmonary Bypass: A Randomized Controlled Study using Near-Infrared Spectroscopy and S-100B. Source Open Anesthesia Journal. 20 (no pagination), 2026. Article Number: e258964583987. Date of Publication: 2026. Author Sasmita D.N.; Perdana A.; Heriwardito A.; Adeline M. Institution (Sasmita, Perdana, Heriwardito, Adeline) Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia (Sasmita, Perdana, Heriwardito) Department of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia Publisher Bentham Science Publishers Abstract Introduction: Cardiopulmonary Bypass (CPB) during pediatric congenital heart surgery is associated with a risk of perioperative neurological injury. This study aimed to evaluate whether intra-CPB administration of dexmedetomidine reduces neuronal injury, as assessed by serum S-100B levels and regional cerebral oxygen saturation (rSO<inf>2</inf>) monitored with near-infrared spectroscopy (NIRS). Method(s): This double-blind randomized controlled trial included 36 children aged 0-18 years; 32 patients were included in the final analysis (16 per group) undergoing open-heart surgery with CPB. Patients were randomized to receive either dexmedetomidine or placebo, with 16 patients in each group. In the dexmedetomidine group, 0.5 microg/kg dexmedetomidine was added to the CPB priming solution, followed by a continuous infusion of 0.25 microg/kg/h into the CPB reservoir during bypass. Serum S-100B levels were measured before CPB and 6-12 hours postoperatively. Cerebral rSO<inf>2</inf> was monitored at predefined perioperative time points. Secondary outcomes included duration of mechanical ventilation, cardiac intensive care unit length of stay, and 7-day mortality. Result(s): Baseline pre-CPB S-100B levels did not differ significantly between the control and dexmedetomidine groups [8.76 (3.04-14.70) vs. 11.89 (3.93-14.20) pg/mL; p = 0.127]. Post-CPB S-100B levels were significantly higher in the control group than in the dexmedetomidine group (33.97 vs. 9.39 pg/mL; p = 0.019). The change in S-100B levels also differed significantly between groups, with an increase in the control group and a decrease in the dexmedetomidine group (+14.62 vs. -4.53 pg/mL; p = 0.001). Cerebral rSO<inf>2</inf> showed similar temporal trends in both groups, with no statistically significant between-group differences at any measurement time point. Duration of mechanical ventilation, cardiac intensive care unit length of stay, and 7-day mortality were comparable between groups. Discussion(s): Intra-CPB dexmedetomidine was associated with lower postoperative S-100B levels, suggesting a potential reduction in biochemical evidence of neuronal injury during pediatric cardiac surgery with CPB. However, this biochemical effect was not accompanied by measurable differences in cerebral oxygenation or short-term clinical outcomes, indicating that its clinical significance remains uncertain. Conclusion(s): Intra-CPB dexmedetomidine administration was associated with lower postoperative S-100B levels in pediatric patients undergoing open-heart surgery with CPB. Larger studies incorporating serial biomarker measurements and long-term neurodevelopmental follow-up are warranted to determine whether this biochemical effect translates into clinically meaningful neuroprotection. Clinical Study Trial Number: TCTR20260317004. Copyright © 2026 The Author(s). Published by Bentham Open., 2026. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. <146> Accession Number 2050947319 Title Delayed diagnosis of selected thoracic and mediastinal conditions in young adults: a focused narrative review of clinical pitfalls, cognitive biases, and system barriers. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1964531. Date of Publication: 2026. Author Hazboun R.; Ayasa Y.; Omarion A.; Faroun J.; Zghyer J.; Jawabreh T.; Abu Asbeh Y. Institution (Hazboun, Ayasa, Omarion, Faroun, Zghyer, Abu Asbeh) Al-Quds University Faculty of Medicine, Abu Dis, Palestine (Hazboun, Ayasa, Omarion, Faroun, Zghyer, Jawabreh, Abu Asbeh) Al Quds Medical Research Association, Jerusalem, Palestine (Jawabreh) Al-Quds Bard College, Al-Quds University, West Bank, Abu Dis, Palestine Publisher Frontiers Media SA Abstract Background - Thoracic and mediastinal conditions affecting the esophagus, diaphragm, mediastinum, and airway carry considerable morbidity when diagnosis is delayed. Young adults are often perceived as low risk for serious thoracic disease, and low clinical suspicion, atypical symptoms, and cognitive and healthcare-system barriers can delay recognition. Methods - This focused narrative review searched PubMed and Scopus, supplemented by Google Scholar, for studies published between January 2000 and May 2026, with selected earlier landmark studies retained where essential. Search terms included "thoracic surgical conditions," "young adults," "late diagnosis," "misdiagnosis," and "unusual presentation." Five conditions were selected purposively to illustrate contrasting mechanisms and time-courses of diagnostic delay rather than to catalogue thoracic disease exhaustively. No formal systematic search protocol, study-level quality appraisal, or narrative-review quality instrument was applied. Results - Five diagnostic categories are examined: esophageal perforation and Boerhaave syndrome, traumatic diaphragmatic injury, primary mediastinal germ cell tumors, airway tumors misdiagnosed as asthma, and Hodgkin lymphoma presenting as an anterior mediastinal mass. Hodgkin lymphoma is included as a mediastinal diagnostic pitfall because it resembles other anterior mediastinal tumors and requires histological sampling for definitive diagnosis. Together, these conditions illustrate how overlapping cognitive and systemic barriers contribute to diagnostic delay. The strength and age relevance of the supporting evidence differ markedly between conditions and are stated explicitly, as much of the foundational literature derives from broader adult populations rather than cohorts restricted to ages 18-40. Conclusions - Diagnostic delay reflects the combined effects of non-specific presentation, anchoring, premature closure, limited access to imaging, and delayed specialist referral. Consequences differ by condition: in acute mechanical and perforation emergencies, delays measured in hours may affect contamination, deterioration, and operative complexity, whereas in indolent mediastinal malignancies delay principally affects diagnostic complexity, symptom and psychological burden, and time to staging and treatment, while prognosis remains strongly influenced by histological subtype and tumor biology. Structured reassessment after an unexpected treatment response, timely cross-sectional imaging, disease-specific testing, and early specialist referral are practical measures available to first-contact clinicians. Copyright © 2026 Hazboun, Ayasa, Omarion, Faroun, Zghyer, Jawabreh and Abu Asbeh. <147> Accession Number 2051096091 Title Hemodynamic and biomechanical impact of proximal aortic surgery on the cardiovascular system: a systematic review and meta-analysis. Source Journal of Thoracic Disease. 18(10) (no pagination), 2026. Article Number: 1090. Date of Publication: 01 Oct 2026. Author van Sambeeck P.S.; Hermans B.P.; Nauta F.J.H.; Hasami N.A.; Saouti N.; Verkroost M.W.A.; Trimarchi S.; Czerny M.; Heijmen R.H. Institution (van Sambeeck, Hermans, Nauta, Hasami, Saouti, Verkroost, Heijmen) Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands (Trimarchi) Department of Clinical and Community Sciences, University of Milan, Milan, Italy (Czerny) Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany Publisher AME Publishing Company Abstract Background: The consequences of proximal aortic (PA) replacement with a stiff vascular prosthesis remain insufficiently understood. This systematic review and meta-analysis aims to consolidate evidence regarding the hemodynamic and biomechanical effects of PA surgery on the cardiovascular system. Method(s): Four databases were searched on April 16th, 2025. Clinical and experimental studies reporting hemodynamic or biomechanical outcomes after PA compliance alterations were included. Exclusion criteria comprised non-original work, computational models, acute procedures, interventions beyond the PA, and PA constriction surgeries. Primary outcomes reflected cardiac functioning, hemodynamics, and aortic biomechanics. Result(s): Thirteen studies (six clinical, seven experimental) were included. Six studies measured changes pre- and post-intervention, seven studies compared changes to a control group. Pulse pressure (investigated in four studies) significantly increased in one experimental study (37.7+/-5.9 vs. 49.2+/-6.9 mmHg, P=0.01). Left ventricular mass (one study) increased significantly following stiff prosthetic replacement versus optimal medical therapy (+3.67+/-4.1 vs. +0.62+/-4.4 g/m^2, P<0.001). Blood flow velocity of the PA (two studies) showed significant increases in both studies. Two (of five) studies reported significant increases in aortic wall mechanics parameters including mean wall shear stress (WSS) (0.31 vs. 0.82 Pa, P=0.04) and maximal WSS (0.55 vs. 1.11 Pa, P=0.04). Meta-analysis (four studies) found increased distensibility [standardized mean change score (SMCC) 0.50, 95% confidence interval (CI): 0.24-0.76, k=3] and circumferential strain (SMCC 0.55, 95% CI: 0.00-1.10, k=3) of the descending aorta. Ejection fraction (SMCC 0.08, 95% CI: -0.29-0.45, k=3) and pulse pressure (SMCC 0.47, 95% CI: -0.36-1.31, k=3) remained unchanged. Certainty of evidence was very low, and risk of bias was moderate. Conclusion(s): PA stiffening due to a vascular prosthesis appears to have limited systemic hemodynamic effects, likely due to compensatory mechanisms (e.g. increased left ventricular mass and distal aortic adaptation). Local distensibility, WSS and flow dynamics are adversely affected. Copyright Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/. <148> Accession Number 2051048523 Title Cardiac involvement in Behcet's disease: a comprehensive state-of-the-art review. Source Clinical and Experimental Rheumatology. 44(10) (pp 2140-2152), 2026. Date of Publication: 01 Oct 2026. Author Belfeki N.; Ghriss N.; Jebri F.; Hamrouni H.; Hatemi G.; Mekinian A. Institution (Belfeki, Ghriss) Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France (Jebri) Department of Cardiology, Polyclinique de l'Europe, Saint Nazaire, France (Hamrouni) Department of Imaging, Groupe Hospitalier Sud Ile de France, Melun, France (Hatemi) Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (Mekinian) Department of Internal Medicine and Inflammation-Immunopathology-Biotherapy (DHUi2B), Hopital Saint Antoine, Assistance Publique des Hopitaux de Paris, Sorbonne Universites, UPMC University, Paris, France Publisher Clinical and Experimental Rheumatology S.A.S. Abstract Behcet's disease (BD) is a chronic multisystemic inflammatory vasculitis which can cause cardiac involvement in less than 6%. It can affect all cardiac wall giving rise to pericarditis, myocarditis, endocardial lesions with valvular involvement (especially aortic insufficiency), intracardiac thrombosis, coronary arteritis, myocardial infarcts, arrythmia, and aortitis. Clinical presentation can be confusing, silent, or overshadowed, so diagnosis is frequently delayed. Early diagnosis is mandatory and different imaging techniques play a pivotal role to screen the heart. Biological agents, including tumour necrosis factor inhibitors, show promising results. Cardiac surgery must be accompanied by immunosuppressive therapy to prevent iatrogenic or trauma-triggered pseudo aneurysm secondary to arterial hypersensitivity. A multidisciplinary approach and tailored monitoring are essential to improve patient outcome. Strong data are still lacking to define evidence-based diagnostic algorithms, risk-stratification tools, and standardised management strategies for this severe cardiac manifestation. Besides, further studies are needed to determine specific biomarkers to refine early diagnosis, assess therapeutic efficiency, and prognosis. Through a comprehensive literature review, we aim to synthesise current data on the epidemiology, clinical presentation, contemporary imaging modalities, prognosis, and evidence-based management strategies of cardiac involvement in BD, and to highlight emerging perspectives. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2026. <149> Accession Number 2050935160 Title Robotic-assisted beating heart surgery: a comprehensive review. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1916578. Date of Publication: 2026. Author Abuzied O.; Abayazid M. Institution (Abuzied, Abayazid) Control and Instrumentation Engineering Department, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia (Abayazid) Interdisciplinary Research Center for Bio-Systems and Machines, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia Publisher Frontiers Media SA Abstract Robotic-assisted minimally invasive cardiac surgery offers the potential to perform off-pump beating heart procedures without cardiopulmonary bypass, but active closed-loop algorithmic motion compensation, as distinct from image-stabilization, motion-tracking, and mechanical-stabilization approaches that have seen limited clinical use, has not yet entered human clinical trials despite two decades of research. This scoping review, conducted using the PRISMA-ScR framework, addresses three questions: what are the quantitative performance limits of current sensing, prediction, and control methods; what is the state of clinical translation; and what barriers prevent first-in-human deployment. Studies were included if they reported methods or quantitative results for sensing, predicting, or compensating cardiac motion in robotic surgery (61 studies included); non-robotic stabilization studies and non-English publications were excluded. Four databases were searched from 1998 to May 2026; formal risk of bias assessment was not performed, consistent with PRISMA-ScR guidance. Results were synthesized narratively by thematic area. Key results include: dual Fourier-series EKF achieves 0.73-0.81 mm RMSE at 180 ms horizon; neural network approaches reduce this by 60% at 160 ms latency; cascade MPC-AOB maintains <0.08 N RMS force error across threefold stiffness variation; and shared canonical control reduces surgeon tracking error by 41%. The primary barrier is a systems integration deficit rather than any isolated algorithmic shortcoming. Six open challenges are classified by difficulty. The evidence base is limited by predominant porcine model validation. This review was not pre-registered, and received no external funding. Copyright © 2026 Abuzied and Abayazid. <150> Accession Number 2050937483 Title Cardiovascular outcomes of oral incretin-based drugs in type 2 diabetes: a GRADE-assessed meta-analysis of 67, 679 patients. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1884895. Date of Publication: 29 Sep 2026. Author Ali M.F.; Mohammed O.F.; Suhail A.; Naseer F.; Shafi N.; Arshad M.U.; Shazly O.; Mohmand M.S.; Ahmad H.; Binashikhbubkr N.K.; Maaz M.; Khan M.; Neppala S.; Al-Jarshawi M.; Hemida M.F. Institution (Ali) Department of Internal Medicine, HCA Healthcare Centerpoint Medical Center, Kansas City, MO, United States (Mohammed) Faculty of Medicine, Osmania Medical College, Hyderabad, India (Suhail) Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan (Naseer) Department of Medicine, Nishtar Medical University, Multan, Pakistan (Shafi) Department of Medicine, Arnot Ogden Medical Center, Elmira, NY, United States (Arshad, Ahmad) Department of Medicine, Shalamar Medical and Dental College, Lahore, Pakistan (Shazly) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Mohmand) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Binashikhbubkr) College of Medicine and Health Science, Hadhramout University, Hadhramout, Yemen (Maaz, Khan) Department of Medicine, Bacha Khan Medical College, Mardan, Pakistan (Neppala) Department of Cardiology, The University of Texas Health Science Center, San Antonio, TX, United States (Al-Jarshawi) NIHR Academy, National Institute for Health & Care Research, Leeds, United Kingdom (Al-Jarshawi) Keele Cardiovascular Research Group, Faculty of Medicine & Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (Al-Jarshawi) Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Informatics, Imaging & Data, University of Manchester, Manchester, United Kingdom (Al-Jarshawi) Cardiology Department, Royal Stoke University Hospitals, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom (Al-Jarshawi) Department of Medicine, Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom (Hemida) Department of Internal Medicine, Alexandria Main University Hospital, Alexandria, Egypt (Hemida) Department of Internal Medicine, University of Vermont, Burlington, VT, United States (Hemida) Department of Cardiovascular Medicine, American Society for Inclusion, Diversity, Equity in Healthcare (ASIDE), Lewes, DE, United States Publisher Frontiers Media SA Abstract Background - While injectable GLP-1 receptor agonists like semaglutide have demonstrated clear cardiovascular benefits in type 2 diabetes mellitus (T2DM), the role of oral incretin-based therapies, including oral semaglutide and DPP-4 inhibitors-remains less well defined. Comprehensive evaluation of their cardiovascular efficacy is warranted. Research question - What are the cardiovascular outcomes associated with oral incretin-based therapies, specifically oral semaglutide and DPP-4 inhibitors, in patients with T2DM compared to placebo or standard care. Methods - We searched electronic databases for randomized controlled trials (RCTs). Meta-analysis was conducted in R version 4.4.3 using the "meta" and "metasens" packages. Statistical analysis was performed using R software and RStudio (version 4.4.2). We calculated pooled estimates using risk ratios (RR) with 95% confidence intervals (CIs). Results - A total of 9 studies comprising 67, 679 patients were included, of which two evaluated oral semaglutide and the remaining seven assessed DPP-4 inhibitors. There was no significant reduction in all-cause mortality (RR 0.97, 95% CI 0.90-1.04, p = 0.35) or cardiovascular death (RR 0.98, 95% CI 0.91-1.05, p = 0.48). Major adverse cardiovascular events (MACE) showed a non-significant reduction overall (RR 0.95, 95% CI 0.91-1.00, p = 0.06), with oral semaglutide demonstrating a significant benefit (RR 0.86, 95% CI 0.78-0.95, p = 0.003). Non-fatal myocardial infarction (MI) (RR 0.98, 95% CI 0.88-1.09) and non-fatal stroke (RR 0.93, 95% CI 0.83-1.03) were not significantly affected. Hospitalizations due to heart failure (RR 0.98, 95% CI 0.84-1.13) and unstable angina (RR 1.00, 95% CI 0.87-1.15) remained unchanged. Coronary revascularization was slightly reduced with oral semaglutide (RR 0.76, 95% CI 0.64-0.91). Adverse events leading to discontinuation were higher with oral semaglutide (RR 1.51, 95% CI 1.15-1.98), while serious adverse events were significantly reduced (RR 0.96, 95% CI 0.94-0.99, p = 0.003). Sensitivity analyses were conducted due to significant heterogeneity in key outcomes. While omitting certain studies reduced heterogeneity, the overall results remained consistent. Conclusion - Oral incretin-based therapies were not associated with significant reductions in all-cause mortality, cardiovascular death, or MACE overall, though oral semaglutide showed a significant MACE benefit and reduced coronary revascularization on subgroup analysis. Non-fatal MI, fatal or non-fatal MI, non-fatal stroke, fatal or non-fatal stroke and hospitalization due to heart failure or unstable angina were unaffected, and oral semaglutide carried a higher risk of treatment discontinuation. These findings suggest no clear class-wide cardiovascular benefit of oral incretins, with signals specific to oral semaglutide warranting confirmation in dedicated trials. Systematic Review Registration - PROSPERO CRD420251113835. Copyright © 2026 Ali, Mohammed, Suhail, Naseer, Shafi, Arshad, Shazly, Mohmand, Ahmad, Binashikhbubkr, Maaz, Khan, Neppala, Al-Jarshawi and Hemida. <151> Accession Number 2051059633 Title Physical Recovery and Health-Related Quality of Life Outcomes Following Cardiac Surgery: A Systematic Review. Source CJC Open. (no pagination), 2026. Date of Publication: 2026. Author LeBlanc J.M.; LeBlanc B.P.; Ecarnot F.; Adams C.; Kent W.D.T.; Fedak P.W.M. Institution (LeBlanc, LeBlanc) Department of Biology, Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States (Ecarnot) SINERGIES Laboratory, University Marie & Louis Pasteur, Besancon, France (Ecarnot) Department of Cardiology, University Hospital Besancon Franche-Comte, Besancon, France (Adams, Kent, Fedak) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada Publisher Elsevier Inc. Abstract Background: Cardiac surgery is the cornerstone of therapy for advanced coronary, aortic, and valvular heart disease. As survival improves, outcomes now include physical recovery and health-related quality of life (HRQoL). Although a synthesis linking recovery metrics with HRQoL remains lacking, in this systematic review we aimed to characterize recovery trajectories and their determinants across diverse surgical populations and approaches. Method(s): We conducted a systematic review of PubMed, Embase, and Cochrane Library through December 31, 2025. Eligible studies included adults who underwent coronary artery bypass grafting, surgical valve repair or replacement, or aortic root procedures, and that reported quantitative recovery end points or validated HRQoL measures. Transcatheter-only procedures were excluded unless directly compared with surgical cohorts. Two reviewers independently screened and extracted data using Covidence (https://www.covidence.org) per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result(s): Of 1499 records, 25 studies were included (n = 32,322). Cardiac surgery consistently produced substantial improvements in HRQoL and physical recovery, with postoperative scores converging toward age-matched norms by 6-12 months regardless of procedure type. Minimally invasive techniques generally reduced intensive care unit and hospital stays, although randomized trial findings were inconsistent. Postoperative complications, particularly atrial fibrillation and renal failure, were linked to impaired long-term recovery. Improvements were strongly associated with baseline functional status and cardiac rehabilitation participation. Conclusion(s): Physical recovery and HRQoL after cardiac surgery are influenced by surgical technique and patient factors. Although minimally invasive approaches often enabled faster short-term recovery, long-term HRQoL appeared comparable across procedures. Prevention of postoperative complications is a key modifiable determinant. Standardized recovery metrics and validated HRQoL instruments are essential to advance patient-centred cardiac care. Copyright © 2026 The Authors <152> Accession Number 652454665 Title Comparative effects of three different doses of intrathecal morphine on the quality of analgesia in elderly patients undergoing cardiac surgeries through sternotomy - prospective randomized control trial. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Kalla K.P.G.; Dhananj S.; Sunder N.; Bhupesh K.; Pankaj A. Institution (Kalla, Dhananj, Sunder, Bhupesh) POST GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH, Chandigarh, India (Pankaj) POST GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH, Chandigarh, India Publisher Springer Nature Abstract Introduction: Intrathecal morphine (ITM) is an effective analgesic, but its optimal dose and safety in elderly cardiac surgery patients are unclear. This study aimed to address this knowledge gap by systematically evaluating the dose-dependent effects of ITM in elderly patients undergoing cardiac surgeries with midline sternotomy. Objective(s): Primary objective of this study was to compare the quality of analgesia between the groups in the postoperative period for 24 hours after extubation. Secondary objective is to compare the cumulative intraoperative fentanyl dose with the total ketorolac dose administered in the postoperative period up to 24 hours, time taken for the first rescue analgesia, incidence of respiratory depression, nausea, vomiting, pruritic, and reintubation due to respiratory depression between the groups. Method(s): This prospective, randomized, double-blind interventional study was carried out at the PGIMER, Chandigarh, India. Patients aged >65 years with NYHA class I-III, LVEF >50%, and scheduled for elective cardiac surgery via midline sternotomy were enrolled. Participants were randomly assigned to one of three study groups. Group 1 received 0.4 mg/kg 0.5% hyperbaric bupivacaine + 2 mcg/kg ITM, Group 2 received 0.4 mg/kg 0.5% hyperbaric bupivacaine + 3 mcg/kg ITM, and Group 3 received 0.4 mg/kg 0.5% hyperbaric bupivacaine + 4 mcg/kg ITM. All patients received standardized postoperative analgesia with intravenous paracetamol (1 g) administered in three doses at 8-hour intervals. Rescue analgesia was provided with intravenous ketorolac (0.25 mg/kg) for Visual Analogue Scale (VAS) pain scores >=4, with repeated doses given at 30-minute intervals if necessary. The incidence of opioid-related adverse effects, were monitored. Respiratory depression was defined as a respiratory rate of <8 breaths per minute and a PaCO<inf>2</inf> >45 mm Hg. Result(s): A total of 75 patients were randomly allocated in equal numbers to the three groups. Baseline demographics, clinical characteristics, and intraoperative data were comparable among groups. No failed or traumatic spinal procedures occurred. The primary outcome, analgesic quality measured by VAS at rest over 24 hours, showed no significant differences among groups from 0 to 15 hours. At 18, 21, and 24 hours, Group 1 had significantly higher VAS scores compared with Groups 2 and 3 (p < 0.05), while Groups 2 and 3 did not differ significantly. Intraoperative fentanyl requirements were similar among groups (p=0.573). Postoperative ketorolac consumption in the first 24 hours was significantly greater in Group 1 compared with Groups 2 and 3 (p<0.01). Time to first rescue analgesia was longest in Group 3, followed by Group 2, and shortest in Group 1, with a significant difference between Groups 1 and 3 (p=0.016). Respiratory depression occurred only in Group 3 (20%; p=0.009). Delayed extubation and need for non-invasive ventilatory support were observed primarily in Group 3. Nausea occurred in 9.3% of patients with no intergroup difference; no vomiting was reported. Pruritus was observed in one patient in Group 3. Duration of postoperative mechanical ventilation and ICU length of stay did not differ significantly across groups. Conclusion(s): this study highlights that 3 mcg/kg ITM, when administered to elderly patients undergoing cardiac surgery with midline sternotomy, appears to offer the optimal balance between analgesic efficacy and safety as it provides effective postoperative analgesia, reduces opioid consumption, and delays the need for rescue analgesia with less incidence of respiratory depression in Asian population. While providing a similar analgesia the 4 mcg/kg ITM dose carries an increased risk of respiratory complications, emphasizing the importance of cautious dosing in high-risk population. The findings of this study will aid clinicians in determining the ideal dose of ITM that provides optimal analgesia with minimal risk of complications in the elderly population. (Figure presented) (Table presented). <153> Accession Number 652454205 Title Sub-anesthetic ketamine and prevention of chronic postsurgical pain, early mobilization, and postoperative complications: a systematic review and meta-analysis. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Gherghina V.; Cindea I.; Prazaru M.; Iosif D.; Petre A. Institution (Gherghina) Facultatea de Medicina, Universitatea Ovidius, Constanta, Romania (Cindea) Facultatea de Medicina, Universitatea Ovidius, Constanta, Romania (Prazaru) ATI, SCJU Constanta, Constanta, Romania (Iosif, Petre) ATI, SCJU Constanta, Constanta, Romania Publisher Springer Nature Abstract Introduction: Chronic postsurgical pain (CPSP) affects 10-50% of surgical patients and is mechanistically linked to maladaptive synaptic plasticity - central sensitization driven by NMDA receptor-mediated long-term potentiation. Sub-anesthetic ketamine interrupts this process perioperatively. Beyond analgesia, adequate pain control facilitates early mobilization, which independently reduces thromboembolic and pulmonary complications and shortens hospital stay. A quantitative synthesis of these downstream clinical and economic outcomes is lacking. Method(s): Systematic review and meta-analysis of RCTs and prospective controlled studies in adult surgical patients receiving sub-anesthetic ketamine perioperatively. Databases: MEDLINE, Embase, CENTRAL, WHO ICTRP (inception-2025). Co-primary outcomes: (1) incidence of CPSP at 3 and 6 months (NRS >= 4 or validated questionnaire); (2) time to first mobilization (hours postoperatively). Secondary Outcomes: incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative pulmonary complications (PPCs); length of hospital stay (LOS, days); total direct hospitalization costs (where reported). Respiratory function was assessed via FEV<inf>1/FVC</inf> ratio and SpO<inf>2</inf> nadir in the PACU. Risk of Bias: RoB-2 and ROBINS-I for non-randomized studies. Random-effects meta-analysis; subgroup analyses by surgical category (abdominal, thoracic, orthopedic). Result(s): Thirty-six studies (n = 3,740 patients) were included. CPSP incidence was significantly reduced in the ketamine group at 3 months (RR 0.62, 95% CI 0.49-0.78; I2 = 41%) and 6 months (RR 0.58, 95% CI 0.44-0.76). Time to first mobilization was reduced by a mean of 4.2 h (95% CI 2.8-5.6; p < 0.001). DVT/PE incidence was lower (RR 0.67, 95% CI 0.48-0.93), as was the composite PPC rate (RR 0.72, 95% CI 0.55-0.94). LOS was reduced by a mean of 0.9 days (95% CI 0.5-1.3; p < 0.001). Postoperative SpO<inf>2</inf> nadirs were higher and PACU desaturation episodes less frequent in the ketamine arm (RR 0.61, p = 0.003). Cost-reduction analyses in three studies reported savings of 280-640 per patient, driven primarily by reduced LOS and complication management. Conclusion(s): Perioperative sub-anesthetic ketamine significantly reduces the incidence of chronic postsurgical pain at 3 and 6 months, facilitates earlier mobilization, and is associated with fewer thromboembolic and pulmonary complications, shorter hospitalization, and lower healthcare costs. These findings establish ketamine as a mechanistically grounded, outcomes-relevant component of enhanced recovery protocols in surgical critical care. <154> Accession Number 2050853027 Title Individualized Cardiac Index-Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial. Source JAMA. (no pagination), 2026. Date of Publication: 2026. Author Saugel B.; Meidert A.S.; Meyhoff C.S.; Sort R.; Aasvang E.K.; Bergholz A.; Serir A.; Schwartze E.; Thomsen K.K.; Zollner C.; Berthold S.; Borrmann M.; Esser J.; Laska A.; Scheiermann P.; Foss N.B.; Olsen J.W.; Madsen L.M.; Welling A.H.; Gaik C.; Roth S.; Schroder J.; Vives M.; Klimovic A.; Eichlseder M.; Goldmann S.; Renne T.; Hedrich H.; Vettorazzi E.; Zapf A.; Kouz K.; Flick M.; Grusser L.; Larmann J.; Khader W.; Balasova L.; Huge V.; Karlsen A.P.H.; Kiel L.B.; Wulff T.L.; Henriksen M.R.; Muller R.B.; Graeser K.; El-Ahmadi A.; Sogaard M.; Norgaard M.; Jepsen M.L.; Jans O.; Bundgaard M.; Munch T.; Dam M.; Hojlund J.; Stendell L.; Ieppsen U.; Melchiorsen J.U.; Christiansen T.L.; M'Pembele R.; Bucur V.; Tenge T.; Bartholomaus P.; Zollner M.; Boessner-Weiss T.; Bunsch M.; Dahlem R.; Fisch M.; Greiwe G.; Hackert T.; Hoppe P.; Krause L.; Meyer F.; Moll-Khosrawi P.; Nickel F.; Niessen A.; Reuter S.; Schmalfeldt B.; Schulte-Uentrop L.; Wulschlager K.M.; Zambiasi F.; Steinhaus M.; Nau C.; Olsson S.; Franz M.-L.; Vojnar B.; Koch T.; Haberl S.; Kult M.; Brandes F.; Niedermaier S.; Trebo A.; Zwissler B.; Groene P.; Lamm L.; Berg E.; Bischoff R.; Burges A.; Hagemann F.; Mahner S.; Reichenbach J.; Trillsch F.; Wirth U.; Werner J.; Renz B.; Andrassy J.; Niess H.; Guba M.; Rubio I.; Montero P.; Sala C.; Moncada R.; Benes J.; Zatloukal J.; Sikulova K. Institution (Saugel, Bergholz, Serir, Schwartze, Thomsen, Zollner, Kouz, Flick, Bunsch, Greiwe, Hoppe, Meyer, Moll-Khosrawi, Schulte-Uentrop, Wulschlager) Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Saugel, Thomsen, Kouz) Outcomes Research Consortium, Houston, TX, United States (Meidert, Berthold, Borrmann, Esser, Laska, Scheiermann) Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany (Meyhoff, Madsen, Karlsen, Kiel, Wulff, Henriksen, Muller, Graeser, El-Ahmadi, Sogaard, Norgaard, Jepsen) Department of Anaesthesia and Intensive Care, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark (Meyhoff, Sort, Aasvang, Foss) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Sort, Foss, Olsen, Stendell, Melchiorsen, Christiansen) Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, Copenhagen, Denmark (Aasvang, Welling, Jans, Bundgaard, Munch, Dam) Department of Anesthesiology, Center for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Gaik) Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany (Roth, M'Pembele, Bucur, Tenge, Bartholomaus) Department of Anaesthesiology, Medical Faculty, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany (Schroder) Department of Anesthesiology and Intensive Care, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany (Vives) Department of Anesthesia and Critical Care, Clinica Universidad de Navarra, Pamplona, Spain (Vives) School of Medicine, Universidad de Navarra, Pamplona, Spain (Vives) IdiSNA, Instituto de Investigacion Sanitaria de Navarra, Pamplona, Spain (Klimovic) Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, University Hospital in Plzen, Plzen, Czechia (Eichlseder) Division of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria (Goldmann) Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany (Renne) Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Renne) Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland (Hedrich, Vettorazzi, Zapf, Krause, Zambiasi) Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Gruser, Larmann, Khader, Balasova) Department of Anesthesiology, Medical Faculty, RWTH Aachen, University Aachen, Germany (Huge) Schoen Hospital Bad Aibling, Department of Critical Care, Medicine and Anesthesiology, Bad Aibling, Germany (Berg, Bischoff) Department of Urology, LMU University Hospital, Munich, Germany (Steinhaus, Nau, Olsson) University Hospital Schleswig-Holstein (UKSH), Campus Lubeck, Lubeck, Germany (Franz) University of Lubeck, Lubeck, Germany (Hojlund, Ieppsen) Department of Anaesthesia and Intensive Care, Hvidovre University Hospital, University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark (Reuter, Schmalfeldt) Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Sikulova) Department of Anesthesiology and Intensive Care Medicine, University Hospital in Plzen, Plzen, Czechia (Benes, Zatloukal) Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Charles University, University Hospital in Plzen, Plzen, Czechia (Vojnar, Koch) Marburg University, Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, Marburg, Germany (Zollner, Boessner-Weiss) Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Graz, Austria (Haberl, Kult, Brandes, Niedermaier, Trebo, Zwisler, Groene, Lamm) Department of Anaesthesiology, LMU University Hospital, Munich, Germany (Dahlem, Fisch) Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Rubio, Montero, Sala, Moncada) Department of Anesthesia & Critical Care, Clinica Universidad de Navarra, Pamplona, Spain (Wirth, Werner, Renz, Andrassy, Nies, Guba) Department of General, Visceral and Transplant Surgery, University Hospital LMU Munich, Munich, Germany (Hackert, Nickel, Niesen) Department of General, Visceral and Thoracic Surgery, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Burges, Hagemann, Mahner, Reichenbach, Trillsch) Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany Publisher American Medical Association Abstract Importance: It remains unclear if intraoperative hemodynamic therapy should be guided by cardiac index. Objective(s): To evaluate whether individualized cardiac index-guided hemodynamic therapy vs routine hemodynamic therapy improves outcomes in high-risk patients undergoing elective major abdominal surgery. Design, Setting, and Participant(s): This multicenter, single-blind, superiority randomized clinical trial enrolled high-risk patients undergoing elective major abdominal surgery between October 8, 2023, and October 25, 2025, at 12 university medical centers in Austria, the Czech Republic, Denmark, Germany, and Spain. The date of last follow-up was January 15, 2026. Intervention(s): Patients were randomized to individualized cardiac index-guided hemodynamic therapy targeting the patient's preoperative resting cardiac index vs routine hemodynamic therapy (with blinded cardiac index monitoring). Main Outcomes and Measures: The primary outcome was a composite of acute kidney injury, acute myocardial injury, severe infectious complications, nonfatal cardiac arrest, or death within the first 7 postoperative days. Secondary outcomes included the individual components of the primary outcome within the first 7 postoperative days. Result(s): Of the 1128 patients enrolled, 1111 were randomized and 1095 were included in the primary analysis (median age, 67 years [IQR, 59-74 years]; 49.4% were female). The primary outcome occurred in 243 of 549 patients (44.3%) in the individualized cardiac index-guided hemodynamic therapy group vs 256 of 546 patients (46.9%) in the routine hemodynamic therapy group (relative risk, 0.94 [95.1% CI, 0.83-1.08]; P =.38). There were no between-group differences for the incidence of the individual components of the primary outcome within the first 7 postoperative days. Conclusions and Relevance: Among high-risk patients undergoing elective major abdominal surgery, individualized cardiac index-guided hemodynamic therapy targeting the patient's preoperative resting cardiac index did not reduce the incidence of a composite outcome of acute kidney injury, acute myocardial injury, severe infectious complications, nonfatal cardiac arrest, or death within the first 7 postoperative days compared with routine hemodynamic therapy. Copyright © 2026 American Medical Association. <155> Accession Number 652454624 Title Short- and long-term impact of early supplemental parenteral nutrition in critically ill children with cardiac disease. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Haghedooren R.; Gunst J.; Guiza F.; Dulfer K.; Van Cleemput H.; Jacobs A.; Verbruggen S.; Wouters P.; Joosten K.; Van den Berghe G.; Vanhorebeek I. Institution (Haghedooren, Gunst, Guiza, Van Cleemput, Jacobs, Wouters, Van den Berghe, Vanhorebeek) Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium (Dulfer) Department of paediatrics, Pediatric Intensive Care, Erasmus MC-Sophia, Rotterdam, Netherlands (Verbruggen, Joosten) Division of Pediatric Intensive Care Unit, Department of Neonatal and Pediatric ICU, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands Publisher Springer Nature Abstract Introduction: Children with cardiac diseases show a high prevalence of malnutrition and risk of developmental impairment. Optimal nutrition for these patients while they are treated in the pediatric intensive care unit (PICU) is still debated (1). The PEPaNIC RCT (2) and its followup studies (3,4) performed in a general population of critically ill children demonstrated that supplementing insufficient enteral nutrition with parenteral nutrition within 24 hours after PICU admission (early-PN) worsened acute outcomes and long-term neurocognitive development, as compared with not giving supplemental PN before day 8 (late-PN). Whereas early full nutrition is often still advocated for cardiac PICU patients, we hypothesized that early-PN is also harmful to these patients. Method(s): This is a secondary analysis of the PEPaNIC RCT (n=1440) and its 2- and 4-year follow-up (2-4), focusing on all participating patients admitted to the PICU with a cardiac diagnosis. Assessed short-term outcomes included acquisition of a new infection; need of renal replacement therapy; duration of mechanical ventilation, PICU stay and hospital stay; and ICU, hospital and 90-day mortality. Assessed long-term outcomes comprised mortality; anthropometrics; clinical tests for intelligence, visual-motor integration, alertness, motor coordination, inhibitory control, cognitive flexibility and memory; and parent/ caregiver-reported executive functions and emotional and behavioral problems. Multivariable Cox proportional hazards and logistic or linear regression analyses were performed adjusted for risk factors. Result(s): The PEPaNIC study included 608 cardiac patients (age median (IQR) 0.6 (0.2-4.2) year, 90% cardiac surgery, 309 early-PN, 299 late-PN) of whom 365 (183 early-PN, 182 late-PN) and 314 (145 early-PN, 169 late-PN) participated in the 2- and 4-year follow-up, respectively. Early-PN worsened short-term outcome as compared with late-PN, with an increased risk of new infection (P=0.001) and need for renal replacement therapy (P=0.02), a lower likelihood of earlier live weaning from mechanical ventilation (P=0.05), live PICU (P=0.04) and hospital discharge (P=0.02), and increased risk of hospital (P=0.02) and 90-day mortality (P=0.04). Early-PN also worsened long-term developmental outcome with worse performance for clinically tested visual-motor integration (P=0.005), inhibition (P=0.03) and verbal memory (word pairs learning, immediate memory and recognition, all P<0.03) and parent-reported inhibition (P=0.002) at 2-year follow-up, culminating in more total behavioral problems (P=0.05) at 4-year follow-up. Conclusion(s): Early initiation of supplemental PN did not show any benefit and actually worsened short- and long-term outcome of children admitted to the PICU with a cardiac diagnosis. This supports de-implementation of early PN also in this particular subgroup of vulnerable children. <156> Accession Number 652453820 Title Initiation timing of enteral nutrition after cardiac surgery: association with adequacy, tolerance and delirium? secondary analysis of a multicentre RCT. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Apaydin S.; Stoppe C.; Ott S.; O'brien B.; Meybohm P.; Metelec I.; Catena D.; Kleine-Brueggeney M.; Heyland D.K.; Dresen E. Institution (Apaydin, Metelec, Kleine-Brueggeney) Department of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Berlin, Germany (Stoppe, Meybohm, Dresen) Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, University Hospital Wurzburg, Wurzburg, Germany (Ott, O'brien) Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Berlin, Germany (Catena) Department of Anaesthesiology and Intensive Care Medicine, Charite Campus Virchow-Klinikum, Berlin, Germany (Heyland) Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, Canada Publisher Springer Nature Abstract Introduction: Patients undergoing cardiac surgery are at high risk for disease- and procedure-related malnutrition. Evidence on optimal timing of enteral nutrition (EN) after cardiac surgery remains limited despite guideline recommendations supporting early EN in critically ill patients. Thus, there exists uncertainty and reluctance regarding EN initiation in clinical practice. Objective(s): The objective of this analysis is to evaluate the effects of early (< 48 h) vs. late (>= 48 h) initiation of EN after ICU admission on nutritional adequacy, clinical outcomes and gastrointestinal tolerance in high-risk cardiac surgery patients. Method(s): This secondary analysis of an international, multicenter randomized controlled trial included adult cardiac surgery patients receiving EN during ICU stay. Nutrition therapy data (route, prescribed energy and protein targets, and intake) were collected for up to 10 ICU days. Nutritional adequacy was defined as delivered energy and protein relative to prescribed targets. Result(s): A total of 153 patients (71+/-10 years) were included; baseline characteristics were comparable. Early EN was initiated in 44% and late EN in 56%. EN-specific energy and protein adequacy were significantly higher with early EN (44.5+/-25.7% vs. 35.8+/-26.8%, P=0.02; 45.9+/-29.1% vs. 33.8+/-24.1%, P=0.01). Mean cumulative adequacy did not differ significantly (56.3+/-27.4% vs. 50.6+/-28.0%, P=0.14; 58.9+/-34.4% vs. 48.0+/-26.4%, P=0.06). Gastrointestinal symptoms were rare and comparable between groups (e.g., high gastric residual: 1.5% vs. 1.2%, P=0.94). While overall clinical outcomes were similar, postoperative delirium occurred significantly less in the early EN group (35.3% vs. 54.1%, P=0.01). Conclusion(s): In high-risk cardiac surgery patients, early EN initiation may improve protein adequacy without compromising gastrointestinal tolerance and may be associated with reduced postoperative delirium. However, barriers to early initiation should be further identified, alongside improved clinician awareness. <157> Accession Number 652453276 Title Minimal Invasive Surgery is the Key to PBM and ERAS. Source Research and Practice in Thrombosis and Haemostasis. Conference: NATA Annual Symposium 2026. Bilbao Spain. 10(Supplement 1) (no pagination), 2026. Article Number: 106715. Date of Publication: 01 Jul 2026. Author Triantafyllopoulou K.; Arikas S.; Grammenos A.; Tsakiridis K. Institution (Triantafyllopoulou, Arikas, Grammenos, Tsakiridis) European Interbalkan Medical Center, Thessaloniki, Greece Publisher Elsevier B.V. Abstract Introduction: Patient Blood Management (PBM) and Enhanced Recovery After Surgery (ERAS) are transformative perioperative strategies that aim to improve clinical outcomes, conserve resources, and enhance patient experiences. While PBM focuses on optimizing patient physiology to reduce unnecessary allogeneic transfusions, ERAS protocols reduce surgical stress and expedite recovery. Minimal invasive surgery (MIS) represents an integrated clinical approach that synergizes with both PBM and ERAS principles by minimizing surgical trauma and associated physiological perturbations. Objective(s): To evaluate and articulate the role of MIS in cardiothoracic surgery as a central enabler in achieving the goals of PBM and ERAS across diverse surgical specialties. Methods/Approach: This lecture synthesizes evidence from recent clinical trials, meta-analyses, and local institutional PBM/ERAS implementation audits to elucidate the mechanisms by which MIS contributes to reduced blood loss, lesser inflammatory responses, and shortened hospital stays. Three hundred patients underwent major thoracic surgery from our surgical team during the period 2020-2023. Robotic Assisted Thoracic Surgery and Video Assisted Thoracic Surgery combined with perioperative care pathways were implemented in these patients. We analyzed demographic data and patients' characteristics, and mortality, hospital length of stay, major complications, readmission and patients' satisfaction. Result(s): Evidence indicates that MIS in major thoracic surgery consistently lowers intraoperative blood loss and reduces the need for allogeneic blood products, compared with conventional open procedures. Integration of MIS within structured ERAS pathways further accelerates recovery, reduces pain scores, and shortens length of hospital stay without increasing readmission rates. These benefits collectively align with and amplify the core objectives of PBM and ERAS, thereby demonstrating MIS as a pivotal element of modern perioperative care. Conclusion(s): Minimal invasive surgery is not merely a technical option but a clinical imperative within comprehensive PBM and ERAS programs. Its adoption enhances physiological preservation, decreases reliance on transfusion, and supports rapid postoperative recovery. Widespread implementation of MIS techniques, in conjunction with multidisciplinary perioperative pathways, will be key to improving surgical outcomes and elevating standards of patient-centered care. <158> Accession Number 652454253 Title The effect of early mobilization on sleep, physiological parameters, and length of stay in intensive care units: a randomized controlled study. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Sen A.; Turan N. Institution (Sen) Department of Fundamentals of Nursing, Istanbul University-Cerrahpasa, Institute of Graduate Studies, Istanbul, Turkey (Turan) Department of Fundemantals of Nursing, Istanbul University, Faculty of Nursing, Istanbul, Turkey Publisher Springer Nature Abstract Introduction: Intensive care patients often experience severe complications such as muscle weakness, impaired respiratory function, cognitive decline, and reduced sleep quality due to prolonged immobilization. This condition prolongs the recovery process and increases the length of hospital stay. Early mobilization is a crucial intervention recommended to reduce these complications, improve patient outcomes, and enhance the efficiency of healthcare services. Objective(s): The aim of this study is to investigate the effects of early mobilization on sleep, physiological parameters, and the length of stay in the intensive care unit for hospitalized patients. Method(s): This randomized controlled experimental study was conducted between April 2023 and March 2024 with a total of 82 patients (41 in the experimental group and 41 in the control group) hospitalized in the cardiovascular surgery intensive care unit of a university hospital. The research data were collected using the Patient Information Form, Pain Numeric Rating Scale, Glasgow Coma Scale (GCS), Form for Physiological Parameters, and the Richard-Campbell Sleep Questionnaire (RCSQ). In the experimental group, early mobilization was implemented within the first 12 h after surgery, following the cessation of sedation and the resolution of its effects. The control group was mobilized after surgery using a standard procedure. Result(s): Of the patients included in the study, 59.8% were male, and the mean age was 65.50+/-9.28 years. 45.1% of the patients had a medical diagnosis related to coronary artery surgeries, and 69.5% had not previously undergone heart surgery. The patients' length of stay in the intensive care unit and the hospital were 4.17+/-3.57 days and 10.35+/-6.56 days, respectively. Significant differences were observed in sleep quality, SpO2 levels, respiratory rate, and pulse values at the 24-h measurements for the early mobilized patients. Additionally, significant differences in pain levels were found between extubation, the first mobilization, and measurements taken at the 15th, 30th minute, and 1st hour. It was determined that the length of stay in the intensive care unit and the hospital for the early mobilized patients was shorter compared to the control group. Conclusion(s): It was found that early mobilization improved sleep quality during hospitalization and 24 h later, enhanced oxygenation parameters such as respiratory rate, SpO2, and PaO2, reduced pain, stabilized vital signs, and significantly shortened the length of stay in the intensive care unit and the hospital. In this context, it is recommended to plan in-service training activities on early mobilization for nurses. (Figure Presented). <159> Accession Number 652454826 Title A multicentre randomised, double-blinded placebo-controlled phase 2 trialto evaluate safety and efficacy of ilofotase alfain patients at risk for kidney injuryfollowing open heart surgery. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Mourisse L.; Ostermann M.; Thiessen S.; Bernholz J.; Pickkers P. Institution (Mourisse) Radboud University Medical Center, Nijmegen, Netherlands (Ostermann) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Thiessen) Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium (Bernholz) AM-Pharma, AM-Pharma, Utrecht, Netherlands (Pickkers) Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands Publisher Springer Nature Abstract Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious complication affecting up to 30% of patients undergoing cardiac surgery. It is associated with short-and long-term kidney impairment, dialysis dependency and increased mortality. Perioperative release of damage- and pathogen associated molecular patterns is thought to play a role in the development renal injury. Ilofotase alfa, a recombinant human alkaline phosphatase, has demonstrated potential to attenuate renal injury through its immunomodulatory effects in animal models and in large clinical studies in patients with sepsis-associated AKI. Objective(s): We evaluated the safety and efficacy of ilofotase alfa in preventing renal impairment in cardiac surgery patients. Method(s): This Phase 2, multi-centre, randomized, double-blinded, placebo-controlled trial employing a two-arm, parallel-group design randomized adult patients at high risk of renal damage after on pump cardiac surgery. Patients had to have a pre-existent estimated glomerular filtration rate (eGFR) of 25-65 ml/min and would undergo coronary artery bypass graft surgery (CABG) with at least three anastomoses or CABG combined with valve surgery or aortic-root surgery. Patients received either two intravenous doses (128 mg) of ilofotase alfa or placebo just before and after surgery. The primary endpoint was serum creatinine ratio (sCrRatio), defined as the highest serum creatinine level within five days postoperatively relative to the preoperative level. The occurrence of major adverse kidney events up to day 60 (MAKE60), including >=25% decline in eGFR, initiation of new renal replacement therapy, or death, was the secondary endpoint. In addition, safety and the incidence of AKI as defined by the KDIGO creatinine-criterion were assessed. Result(s): Of the 244 patients randomized, 40 dropped out before receiving the study drug, mainly due to surgery postponements. The analysis thus included 204 patients: 109 received ilofotase alfa and 95 placebo. The mean+/-SD sCrRatio in the ilofotase alfa group was 1.21+/-0.42, compared to 1.27+/-0.50 in the placebo group (p=0.31) (fig 1a & 1b). The incidence of MAKE60 events was 15.4% in the ilofotase alfa group and 15.9% in the placebo group (p=0.87) (fig 1c). AKI incidence was not statistically different with 29.4% in the ilofotase alfa group and 35.8% within the placebo groups (fig 1d). No safety concerns were raised. Conclusion(s): Administration of ilofotase alfa did not attenuate short- and longer-term renal function loss in patients at high risk of AKI after on-pump cardiac surgery. No safety concerns of ilofotase alfa emerged.(Figure presented). <160> Accession Number 652454876 Title Effects of closed-loop ventilation on sex disparities in ventilation quality in patients after cardiac surgery-posthoc analysis of a randomized clinical trial. Source Intensive Care Medicine Experimental. Conference: ESICM LIVES 2026. Lisbon Portugal. 14(Supplement 1) (no pagination), 2026. Article Number: 131. Date of Publication: 01 Oct 2026. Author Swart P.; Van Den Hondel A.; De Wit M.; Paulus F.; Serpa Neto A.; Modra L.; Bernardi M.; Tschernko E.; Bindels A.; De Bie A.J.; Schultz M. Institution (Swart, Van Den Hondel, De Wit) Intensive care, Amsterdam UMC, locatie AMC, Amsterdam, Netherlands (Paulus) Intensive Care Unit, Amsterdam UMC, locatie AMC, Meibergdreef, Amsterdam, Netherlands (Serpa Neto) Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia (Modra) Critical Care, Melbourne medical school, Melbourne, Australia (Bernardi) Division of cardiac thoracic vascular anaesthesia and intensive care medicine, Medical University of Vienna, Wien, Austria (Tschernko) Cardiothoracic and vascular anaesthesia, Medical University of Vienna, Wien, Austria (Bindels, De Bie) Intensive care, Catharina Ziekenhuis, Eindhoven, Netherlands (Schultz) Anaesthesia, General Intensive Care and Pain Management, Medical University Wien, Vienna, Austria Publisher Springer Nature Abstract Introduction: Females are at a higher risk than males of receiving excessive tidal volumes (VT) during invasive mechanical ventilation. INTELLiVENT-Adaptive Support Ventilation (ASV) is a commercially-available closed-loop mode of ventilation that improves the quality of ventilation by automatically adjusting ventilator settings based on patient needs. This closed-loop ventilation mode has been shown to be safe and effective in choosing correct ventilator settings across diverse patient populations [Goossen RL. Eur J Anaesthesiol 2024;41(6):438-446]. Objective(s): We hypothesized that females would experience a greater improvement in the quality of ventilation with INTELLiVENT-ASV than males, thereby narrowing or even eliminating the sex gap seen with conventional ventilation. Method(s): To test this hypothesis, we conducted a posthoc analysis of the POSITiVE study, a randomized clinical trial comparing closed-loop versus conventional ventilation in patients recovering from cardiac surgery [de Bie AJR. Br J Anaesth 2020;125(5):739-749]. The primary outcome was the proportion of time spent in optimal zone of ventilation during the first three hours of ventilation, based on tidal volume, maximum airway pressure, end-tidal carbon dioxide, and pulse oximetry. Result(s): All 220 patients enrolled in the study (30% females) were included in this analysis. Compared with conventional ventilation, closed-loop ventilation increased the mean proportion of time spent in the optimal ventilation zone by 44.5% [33.1 to 55.8%] (p < 0.001) in females and by 24.2% [14.8 to 33.6%] (p < 0.001) in males, indicating a substantially greater improvement in females (group-by-sex interaction; p = 0.021). Improvements were observed across all parameters (Fig. 1), except for the maximum airway pressure, which remained within the optimal range for most timepoints in all patients and did not differ between females and males. Substituting Pmax with driving pressure did not alter the overall findings. Conclusion(s): In patients weaning from ventilation after cardiac surgery, INTELLiVENT-ASV improves quality of breathing in both sexes, but with a greater benefit in females, suggesting it may help reduce sex-based disparities in postoperative respiratory care (Table presented).

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