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Total documents retrieved: 161 Results Generated From: Embase <1980 to 2026 Week 38> Embase Weekly Updates (updates since 2026-09-10) - (161 records) <1> Accession Number 651417160 Title Stented vs. stentless in aortic stenosis: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 05 Jun 2026. Author Saeed A.; Gerges K.M.; Saeed O.; Alasnag M.; Whitlock R.; Myers P.O.; Balacumaraswami L.; Alesawy A.F.; Abraheem A.; Elraggal D.; Khalleefah D.R.; Elmesherghi A.F.; Fahaid A.; Aljefairi N.; Elhadi M.; Mamas M. Institution (Saeed, Saeed) Faculty of Medicine, Al-Azhar University, Damietta, Egypt (Gerges) Faculty of Medicine, Sohag University, Egypt (Alasnag) Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia (Whitlock) Population Health Research Institute and McMaster University, Hamilton, ON, Canada (Myers) Hopital de La Tour in Geneva, Zurich University Hospital, Zurich, Switzerland (Balacumaraswami) Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (Alesawy) Clinical microbiology and Immunology Department, Benha university, Egypt (Abraheem) Faculty of Medicine, University of al-azhar, Cairo, Egypt (Elraggal) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Khalleefah) Faculty of Medicine, Sirte University, Sirte, Libyan Arab Jamahiriya (Elmesherghi, Fahaid, Aljefairi, Elhadi) Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya (Elhadi) College of Medicine, Korea University, Seongbuk-gu, 145 Anam-ro, Seoul, South Korea (Mamas) Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom Abstract BACKGROUND: Symptomatic aortic stenosis (AS) is often treated surgically with aortic valve replacement using stented or stentless prostheses. While stentless valves offer potential hemodynamic benefits, a robust synthesis of the evidence regarding clinical outcomes is needed. This systematic review and meta-analysis assessed the effectiveness and safety of both valve types. METHOD(S): This study followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD42025636952). We systematically searched PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, with a search update in May 2025. We included both randomized and non-randomized studies. The outcomes were early and overall mortality rates, stroke, pacemaker implantation, endocarditis, postoperative atrial fibrillation, total reoperation, severe prosthesis-patient mismatch, hospital stay, cardiopulmonary bypass time, cross-clamp time, and hemodynamic parameters, including postoperative mean aortic valve gradient, left ventricular mass and left ventricular mass index, and left ventricular ejection fraction. A random-effects model with odds ratios (ORs) and mean differences (MDs) was employed. RESULT(S): After screening 1,385 records, 20 studies were included, involving 3,940 participants with AS. Studies were first analyzed by design (randomized and non-randomized), and then pooled. There were no significant differences in all-cause mortality rates either early (OR = 1.04, 95% CI: [0.65 to 1.68], p = 0.861) or overall mortality at 1 year (OR = 0.86, 95% CI: [0.28 to 2.63], p = 0.797) and beyond 1 year (OR = 0.95, 95% CI: [0.62 to 1.46], p = 0.820). Postoperative complications showed comparable results between groups, except for pacemaker implantation, which was significantly increased in stentless valves (OR = 1.82, 95% CI: [1.14 to 2.92], p = 0.013). Hemodynamic outcomes showed no significant differences between groups. CONCLUSION(S): Our study revealed that the rates of early and overall mortality, postoperative complications, and hemodynamic parameters were comparable between stented and stentless valve groups. However, patients receiving stentless valves exhibited a significantly higher incidence of pacemaker implantation. Copyright © 2026. The Author(s). <2> Accession Number 2046481893 Title Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (SNaPP): an international, randomised, controlled, phase 4 trial. Source The Lancet Respiratory Medicine. 14(9) (pp 761-774), 2026. Date of Publication: 01 Sep 2026. Author Leslie K.; Darvall J.N.; Chan M.T.V.; Peyton P.J.; Myles P.S.; Corcoran T.B.; Short T.G.; Olesnicky B.L.; Webb A.R.; Devlin N.; Tran-Duy A.; Maxwell-Wright H.; Schultz-Ferguson C.; Fitzpatrick P.; Sidiropoulos S.; Braat S.; Story D.A. Institution (Leslie, Darvall, Peyton, Devlin, Tran-Duy, Maxwell-Wright, Schultz-Ferguson, Fitzpatrick, Sidiropoulos, Braat, Story) University of Melbourne, Melbourne, VIC, Australia (Leslie, Darvall) Royal Melbourne Hospital, Melbourne, VIC, Australia (Chan) Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong (Peyton, Sidiropoulos, Story) Austin Hospital, Melbourne, VIC, Australia (Myles, Webb) Monash University, Melbourne, VIC, Australia (Myles) The Alfred, Melbourne, VIC, Australia (Corcoran) University of Western Australia and Royal Perth Hospital, Perth, WA, Australia (Short) University of Auckland and Auckland City Hospital, Auckland, New Zealand (Olesnicky) University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia (Webb) Frankston Hospital, Melbourne, Australia Publisher Elsevier Ltd Abstract Background: Sugammadex and neostigmine are used to reverse aminosteroid neuromuscular-blocking drugs at the end of surgery. We aimed to determine whether reversal of neuromuscular blockade with sugammadex reduces the incidence of postoperative pulmonary complications or death compared with neostigmine. Method(s): We conducted a pragmatic, international, multicentre, randomised, controlled, phase 4 trial involving 44 hospitals in Australia, Aotearoa New Zealand, and Hong Kong. Eligible patients were adults (aged >=40 years) who were having abdominal or thoracic surgery under general anaesthesia and lasting at least 2 h, with an expected postoperative hospital stay of 1 night or longer. Patients were randomly assigned (1:1) to sugammadex or neostigmine, administered intravenously in doses chosen by the attending anaesthesiologist, for reversal of rocuronium-induced or vecuronium-induced neuromuscular blockade at the end of surgery. Randomisation was done via a web-based service, in random permuted blocks of varying sizes of 2 and 4 and stratified by centre. Patients, research staff who were responsible for outcome assessments, and members of the endpoint adjudication committee were masked to group assignment. The primary outcome was postoperative pulmonary complications or death up to hospital discharge (or postoperative day 7 if still in hospital). The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000394640) and is closed to accrual. Finding(s): Patients were recruited between July 21, 2023, and July 3, 2025; 3498 patients were included in the intention-to-treat population (1745 [49.9%] in the sugammadex group and 1753 [50.1%] in the neostigmine group). Postoperative pulmonary complications or death occurred in 331 (19.0%) of 1743 patients in the sugammadex group and 377 (21.5%) of 1752 patients in the neostigmine group (risk ratio [RR] 0.88 [95% CI 0.77-1.00]; p=0.049). Death occurred in one (0.1%) and two (0.1%) patients (RR 0.50 [95% CI 0.05-5.53]; p >0.99), atelectasis in 320 (18.4%) of 1742 patients and 370 (21.1%) of 1750 patients (0.86 [0.76-0.99]; p=0.030), pneumonia in 37 (2.1%) of 1742 patients and 38 (2.2%) of 1750 patients (0.98 [0.62-1.53]; p=0.92), and pulmonary aspiration in four (0.2%) of 1742 and seven (0.4%) of 1750 patients (0.57 [0.17-1.96]; p=0.38) in the sugammadex and neostigmine groups, respectively. Acute respiratory distress syndrome was not reported. No adverse events were deemed to be treatment related. Interpretation(s): Sugammadex reduced the incidence of postoperative pulmonary complications or death compared with neostigmine. The risk reduction was small with atelectasis of uncertain clinical significance being the most common complication. Sugammadex can be considered as a first-line drug for reversal of aminosteroid-induced neuromuscular blockade at the end of surgery. Funding(s): Australian Medical Research Future Fund and the Hong Kong Health and Medical Research Fund. Copyright © 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license <3> Accession Number 2046176828 Title A Bayesian re-analysis of hypothermic oxygenated perfusion versus static cold storage in the NIHP2019 heart transplantation trial. Source Journal of Heart and Lung Transplantation. 45(9) (pp 1422-1426), 2026. Date of Publication: 01 Sep 2026. Author Heuts S.; Lebreton G.; Dellgren G.; Wallinder A.; Rega F.; Para M.; Michel S.; Schramm R.; Begot E.; Vandendriessche K.; Kamla C.; Gerosa G.; Berman M.; Boeken U.; Clark S.; Ranasinghe A.; Ius F.; Forteza A.; Pivodic A.; Hennig F.; Guenther S.; Kaul P.; Goerler A.; Aliabadi-Zuckermann A.; Gummert J.F.; Van Cleemput J.; Zuckermann A.; Knosalla C. Institution (Para) Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Universite Paris Cite, Paris, France (Michel, Kamla) Clinic of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany (Michel, Kamla) Munich Heart Alliance, German Center for Cardiovascular, Research, Munich, Germany (Schramm, Guenther, Gummert) Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany (Begot) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Vandendriessche) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Gerosa) Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy (Berman, Kaul) Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (Boeken) Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany (Clark) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (Ranasinghe) Cardiac Surgery, Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Trust, Birmingham, United Kingdom (Ius, Goerler) Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany (Forteza) Department of Cardiac Surgery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain (Pivodic) APNC Sweden, Molndal, Sweden (Hennig, Knosalla) Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany (Hennig, Knosalla) Charite-Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Germany (Aliabadi-Zuckermann, Zuckermann) Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Van Cleemput) Department of Cardiology, University Hospitals Leuven, Leuven, Belgium (Heuts, Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands (Lebreton) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Dellgren) Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Dellgren, Wallinder) Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Publisher Elsevier Inc. Abstract The NIHP2019-trial compared hypothermic oxygenated perfusion (HOPE) with static cold storage (SCS) during heart transplantation and investigated clinical outcomes. This post hoc Bayesian re-analysis estimated the probability of clinically meaningful overall treatment effects. In total, 204 patients were analyzed at 12 months (HOPE n = 101, SCS n = 103). Bayesian models with minimally informative priors were used to derive relative risks (RR), absolute risk differences (ARD), and posterior probabilities. In these Bayesian models, HOPE was associated with lower rates of the primary composite endpoint (RR 0.71, 95%CrI 0.49-0.99; ARD -13.8%, 95%CrI -26.8; -0.4%). The probability of any benefit was 97.8%, and the probability of a clinically relevant effect exceeded 90%. For all-cause mortality, the probability of benefit was 90.5%, with a >85% probability of a clinically relevant effect. The results were robust across sensitivity analyses. These findings demonstrate clinically meaningful benefits with HOPE and provide a complementary interpretation of the NIHP2019-trial's results. Copyright © 2026 The Authors. <4> Accession Number 2049277114 Title Landscape of Biomarker Use in Critically Ill Patients: Systematic Evidence Map of Acute Kidney Injury and Implications for Practice. Source Critical Care Medicine. (no pagination), 2026. Date of Publication: 2026. Author Kane-Gill S.L.; Boyer K.M.; Akcan Arikan A.; Barreto E.F.; Belcher J.M.; Lumlertgul N.; Kellum J.A. Institution (Kane-Gill) Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States (Boyer) Society of Critical Care Medicine, Mt. Prospect, IL (Akcan Arikan) Divisions of Critical Care Medicine and Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States (Barreto) Department of Pharmacy, Mayo Clinic, Rochester, MN, United States (Belcher) Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Lumlertgul) Centre of Excellence in Critical Care Nephrology and Excellence Centre in Critical Care Nephrology, Division of Nephrology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand (Kellum) The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States Publisher Lippincott Williams and Wilkins Abstract Objectives: - Create systematic evidence maps of novel biomarkers of kidney injury from a mapping review to guide future implementation in patient care. Data Sources: - PubMed/MEDLINE and Embase. Study Selection: - Systematic evidence maps included clinical trials and observational studies in critically ill patients, investigating novel kidney biomarkers for acute kidney injury (AKI). Data Extraction: - Six thousand eight hundred five records were screened, and 1116 studies were included that related to one or more novel biomarkers and AKI. Data Synthesis: - Adult populations accounted for 78.6% of the studies, and 93.3% used a cohort design to investigate AKI biomarkers. Mixed critically ill populations, cardiac surgery, and sepsis were identified as the most frequently studied clinical contexts in 69.5% of the studies. Systematic evidence maps were synthesized for biomarker studies to predict AKI (n = 944), prognosticate clinical outcomes (n = 647), diagnose AKI etiology (n = 109), enrich clinical trials (n = 6), and manage AKI (n = 12). Implementation strategies for patient care included surveilling patients at risk of AKI, including patients undergoing surgery and those exposed to multiple nephrotoxic drugs. Conclusion(s): - Substantial clinical evidence assessing the accuracy of biomarkers compared with diagnosis of AKI exists, with fewer practical trials in clinical use. Still, guidance on implementation approaches can be gleaned from evaluations using biomarkers for the management of critically ill patients, particularly in surgical and nephrotoxin-exposed populations where evidence is available. This review identifies the landscape of current evidence and highlights priorities for future management and enrichment trials needed to bridge the gap between predictive accuracy and clinical decision-making. Copyright © 2026 by the Society of Critical Care Medicine and Wolters Kluwer Health, LLC. All Rights Reserved. <5> Accession Number 2048771213 Title Closing the Gap: Examining Representation of Women in Ischemic Heart Disease Guideline Studies. Source Journal of the American Heart Association. 15(10) (no pagination), 2026. Article Number: e038120. Date of Publication: 2026. Author Abdelnour J.; Alameh A.; Anaya F.; Driscoll K.; Abdelnour N.; Sukhon F.; Jabri A.; Alhuneafat L.; Yaghmour R.; Alqarqaz M.; Aggarwal V.; Abbas A.E.; Nandar P.P.; Siraj A.; Gulati M. Institution (Abdelnour, Anaya, Driscoll, Yaghmour) Department of Medicine, Cleveland, OH, United States (Alameh, Sukhon, Nandar, Siraj) Heart and Vascular Department, Case Western MetroHealth Medical Center, Cleveland, OH, United States (Abdelnour) Northeast Ohio Medical University, Rootstown, OH, United States (Jabri, Abbas) Division of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, OH, United States (Alhuneafat) Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, United States (Alhuneafat) Michigan State University College of Human Medicine, Grand Rapids, MI, United States (Alqarqaz, Aggarwal) Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, United States (Gulati) Department of Cardiology, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, CA, United States (Gulati) Baim Institute for Clinical Research, Boston, MA, United States Publisher American Heart Association Inc. Abstract BACKGROUND: This study aimed to evaluate the representation of women in cardiovascular clinical trials referenced in the American College of Cardiology and American Heart Association guidelines, given the historical underrepresentation of women in such trials, which limits generalizability and perpetuates health care disparities. METHOD(S): We conducted a systematic review of studies referenced in American College of Cardiology and American Heart Association guidelines for chronic coronary artery disease, chest pain, and coronary artery revascularization. Data extraction focused on study type, publication year, total study population, and proportion of women enrolled. Participation-to-prevalence ratios were calculated to assess gender representation relative to disease prevalence among women in the United States. RESULT(S): Our systematic review encompassed 1690 studies revealing persistent underrepresentation of women across all guideline areas: revascularization (29.5%), chronic coronary artery disease (33.3%), and chest pain (40%). Participation-toprevalence ratios ranged from 68.2% to 83.2%, indicating substantial gaps in representation compared with disease burden. Trends over 4 decades showed variability in women's inclusion, with some improvement but minimal overall progress. CONCLUSION(S): Despite increased awareness and advocacy, our findings highlight ongoing gender disparities in cardiovascular research. Proactive strategies are needed to enhance women's participation in clinical trials, ensuring equitable and effective health care interventions. Addressing these disparities is critical for developing tailored treatments and improving cardiovascular outcomes globally. Future research should prioritize identifying and overcoming barriers to women's enrollment in cardiovascular trials to promote inclusive clinical practice and mitigate health care disparities. Copyright © (2026), (American Heart Association Inc.). All rights reserved. <6> Accession Number 652154644 Title A Comparison of Dexmedetomidine, Nicardipine, and Labetalol for Hypotensive Anesthesia: Effects on Surgeon Visibility, Blood Loss, Hemodynamic Parameters, and Operation Time in Orthognathic Surgery. Source Journal of Oral and Maxillofacial Surgery. Conference: 108th AAOMS Annual Meeting, Scientific Sessions and Exhibition. Seattle United States. 84(9 Supplement) (pp S33-S34), 2026. Date of Publication: 01 Sep 2026. Author Courtney M.; Mehra P.; Mustafa W.; Dienes E.; He X.; Jalihal P. Institution (Courtney) Boston University, Boston Medical Center, Boston, MA, United States Publisher W.B. Saunders Abstract Orthognathic surgery carries significant potential for intraoperative blood loss due to the rich vascular supply of the head and neck, which can obscure surgical field visibility and increase operative time. Hypotensive anesthesia, involving controlled reduction of mean arterial pressure to < 70 mmHg, is widely accepted to reduce blood loss and improve surgical field visibility. While multiple agents can induce hypotensive anesthesia, no consensus exists regarding optimal medication selection. This study compares three agents: labetalol (beta-blocker), nicardipine (calcium channel blocker), and dexmedetomidine (alpha-2 agonist), in the setting of orthognathic surgery. This randomized, double-blinded, prospective trial enrolled ASA I-II patients undergoing orthognathic surgery (Le Fort I, SARPE, bilateral sagittal split osteotomy, or combination procedures) with a single surgeon at Boston Medical Center. Ninety participants were enrolled between March 2025 and January 2026 (n = 30 per group). Patients were excluded if taking home beta-blockers, calcium channel blockers, or alpha-2 agonists, with stratified randomization by surgical site (maxillary only or double jaw). The primary outcome was intraoperative surgical field visibility assessed by the blinded surgeon using Fromme score (0-5, where 0 = no bleeding and 5 = massive uncontrollable bleeding). Secondary outcomes included estimated blood loss (EBL), hemodynamic parameters (MAP, systolic blood pressure, heart rate), operation time, and adverse events. This study was approved by the Boston Medical Center Institutional Review Board (Protocol #H-43663), and written informed consent was obtained from all participants prior to enrollment. An intention-to-treat analysis was performed. Demographic variables, surgical characteristics, and outcome measures (including Fromme score, EBL, hemodynamic parameters, and operation time) were summarized using counts and percentages for categorical variables and medians with interquartile ranges for continuous variables. Between-group differences were assessed using Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables. Prespecified subset analyses were performed by surgery type, use of additional intraoperative medications, and single-agent versus multi-agent study drug administration. Of 90 enrolled participants, 85 were included in the ITT analysis (dexmedetomidine n = 28, nicardipine n = 28, labetalol n = 29); 5 were excluded as they did not receive the assigned agent. Treatment groups were well-matched at baseline with no significant differences in age, sex, ASA classification, baseline blood pressure, or surgical distribution (all P > .2). Fromme scores did not differ significantly across groups (P = .715), with the majority of patients in each arm scoring 1-2. EBL (300, 250, 350 mL; P = .379) and operative duration (238, 206, 233 min; P = .896) were comparable. Dexmedetomidine and nicardipine achieved significantly lower systolic (94.6, 95.4 vs 99.2 mmHg; P = .039) and diastolic blood pressure (52.7, 52.0 vs 55.1 mmHg; P = .024) compared to labetalol, with MAP trending lower (69.5, 69.6 vs 72.7 mmHg; P = .051). Heart rate was significantly higher with nicardipine versus dexmedetomidine and labetalol (86.3 vs 74.8 and 80.4 bpm; P = .007). Subset analyses are pending final data verification. All three agents achieved comparable surgical field visibility, blood loss, and operative duration, supporting equivalent clinical efficacy. Dexmedetomidine and nicardipine achieved greater intraoperative blood pressure reductions, while nicardipine was associated with a significantly higher heart rate, likely reflecting reflex tachycardia secondary to vasodilation. Labetalol achieved adequate hypotension with a more moderate hemodynamic profile. These findings support individualized agent selection based on provider familiarity, patient-specific considerations, and institutional availability without compromising surgical outcomes. <7> Accession Number 2049042316 Title Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: a PRISMA-compliant systematic review and meta-analysis. Source Chinese Medical Sciences Journal. 41(2) (pp 89-99), 2026. Date of Publication: 01 Jun 2026. Author Yao Y.-T.; More A.; Chao M.; Huang S. Institution (Yao, Huang) Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Yao, Huang) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China (Yao, More, Chao) Center of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston, TX, United States (Yao, More, Chao) Outcomes Research Consortium, Houston, TX, United States Publisher KeAi Communications Co. Abstract Background: Effective postoperative analgesia is critical to recovery after cardiac surgery. Continuous wound infiltration (CWI) with local anesthetics (LAs) has been proposed as an opioid-sparing adjunct, but its efficacy beyond pain control and its safety profile remain incompletely defined. Method(s): We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CWI with control in adult cardiac surgery. PubMed, Embase, and Cochrane CENTRAL were searched from inception to August 30, 2025, and updated on April 2, 2026. Primary outcomes were postoperative Visual Analogue Scale (VAS) pain scores and cumulative morphine consumption. Secondary outcomes included mechanical ventilation duration, length of stay, mortality, complications, patient satisfaction, and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Result(s): Twelve RCTs involving 2,117 patients were included. CWI significantly reduced VAS during mobilization at 24 h (MD=-0.93, 95% confidence interval [CI]: -1.53--0.33, P = 0.002) and 48 h (MD=-0.80, 95% CI: -1.17--0.44, P < 0.001), and decreased 48-hour morphine consumption (MD=-8.10 mg, 95% CI: -13.41--2.79, P = 0.003). No significant effects were observed on VAS at rest, mechanical ventilation duration, ICU or hospital length of stay, mortality, or major cardiovascular, pulmonary, renal, gastrointestinal complications, or postoperative infections. Patient satisfaction was higher with CWI. Technical complications were uncommon, and no clinically significant LA toxicity was reported. Conclusion(s): In adult cardiac surgery, CWI with LAs modestly improves analgesia during mobilization and reduces opioid requirements without clear improvement in major clinical outcomes or length of stay. CWI appears safe and feasible and may serve as an adjunct in multimodal, opioid-sparing analgesia strategies. Further adequately powered trials are warranted to define its comparative effectiveness within contemporary enhanced recovery after surgery (ERAS) pathways. Copyright © 2026 The Authors. Publishing Services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/ <8> Accession Number 2048645831 Title Effect of Transcutaneous Electrical Nerve Stimulation on Multidimensional Pain Outcomes After Thoracic Surgery: A Secondary Analysis of a Randomized Controlled Trial. Source Medicina (Lithuania). 62(8) (no pagination), 2026. Article Number: 1543. Date of Publication: 01 Aug 2026. Author Alamo-Arce D.D.; Lopez-Fernandez D.; Medina-Ramirez R.; Etopa-Bitata M.D.P.; Quintana-Montesdeoca M.D.P.; Garcia-Rodriguez I.; Dominguez-Trujillo P.D.; Garcia-Quintana M.; Freixinet-Gilart J.L. Institution (Alamo-Arce, Medina-Ramirez, Garcia-Rodriguez, Garcia-Quintana) Soc-Dig Research Group, University of Las Palmas de Gran Canaria, 35016, Las Palmas, Spain (Lopez-Fernandez, Dominguez-Trujillo, Freixinet-Gilart) Health Science Faculty, University of Las Palmas de Gran Canaria, Las Palmas, Spain (Etopa-Bitata) Education Sciences Faculty, University of Las Palmas de Gran Canaria, Las Palmas, Spain (Quintana-Montesdeoca) Mathematic Department, University of Las Palmas de Gran Canaria, Las Palmas, Spain Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Postoperative pain after thoracic surgery is a multidimensional experience that includes both sensory, evaluative, and affective components. While transcutaneous electrical nerve stimulation (TENS) has demonstrated benefits for postoperative pain management, its association with affective pain outcomes remains less explored. This study aimed to explore the affective dimension of postoperative pain through a secondary analysis of data from a previously conducted randomized controlled trial. Material(s) and Method(s): Data were derived from a randomized controlled trial investigating the effects of TENS on postoperative recovery after thoracic surgery. A total of 109 patients were included and allocated into three groups: experimental (TENS + physiotherapy, n = 37), placebo (sham TENS + physiotherapy, n = 37), and control (physiotherapy alone, n = 35). The main outcome of interest in this exploratory secondary analysis was the affective dimension of pain, assessed using the Pain Rating Index-Affective (PRI-A) subscale of the McGill Pain Questionnaire before and after the 3-week rehabilitation program. Result(s): Improvements were observed across several pain-related variables during the intervention period. For the affective dimension of pain, the experimental group demonstrated greater reduction in PRI-A scores than the placebo and control groups. The mean reduction in PRI-A was 0.97 in the experimental group, compared to 0.27 in the placebo group and 0.57 in the control group (p < 0.0001). Between-group comparisons showed moderate to large standardized effect sizes favoring the experimental group, although the absolute magnitude of PRI-A changes was modest. Conclusion(s): This secondary exploratory analysis suggests that TENS combined with physiotherapy may contribute to improvements in the affective dimension of postoperative pain following thoracic surgery. These findings support further investigation of multidimensional pain outcomes within postoperative rehabilitation settings. Copyright © 2026 by the authors. <9> Accession Number 2048736591 Title Effects of personalized structured telemedicine-based exercise cardiac rehabilitation on health outcomes in patients with coronary heart disease: a systematic review and meta-analysis. Source European Journal of Cardiovascular Nursing. 25(1) (pp 68-88), 2026. Date of Publication: 01 Jan 2026. Author Liu Y.; Wang X.; Li J.; Huang X.; Yu J.; Chen M. Institution (Liu, Wang) School of Nursing, Wenzhou Medical University, Chashan Higher Education Park, Zhejiang Province, Wenzhou City, China (Liu, Wang) Cixi Biomedical Research Institute, Wenzhou Medical University, No. 508 North Second Ring East Road, Ningbo City, Zhejiang Province, Cixi City, China (Li, Huang, Chen) Lishui Central Hospital and the Fifth Affiliated Hospital of Wenzhou Medical University, No. 289 Kuocang Road, Liandu District, Zhejiang Province, Lishui City, China (Yu) Wenzhou Medical University Affiliated Cixi Hospital, Cixi People's Hospital, No. 999 South Second Ring East Road, Ningbo City, Zhejiang Province, Cixi City, China Publisher Oxford University Press Abstract Aims: Despite its proven effectiveness, traditional exercise-based cardiac rehabilitation (exCR) suffers from low participation rates. However, telemedicine-based exCR can overcome access barriers to traditional rehabilitation while providing personalized, structured exercise training and remote monitoring. The aim of this review is to ascertain the efficacy of personalized, structured, telemedicine-based exCR in improving health outcomes in patients with coronary heart disease (CHD). Methods and Results: A systematic search was conducted in databases including Cochrane Library, PubMed, Web of Science, Embase, CINAHL, Scopus, Medline, China National Knowledge Infrastructure, Wanfang, VIP, and SINOMED from inception to March 2024 to identify randomized controlled trials (RCTs). The final analysis included 19 RCTs comprising 2219 participants. Among patients with CHD, telemedicine-based exCR demonstrated comparable effects to centre-based exCR across multiple outcomes, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life (all P > 0.05). Notably, when compared with usual care, telemedicine-based exCR showed significant improvements in exercise capacity [standardized mean difference (SMD) = 0.23, 95% CI: (0.12, 0.35), I2 = 34%, P < 0.0001], physical activity level [SMD = 0.32, 95% CI: (0.09, 0.54), I2 = 53%, P = 0.006], diastolic blood pressure [mean difference (MD) = -1.54, 95% CI: (-2.89, -0.20), I2 =8%, P = 0.02], body mass index [MD = -0.54, 95% CI: (-1.94, -0.14), I2 = 4%, P = 0.008], and depression [SMD = -0.27, 95% CI: (-0.42, -0.13), I2 = 33%, P = 0.0002]. Conclusion(s): Telemedicine-based exCR is equally effective as centre-based exCR in improving key health outcomes for patients with CHD, including exercise capacity, physical activity levels, cardiovascular risk factors, and quality of life. Furthermore, telemedicine-based exCR shows superior effectiveness to usual care, with statistically significant improvements in exercise capacity, physical activity, diastolic blood pressure, and depressive symptoms. Registration: PROSPERO: CRD42024521465. 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) <10> Accession Number 2048979709 Title Clinical Outcomes of Conduction System versus Right Ventricular Pacing after TAVR: A Systematic Review and Meta-Analysis. Source PACE - Pacing and Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Shakeel R.; Uddin A.; Ladhani D.; Mansoor K.T.; Mansour A.; Talpur B.Z.; Azeem M.H.; Fatima A.; Sajid E.U.; Chaudhry S.A.A.; Khan Z.; Aminpoor H. Institution (Shakeel, Uddin, Ladhani, Mansoor, Talpur, Azeem, Fatima, Khan) Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan (Mansour) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Sajid) Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States (Chaudhry) ABWA Medical College, Faisalabad, Pakistan (Aminpoor) Faculty of Medicine, Kabul University of Medical Sciences "Abu Ali Ibn Sina", Kabul, Afghanistan Publisher John Wiley and Sons Inc Abstract Background: Permanent pacemaker implantation is required in up to 25% of patients after transcatheter aortic valve replacement (TAVR). Conventional right ventricular pacing (RVP) may promote dyssynchrony, whereas conduction system pacing (CSP) preserves physiological activation. Research Question: Does CSP improve clinical, echocardiographic, electrical, and procedural outcomes compared with RVP in patients requiring pacing after TAVR?. Method(s): We conducted a PROSPERO-registered systematic review and meta-analysis following PRISMA 2020. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through June 2026 for randomized and comparative observational studies of CSP versus RVP after TAVR. Random-effects models generated risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Prediction intervals, cumulative meta-analysis, leave-one-out analyses, and GRADE assessment were performed. Result(s): Six studies, one randomized trial and five observational studies, enrolled 675 patients (CSP, n = 344; RVP, n = 331). CSP was associated with fewer heart-failure hospitalizations (RR 0.49, 95% CI 0.29-0.83; p = 0.017; I2 = 5%) and shorter paced QRS duration (MD -31.05 ms, 95% CI -34.07 to -28.02; p < 0.001; I2 = 0%). All-cause mortality, cardiovascular death, and change in left ventricular ejection fraction did not differ significantly. Implantation success was modestly lower with CSP (RR 0.91; p = 0.014). Conclusion(s): CSP was associated with fewer heart-failure hospitalizations and shorter paced QRS duration than RVP after TAVR. Evidence was predominantly observational, and no significant differences were demonstrated in mortality or change in left ventricular ejection fraction. The potential clinical relevance of CSP when a high ventricular pacing burden is anticipated remains plausible but was not directly demonstrated by the available data; adequately powered randomized trials are required before routine adoption. Copyright © 2026 Wiley Periodicals LLC. <11> Accession Number 2048914972 Title Effectiveness of Leg Cycle Ergometry Exercise on Functional Capacity, Muscle Strength and Quality of Life in Post-CABG Patients: A Systematic Review. Source Journal of Clinical and Diagnostic Research. 20(9) (pp YC07-YC11), 2026. Date of Publication: 01 Sep 2026. Author Vinerkar D.D.; Vardhan V. Institution (Vinerkar) Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, Wardha, India (Vardhan) Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Maharashtra, Wardha, India Publisher JCDR Research and Publications Pvt Ltd Abstract and the Cochrane RoB-2 tool was used to assess risk of bias. <inf>Introduction:</inf> <inf>Coronary</inf> Artery Bypass Grafting <inf>(CABG) is</inf> The review followed the Population, Intervention, Comparison, performed to restore myocardial perfusion and reduce morbidity Outcome and Time (PICOTS) framework. The search strategy in patients with coronary artery disease. Postoperative patients included combinations of keywords using Boolean operators commonly experience reduced functional capacity, respiratory ("CABG", "coronary artery bypass", "leg cycle ergometry", muscle weakness and limited exercise tolerance, <inf>necessitating</inf> "aerobic training", "early mobilisation") across PubMed, Scopus structured rehabilitation. Leg cycle ergometry has gained and Nested Knowledge. Only RCTs involving adult CABG increasing interest as an early rehabilitation. patients who received leg cycle ergometry were included. Aim(s): <inf>To systematically review</inf> Randomised Controlled <inf>Trials</inf> Studies involving other cardiac surgeries or non randomised (RCT) evaluating the effectiveness of leg cycle ergometry in designs were excluded. postoperative rehabilitation following CABG surgery. This Results: From 223 records, five RCTs met the inclusion <inf>systematic review was registered in</inf> PROSPERO. The <inf>review</inf> criteria. Overall, the included RCTs demonstrated consistent was structured according to the PICOTS framework: Population improvements across major postoperative outcomes. - adult CABG patients; Intervention - leg cycle ergometry; Leg cycle ergometry performed for 1-3 weeks resulted in <inf>Comparator - standard physiotherapy,</inf> walking, <inf>or resistance</inf> significantly greater gains in functional capacity and lower-training; Outcomes - functional capacity, muscle strength, limb strength compared with standard physiotherapy alone. <inf>pulmonary function and quality of</inf> life; <inf>Timing - immediate</inf> Respiratory muscle strength was better preserved in studies postoperative period; Study design - RCTs. measuring Maximal Inspiratory Pressure (MIP) and Maximal Material(s) and Method(s): <inf>The present review was conducted</inf> Expiratory Pressure (MEP), and additional benefits were noted in Physiotherapy, <inf>Institute</inf> the <inf>of</inf> Department <inf>Higher</inf> Ravi <inf>Education</inf> Nair of Physiotherapy Cardiovascular <inf>and Research,</inf> College, <inf>Sawangi,</inf> and Datta Respiratory <inf>Wardha,</inf> Meghe in (PHQ-9), <inf>{Pittsburgh</inf> psychological Generalised <inf>Sleep Quality</inf> outcomes Anxiety <inf>Index</inf> Disorder {Patient <inf>(PSQI)}</inf> 7 <inf>and</inf> Health (GAD-7)}, <inf>overall</inf> Questionnaire-9 <inf>quality</inf> sleep quality <inf>of</inf> life Maharashtra, India followed <inf>Preferred Reporting Items for</inf> {36-Item Short Form Survey (SF-36)}. However, heterogeneity <inf>Systematic reviews and Meta-Analyses</inf> (PRISMA) <inf>guidelines</inf> in intervention duration, exercise intensity and outcome tools <inf>and was registered in International Prospective Register of</inf> limited direct comparison of effect sizes. Three studies were <inf>Systematic Reviews (PROSPERO). A comprehensive search</inf> rated as low-risk of bias, while two presented some concerns. <inf>was conducted</inf> in PubMed, <inf>Scopus and Nested Knowledge</inf> Conclusion(s): Leg cycle ergometry is an effective and safe (2015-2025). <inf>Eligible studies were RCTs involving adult patients</inf> adjunct in early post-CABG rehabilitation. Further standardised undergoing CABG who were also undergoing postoperative leg RCTs are warranted to strengthen evidence for widespread cycle ergometry. Data extraction followed a standardised format clinical implementation. Copyright © 2026 JCDR Research and Publications Pvt Ltd. All rights reserved. <12> Accession Number 2046086501 Title Incidence and Associations of Acute Kidney Injury After Lung Resection Surgery: A Systematic Review and Meta-analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3386-3395), 2026. Date of Publication: 01 Oct 2026. Author Shan X.-S.; Yan J.; Wang Y.-Q.; Zhang Y.; Li X.-Y.; Koutentis C.; Popescu W.M.; Ji F.-H.; Liu H. Institution (Shan, Yan, Zhang, Li, Ji) Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China (Shan, Yan, Zhang, Li, Ji) Institute of Anesthesiology, Soochow University, Suzhou, China (Shan, Liu) Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, United States (Wang) Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China (Koutentis) Department of Anesthesiology, One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY, United States (Popescu) Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States Publisher W.B. Saunders Abstract The incidence and clinical implications of acute kidney injury (AKI) following thoracic lung resection surgery remain insufficiently characterized. The authors conducted a systematic review to determine the incidence of AKI, identify risk factors for AKI, evaluate preventive interventions for AKI, and assess the associations of AKI with key postoperative outcomes. A systematic search of PubMed, Embase, and the Cochrane Library was conducted through June 25, 2025. The authors included observational and interventional studies that reported the incidence of AKI following lung resection, defined according to Risk, Injury, Failure, Loss, End-stage (RIFLE), Acute Kidney Injury Network (AKIN), or Kidney Disease: Improving Global Outcomes (KDIGO) consensus-based criteria. The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251142075). Twenty studies involving 19,918 patients were included. The pooled incidence of AKI was 5.31% (95% confidence interval [CI], 3.61%-6.70%), with mild AKI and moderate to severe AKI occurring in 5.51% and 0.96% of patients, respectively. AKI was significantly associated with prolonged hospital stay (mean difference, 0.92 days; 95% CI, 0.52-1.30 days) and increased short-term mortality (risk ratio, 5.60; 95% CI, 1.66-18.83). Goal-directed fluid therapy did not significantly reduce the risk of AKI (risk ratio, 0.64; 95% CI, 0.32-1.27). AKI is a common complication following thoracic lung resection surgery and is strongly associated with a broad spectrum of severe adverse postoperative outcomes. In patients undergoing lung resection, AKI should be considered as a highly significant prognostic indicator that requires early risk stratification and proactive preventive strategies. Copyright © 2026 Elsevier Inc. <13> Accession Number 2038561740 Title The Effect of Preoperative Hydration on Cardiac Surgery-Associated Acute Kidney Injury. Source Brazilian Journal of Cardiovascular Surgery. 41(2) (no pagination), 2026. Article Number: e20240354. Date of Publication: 2026. Author Karakoc A.Z.; Ozcan E.; Akardere O.F.; Cevirme D.; Zengin A.; Sunar H. Institution (Karakoc) Department of Cardiovascular Surgery, Sehit Prof. Dr. Ilhan Varank Sancaktepe Research and Training Hospital, Istanbul, Turkey (Ozcan, Akardere, Sunar) Department of Cardiovascular Surgery, Kartal Kosuyolu Heart Research and Training Hospital, Istanbul, Turkey (Cevirme) Department of Cardiovascular Surgery, Istinye University Faculty of Medicine, Istanbul, Turkey (Zengin) Department of Cardiovascular Surgery, Fatih Gebze State Hospital, Kocaeli, Turkey Publisher Sociedade Brasileira de Cirurgia Cardiovascular Abstract Objective: The aim of this study was to determine the effect of preoperative intravenous saline hydration on postoperative renal functions and the prevention of acute kidney injury subsequent to open-heart surgery. Method(s): Our investigation was designed as a prospective, randomized, and controlled single-center trial. We included 110 patients with basal renal functions that were not disrupted and who were undergoing cardiac surgery from October to December 2020. The first group (control) had fluid restriction for 12 hours prior to surgery (n = 55), and the second group (case) was hydrated with 0.9% normal saline for 12 hours before surgery (n = 55). Result(s): In the hydration group, creatinine values dropped below the preoperative values (P = 0.008) and the glomerular filtration rate values rose above the preoperative levels (P = 0.003). The early-term mortality rates were 0% for the hydration group and 5.45% for the control group (n = 3). Besides, in the hydration group, the glomerular filtration rate values on the 30th day and 360th day after surgery increased to levels even higher than those recorded preoperatively. Conclusion(s): As a result of much effort, we showed that preoperative hydration can prevent severe cardiac surgery-associated acute kidney injury and related in-hospital mortality. Copyright © 2026, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved. <14> Accession Number 2048667591 Title Better Discrimination, Unchanged Practice: Are Machine Learning Models Ready to Replace Established Risk Scores in Cardiac Surgery? A Narrative Review. Source Life. 16(8) (no pagination), 2026. Article Number: 1371. Date of Publication: 01 Aug 2026. Author Magouliotis D.E.; Sicouri S.; Androutsopoulou V.; Zotos P.-A.; Baudo M.; Ramlawi B. Institution (Magouliotis, Sicouri, Baudo, Ramlawi) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Androutsopoulou, Zotos) Department of Cardiothoracic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece (Ramlawi) Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Preoperative risk stratification underpins consent, treatment selection, and quality benchmarking in cardiac surgery, a task served for two decades by regression-derived scores such as the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM), together with procedure-specific tools. A rapidly expanding literature reports that machine learning (ML) models achieve higher discrimination than these scores, yet established scores remain the instruments actually used at the bedside. This narrative review examines that paradox. Drawing on studies emphasized between 2023 and 2026, we argue that the reported advantage of ML is real but modest. This advantage is driven primarily by improved discrimination, while key measures of clinical value, including calibration, net benefit, and external or temporal validation, are infrequently reported. We organize the evidence around a four-lens appraisal (discrimination, calibration, clinical utility, and generalizability) and show that most cardiac surgery ML studies focus only on discrimination. We then consider why superior discrimination has not changed practice and outline the evidence needed for an ML-based risk model to justify replacing an established scoring system. The current literature supports a measured conclusion: ML is a discrimination upgrade in search of clinical proof. Copyright © 2026 by the authors. <15> Accession Number 2046649048 Title From legacy to future: A global bibliometric analysis of the Ross procedure over 60 years. Source Asian Cardiovascular and Thoracic Annals. 34(7) (pp 609-617), 2026. Date of Publication: 01 Sep 2026. Author Cubas W.S.; Alfabeto A.; Kawaguchi Y.; Guo L.-R.; Chu M.W.A. Institution (Cubas, Alfabeto, Kawaguchi, Guo, Chu) Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada Publisher SAGE Publications Inc. Abstract Background: The Ross procedure, introduced in 1967, transformed cardiac surgery. This study presents one of the first global bibliometric analyses, to the best of our knowledge, mapping research trends, collaborations, and authorship to identify future directions in this field. Method(s): A global bibliometric analysis of Ross procedure publications (1967-2025) was performed using Scopus and PubMed. Data processed in R (bibliometrix, biblioshiny) explored productivity, collaborations, authorship, and thematic evolution. Future publication trends to 2050 were forecast using a linear extrapolation model with 95% confidence intervals. Result(s): A total of 2370 Ross procedure publications were identified (1967-2025), showing an 8.1% average annual growth rate. Original articles dominated (65%), followed by reviews/meta-analyses (13.9%) and case reports (13.5%). Among 6228 authors (69.5% male), collaboration averaged 4.9 coauthors/document, with 12.6% international partnerships. The USA (32.3%), the Netherlands (19.3%), and Germany (14.5%) led in productivity. Top institutions were Erasmus University Medical Center (4.3%), Mount Sinai Health System (3.0%), and University Heart Center Lubeck (2.2%). Major journals included Annals of Thoracic Surgery (13.5%), Journal of Thoracic and Cardiovascular Surgery (12.2%), and European Journal of Cardio-Thoracic Surgery (7.6%). Faculty surgeons authored 66% of first-author papers. Main research themes involved allograft reintervention, durability, suture technique, failure, and postoperative complications. Linear regression predicted 164 annual publications by 2050. Conclusion(s): This analysis reveals an exponentially increasing and sustained global interest in the Ross procedure, which continues to shape cardiac surgery worldwide. The findings highlight growing research output, robust international collaboration, and a focus on clinical innovation, ensuring ongoing advancements in surgical techniques, patient outcomes, and global cardiovascular surgical excellence. Copyright © The Author(s) 2026 <16> Accession Number 2049048917 Title Association of Operative Timing with Clinical Outcomes and Safety in Thoracic Organ Transplantation: A Meta-Analytic Synthesis of Evidence. Source Heart and Lung. 80 (no pagination), 2026. Article Number: 102926. Date of Publication: 01 Nov 2026. Author Hussein A.M.; Hammadeh B.M.; Asassfeh A.; Yaghi G.; Alzoubi A.; Shabaneh A.; Al-Hayk A.; Rawashdeh B.; Rackauskas M.; Aladaileh M. Institution (Hussein, Hammadeh, Yaghi) Faculty of Medicine, Al- Balqa' Applied University, Salt, Jordan (Asassfeh, Rawashdeh) Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States (Alzoubi) Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, United States (Shabaneh) Department of General Surgery, University of Missouri - Kansas City, Kansas City, MO, United States (Al-Hayk) Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States (Rackauskas, Aladaileh) Division of Thoracic Surgery, Department of Surgery, University of Florida, Gainesville, FL, United States Publisher Elsevier Inc. Abstract Background: Thoracic organ transplantation is often performed at night because of donor availability and the need to minimize cold ischemia time. Whether operative timing is independently associated with short- and long-term outcomes after heart and lung transplantation remains uncertain. Method(s): We conducted a PRISMA-guided systematic review and meta-analysis with PROSPERO registration. PubMed, Scopus, the Cochrane Library, and Web of Science were searched through November 2025 for studies comparing daytime versus nighttime heart or lung transplantation. Primary outcomes included short-term mortality (in-hospital, 30-day, and 90-day) and mid-to-long-term survival (1, 3, and 5 years). Secondary outcomes included major postoperative complications and resource utilization. Pooled risk ratios or mean differences were estimated, with prespecified subgroup and sensitivity analyses. Result(s): Eight studies were included. Definitions of daytime and nighttime varied considerably across cohorts. Daytime transplantation was associated with a lower incidence of in-hospital mortality (RR, 0.89; 95% CI, 0.82 to 0.97; P = 0.029). However, no statistically significant differences were observed in 30-day, 90-day, or 1-, 3-, and 5-year mortality. Secondary outcomes, including ECMO support, pacemaker implantation, major complications, ICU length of stay, and overall hospital length of stay (LOS), were largely comparable between groups. A subgroup analysis suggested shorter hospital LOS after daytime heart transplantation, although this finding was not observed for lung transplantation or overall hospital LOS. Sensitivity analyses showed that the observed association with in-hospital mortality was influenced by the largest contributing cohort. Conclusion(s): Daytime transplantation was associated with a lower incidence of in-hospital mortality, but this association was not observed across subsequent mortality time points. Safety outcomes and resource utilization were otherwise comparable, and the available evidence did not demonstrate consistently worse outcomes following nighttime transplantation within structured thoracic transplant systems. Copyright © 2026 Elsevier Inc. <17> Accession Number 2048677542 Title Pregnancy Outcomes After Belatacept Exposure in Solid Organ Transplant Recipients: A Scoping Review. Source Healthcare (Switzerland). 14(16) (no pagination), 2026. Article Number: 2561. Date of Publication: 01 Aug 2026. Author Tawhari I.; Alotaibi M.; El Hennawy H.; Yamani F.; Alqahtani M.; Asiri K.; Tawhari M. Institution (Tawhari) Department of Internal Medicine, Section of Nephrology, College of Medicine, King Khalid University, Abha, Saudi Arabia (Alotaibi) Department of Internal Medicine, Section of Nephrology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (El Hennawy) Surgery Department, Section of Transplantation, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia (El Hennawy) King Abdullah International Medical Research Center, Jeddah, Saudi Arabia (Yamani) Department of Nephrology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Alqahtani) College of Medicine, King Khalid University, Abha, Saudi Arabia (Asiri) Department of Nephrology, Armed Forces Hospitals Southern Region, Khamis Mushayte 61961, Saudi Arabia (Tawhari) College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Tawhari) Department of Medicine, Division of Nephrology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia (Tawhari) King Abdullah International Medical Research Center, Riyadh, Saudi Arabia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Pregnancy after solid organ transplantation carries increased maternal and fetal risks, compounded by the teratogenicity, nephrotoxicity, and metabolic effects of available immunosuppressive agents. Belatacept, a calcineurin inhibitor-sparing T-cell costimulation blocker with favorable renal and metabolic profiles, has emerged as an alternative; however, evidence regarding its safety during pregnancy remains scarce. Method(s): A scoping review was conducted per PRISMA-ScR recommendations. PubMed, Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched (January 2015-March 2025), supplemented by citation searching, for studies reporting pregnancy outcomes in solid organ transplant recipients receiving belatacept. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Result(s): Three studies (one case series and two case reports) encompassing 21 pregnancies among 15 recipients were included, predominantly in kidney transplant recipients; several recipients contributed more than one pregnancy, so pregnancy-level outcomes are not statistically independent. Sixteen pregnancies resulted in live birth and five ended in miscarriage, at least four of which occurred in pregnancies with periconception mycophenolate exposure. No congenital malformations were reported among live-born infants, although the number of exposures is far too small to characterize teratogenic risk. Stable allograft function was reported in 14 of 19 pregnancies with available follow-up, with no rejection episodes during belatacept exposure. Maternal complications included preeclampsia (8 of 16 in the case series), gestational diabetes, cytomegalovirus reactivation, and acute kidney injury. Low birth weight (<2500 g) was reported in all live births, predominantly in the context of preterm delivery. Conclusion(s): The published cases have not identified congenital malformations to date, but the number of documented exposures is far too small to characterize teratogenic risk, and the overall certainty of evidence is very low. Because no comparative studies were available, maternal and neonatal outcomes cannot be assumed equivalent to those of conventional immunosuppression. Belatacept cannot be recommended for routine use during pregnancy; clinical decisions must remain individualized, and preconception counseling and prospective multicenter registries are urgently needed. Copyright © 2026 by the authors. <18> Accession Number 2048007165 Title Sodium-Glucose Cotransporter-2 Inhibitors in Valvular Heart Disease: From Mechanistic Insights to Clinical Application. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(9) (no pagination), 2026. Article Number: 105568. Date of Publication: 01 Sep 2026. Author Allaham H.; Gibson C.M.; Finn A.; Alhaddad I.; Gupta A. Institution (Allaham, Finn, Gupta) Division of Cardiovascular Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, United States (Gibson) Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Finn) CVPath Institute, Gaithersburg, MD, United States (Alhaddad) Division of Cardiovascular Medicine, Jordan Hospital, Amman, Jordan Publisher Elsevier B.V. Abstract Valvular heart disease encompasses a diverse group of hemodynamic disorders that are frequently associated with heart failure, recurrent hospitalizations, and substantial morbidity despite advances in transcatheter and surgical therapies. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a cornerstone of cardiovascular and renal disease management, demonstrating consistent benefits across a broad range of patient populations. Beyond their established effects in heart failure, diabetes mellitus, and chronic kidney disease, accumulating evidence suggests that SGLT2 inhibitors may favorably influence key biological pathways involved in valvular heart disease, including inflammation, oxidative stress, fibrosis, endothelial dysfunction, and adverse cardiac remodeling. Preclinical and translational studies have provided mechanistic support for a potential role of SGLT2 inhibition in modifying valvular and myocardial disease processes. Emerging clinical evidence suggests possible benefits across several forms of valvular heart disease, including degenerative aortic stenosis, functional mitral regurgitation, tricuspid regurgitation, rheumatic mitral stenosis, and bioprosthetic valve degeneration. In addition, growing interest has focused on the integration of SGLT2 inhibitors into contemporary structural heart practice, particularly among patients undergoing transcatheter aortic valve replacement, transcatheter edge-to-edge repair, and other structural interventions. This narrative review summarizes the mechanistic rationale, current clinical evidence, and practical considerations surrounding the use of SGLT2 inhibitors in valvular heart disease and structural heart interventions. We discuss the strengths and limitations of the existing literature, identify important gaps in knowledge, and highlight future directions for research aimed at defining the role of SGLT2 inhibitors as an adjunctive therapy in structural heart disease. Copyright © 2026 The Author(s). <19> Accession Number 2048701953 Title Feasibility and Safety of Operating Room Extubation After Minimally Invasive Cardiac Valve Surgery: A Systematic Review and Meta-Analysis. Source Journal of Cardiovascular Development and Disease. 13(8) (no pagination), 2026. Article Number: 368. Date of Publication: 01 Aug 2026. Author Magouliotis D.E.; Sicouri S.; Androutsopoulou V.; Baudo M.; Brecher V.; Avgerinos D.V.; Athanasiou T.; Ramlawi B. Institution (Magouliotis, Sicouri, Baudo, Brecher, Ramlawi) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Androutsopoulou) Department of Cardiothoracic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece (Avgerinos) Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece (Athanasiou) Department of Surgery and Cancer, Imperial College London, London, United Kingdom (Ramlawi) Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Minimally invasive cardiac valve surgery has emerged as a preferred approach in selected patients, yet optimal postoperative extubation timing remains debated. This systematic review and meta-analysis examined clinical outcomes associated with extubation in the operating room (OR) versus the intensive care unit (ICU) among adult patients undergoing minimally invasive cardiac valve surgery. Method(s): The study was conducted according to PRISMA guidelines. A single unit of analysis was applied throughout. Pooled odds ratios were computed with the Mantel-Haenszel random-effects method; where a study reported only a matched or covariate-adjusted estimate, that estimate was reserved for a prespecified sensitivity analysis using the generic inverse-variance method. Result(s): Five observational studies (2023-2025) including 1101 OR-extubated and 899 ICU-extubated patients from high-volume centers with fast-track or enhanced recovery pathways were included. OR extubation was associated with lower odds of reintubation (OR 0.40; 95% CI 0.24-0.69; I2 = 0%), postoperative delirium (OR 0.47; 95% CI 0.31-0.72; I2 = 0%), and pneumonia (OR 0.30; 95% CI 0.16-0.53; I2 = 0%). No significant differences were observed for new-onset atrial fibrillation, stroke, or reoperation for bleeding. Thirty-day mortality was reported by four of the five studies and comprised few events (5 of 1043 ORE versus 17 of 645 ICE across the four studies reporting this outcome); given the small number of events, the concentration of deaths in the higher-risk ICU-extubated patients, and the reliance of the pooled estimate on two confounded cohorts, this difference is not interpretable as a treatment effect, and no pooled odds ratio is reported here. Length of stay was consistently shorter after OR extubation but was not pooled because of extreme heterogeneity (I2 = 96-100%). Sensitivity analyses using adjusted estimates attenuated the associations for reintubation and pneumonia, consistent with substantial confounding by indication. Conclusion(s): In appropriately selected patients undergoing minimally invasive valve surgery, OR extubation is feasible and is associated with a recovery profile at least comparable to that of ICU extubation. Because extubation location was determined largely by intraoperative and early postoperative stability, these associations should be read as reflecting patient selection rather than a causal benefit of the strategy. The findings support the feasibility of OR extubation in appropriately selected patients at experienced centers and motivate prospective, ideally randomized, evaluation. Copyright © 2026 by the authors. <20> Accession Number 2041404879 Title Impact of subthreshold troponin levels and temporal trends on short term adverse cardiovascular outcomes in patients discharged from the emergency department: a RACE-IT trial substudy. Source Clinical Research in Cardiology. 115(10) (pp 1785-1793), 2026. Date of Publication: 01 Oct 2026. Author Qureshi M.A.; Cook B.; Brennan B.; Miller J.; McCord J. Institution (Qureshi) Henry Ford Jackson Hospital, Jackson, MI, United States (Cook, Brennan, Miller, McCord) Henry Ford Hospital, Detroit, MI, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: High-sensitivity cardiac troponin I assays enable early exclusion of myocardial infarction in the emergency department. However, the clinical implications of detectable troponin values below the 99th percentile upper reference limit (4-18 ng/L) remain unclear. Objective(s): To assess the association between subthreshold troponin levels and 30-day outcomes in patients from the RACE-IT trial, using exact troponin values when available. Method(s): This post-hoc analysis of the RACE-IT stepped-wedge randomized controlled trial included patients with troponin <= 18 ng/L across nine EDs. Patients were stratified by initial troponin, peak value, absolute change, and percent change. The primary outcome was a 30-day composite of all-cause death, acute MI, percutaneous coronary intervention, and coronary artery bypass grafting. Logistic regression analysis after adjusting for age, sex, race, and coronary artery disease was performed. Result(s): Among 19,194 patients with troponin <= 18 ng/L, 117 (0.6%) experienced the composite outcome. Higher troponin levels were associated with increased event rates in unadjusted analyses. Adjusted analyses showed no independent associations overall, though patients whose highest troponin values fell within the >= 11- <= 18 ng/L range continued to demonstrate significantly worse outcomes than those with lower peak levels. Elevated troponin values correlated with older age, male sex, and greater comorbidity burden. Conclusion(s): In this post-hoc analysis of patients with troponin values below the 99th percentile URL, absolute levels and temporal changes were not independently associated with 30-day adverse outcomes. These findings support the use of subthreshold troponin values in rapid rule-out protocols, emphasizing the need to consider clinical context and comorbidities in risk assessment. Copyright © Springer-Verlag GmbH Germany, part of Springer Nature 2025. <21> Accession Number 2048991722 Title Effects of perioperative MESNA on lipid peroxidation and myocardial injury in patients undergoing coronary artery bypass grafting: a randomized, double-blind, placebo-controlled trial. Source Naunyn-Schmiedeberg's Archives of Pharmacology. (no pagination), 2026. Date of Publication: 2026. Author Dastmardi S.; MalekHosseini H.; Salehi M.; Mahboubi F.; Mohammadi K. Institution (Dastmardi, Mahboubi, Mohammadi) Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (MalekHosseini, Salehi) Department of Cardiovascular Surgery, Faculty of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Dastmardi, Mohammadi) Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Mohammadi) Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar Ave., Enghelab Sq., Tehran, Iran, Islamic Republic of Publisher Springer Science and Business Media Deutschland GmbH Abstract Oxidative stress is a major contributor to myocardial injury following coronary artery bypass grafting (CABG). MESNA (sodium 2-mercaptoethane sulfonate), a thiol-containing antioxidant, has demonstrated potent free radical scavenging properties. This study evaluated the effects of perioperative MESNA administration on oxidative stress, myocardial injury biomarkers, and early postoperative cardiac function in patients undergoing elective on-pump CABG. In this randomized, double-blind, placebo-controlled trial, 100 adults undergoing elective isolated CABG with cardiopulmonary bypass were randomly assigned (1:1) to receive intravenous MESNA (1600 mg) or placebo. The primary outcome was postoperative oxidative stress assessed by serum malondialdehyde (MDA). Secondary outcomes included cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), and left ventricular ejection fraction (LVEF). Baseline MDA concentrations were comparable between groups. MESNA significantly reduced postoperative MDA concentrations over the first 24 h compared with placebo (group-by-time interaction, P < 0.001). CK-MB concentrations were significantly lower in the MESNA group, with an estimated between-group difference of - 22.42 U/L at 24 h (P = 0.001). In contrast, cTnI concentrations did not differ significantly between groups. Patients receiving MESNA had higher LVEF at hospital discharge, and this association remained significant after multivariable adjustment (adjusted beta = 2.93, 95% CI 0.98-4.87; P = 0.004). No treatment-related adverse events were observed. In patients undergoing elective on-pump CABG, perioperative administration of MESNA was associated with reduced postoperative lipid peroxidation, lower CK-MB release, and improved early postoperative ventricular function. Larger multicenter studies are needed to confirm these findings and their clinical significance. Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026. <22> Accession Number 2048878372 Title A Systematic Review of Hypnosis for Clinical Pain Relief. Source European Journal of Pain. 30(8) (no pagination), 2026. Article Number: e70369. Date of Publication: 01 Sep 2026. Author Yim T.H.; Derbyshire S.W.G. Institution (Yim, Derbyshire) Department of Psychology, National University of Singapore, Singapore Publisher John Wiley and Sons Inc Abstract Background: Previous reviews report moderate reductions in clinical pain with hypnotic suggestion but provide only partial views by comparing hypnosis with inactive controls alone or including few studies or mixed control groups. This review comprehensively evaluated the efficacy of hypnosis in reducing clinical pain intensity compared with non-active and active controls. Method(s): Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review guidelines with comprehensive literature search and meta-analysis. A total of 106 studies met inclusion criteria; 104 effect sizes from 84 studies were pooled using random-effects models, and 22 studies were narratively synthesised. Five databases were searched from inception to October 2025 for randomised controlled trials evaluating hypnosis versus non-active or active non-pharmacological controls for clinical pain intensity. Two independent reviewers screened articles and extracted data using standardised tools. Result(s): Meta-analysis of 57 studies (4572 participants) showed reduced post-intervention pain following hypnosis versus non-active controls (SMD -0.33). Pre-post change scores yielded a comparable but non-significant effect (SMD -0.31). Subgroup analyses showed no differences by pain type, control type or delivery mode. Hypnosis did not outperform active controls, including relaxation (14 studies, SMD -0.13), pain education (7 studies, SMD -0.17 to -0.19) or cognitive-behavioural therapy (5 studies, SMD -0.32). Conclusion(s): Hypnosis yields modest reductions in clinical pain comparable to other psychological interventions. Significance Statement: This review provides a comprehensive synthesis of randomised trials evaluating hypnosis for clinical pain intensity, distinguishing non-active from active comparators and examining delivery mode, pain type and risk of bias. Hypnosis produced only small reductions in pain and did not clearly outperform relaxation, pain education or cognitive-behavioural therapy. These findings refine expectations for hypnoanalgesia, suggesting it may provide low-risk supportive care for selected patients, but should not be presented as a reliably superior pain-reduction treatment option. Trial Registration: Prospero (CRD42024608722). Copyright © 2026 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC . <23> Accession Number 2043950097 Title Intravenous Lidocaine in Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3396-3404), 2026. Date of Publication: 01 Oct 2026. Author Mamun M.A.; Saleem Y.; El-Tahlawy Y.; Mahmood W.U.; Lubbad O.; Kabir T. Institution (Mamun, Saleem, El-Tahlawy, Mahmood, Lubbad) Brighton and Sussex Medical School, Brighton, United Kingdom (Kabir) Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom Publisher W.B. Saunders Abstract Effective postoperative recovery after video-assisted thoracoscopic surgery (VATS) remains a significant challenge, with patients frequently experiencing moderate to severe pain, pulmonary decline, and postoperative nausea and vomiting (PONV) despite modern multimodal analgesia. Intravenous lidocaine has been proposed as an opioid-sparing adjunct with systemic analgesic and antihyperalgesia properties, but its role in VATS is uncertain. This systematic review and meta-analysis identified a total of 31 studies, of which 9 randomized controlled trials involving 672 patients met the inclusion criteria and were included in the final quantitative and qualitative synthesis. Five trials (n = 328) assessing 24-hour opioid use and 3 trials (n = 242) assessing 48-hour use showed no reduction in postoperative morphine consumption with lidocaine. Similarly, pooled movement pain scores at 24 and 48 hours (3 trials, n = 200 each) demonstrated no significant difference between groups. Although 4 trials (n = 272) reported a marked reduction in intraoperative remifentanil requirements, this did not translate into improved postoperative analgesia. In contrast, lidocaine produced a consistently favorable antiemetic effect: 5 trials (n = 360) showed a significant reduction in PONV with negligible heterogeneity. Limitations included small sample sizes, varying bolus and infusion regimens, heterogeneity in background analgesic protocols, and incomplete reporting of outcomes such as inflammatory markers and pulmonary physiology, all of which reduce confidence in effect estimates. Overall, current evidence indicates that while intravenous lidocaine is safe and offers a reproducible reduction in PONV, it does not improve postoperative pain or opioid consumption following VATS. Larger, standardized trials are required to determine whether specific subgroups or dosing strategies may yield a greater benefit in thoracic minimally invasive surgery. Copyright © 2026 The Author(s) <24> Accession Number 2047916614 Title Left Atrial Inflow Ventricular Assist Device Utilization in Patients With Small or Restrictive Left Ventricles: A Systematic Review. Source Artificial Organs. 50(9) (pp 1207-1216), 2026. Date of Publication: 01 Sep 2026. Author Jones A.J.; Smoot D.; Fayek F.B.; Rahimov D.; Wood C.T.; Rajab T.K.; Eisen H.J.; Alvarez R.; Rame J.E.; Rajagopal K.; Hoopes C.W.; Tchantchaleishvili V. Institution (Jones, Fayek, Rahimov, Rajagopal, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States (Smoot) Drexel University College of Medicine, Philadelphia, PA, United States (Wood) Department of Surgery, University of Illinois College of Medicine, Chicago, IL, United States (Rajab) Department of Cardiovascular Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR, United States (Eisen, Alvarez, Rame) Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, United States Publisher John Wiley and Sons Inc Abstract Background: Conventional mechanical circulatory support offers limited options for patients with small or restrictive left ventricles. Left atrial inflow (LA-Ao) ventricular assist device (VAD) configuration represents an alternative to conventional apical left ventricular assist device (LVAD). However, outcomes data remain limited. To address this, we evaluated patient characteristics, procedural details, and outcomes of LA-Ao VAD configuration in this population. Method(s): A systematic search was conducted to identify case reports and series of patients with small or restrictive left ventricles who underwent LA-Ao LVAD implantation. A total of 21 reports, representing 27 patients, were included. Patient-level data were extracted for analysis. Result(s): Thirteen adult and 14 pediatric patients underwent LA-Ao VAD implantation. Median age was 57 [46-62] years in adults and 3.5 [0.8-9] years in children. Hypertrophic cardiomyopathy and restrictive cardiomyopathy were the predominant diagnoses in both adults and children, accounting for 54% (7/13) and 29% (4/14), and 46% (6/13) and 43% (6/14), respectively. Median left ventricular ejection fraction was 44% [39-53] in adults and 45% [36-61] in children, and median left ventricular end-diastolic diameter was 42 [35-42] mm in adults and 33 [29-34] mm in children. The most used devices were HeartWare HVAD (46%, 6/13) in adults, and Berlin Heart (64%, 9/14) in children. Overall pulmonary capillary wedge pressure decreased from 23 [19-27] to 7 [0-9] mmHg (p = 0.02), and cardiac index increased from 2.0 [1.3-2.8] to 3.1 [2.7-3.7] L/min/m2 (p = 0.04). In-hospital mortality included one fatal case (7.7%) in each group. Overall survival was 85% (11/13) in adults at median follow-up of 6.7 [4.4-19.9] months and 86% (12/14) in children at 2.3 [1.2-8.1] months. Conclusion(s): The LA-Ao configuration of VAD is a viable strategy for mechanical circulatory support in patients with small or restrictive left ventricles. It offers effective unloading of the left atrium and improved cardiac index, supporting its role as an alternative to the conventional LVAD approach. Copyright © 2026 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <25> Accession Number 2046515544 Title Echocardiography before non-cardiac surgery: current knowledge, guideline recommendations, and clinical evidence - a narrative review. Source Journal of Clinical Monitoring and Computing. 40(5) (pp 1057-1063), 2026. Date of Publication: 01 Oct 2026. Author Mertin V.; Stroda A.; Bruns T.; Lurati Buse G. Institution (Mertin, Stroda, Bruns, Lurati Buse) Department of Anesthesiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany Publisher Springer Science and Business Media B.V. Abstract This narrative review provides an overview of the evidence on transthoracic echocardiography (TTE) at rest in patients undergoing non-cardiac surgery with regard to detection of new diagnoses, TTE-driven management changes, and outcome impact of preoperative TTE. It summarizes the evidence on preoperative TTE and reviews the current recommendations by professional societies from both Europe and Northern America. TTE is a very important non-invasive diagnostic tool to obtain information on cardiac function before surgery. While studies on the effectiveness of preoperative TTE are limited, there is evidence that TTE before non-cardiac surgeries can detect new diagnoses in a relevant proportion of patients. Also, data on changes in management based on TTE findings is scarce. Both the American Heart Association and the American College of Cardiologists and the European Society of Cardiology have recently published updated recommendations regarding the use of TTE before non-cardiac surgery. While both societies are in favour of TTE in symptomatic patients and do not recommend TTE to be performed routinely, several differences remain. Information on outcome benefits in patients having received TTE prior to surgery is not conclusive. In this review we could detect several knowledge gaps concerning the yield and impact on management and outcome of preoperative TTE in non-cardiac surgery patients. Copyright © The Author(s) 2026. <26> Accession Number 2048764881 Title Cytokine trajectories after cardiopulmonary bypass in children: a systematic review and quantitative synthesis. Source International Journal of Cardiology Congenital Heart Disease. 25 (no pagination), 2026. Article Number: 100698. Date of Publication: 01 Sep 2026. Author Pisesky A.E.; Breatnach C.; Foroutan F.; Parshuram C.; Floh A. Institution (Pisesky) Department of Pediatrics, Stollery Children's Hospital, University of Alberta, 8440 112 St NW, Edmonton, Canada (Breatnach) Intensive Care Medicine, Children's Health Ireland at Crumlin, Cooley St, Dublin, Ireland (Foroutan) Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada (Parshuram, Floh) Department of Critical Care Medicine, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, Canada (Parshuram) Centre for Safety Research, Child Health Evaluative Sciences, The Research Institute, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, Canada (Parshuram) Department of Paediatrics and Interdepartmental Division of Critical Care Medicine, University of Toronto, 27 King's College Circle, Toronto, Canada (Floh) Labatt Family Heart Centre, Division of Cardiac Critical Care, The Hospital for Sick Children, Toronto, Canada Publisher Elsevier B.V. <27> Accession Number 2045529296 Title Concordance of Large Language Model Recommendations with Multidisciplinary Heart Team Decisions in Coronary Revascularization and Aortic Valve Intervention: A Systematic Review and Pooled Analysis. Source Cardiology and Therapy. 15(3) (pp 393-406), 2026. Date of Publication: 01 Sep 2026. Author Rouhi A.D.; Menon S.V.; Ghanem Y.K.; Han J.J. Institution (Rouhi) Washington University in St. Louis School of Medicine, St. Louis, MO, United States (Menon) Cooper Medical School of Rowan University, Camden, NJ, United States (Ghanem) Department of Surgery, Cooper University Hospital, Camden, NJ, United States (Han) Division of Cardiac Surgery, Department of Surgery, Cooper University Hospital, 24 S 6th Street, Camden, NJ, United States Publisher Adis Abstract Introduction: The multidisciplinary heart team (HT) remains the cornerstone of decision-making for complex cardiovascular disease. Large language models (LLMs) and other generative artificial intelligence models have recently emerged as potential decision support tools across diverse clinical settings. We sought to synthesize current evidence and quantitatively estimate concordance between LLM recommendations and HT decisions. Method(s): A literature search was performed using PubMed, Scopus, and Web of Science for primary studies published between November 2022 and February 2026 that evaluated recommendations by LLMs against multidisciplinary HT decisions. Studies reporting overall agreement were included for quantitative pooling. Random-effects meta-analysis was performed to determine proportion of agreement. Result(s): Four retrospective concordance studies were included regarding decision-making in coronary revascularization and aortic valve intervention. LLM-HT concordance ranged from 65% to 82% for coronary revascularization and was 77% for aortic valve intervention. In random-effects meta-analysis, the pooled agreement between LLM recommendations and HT decisions was 0.73 (95% CI 0.60-0.83) with substantial heterogeneity. Discordance stemmed from LLM reliance on outdated trial evidence and limited transparency regarding utilized data, with misclassifications observed in cases of octogenarians with aortic stenosis. Detailed prompts generally improved accuracy and reliability of LLM recommendations. Conclusion(s): These preliminary findings suggest LLMs may have potential as adjunctive decision support tools for multidisciplinary HTs. There remains potential for misclassification when patient-specific factors and conflicting guidelines complicate decision-making. Further prospective evaluation across diverse LLMs is essential before clinical deployment can be recommended. Copyright © The Author(s) 2026. <28> Accession Number 2048549746 Title JCS 2026 Guideline on Management of Large Vessel Vasculitis. Source Circulation Journal. 90(7) (pp 908-943), 2026. Date of Publication: 2026. Author Nakaoka Y.; Watanabe Y.; Sugihara T.; Nagasaka K.; Tamura N.; Yoshifuji H.; Yajima N.; Aono F.; Hashimoto T.; Ishizu A.; Iida T.; Ishii T.; Kiko T.; Maejima Y.; Miyamae T.; Nakano Y.; Nanki T.; Niiro H.; Ota H.; Okochi N.; Sada K.; Shigematsu K.; Uchida H.A.; Abe Y.; Aoki-Kamiya C.; Arita Y.; Handa T.; Hiwa R.; Honda M.; Ishihara R.; Ishizaki J.; Ito S.; Iwahashi T.; Iwata N.; Kadoba K.; Kamiyama Y.; Kawazoe M.; Kida T.; Kidoguchi G.; Kobayashi D.; Kobayashi K.; Kurata A.; Miyawaki Y.; Nakagama S.; Nishioka N.; Onimaru M.; Onishi Y.; Sakai R.; Sanada H.; Shimizu Y.; Shirai T.; Sugano E.; Takahashi K.; Tamechika S.-Y.; Ueda J.; Umezawa N.; Watanabe R.; Yanai R.; Yoshida T.; Amano K.; Harigai M.; Isobe M.; Kitaoka H.; Tanemoto K. Publisher Japanese Circulation Society <29> Accession Number 2048433363 Title Transseptal versus left atrial approach for mitral valve surgery: A systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. 34(7) (pp 642-655), 2026. Date of Publication: 01 Sep 2026. Author Paramkusam S.M.C.; Paramkusam A.V.; Abuzayed B.; Omaruddin L.; Pavuluri K.S.; Ghosh A.; Basri A.; Malik A.B.; Ramkhalawon S.V.; Mukunde A.-C.; Imam B.; Ezhil S.R. Institution (Paramkusam) Katuri Medical College and Hospital, Andhra Pradesh, Guntur, India (Paramkusam) Jonelta Foundation School of Medicine - UPHSD, Las Pinas, Philippines (Abuzayed) Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom (Omaruddin) Royal College of Surgeons, Bahrain, Ireland (Pavuluri) Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom (Ghosh) Nazareth Hospital, Philadelphia, PA, United States (Basri) Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan (Malik) Washington University in St Louis, St Louis, United States (Ramkhalawon) SAJ Flacq Hospital, Flacq, Mauritius (Mukunde) Universidad de Montemorelos, Montemorelos, Mexico (Imam) University of Pittsburgh Medical Center, Pittsburgh, United States (Ezhil) M.S. Ramaiah Medical College, Bangalore, India (Paramkusam, Paramkusam, Abuzayed) Publisher SAGE Publications Inc. Abstract Objective: Surgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS. Method(s): This meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation. Result(s): Twenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07-1.95]; P = 0.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group. Conclusion(s): Our meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence. Copyright © The Author(s) 2026 <30> Accession Number 2048701929 Title Mapping Efficiency of an Octaspline Versus Pentaspline Multielectrode Catheter for High-Density Mapping of Regular Atrial Tachyarrhythmias: A Multicenter Randomized Cross-Over Trial. Source Journal of Cardiovascular Development and Disease. 13(8) (no pagination), 2026. Article Number: 379. Date of Publication: 01 Aug 2026. Author Mahmoodi B.K.; Balt J.C.; Khan M.; Wijffels M.C.E.F.; de Ruiter G.S.; Szili-Torok T.; Yap S.-C. Institution (Mahmoodi, Yap) Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, Netherlands (Balt, Wijffels) Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands (Khan, de Ruiter) Department of Cardiology, Hospital Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands (Szili-Torok) Department of Internal Medicine, Cardiology Center, University of Szeged, 6725, Szeged, Hungary Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Catheter ablation of regular atrial tachyarrhythmias (ATs) relies on high-density electroanatomical mapping and can be technically challenging. We compared the mapping efficiency of the Octaray and Pentaray catheters in patients undergoing AT mapping. Method(s): Patients with either left or right AT underwent three-dimensional Coherent mapping using both the Octaray and Pentaray catheters in a randomized cross-over design. The primary endpoint was the total number of electrograms acquired per map at a predefined filling threshold of 5 mm. Result(s): A total of 46 patients with left or right AT were enrolled across three ablation centers. Successful mapping with both catheters was achieved in 39 patients (20 left ATs and 19 right ATs). The median number of electrograms acquired per map (7437 vs. 4679; p < 0.001) and median electrogram density (50.2 vs. 29.8 electrograms/cm2; p < 0.001) was significantly higher with Octaray than with Pentaray. Furthermore, median mapping times were significantly shorter with Octaray (5.4 vs. 8.1 min; p < 0.001), resulting in an approximately 2.5-fold higher acquisition rate (1489 vs. 602 electrograms/minute; p < 0.001). In addition, Octaray demonstrated a significantly lower proportion of internal points compared with Pentaray, particularly in low-voltage regions (bipolar voltage < 0.5 mV; 22% vs. 44%; p = 0.01). Conclusion(s): Compared with Pentaray, use of the Octaray catheter facilitated faster high-density electroanatomical mapping of complex ATs, thereby improving mapping efficiency. Copyright © 2026 by the authors. <31> Accession Number 2048696000 Title Clinical Outcomes and Postprocedural Antithrombotic Management After Left Atrial Appendage Occlusion in Patients with Gastrointestinal Bleeding: A Systematic Review and Expert-Informed Clinical Framework. Source Biomedicines. 14(8) (no pagination), 2026. Article Number: 1801. Date of Publication: 01 Aug 2026. Author Vukovic J.; Becic T.; Radic J.; Radic M.; Marcic L.; Fabijanic D.; Jukic I. Institution (Vukovic, Jukic) Department of Internal Medicine, Division of Gastroenterology, University Hospital of Split, Split, Croatia (Vukovic, Radic, Radic) 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 Nephrology, Dialysis and Arterial Hypertension, University Hospital of Split, Split, Croatia (Radic) Department of Internal Medicine, Division of Rheumatology, Allergology and Clinical Immunology, University Hospital of Split, Split, Croatia (Marcic) Department of Diagnostic and Interventional Radiology, University Hospital of Split, Split, Croatia (Fabijanic) Department of Clinical Propedeutics, School of Medicine, University of Split, Split, Croatia (Jukic) Faculty of Health Sciences, University of Split, Split, Croatia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Patients with atrial fibrillation (AF) and a history of gastrointestinal (GI) bleeding represent a particularly challenging clinical population due to the coexistence of elevated thromboembolic and hemorrhagic risks. Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative strategy for stroke prevention in patients in whom long-term oral anticoagulation is contraindicated or poorly tolerated. However, evidence specifically addressing clinical outcomes and optimal postprocedural antithrombotic management in this subgroup remains limited. Method(s): A comprehensive systematic literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane CENTRAL from database inception to April 2026. Studies were eligible if they included patients with prior gastrointestinal bleeding as the primary study population or reported separately extractable outcomes for a predefined gastrointestinal bleeding subgroup. The primary outcomes were recurrent GI bleeding, thromboembolic events, and all-cause mortality, while secondary outcomes included procedural success, device-related thrombosis, and postprocedural antithrombotic strategies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized qualitatively in accordance with PRISMA 2020 recommendations. Result(s): Five observational studies reporting GI bleeding-specific outcomes were included in the systematic evidence synthesis. Procedural success rates were consistently high, and LAAO was associated with acceptable thromboembolic outcomes during follow-up. Nevertheless, recurrent GI bleeding remained a clinically relevant complication, particularly in patients with a prior bleeding history. Postprocedural antithrombotic regimens varied widely, ranging from short-term oral anticoagulation to dual or single antiplatelet therapy and reduced-intensity strategies. Less intensive regimens appeared feasible in carefully selected patients at very high bleeding risk; however, no universally optimal approach could be identified. Conclusion(s): Available observational evidence suggests that LAAO may represent a stroke prevention option in selected patients with AF and prior GI bleeding, although firm conclusions regarding net clinical benefit and the optimal postprocedural antithrombotic strategy cannot currently be drawn. Its net clinical benefit is closely linked to individualized postprocedural management, particularly the choice and intensity of antithrombotic therapy. These findings highlight the importance of a multidisciplinary, patient-centered approach and underscore the need for prospective studies to establish evidence-based treatment strategies in this high-risk population. Copyright © 2026 by the authors. <32> Accession Number 2046437396 Title Routine Versus Selective Temporary Epicardial Pacing Wire Placement: A Scoping Review. Source Surgery Today. 56(10) (pp 2140-2148), 2026. Date of Publication: 01 Oct 2026. Author Akele O.; Osuji E.; Patel V.; Kamal M.; Kiernan P.; Dhakal R.; Khoury M.E.; Shahani R. Institution (Akele, Patel, Kamal, Kiernan) Department of Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, United States (Osuji) Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States (Dhakal) Department of Medicine, Staten Island University Hospital, Staten Island, NY, United States (Khoury) Department of Cardiology, Staten Island University Hospital, Staten Island, NY, United States (Shahani) Department of Cardiothoracic Surgery, Staten Island University Hospital Heart Institute, Staten Island, NY, United States Publisher Springer Abstract Temporary epicardial pacing wires (TEPWs) are used widely for rhythm management in cardiac surgery. However, their routine placement is being debated increasingly because of low utilization and potential procedural risks. We compared routine versus selective TEPW placement practices and assessed the utilization, complications, and predictors of pacing need. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Cochrane Library until June 2025. Studies were included if they examined TEPW strategies in adult or pediatric cardiac surgery and reported outcomes related to wire use, complications, or predictors of pacing need. Eleven studies involving 16,874 patients (14,957 adults, 1,917 children) were included. Routine placement rates ranged from 73.5% to 89.9%, but utilization was low at 2.9%-29.6%. Selective strategies showed higher utilization of 30%-100% with fewer unused wires. Predictors of the need for TEPW included intraoperative arrhythmias, prolonged CPB, and complex procedures. Complications were rare. Thus, routine TEPW placement often leads to unnecessary wire use. Selective strategies based on intraoperative and clinical predictors may optimize patient care. Developing a risk-based tool could enhance decision-making and reduce procedural burden. Copyright © The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd. 2026. <33> Accession Number 2038561655 Title Sternal Closure Techniques Using Steel Wires and Predictors of Sternal Wound Complications: A Randomized Controlled Trial. Source Brazilian Journal of Cardiovascular Surgery. 41(3) (no pagination), 2026. Article Number: e20260056. Date of Publication: 2026. Author Mogahed M.A.; Abdelaal M.M.; Elfeky W.M.; Elghanam A.R.; Elesawy M.M.; Abdelalim M.M. Institution (Mogahed, Abdelaal, Elfeky, Elghanam, Elesawy, Abdelalim) Department of Cardiothoracic Surgery, Faculty of Medicine, Kafr Elsheikh University, Kafr El Sheikh, Egypt Publisher Sociedade Brasileira de Cirurgia Cardiovascular Abstract Introduction: Median sternotomy is the gold standard for cardiac surgery but carries a significant risk of wound complications, including sternal dehiscence and wound infections. Objective(s): This study aimed to compare the early efficacy and complication rates of three distinct steel-wire sternal closure techniques and identify potential risk factors of complications. Method(s): We conducted a randomized controlled study on patients undergoing cardiac surgery. Patients were randomly allocated into three groups of sternal closure techniques: simple interrupted (Group A), figure-of-eight (Group B), or a modified combined technique (Group C). Baseline characteristics, intraoperative parameters, postoperative recovery outcomes, and sternal wound complications including sternal dehiscence and superficial and deep wound infections were evaluated. Binomial logistic regression was performed to determine independent risk factors for complications. Result(s): One hundred sixty-five adult cardiac patients were finally included in the study. All three intervention groups (n = 55) were well-matched regarding baseline characteristics and intraoperative parameters. The incidence of sternal dehiscence (6.1%) and superficial (7.9%) and deep wound infections (3.6%) did not differ significantly among the three wire closure techniques (P > 0.05). However, logistic regression identified numerous factors associated with superficial sternal wound infections including old age, obesity (body mass index > 30), comorbidities, elevated C-reactive protein and HbA1C, prolonged cardiopulmonary bypass time, extended operative time, and longer intensive care unit stay (P < 0.05 for all). Conclusion(s): The three steel-wire closure techniques demonstrated comparable early postoperative stability and similar rates of sternal wound complications. Technique choice may be based on surgeon preference. Copyright © 2026, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved. <34> Accession Number 2048798270 Title Construction of an evidence-based exercise rehabilitation protocol for older adults undergoing heart valve intervention: A modified delphi study. Source Geriatric Nursing. 73 (no pagination), 2026. Article Number: 104325. Date of Publication: 01 Oct 2026. Author Zhang R.; Wu L.; Lan X.; Huang P.; Tian F.; Chen S.; Chen Y. Institution (Zhang, Wu, Lan, Huang, Chen) Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Fujian Branch of National Clinical Research Center for Cardiovascular Diseases, Xiamen, China (Tian) Tianjin Medical University, Tianjin, China (Chen) Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medicine, Fujian Province, Quanzhou, China Publisher Elsevier Inc. Abstract Background Patients undergoing interventional treatment (e.g., TAVR) are predominantly older adults characterized by frailty and multiple comorbidities. While exercise-based cardiac rehabilitation is beneficial, existing guidelines are often generalized, with limited structured protocols specifically tailored to the safety needs and physical limitations of this vulnerable population. Objectives To construct an evidence-based, expert consensus protocol for exercise rehabilitation specifically tailored for older adults after interventional treatment for valvular heart disease. Method A systematic literature review and evidence synthesis were conducted, followed by two rounds of modified Delphi consultations with 17 multidisciplinary experts from six provinces in China. Authority coefficients (Cr) were calculated to assess expert validity, and consensus was evaluated using Kendall's W and coefficients of variation. Results Expert engagement was high, with response rates of 77.3% and 100% in the two rounds, and high authority (Cr > 0.7). Consensus was achieved across feasibility, appropriateness, and effectiveness (Kendall's W, P < 0.05). The final protocol comprises 8 dimensions and 36 items. Key geriatric-focused features include preoperative frailty and fall risk assessments, staged low-intensity prehabilitation, and culturally adapted home-based exercises (e.g., Tai Chi/Baduanjin) to support safety and adherence. A multi-level safety-oriented framework was developed, incorporating risk stratification, individualized low-intensity exercise prescription, continuous physiological monitoring, and structured follow-up during rehabilitation. Conclusions This consensus-based protocol addresses the needs of older valve intervention patients by integrating safety monitoring with individualized, progressive exercise prescriptions. It provides a practical, safety-oriented framework for healthcare professionals to implement early mobilization and home-based rehabilitation, ultimately supporting functional recovery in high-risk elderly patients. Copyright © 2026 Elsevier Inc. <35> Accession Number 652100714 Title Complete Revascularization Guided by Functional Coronary Angiography in STEMI. Source The New England journal of medicine. 395(10) (pp 972-982), 2026. Date of Publication: 10 Sep 2026. Author Biscaglia S.; Erriquez A.; Colaiori I.; Hakeem A.; Mantovani F.; Menozzi M.; Barbierato M.; Arioti M.; Bugani G.; Scarsini R.; D'Amario D.; Donazzan L.; Polimeni A.; Giordan M.; Benatti G.; Venturi G.; Ruozzi M.; Moretti F.; Monello A.; Moscarella E.; Versaci F.; Shah J.A.; Guiducci V.; Cavazza C.; Gallo F.; Rubboli A.; Borgi M.; Lakho A.A.; Capecchi A.; Lanzilotti V.; Ottani F.; Casella G.; Leone A.M.; Tebaldi M.; Pavasini R.; Piccolo R.; Farina J.; Martella D.; Campo G. Institution (Biscaglia, Erriquez, Pavasini, Farina, Campo) Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy (Colaiori, Versaci, Borgi) Cardiology Intensive Care Unit, Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy (Hakeem, Shah, Lakho) National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan (Mantovani, Guiducci) Cardiology Unit, Azienda Unita Sanitaria Locale-IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia, Italy (Menozzi, Cavazza, Ottani) Cardiovascular Department, Infermi Hospital, Rimini, Italy (Barbierato, Gallo) Unita Operativa Complessa Cardiologia, Ospedale dell'Angelo, Mestre, Italy (Arioti, Rubboli) Cardiology Department, S. Maria delle Croci Hospital, Ravenna, Italy (Bugani, Capecchi, Lanzilotti, Casella) Cardiology Unit, Ospedale Maggiore, Bologna, Italy (Scarsini) Cardiology Unit, Integrated University Hospital, Verona, Italy (D'Amario) Azienda Ospedaliero-Universitaria Maggiore della Carita, Dipartimento Toraco-Cardio-Vascolare, Unita Operativa Complessa di Cardiologia, Novara, Italy (Donazzan) Department of Cardiology, Ospedale Regionale San Maurizio, Bolzano, Italy (Polimeni) Division of Cardiology, Azienda Ospedaliera di Cosenza, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy (Giordan) Unit of Interventional Cardiology, Ospedale Santa Maria della Misericordia, Rovigo, Italy (Benatti) Division of Cardiology, Parma University Hospital, Parma, Italy (Venturi) Mater Salutis Hospital, Legnago, Italy (Ruozzi) Cardiology Unit, Ospedale Civile di Baggiovara, Modena, Italy (Moretti) Cardiology Unit, Azienda Socio-Sanitaria Territoriale-Ospedale Papa Giovanni XXIII, Bergamo, Italy (Monello) Cardiology Unit, Ospedale San Guglielmo da Saliceto, Piacenza, Italy (Moscarella) Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli, Naples, Italy (Leone) Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina-Gemelli Isola, Rome, United States (Tebaldi) Cardiology Unit, Infermi Hospital, Faenza, Italy (Piccolo) Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy (Martella) We4 Clinical Research, Milan, United States Abstract BACKGROUND: Complete coronary-artery revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, but the preferred strategy for identifying nonculprit lesions that warrant treatment remains uncertain. METHOD(S): In this international, randomized trial, we assigned patients with STEMI and multivessel disease in whom the culprit lesion had been successfully treated to undergo complete coronary-artery revascularization guided by functional coronary angiography (physiology-guided group) or by conventional angiography (angiography-guided group). The primary outcome was a composite of death from any cause, myocardial infarction, cerebrovascular accident (stroke or transient ischemic attack), or ischemia-driven revascularization, assessed in a time-to-event analysis. The primary safety outcome was a composite of contrast-associated acute kidney injury or major bleeding. RESULT(S): A total of 1823 patients underwent randomization; 913 were assigned to the physiology-guided group and 910 assigned to the angiography-guided group. The median age of the patients was 66 years (interquartile range, 58 to 76), and 24% were women. At a median follow-up of 17.9 months, a primary-outcome event had occurred in 81 patients (8.9%) in the physiology-guided group and in 125 patients (13.7%) in the angiography-guided group (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.83; P<0.001). A primary-safety-outcome event occurred in 42 patients (4.6%) in the physiology-guided group and in 65 patients (7.1%) in the angiography-guided group (hazard ratio, 0.63; 95% CI, 0.43 to 0.93; P = 0.02). CONCLUSION(S): In patients with STEMI and multivessel coronary artery disease, a strategy of complete coronary-artery revascularization guided by functional coronary angiography resulted in a lower risk of a primary-outcome event (death, myocardial infarction, cerebrovascular accident, or ischemia-driven revascularization) than a strategy guided by conventional angiography. (Funded by the Italian Health Ministry and others; AIR-STEMI ClinicalTrials.gov number, NCT05818475.). Copyright © 2026 Massachusetts Medical Society. <36> Accession Number 2044602284 Title Outcomes of robotically-assisted aortic valve surgery: A systematic review. Source Perfusion (United Kingdom). 41(6) (pp 850-859), 2026. Date of Publication: 01 Sep 2026. Author Leung H.F.A.; Erquiaga Y.; Caputo M.; Angelini G.D.; Vohra H.A. Institution (Leung, Erquiaga, Caputo, Angelini, Vohra) Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom (Caputo) School of Medicine, University of Auckland, Auckland, New Zealand Publisher SAGE Publications Ltd Abstract Introduction: Aortic valve disease is a noteworthy public health burden, with aortic valve surgery commonly being used to treat the condition. While aortic valve surgery is traditionally performed using an open approach involving median sternotomy, less invasive surgical methods have been developed over the years as an endeavour to improve surgical outcomes, such as the incorporation of robotic assistance. However, information and research regarding robotically-assisted aortic valve surgery remains scarce. Method(s): Through this original systematic review, which is the first of its kind, the outcomes of robotically-assisted aortic valve surgery were investigated. Ultimately, 26 papers involving a total of 362 cases were included in this study. Data items that directly relate to surgical outcomes were comprehensively recorded and tabulated. Result(s): Analyses of the data demonstrated that robotically-assisted aortic valve surgery is a feasible procedure with apparent safety and a relatively low risk for complications and adverse events. However, the level of existing evidence remains low due to several limitations including a lack of existing literature and potential publication bias. Conclusion(s): To accurately determine the safety profile of robotically-assisted aortic valve surgery and make meaningful comparisons between the procedure and other alternatives, future large-scale, multicenter cohort studies with comparators, or ideally randomised controlled trials followed by a meta-analysis of the results should be performed. Copyright © The Author(s) 2026 <37> Accession Number 2048601887 Title Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 520. Date of Publication: 01 Dec 2026. Author Yang J.; Liao T.; Luo J.; Ma A.; He J.; Li H.; Liu R.; Yu Y.; Peng J. Institution (Yang, Liao, Ma, He, Li) The College of Medicine, Kunming University of Science and Technology, Yunnan, Kunming, China (Yang, Liao, Ma, He, Li, Liu, Yu, Peng) Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Yunnan, Kunming, China (Luo) Department of Anaesthesiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Yunnan, Kunming, China Publisher BioMed Central Ltd Abstract Background: Opioids are frequently used in general anesthesia but may delay recovery owing to adverse effects, which include respiratory depression, postoperative nausea and vomiting (PONV), and opioid-induced hyperalgesia. Opioid-free anesthesia (OFA), based on multimodal analgesia, offers an alternative to mitigate these issues and enhance recovery in thoracic surgery. However, high-quality evidence confirming its effectiveness and safety is needed. Method(s): The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this study. PubMed, Web of Science, Embase, and Cochrane Library were systematically searched from inception to March 01, 2025, for randomized controlled trials (RCTs) that compared OFA and opioid-based anesthesia (OBA) in patients undergoing video-assisted thoracoscopic surgery (VATS). Study titles, abstracts, and full texts were separately evaluated for eligibility by two researchers; disagreements were resolved by discussion or a third researcher. The Cochrane Risk of Bias tool was used to evaluate the risk of bias in included studies. Primary outcomes included PONV incidence and 24-h postoperative pain scores. Secondary outcomes included chronic pain, intraoperative hemodynamic events, length of stay in the recovery room, length of hospitalization, and quality of recovery (as measured by QoR-40/QoR-15). Result(s): This systematic review and meta-analysis consisted of 10 RCTs involving 1,106 patients. OFA reduced the risk of PONV (risk ratio (RR) = 0.41, 95% confidence interval (CI): 0.380-0.665) and the incidence of postoperative chronic pain at 3 months (RR = 0.566, 95% CI: 0.347-0.925), compared with OBA. However, the 24-h postoperative pain scores did not differ (MD = 0.082, p = 0.305). Bradycardia incidence was lower in the OFA group, but hypotension rates did not differ. The length of stay in recovery rooms and the length of hospitalization did not differ significantly. Although 24-h QoR-40 scores favored OFA (mean difference = 2.914, 95% CI: 1.017-4.811), this improvement did not reach the clinically established threshold of 6.3 points. Conclusion(s): Without worsening intraoperative hemodynamic instability or extending postoperative recovery, OFA significantly reduced the incidence of PONV and chronic pain in patients undergoing VATS. These results validate OFA as a potentially safe and effective anesthetic strategy for improving postoperative recovery after thoracic surgery. Further large-scale RCTs are warranted to standardize OFA protocols and validate its long-term advantages. Trial registration: Registration of systematic reviews: CRD42025636410. Copyright © The Author(s) 2026. <38> Accession Number 2048930161 Title Mechanical versus bioprosthetic valves for tricuspid valve replacement in Chinese patients: a systematic review and meta-analysis. Source Journal of Thoracic Disease. 18(7) (pp 743), 2026. Date of Publication: 31 Jul 2026. Author Song J.; Zong X.; Hou J. Institution (Zong, Hou) Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, China (Song, Hou) Department of Cardiovascular Surgery, West China Tianfu Hospital of Sichuan University, Chengdu, China Publisher AME Publishing Company Abstract Background: Tricuspid valve replacement (TVR) is a critical intervention for severe tricuspid valve disease but carries high perioperative mortality. The optimal choice between mechanical and bioprosthetic valves remains controversial, and large-sample evidence specific to the Chinese population is lacking. This study aimed to systematically evaluate the clinical efficacy and safety of mechanical versus bioprosthetic valves in Chinese patients undergoing TVR. Method(s): PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP (VIP Database), Chinese Biomedical Literature Database (CBM), and the Chinese Medical Journal Database were searched from inception to December 31, 2025. Eligible study types included randomized controlled trials, prospective or retrospective cohort studies, and case-control studies comparing mechanical and bioprosthetic valves in Chinese TVR patients; case reports, reviews, and conference abstracts were excluded. Participants were Chinese patients (including China's mainland, Hong Kong, Macau, and Taiwan) undergoing TVR. The intervention of interest was TVR with a mechanical prosthesis versus a bioprosthesis. Risk of bias for cohort studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed with Review Manager 5.4.1, calculating relative risks for dichotomous outcomes and hazard ratios (HRs) for survival data. A fixed-effect model was used when I^2<50%; otherwise, a random-effects model was applied. Result(s): Eight retrospective cohort studies (1,504 patients: 537 mechanical, 967 bioprosthetic) were included. No statistically significant differences emerged between mechanical and bioprosthetic valves in early mortality [risk ratio (RR) 0.70, 95% confidence interval (CI): 0.48-1.02, P=0.06], long-term survival (HR 1.02, 95% CI: 0.57-1.84, P=0.94), or reoperation rate (RR 1.12, 95% CI: 0.61-2.05, P=0.72). Mechanical valves were associated with significantly higher risks of thromboembolic events (RR 2.09, 95% CI: 1.06-4.13, P=0.03) and bleeding events (RR 4.89, 95% CI: 3.12-7.72, P<0.00001). The rate of pacemaker implantation did not differ significantly between groups (RR 0.82, 95% CI: 0.44-1.53, P=0.54). Conclusion(s): In Chinese TVR patients, overall early and long-term survival as well as reoperation rates do not differ significantly between mechanical and bioprosthetic valves when analyzed across heterogeneous populations. However, this finding does not imply that valve type is unimportant for individual patients. However, mechanical valves significantly increase postoperative thromboembolic and bleeding complications. Clinical decision-making should be individualized, considering patient age, life expectancy, anticoagulation adherence, and bleeding risk. For Chinese patients with good life expectancy and reliable anticoagulation access, mechanical valves remain an option; for those with poor adherence or high bleeding risk, bioprosthetic valves may be safer. Copyright © AME Publishing Company. 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/. <39> Accession Number 2048943348 Title Comparative Study of 0.75% Hyperbaric Ropivacaine versus 0.75% Hyperbaric Ropivacaine with Clonidine for Lower Limb Surgeries under Spinal Anaesthesia. Source International Journal of Current Pharmaceutical Review and Research. 18(4) (pp 1274-1280), 2026. Date of Publication: 2026. Author Sripriyanka R.; Lalitha R.; Anoumandane A.; Ravi B. Institution (Sripriyanka, Anoumandane, Ravi) Department of Anaesthesia, ACS Medical College and Hospital, Tamil Nadu, Chennai, India (Lalitha) Department of Anaesthesia, Faith Multispeciality Hospital, Perambur, Tamil Nadu, Chennai, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Spinal anaesthesia remains a cornerstone technique for lower-limb surgeries, and optimizing the balance between rapid onset, prolonged analgesia, and hemodynamic stability continues to be an important area of clinical research. Objective(s): To compare the onset, duration, and quality of sensory and motor blockade, along with hemodynamic stability and adverse effects, between 0.75% hyperbaric ropivacaine alone and 0.75% hyperbaric ropivacaine with clonidine in patients undergoing lower-limb surgeries under spinal anaesthesia. Method(s): This single-centre, prospective, randomized controlled study was conducted in the Department of Anaesthesia, ACS Medical College and Hospital, Chennai, from April 2023 to April 2025, after obtaining IHEC approval (Ref: 816/2023/IEC/ACSMCH). Result(s): Both groups (n=60 each) were demographically and hemodynamically comparable at baseline, with similar age (38.7 +/- 10.1 vs 39.3 +/- 7.6 years), BMI (25.4 +/- 4.4 vs 26.3 +/- 5.1 kg/m2), and vitals (p > 0.05). After spinal anaesthesia, both groups showed transient reductions in heart rate and systolic blood pressure that returned to near-baseline by surgery end. Heart rate declined to 71.4 bpm in Group A and 75.5 bpm in Group B, while SBP reached nadirs of 109.0 mmHg and 103.5 mmHg, respectively. Group B exhibited significantly faster onset of sensory (4.1 min) and motor block (5.1 min), whereas Group L showed markedly longer sensory (263.8 min) and motor block (248.9 min) durations (both p < 0.001). Adverse events were more frequent in Group L (30.0% vs 8.3%, p = 0.007), mainly nausea, pruritus, and bradycardia, indicating a trade-off between prolonged analgesia and tolerability. Conclusion(s): Adding clonidine to 0.75% hyperbaric ropivacaine under spinal anaesthesia significantly prolonged sensory and motor blockade and delayed analgesic requirement but increased adverse events, whereas ropivacaine alone achieved a faster onset with fewer side effects, supporting regimen selection based on the desired balance between duration and tolerability. Copyright © 2026, This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. <40> Accession Number 2048321236 Title A protocol for the impact of Tongmai Jiangtang capsules on the risk of cardiovascular and cerebrovascular events in metabolic syndrome. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1817298. Date of Publication: 28 Jul 2026. Author Li A.; Ma Y.; Lu Q.; Liu C.; Zhou P.; Liang Q.; Tao Y.; Chen M.; Chen Z.; Luo F.; Lei X.; Liu S.; Long J.; Xiao H.; Cui C.; Ren Q.; Zhong T.; Liu J.; Fan G.; Liu Y.; Hui Z.; Chen Q.; Liu Z. Institution (Li, Lu, Liang, Tao, Long, Xiao, Cui, Ren, Liu, Zhong, Liu, Fan, Liu) Department of Endocrinology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (Li, Lu, Liang, Tao, Long, Xiao, Cui, Ren, Liu, Zhong, Liu, Fan, Liu) The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (Li, Lu, Liang, Tao, Long, Xiao, Cui, Ren, Liu, Zhong, Liu, Fan, Liu) Guangzhou University of Traditional Chinese Medicine, Guangzhou, China (Ma, Chen) First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China (Chen, Chen) Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China (Liu, Liu) The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (Zhou) Yinchuan Brain-Heart Integrated Internet Hospital Co., Ltd., Yinchuan, China (Luo, Hui) Shanxi Provincial Hospital of Chinese Medicine, Xi'an, China (Lei, Liu, Chen) Traditional Chinese Medicine Hospital of Sichuan Province, Sichuan, Chengdu, China Publisher Frontiers Media SA Abstract Background - Metabolic syndrome (MetS) significantly increases the risk of major adverse cardiovascular events (MACE), yet evidence-based complementary therapies remain limited. Tongmai Jiangtang Capsule (TJC), a traditional Chinese medicine (TCM) compound, has demonstrated benefits for glycolipid metabolism and microvascular complications, but its effect on hard cardiovascular and cerebrovascular (CCV) endpoints remains unconfirmed. Objective - To explore whether TJC, as an adjunctive therapy to standard care, reduces the incidence of MACE in patients with MetS and Qi deficiency-blood stasis syndrome. Methods - This is a randomized, double-blind, placebo-controlled, multicenter trial. A total of 530 participants aged >=65 years, diagnosed with MetS and the TCM pattern of Qi Deficiency and Blood Stasis, and at high CCV risk, will be enrolled. They will be randomly assigned (1:1) to receive either TJC or a matched placebo, in addition to standard care, for 26 weeks, followed by a 26-week follow-up. The primary endpoint is the composite of 3P-MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke). Secondary endpoints include metabolic parameters, vascular assessments, TCM symptom scores, and quality of life. Omics analyses will explore potential mechanisms. The trial was registered on ClinicalTrials.gov (NCT06908473). Discussion - This rigorously designed trial is expected to provide high-level evidence regarding the role of TJC in preventing CCV events in MetS. If positive, it will offer a novel, multi-target integrative treatment strategy. The findings will also advance the evidence-based evaluation of TCM compounds and contribute to chronic disease prevention goals. Regardless of the primary outcome, the mechanistic insights will inform future research on formula optimization and precision intervention. Clinical Trial Registration - https://clinicaltrials.gov/expert-search?term=NCT06908473, identifier, NCT06908473. Copyright © 2026 Li, Ma, Chen, Lu, Liu, Zhou, Liang, Tao, Chen, Chen, Luo, Lei, Liu, Long, Xiao, Cui, Ren, Liu, Zhong, Liu, Fan, Liu, Hui, Chen and Liu. <41> Accession Number 2048574854 Title The effects of animation-based education provided to older patients scheduled for coronary artery bypass graft surgery on patients' pain, fear, anxiety, and self-care management: A randomized controlled trial. Source Geriatric Nursing. 73 (no pagination), 2026. Article Number: 104257. Date of Publication: 01 Oct 2026. Author Yavuz A.S.P.I.R.G.A.I.P.; Karaman Ozlu Z. Institution (Yavuz) Ataturk University Research Hospital, Department of Cardiovascular Surgery, Erzurum, Turkey (Karaman Ozlu) Ataturk University, Nursing Faculty, Department of Surgical Nursing, Erzurum, Turkey Publisher Elsevier Inc. Abstract The present research was performed to evaluate the effects of animation-based education provided to older patients scheduled for coronary artery bypass graft surgery on patients' pain, fear, anxiety, and self-care management. The research was carried out using a randomized controlled experimental design, with the intervention group receiving animation-based education and the control group participating in the preoperative clinical routine practice. The research data were collected from patients aged 65 and older who were scheduled for coronary artery bypass graft surgery between April 2023 and January 2025. The study was completed with 72 patients undergoing coronary artery bypass graft surgery, including 35 in the intervention group and 37 in the control group. The intervention group had significantly lower mean scores on the Visual Analog Scale, Surgical Fear Questionnaire, and Hospital Anxiety and Depression Scale compared with the control group (p ' 0.05). In contrast, the intervention group demonstrated significantly higher scores on the Self-Care Management in Chronic Diseases Scale and its subscales than the control group (p ' 0.05). The findings indicate that animation-based education provided before coronary artery bypass graft surgery effectively reduced postoperative pain, fear, anxiety, and depression levels while improving self-care management among older adults. Therefore, animation-based education may be considered an effective nursing intervention to support perioperative care and postoperative recovery in older patients undergoing CABG surgery. Copyright © 2026 Elsevier Inc. <42> Accession Number 2046455211 Title Scar-specific outcomes following minimally invasive versus conventional median sternotomy in cardiac surgery: A systematic review and meta-analysis. Source Perfusion (United Kingdom). 41(6) (pp 814-828), 2026. Date of Publication: 01 Sep 2026. Author Chhatwal K.; On Chun Siu A.; Arab S.; Salih A.; Shah A.; Arjomandi Rad A.; Chong G.L.W.; Showkat M.; Punjabi S.; Punjabi P. Institution (Chhatwal, Arab, Salih, Showkat) School of Medicine, Imperial College London, London, United Kingdom (Chhatwal) National Heart and Lung Institute, Imperial College London, London, United Kingdom (On Chun Siu) Department of Cardiology, Royal Berkshire Hospital Foundation Trust, NHS England, London, United Kingdom (Arab) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Shah) Division of Medicine, University College London Medical School, London, United Kingdom (Arjomandi Rad) Department of Cardiothoracic Surgery, Oxford University Foundation Trust, NHS England, Oxford, United Kingdom (Chong) School of Medical Sciences, University of Birmingham, Birmingham, United Kingdom (Punjabi) Department of Dermatology, London North West Hospitals NHS Trust, London, United Kingdom (Punjabi) Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Publisher SAGE Publications Ltd Abstract Background: With improved cardiac surgical outcomes, attention has shifted to patient-centred outcomes, including cosmetic appearances of surgical scars. Minimally invasive cardiac surgery (MICS) is often promoted for its cosmetic benefits, yet empirical evidence remains limited. This study aimed to systematically evaluate scar-specific outcomes comparing MICS to conventional full median sternotomy (FMS) in adult cardiac surgery. Method(s): A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Embase, Central, and Scopus were searched from inception to August 2025. Studies comparing MICS to FMS, reporting scar-related patient-reported outcomes, wound complications, or cosmetic satisfaction, were included. The primary outcome was scar assessment using validated instruments. Random-effects models calculated standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals. Result(s): Twenty-two studies comprising 3131 patients (1459 MICS, 1672 FMS) met inclusion criteria. MICS demonstrated significantly better scar assessment scores (SMD -0.74, 95% CI -1.27 to -0.22; p < 0.01; I2 = 88%, six studies), higher patient satisfaction rates (RR 1.42, 95% CI 1.21-1.66; p < 0.001; I2 = 84%, 12 studies), and reduced wound complications (RR 0.31, 95% CI 0.20-0.47; p < 0.001; I2 = 0%, nine studies). Only six studies reported validated scar assessment scores, highlighting limited integration of these measures. Substantial heterogeneity was observed due to diverse assessment tools and surgical techniques. Conclusion(s): MICS can offer significant advantages in scar-specific outcomes compared to FMS in carefully selected patient populations. Cosmetic outcomes should be interpreted within the context of overall effectiveness and may support shared decision making only when clinical outcomes between surgical approaches are comparable. The lack of standardised scar assessment protocols and limited reporting of cosmetic outcomes represent critical gaps. Future research should prioritise standardised scar evaluation tools and expand cosmetic outcome reporting across all cardiac surgical procedures. Copyright © The Author(s) 2026 <43> Accession Number 2046311735 Title Comparison of Paravertebral Block and Erector Spinae Plane Block in Thoracotomy Using Nociception Level Index Monitoring: A Prospective Randomized Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3315-3322), 2026. Date of Publication: 01 Oct 2026. Author Yorukoglu H.U.; Cesur S.; Alparslan V.; Bulut M.; Aksu C.; Kus A. Institution (Yorukoglu, Cesur, Alparslan, Bulut, Aksu, Kus) Department of Anesthesiology and Reanimation, Kocaeli University, School of Medicine, Kocaeli, Turkey Publisher W.B. Saunders Abstract Objective: Paravertebral block (PVB) is considered the gold-standard regional technique for thoracotomy analgesia, whereas the erector spinae plane block (ESPB) has gained popularity. However, evidence comparing these 2 techniques in open thoracotomy remains inconsistent. The nociception level (NOL) index provides a more objective assessment of intraoperative nociception. This study aimed to compare the analgesic efficacy of preoperative PVB and ESPB during thoracotomy using NOL-guided opioid administration. Design(s): Prospective randomized clinical trial. Setting(s): Single tertiary-care university hospital. Participant(s): Fifty-seven patients who underwent elective thoracotomy surgeries were included in this study. Intervention(s): Patients were randomized to receive preoperative ultrasound-guided PVB or ESPB at the T5 level using 20 mL of 0.25% bupivacaine. Measurements and Main Results: Intraoperative opioid infusion rate was titrated with the NOL index. Intraoperative remifentanil and postoperative morphine consumptions, pain scores at rest and during coughing, rescue analgesic need, and adverse events were recorded. Intraoperative remifentanil consumption was significantly lower in the PVB group than in the ESPB group (431.4 +/- 287.7 mcg vs 863.6 +/- 385.5 mcg, p < 0.001). Total 24-hour postoperative morphine use was also lower in the PVB group (15.2 +/- 6.6 mg vs 20.1 +/- 6.6 mg, p = 0.002). Numeric rating scale (NRS) scores at rest were significantly lower in the PVB group at 9 and 12 hours, while NRS scores during coughing were significantly lower at all postoperative time points. Conclusion(s): In patients undergoing thoracotomy, PVB provided superior intraoperative and postoperative analgesia compared with ESPB, with significantly reduced opioid requirements and lower pain scores. Objective nociception monitoring with the NOL index demonstrated that ESPB may be insufficient for major thoracic surgery. Copyright © 2026 Elsevier Inc. <44> Accession Number 2045312583 Title Does Robot-Assisted Hybrid Coronary Revascularization Matter? Insights From a Single-Center Experience in Patient Quality of Life. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 21(3) (pp 241-249), 2026. Date of Publication: 01 May 2026. Author Bafageeh S.W.; Barnawi H.I.; Ashour M.A.; Alsulami M.M.; Aljefri Y.; Zabani I.; Khalil H.; Elamin O.; Jamjoom A.; AlUthman U. Institution (Bafageeh, Barnawi, Ashour, Elamin, Jamjoom, AlUthman) Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Bafageeh) Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia (Alsulami, Aljefri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Zabani) Department of Anesthesiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Khalil) Department of Cardiology, King Fahad General Hospital, Jeddah, Saudi Arabia Publisher SAGE Publications Ltd Abstract Objective: Coronary artery disease (CAD) significantly affects patient quality of life (QoL). Robot-assisted hybrid coronary revascularization (RHCR) emerged as a minimally invasive alternative to conventional coronary artery bypass grafting (CABG), offering enhanced recovery and improved QoL outcomes. This study evaluates the QoL outcomes of RHCR compared with conventional CABG preoperatively and 4 weeks and 6 months postoperatively using the validated 36-Item Short Form (SF-36) questionnaire. Method(s): This prospective study included 96 patients (48 RHCR, 48 CABG) with multivessel CAD treated at King Faisal Specialist Hospital between July 2018 and December 2020. QoL was assessed using the SF-36 questionnaire across 8 domains with scores obtained preoperatively and at 4 weeks and 6 months after surgery. Statistical analyses were conducted to compare changes between groups. Result(s): The RHCR group consistently reported higher scores for physical functioning and role limitations due to physical health, mental health, social functioning, and general health at all time points. At 4 weeks, RHCR patients experienced significantly better scores in physical functioning (75.4 vs 62.6, P < 0.001), social functioning (72.5 vs 64.2, P = 0.003), and bodily pain (76.8 vs 54.0, P < 0.001). At 6 months, RHCR maintained superiority in physical functioning (94.7 vs 88.0, P < 0.001), general health (84.1 vs 78.1, P = 0.020), and mental health (83.5 vs 75.4, P = 0.002). Conclusion(s): RHCR is associated with greater improvements in QoL compared with conventional CABG, particularly in domains related to physical functioning, role limitations due to physical health, and general health perception. Copyright © The Author(s) 2026 <45> Accession Number 2048643070 Title Premedication of Pediatric Cardiac Population with Midazolam: Comparison of Oral and Sublingual Administration Regarding Plasma Midazolam Concentration, Clinical Effectiveness, Hemodynamic and Behavioral Outcomes. Source Children. 13(8) (no pagination), 2026. Article Number: 1067. Date of Publication: 01 Aug 2026. Author Kousi T.; Karafotia A.; Karageorgos V.; Gkantinas G.; Sofianidou I.; Kanakis M.; Smina A.; Zergioti I.; Tamvakopoulos C.; Antoniou T. Institution (Kousi, Karafotia, Karageorgos, Gkantinas, Sofianidou, Antoniou) Department of Anesthesiology, Onassis Hospital Athens, Athens, Greece (Kanakis) Department of Congenital Cardiac Surgery, Onassis Hospital Athens, Athens, Greece (Smina, Tamvakopoulos) Center for Clinical, Experimental Surgery and Translational Research, Pharmacology-Pharmacotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece (Zergioti) School of Applied Mathematical and Physical Sciences, National Technical University of Athens, Heroon Polytehneiou 9, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Midazolam is widely used as a pediatric premedication, but evidence from direct comparisons of oral and sublingual administration in children with congenital heart disease remains limited, particularly that from pharmacokinetic and physiologic data analyzed together. Method(s): We conducted a single-center prospective randomized study comparing oral midazolam 0.5 mg/kg with sublingual midazolam 0.3 mg/kg in children undergoing cardiac surgery or catheterization procedures under general anesthesia. Plasma midazolam and 1-hydroxymidazolam concentrations were measured approximately 30 min after administration. Log-transformed concentrations were compared using regression/ANCOVA models adjusted for dose and age. Changes in mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO<inf>2</inf>) were analyzed from baseline to 15 and 30 min. Behavioral outcomes included the sedation score, separation from parents, and mask acceptance. Result(s): Sixty-eight children were randomized; 65 had evaluable pharmacokinetic samples and formed the complete-case pharmacokinetic cohort. Adjusted plasma midazolam concentrations did not differ significantly between the groups, with an adjusted geometric mean ratio for sublingual versus oral administration of 0.98 (95% CI 0.53-1.79; unadjusted p = 0.940; Holm-adjusted p = 1.000). The corresponding ratio for 1-hydroxymidazolam was 1.37 (95% CI 0.55-3.41; unadjusted p = 0.494; Holm-adjusted p = 1.000). HR and SpO<inf>2</inf> changes were non-significant between the groups. At 30 min, sublingual administration was associated with a lower adjusted change in MAP compared with oral administration (adjusted difference -12.08 mmHg, 95% CI -19.74 to -4.42; unadjusted p = 0.002, Holm-adjusted p = 0.012). Behavioral outcomes did not differ significantly between the groups. Conclusion(s): In this prospective randomized pediatric cardiac cohort, oral midazolam 0.5 mg/kg and sublingual midazolam 0.3 mg/kg produced comparable plasma concentrations and similar behavioral outcomes. Sublingual administration was not associated with worse HR or SpO<inf>2</inf> responses, although an isolated lower MAP change at 30 min warrants confirmation in larger studies. Sublingual midazolam may represent a feasible lower-dose alternative for premedication in this population. Copyright © 2026 by the authors. <46> Accession Number 2048961499 Title Should Left Atrial Appendage Occlusion Devices Be Routinely Used Instead of Oral Anticoagulants to Prevent Thromboembolic Events, Stroke, and Bleeding for Patients With Non-Valvular Atrial Fibrillation?. Source Journal of Cardiovascular Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Kantharia B.K.; Slee A.; Olshansky B. Institution (Kantharia) Cardiovascular and Heart Rhythm Consultants, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Slee) New Arch Consulting LLC, Seattle, WA, United States (Olshansky) Francois M. Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, United States Publisher John Wiley and Sons Inc Abstract Introduction: Oral anticoagulants (OACs), preferably direct (D)/non-vitamin K (N) dependent OACs [DOACs/NOACs] are recommended for the management of patients with non-valvular atrial fibrillation (AF) at risk for thromboembolic events, including stroke. Left atrial appendage occlusion (LAAO) device implantation has been considered for patients who are unsuitable for OACs or prefer not to take them. Herein, we discuss the clinical evidence for routine use of LAAO instead of OACs for patients with AF at risk of thromboembolic events, stroke, and bleeding. Method(s): From pertinent, recent, randomized clinical trials, the CHAMPION-AF (Watchman Flx vs. NOAC for Embolic Protection in the Management of Patients with Non-Valvular Atrial Fibrillation), and CLOSURE-AF (Catheter-Based Left Atrial Appendage Closure in Patients with Atrial Fibrillation at High Risk of Stroke and Bleeding as Compared with Best Medical Therapy) were selected for review. Result(s): As interpreted by the authors of the CHAMPION-AF trial, LAAOs were considered non-inferior to NOACs at 3 years. In the CLOSURE-AF trial, non-inferiority criteria were not met. For safety, that is, bleeding, LAAO was considered superior in CHAMPION-AF. We found several points related to both trials that are critical to interpret the results and clinical implications of these trials. These points are particularly related to the interpretation of non-inferiority trial design, selection bias, combined primary endpoint, bleeding and peri-procedural bleeding complications, serious adverse events, cross-over rates, sub-group analyses, conflicts of interest, and mechanism of stroke. Conclusion(s): Data from the CHAMPION-AF and CLOSURE trials do not favor routine and widespread use of LAAO devices in non-valvular AF patients over use of OACs. Copyright © 2026 Wiley Periodicals LLC. <47> Accession Number 2048684643 Title COMPARATIVE STUDY OF USG GUIDED SERRATUS ANTERIOR PLANE BLOCK AND ERECTOR SPINAE PLANE BLOCK IN PATIENTS POSTED FOR OFF PUMP CORONARY ARTERY BYPASS GRAFTING SURGERIES. Source International Journal of Drug Delivery Technology. 16(77 Supplement) (pp 386), 2026. Date of Publication: 2026. Author Ponkiya D.A.; Kanase N.; Madanaik S.; Dimble K. Institution (Ponkiya, Kanase, Madanaik, Dimble) Dept of Anaesthesia, Krishna Institute of Medical Sciences Karad Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Effective perioperative analgesia is essential in patients undergoing off-pump coronary artery bypass grafting (OPCABG) to reduce opioid consumption and enhance postoperative recovery. Ultrasound-guided fascial plane blocks such as the erector spinae plane (ESP) block and serratus anterior plane (SAP) block have emerged as useful regional anesthesia techniques for thoracic and cardiac surgeries. This study aimed to compare the analgesic efficacy of ESP block and SAP block in patients undergoing OPCABG. Method(s): This prospective, randomized, double-blinded study was conducted in the Department of Anaesthesiology at Krishna Hospital and Medical Research Centre, Karad, Maharashtra. A total of 84 adult patients scheduled for elective OPCABG were randomly allocated into two groups (n=42 each). Group A received ultrasound-guided bilateral ESP block and Group B received ultrasound-guided bilateral SAP block with 30 mL of 0.25% ropivacaine. The primary outcome was total intraoperative fentanyl consumption. Secondary outcomes included postoperative pain scores assessed using the Visual Analogue Scale (VAS), time to first rescue analgesia, total opioid consumption within 24 hours, postoperative recovery parameters, complications, and patient satisfaction. Result(s): In the present study, the ESP group demonstrated significantly lower VAS scores at 6 and 12 hours postoperatively, a longer time to first rescue analgesia (362.4 +/- 85.7 vs 241.6 +/- 72.3 minutes), fewer rescue analgesic doses, and lower total opioid consumption within the first 24 hours (p < 0.001). Additionally, patients in the ESP group showed earlier extubation, shorter duration of mechanical ventilation, earlier ambulation, a lower incidence of postoperative nausea and vomiting, and higher patient satisfaction compared to the SAP group. Conclusion(s): Ultrasound-guided ESP block provides superior perioperative analgesia, reduces opioid requirement, and improves postoperative recovery compared to SAP block in patients undergoing OPCABG surgery. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <48> Accession Number 2048622172 Title Multidrug-resistant donor-derived infections in solid organ transplantation: a systematic review and meta-analysis of transmission risk factors. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101052. Date of Publication: 01 Dec 2026. Author Lopes C.A.; Mari J.F.; Abdala E.; de Oliveira V.F.; Freire M.P. Institution (Lopes, Mari, Abdala, de Oliveira, Freire) Department of Infectious Diseases and Tropical Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Abdala, de Oliveira, Freire) Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (de Oliveira) Centres for Antimicrobial Optimisation Network (CAMO-Net), Sao Paulo, Brazil Publisher Elsevier Inc. Abstract Purpose: Donor-derived infections (DDIs) caused by multidrug-resistant organisms (MDROs) are rare but potentially devastating complications of solid organ transplantation (SOT), with limited evidence on transmission risk and clinical outcomes. Method(s): We conducted a systematic review in accordance with PRISMA 2020 guidelines, including case reports, case series, and cohorts describing SOT donors with MDRO that reported recipient's infection outcomes (1999-2025). Individual-level data were extracted when available. Meta-analyses of proportions were performed, and bivariable and multivariable logistic regression models were used to identify factors independently associated with DDI and mortality. Result(s): 46 studies comprising 435 donors and 544 transplants were included. Kidney (43.8%), lung (29.2%), and liver transplants (22.7%) were the most frequent. Carbapenem-resistant Enterobacterales (38.9%) predominated in donor isolates. The overall transmission rate was 26.6% (IC95%: 14.3-44.2) despite targeted antimicrobial prophylaxis in 86.5% of high-risk recipients. In multivariable analyses, positive preservation fluid (PF) cultures (p < 0.001), high-risk donor's cultures (p < 0.001), and liver transplantation (p = 0.02) were independently associated with increased transmission, whereas positive culture at screening donation (p < 0.001) and carbapenem resistant Acinetobacter baumannii (p = 0.02) isolation was associated with a lower risk of transmission. Respiratory donor cultures (p = 0.006) were independently associated with transmission in lung transplant-specific models. Conclusion(s): MDRO in SOT donors are associated with high transmission rates. PF for all SOT and respiratory cultures in lung transplant are key predictors of transmission, supporting organ- and site-specific donor screening and microbiological surveillance to mitigate transmission. Copyright © 2026 The Authors <49> Accession Number 2047714529 Title Prognostic value of late gadolinium enhancement in peripartum cardiomyopathy: a systematic review and meta-analysis. Source Future Cardiology. 22(8) (pp 885-892), 2026. Date of Publication: 2026. Author Nurhafizah A.; Huang W.; Kezia C.; Fathoni M.I.; Zahrani R.A.F.; Samban S.A.; Atmojo S. Institution (Nurhafizah, Huang, Kezia, Fathoni, Zahrani, Samban) Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia (Atmojo) Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Publisher Taylor and Francis Ltd. Abstract Background: Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition occurring during late pregnancy or the postpartum period. Although late gadolinium enhancement (LGE) has prognostic value in other cardiomyopathies, its role in PPCM remains unclear. This study aimed to evaluate the prognostic significance of LGE in PPCM. Method(s): Three electronic databases were systematically searched to identify studies assessing the association between LGE and clinical outcomes in PPCM. Outcomes included reduced left ventricular ejection fraction (LVEF), arrhythmia, heart failure decompensation, device implantation, transplantation, and mortality. Pooled hazard ratios were calculated using the generic inverse variance method. Result(s): Eight cohort studies involving 227 patients were included. The mean age was 32.2 +/- 6.6 years and mean LVEF was 30.5%. The pooled hazard ratio analysis revealed that LGE was significantly associated with poor outcomes (HR 1.34, CI 1.04-1.73 I2 = 52%, p = 0.02). Further analysis demonstrated that LGE was strongly linked to adverse clinical outcomes (HR 2.95, CI 1.62-5.37, I2 = 0%, p = 0.004), whereas no significant association was observed with persistently reduced LVEF (HR 1.11, CI 0.85-1.45, I2 = 14%, p = 0.45). Conclusion(s): LGE is associated with poor outcomes in PPCM and may provide complementary prognostic value for risk stratification. Protocol Registration: www.crd.york.ac.uk/prospero identifier is CRD42024568502. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <50> Accession Number 2048930249 Title Targeted intrapleural analgesia through an integrated chest tube after thoracoscopic lung resection: a randomized controlled trial. Source Journal of Thoracic Disease. 18(7) (no pagination), 2026. Article Number: 796. Date of Publication: 31 Jul 2026. Author Tang H.; Lu J.; Wei S.; Ren Y.; Li Q.; Wang L.; Liu X.; Liu J.; Song J.; Chen C.; Hu X. Institution (Tang, Lu, Ren, Li, Liu, Chen, Hu) Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China (Wei, Wang, Liu, Song) Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China (Wei) Outcomes Research Consortium, Houston, TX, United States (Wang) Department of Anesthesiology, Shanghai Shidong Hospital, Shanghai, China Publisher AME Publishing Company Abstract Background: Chest drains are a major contributor to postoperative pain after thoracoscopic lung resection. Localized intrapleural analgesia delivered through the drain itself may provide targeted pain control without additional catheters. This study evaluated whether a drainage-analgesia integrated (DAI) chest tube improves postoperative analgesia after video-assisted thoracoscopic surgery (VATS). Method(s): In this prospective single-center, open-label randomized trial, 47 patients undergoing VATS were allocated to receive either a DAI chest tube (n=22) or standard drainage (STD) chest tube (n=25). Both groups received identical multimodal systemic analgesia, including intravenous patient-controlled analgesia (PCA) with a continuous background sufentanil infusion. The primary endpoint was the visual analog scale (VAS) pain score at 24 hours. The secondary outcomes included PCA activation frequency, sufentanil consumption, drainage outcomes, adverse events, and Quality of Recovery-15 (QoR-15) scores. Result(s): Compared with the STD group, the DAI group had lower VAS pain scores at 24 and 48 hours after surgery (P<0.05). Total sufentanil consumption was similar between the two groups (P=0.49); however, the number of PCA activations was lower in the DAI group than in the STD group (0.1+/-0.4 vs. 0.9+/-1.1; P=0.004). QoR-15 scores at 48 hours were higher in the DAI group than in the STD group, indicating improved patient-reported recovery. No device-related complications were observed. Conclusion(s): In this open-label randomized trial conducted under a standardized background sufentanil PCA regimen, intrapleural local anesthetic delivery through an integrated chest tube was associated with lower early postoperative pain scores and fewer PCA activation attempts. This strategy may represent a simple approach for targeted analgesia within enhanced recovery after surgery (ERAS) pathways for thoracic surgery. Copyright © AME Publishing Company. 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/. <51> Accession Number 2048693681 Title Local Recurrence After Lung Segmentectomy-Risk Factors and Future Directions: A Contemporary Review. Source Cancers. 18(16) (no pagination), 2026. Article Number: 2649. Date of Publication: 01 Aug 2026. Author Buzas A.; Egyed K.; Furak J. Institution (Buzas) National Koranyi Institute of Pulmonology, Department of Thoracic Surgery, Budapest, Hungary (Egyed) Department of Anaesthesiology and Intensive Therapy, Pest County Flor Ferenc Hospital, Kistarcsa, Hungary (Furak) Department of Surgery, Thoracic Surgery, University of Szeged, Szeged, Hungary Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Anatomical segmentectomy has increasingly emerged as an accepted surgical strategy for selected patients with early-stage non-small cell lung cancer (NSCLC), particularly following the JCOG0802/WJOG4607L and CALGB/Alliance 140503 randomized trials. Although these studies demonstrated oncologic equivalence-or even superiority in overall survival-compared with lobectomy in carefully selected tumors, concerns persist regarding increased locoregional recurrence after segmentectomy. Recent evidence suggests that recurrence is influenced not only by surgical technique but also by tumor biology, radiological characteristics, nodal assessment, and patient-specific factors. Method(s): This narrative review critically summarizes contemporary evidence regarding local recurrence after anatomical segmentectomy for early-stage NSCLC. A literature review was performed using PubMed/MEDLINE database and recent thoracic surgical literature published primarily from 2015 onwards. Randomized trials, prospective and retrospective studies, meta-analyses, and expert consensus statements were included, with particular focus on recurrence patterns, tumor biology, radiological features, surgical factors, lymph node assessment, and emerging technologies. Result(s): Segmentectomy provides comparable overall survival to lobectomy in selected patients with small peripheral NSCLC; however, locoregional recurrence remains more frequent after segmentectomy. Major predictors of recurrence include pure-solid radiological appearance, high consolidation-to-tumor ratios, larger tumor size, STAS positivity, lymphovascular invasion, aggressive adenocarcinoma subtypes, inadequate lymph node assessment, and insufficient surgical margins. Hypermetabolic tumors on PET imaging and occult nodal disease further increase recurrence risk. Several studies identified delayed recurrence patterns occurring beyond 5 years after surgery. Conclusion(s): Local recurrence remains the principal oncologic limitation of segmentectomy. Contemporary evidence supports a shift from size-based toward biology-driven surgical decision-making integrating tumor morphology, metabolic activity, histopathological aggressiveness, STAS status, and nodal involvement into surgical planning. Copyright © 2026 by the authors. <52> Accession Number 2048611102 Title Health-Related Quality of Life in Patients Undergoing Cardiac Surgeries in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 4261303. Date of Publication: 2026. Author Wang S.; Tabrizi N.S.; Wang E.Y.; Min J.; Musoni M.; Lin Y. Institution (Wang) Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States (Tabrizi) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, United States (Wang) Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States (Min) Department of Surgery, Stanford University, Palo Alto, CA, United States (Musoni) Department of Cardiothoracic Surgery, King Faisal Hospital, Kigali, Rwanda (Lin) Department of Cardiothoracic Surgery, Univeristy of Washington, Seattle, WA, United States Publisher John Wiley and Sons Inc Abstract Objective: Health-related quality of life (HRQoL) assessment is pivotal for advancing sustainable global cardiac surgery. However, the use and applicability of HRQoL instruments in low- and lower-middle-income countries (LI-LMICs) remain poorly characterized. Method(s): A systematic review of studies assessing HRQoL among patients undergoing cardiac surgery in LI-LMICs was performed using PubMed/MEDLINE, Embase, Scopus, Global Index Medicus, and CABI Global Health. Primary outcomes included the prevalence and types of HRQoL instruments adopted. A meta-analysis of pooled HRQoL scores was performed to examine the impact of cardiac surgery. Result(s): Thirty-eight studies comprising 12,397 patients from seven countries were identified. Most studies were conducted in Iran (21, 55%) or India (7, 18%); only one study (2.6%) originated from a LIC (Rwanda). Generic HRQoL instruments predominated (28/41, 68%), most commonly the Short Form-12/36 (SF-12/36; 20, 49%) and the World Health Organization Quality of Life (WHOQOL) or WHOQOL Brief (WHOQOL-BREF) (4, 9.8%). Cardiac surgery was associated with significant postoperative improvements in HRQoL, including physical (standardized mean difference [SMD]:1.17; 95% CI 0.83-1.51; p < 0.0001) and mental (0.78; 95% CI 0.47-1.09; p < 0.0001) component scores measured by SF-12/36. Significant improvements were also observed across WHOQOL domains: physical (0.84; 95% CI 0.51-1.08; p < 0.0001), psychological (0.54; 95% CI 0.32-0.75; p < 0.0001), social (0.33; 95% CI 0.12-0.53; p = 0.002), and environmental (0.34; 95% CI 0.14-0.55; p = 0.001). Conclusion(s): The use of validated and culturally appropriate HRQoL instruments is crucial for assessing patient-centered outcomes in global cardiac surgery. Although significant improvements in HRQoL following cardiac surgery were observed in LI-LMICs, fewer than 9% of LI-LMICs were represented in the existing literature, highlighting a substantial gap in outcome assessment of global cardiac surgery. Copyright © 2026 Songnan Wang et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <53> Accession Number 2048582312 Title Guidelines Versus Practice: Decision-Making and Outcomes of Transcatheter Aortic Valve Replacement in Patients Younger Than 65. Source American Journal of Cardiology. 276 (pp 1-3), 2026. Date of Publication: 01 Oct 2026. Author Berhanu S.; Jacquemyn X.; Hasan I.; Serna-Gallegos D.; Kliner D.; Toma C.; Makani A.; West D.; Ferdinand F.; Ogami T. Institution (Berhanu, Jacquemyn, Hasan, Serna-Gallegos, Kliner, Toma, Makani, West, Ferdinand, Ogami) UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Berhanu, Jacquemyn, Hasan, Serna-Gallegos, Kliner, Toma, Makani, West, Ferdinand, Ogami) Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States Publisher Elsevier Inc. <54> [Use Link to view the full text] Accession Number 2044629952 Title Postoperative Cognitive Dysfunction and Analgesic Outcomes in Cardiac Surgery: Evaluating the Role of Nerve Block Techniques. Source Clinical Journal of Pain. 42(8) (no pagination), 2026. Article Number: e1388. Date of Publication: 01 Aug 2026. Author Yan M.; Wang K.; Yan H.; Yuan S. Institution (Yan, Wang, Yan, Yuan) Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Beijing, China Publisher Lippincott Williams and Wilkins Abstract Objective: - Cardiac surgery frequently induces moderate to severe postoperative pain that impedes recovery and elevates the risk of opioid dependence and postoperative cognitive dysfunction. This review aims to outline peripheral nerve block approaches in cardiac surgery and examine their analgesic efficacy and potential relationship with postoperative cognitive dysfunction. Material(s) and Method(s): - A comprehensive literature search was performed using the electronic databases PubMed, EMBASE, and Google Scholar for publications up to September 2025. Search terms included regional anesthesia, nerve block, pain management, delirium, cognitive dysfunction, and cardiac surgery. The retrieved literature, including clinical reviews, basic research, clinical trials, and guidelines, was screened and prioritized based on thematic relevance and the strength of clinical evidence. The available evidence was synthesized into a narrative review. Result(s): - The evidence suggests that nerve blocks are an effective component of a multimodal analgesic strategy, significantly reducing postoperative opioid consumption and attenuating neuroinflammatory responses such as microglial activation. However, they have not been conclusively shown to reduce the incidence of postoperative cognitive dysfunction. Current implementation faces challenges, including a lack of technique standardization and the need to adapt to heterogeneous surgical anatomies. Discussion(s): - Nerve blocks are valuable for opioid-sparing analgesia and may modulate neuroinflammation, but their role in preventing postoperative cognitive dysfunction remains unproven. Future efforts should focus on standardizing protocols and conducting mechanistic studies to clarify the relationship between nerve blocks, neuroinflammatory modulation, and long-term neurological outcomes. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. <55> [Use Link to view the full text] Accession Number 2044294951 Title Stroke Risk After Bioprosthetic Aortic Valve Replacement in Aortic Stenosis: Systematic Review and Meta-Analysis. Source Stroke. 57(6) (pp 1643-1657), 2026. Date of Publication: 20 Mar 2026. Author Bou Dargham T.; Hassani S.; Mac Grory B.; Daubert M.A.; Ryan D.; Truong T.; Moumneh M.B.; Kaplan S.J.; Feng W.; El Husseini N. Institution (Bou Dargham) Department of Neurosurgery (T.B.D.), Duke University School of Medicine, Durham, NC, United States (Mac Grory, Ryan, Feng, El Husseini) Department of Neurology, Duke University School of Medicine, Durham, NC, United States (Daubert) Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States (Truong) Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, United States (Kaplan) Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, United States (Hassani) Department of Neurology, Feinberg School of Medicine Northwestern University, Chicago, IL, United States (Moumneh) Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States Publisher Wolters Kluwer Health Abstract BACKGROUND: - Stroke is a possible complication after bioprosthetic aortic valve replacement (AVR) for severe aortic stenosis (AS), impacting morbidity and mortality. Accurate estimates of the proportion of individuals who experience stroke within and beyond the periprocedural period after transcatheter AVR (TAVR), surgical AVR, and valve-in-valve (ViV) replacement are essential for management and prognostication. The objective was to determine the proportion of adults aged >18 who experienced an ischemic stroke after bioprosthetic AVR for AS. METHOD(S): - A systematic search of MEDLINE, Embase, and Web of Science was conducted from database inception through March 2024. Studies reporting on stroke rates at least 90 days after bioprosthetic AVR for severe AS, including ViV procedures, and meeting predefined eligibility criteria were included. The pooled proportion of individuals experiencing a stroke was estimated for TAVR and ViV procedures, whereas comparative analyses between TAVR and surgical AVR were performed using mixed-effects models in studies directly comparing both procedures. RESULT(S): - Twenty-seven studies were included in the native AS treatment cohort, and 5 in the ViV subanalysis. In native AS, the pooled 30-day proportion of individuals who had a stroke after TAVR was 3.0% (95% CI, 2.5-3.9), with different studies reporting major and minor stroke proportions of 1.7% each. At 1 year, all stroke proportion was 5.0% (95% CI, 4.0-6.0), major stroke was 3.0%, and minor stroke was 2.0%. Comparative analysis demonstrated that TAVR was associated with significantly lower odds of all stroke at 30 days compared with surgical AVR (odds ratio, 0.73 [95% CI, 0.57-0.93]). No significant difference in the proportions of individuals who had a stroke was observed in TAVR versus surgical AVR at 1, 2, or 5 years. In the ViV cohort, the pooled 30-day and 1-year all stroke proportion after ViV was 2.0% (95% CI, 1.0-3.0) and 3.0% (95% CI, 2.0-6.0), respectively. CONCLUSION(S): - This meta-analysis provides updated estimates of stroke after bioprosthetic AVR for AS, capturing risk beyond the early periprocedural period. Future studies should investigate the causes of long-term stroke post-AVR, the effects of different antithrombotic therapies on the risk of stroke, as well as the potential impact of these procedures on short and long-term cognitive function. Copyright © 2026 American Heart Association, Inc. <56> Accession Number 2048765456 Title The Long-Term Impact of a Teleprehabilitation Programme on Modifiable Risk Factors and Quality of Life After Cardiac Surgery. Source European Journal of Cardio-thoracic Surgery. 68(8) (no pagination), 2026. Article Number: ezag207. Date of Publication: 01 Aug 2026. Author van Susante L.; Janssen L.; Bidar E.; Slooter G.; Sardari Nia P. Institution (van Susante, Bidar, Sardari Nia) Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, Netherlands (van Susante, Janssen, Slooter) Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands (van Susante, Bidar, Sardari Nia) Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands Publisher European Association for Cardio-Thoracic Surgery Abstract Objectives: To assess the long-term effects of teleprehabilitation on modifiable risk factors and quality of life up to 1 year following elective cardiac surgery. Method(s): This secondary analysis of the Digital Cardiac Counselling trial, a randomized controlled trial, compared multimodal teleprehabilitation with standard care in patients undergoing elective cardiac surgery. The teleprehabilitation programme targeted physical fitness, inspiratory muscle training, psychological support, nutritional optimization, and smoking cessation. Outcomes included trajectories of modifiable risk factors and quality of life measured preoperatively and at 3, 6, and 12 months postoperatively. Generalized linear mixed models assessed differences over time between groups, with exploratory post hoc analyses for individual timepoints. Result(s): Both groups showed postoperative reductions in all assessed modifiable risk factors and improvements in quality of life over time (P < .001), except for nutritional optimization (P = .173). Teleprehabilitation was associated with more favourable trajectories for smoking behaviour (P = .045) and nutritional risk (P = .011), with consistently lower incidences throughout follow-up. Smoking prevalence remained significantly lower in the teleprehabilitation group at all timepoints (P < .05), while malnutrition prevalence was lower at 3 months postoperatively (P = .012). Quality-of-life scores were consistently higher in the teleprehabilitation group throughout follow-up (P = .002). Conclusion(s): Teleprehabilitation in cardiac surgery patients not only reduces postoperative complications, but may also provide additional long-term benefits, particularly in smoking cessation, nutritional optimization, and quality of life. These findings support teleprehabilitation as a valuable addition to standard preoperative care, with possible sustained benefits for long-term lifestyle and quality of life. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <57> Accession Number 2047692640 Title Heparin Dose-Response Curve for Heparin Dose Determination During Cardiopulmonary Bypass for Pediatric Cardiac Surgery: A Prospective Randomized Controlled Study. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3287-3294), 2026. Date of Publication: 01 Oct 2026. Author Gokhale P.; Hasija S.; Choudhury A.; B S.G.; Yadav M.; Chauhan S. Institution (Gokhale, Hasija, Choudhury, Chauhan) Department of Cardiac Anaesthesia and Critical Care, AIIMS, New Delhi, India (B, Yadav) Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi, India Publisher W.B. Saunders Abstract Objectives: To determine whether individualized heparin dosing guided by a heparin dose-response (HDR) curve is noninferior to conventional weight-based dosing in achieving target activated clotting time (ACT) of >=480 seconds before cardiopulmonary bypass (CPB) and to compare total heparin and protamine requirements, postoperative blood loss, and transfusion needs in children younger than 14 years undergoing cardiac surgery with cardiopulmonary bypass support. Design(s): Single-center, prospective, double-blinded, randomized controlled trial. Setting(s): Cardiothoracic operating theaters and intensive care unit of a tertiary care hospital in India. Participant(s): Pediatric (<14 years) patients undergoing elective cardiac surgery with CPB support. Intervention(s): The HDR group received an initial test dose of 100 IU/kg of heparin, and an individualized ACT dose-response curve was constructed to determine the dose required to target an ACT of 480 seconds. Controls received standard 400 IU/kg of heparin. Protamine was given post-CPB per protocol in both groups. Measurements and Main Results: In this noninferiority trial, HDR-guided anticoagulation was assessed against conventional weight-based dosing for first-pass attainment of ACT >=480 seconds before CPB. Target ACT was achieved in 72.2% (26/36) of HDR patients versus 83.3% (30/36) of controls (p = 0.396). Although HDR was associated with lower heparin exposure (260 v 420 IU/kg; p < 0.001) and protamine use (4.1 v 4.8 mg/kg; p = 0.002), as well as reduced 24-hour blood loss (5.2 v 6.5 mL/kg; p = 0.03) and packed red blood cell transfusion (6.8 v 8.2 mL/kg; p = 0.04), it did not demonstrate superior first-attempt ACT attainment. Conclusion(s): HDR-guided heparinization reduced heparin and protamine exposure and was associated with less bleeding and transfusion, but it did not improve first-pass ACT attainment. Because ACT is an imperfect surrogate for anticoagulant adequacy in children on CPB, these findings should be interpreted as ACT-guided dosing data rather than proof of equivalent anticoagulation. Larger multicenter studies with mechanistic and clinical endpoints are needed to confirm these results. Copyright © 2026 Elsevier Inc. <58> Accession Number 2048228800 Title Cost-effectiveness analysis of total intravenous vs. inhalation anaesthesia among adults aged >= 50 y undergoing major non-cardiac surgery. Source Anaesthesia. 81(10) (pp 1378-1385), 2026. Date of Publication: 01 Oct 2026. Author Frempong S.; Kandiyali R.; Mason J.; Hiller L.; Dunn J.; Booth K.; Moonesinghe R.; Pearse R.; Shelley B.; Jhanji S.; Yeung J. Institution (Frempong, Kandiyali, Mason) Centre of Health Economics, University of Warwick, Coventry, United Kingdom (Hiller, Dunn, Booth, Yeung) Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom (Moonesinghe) Department of Targeted Intervention, University College London, London, United Kingdom (Pearse) Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom (Shelley) School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom (Jhanji) Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London, United Kingdom (Jhanji) Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom Publisher John Wiley and Sons Inc Abstract Introduction: Total intravenous and inhalational anaesthesia are used widely to maintain general anaesthesia for major non-cardiac surgery, yet their comparative cost-effectiveness remains uncertain. The VITAL trial evaluated clinical outcomes, showing no difference in days alive and at home at 30 days. We conducted an economic evaluation alongside VITAL to determine whether total intravenous anaesthesia offers an economic advantage within the UK NHS. Method(s): A within-trial economic evaluation was conducted from the NHS and personal social services perspective over a 6-month time horizon. Resource use was collected from trial records and questionnaires, and health-related quality of life was measured using EuroQol five-dimension five-level instrument at baseline, discharge, 30 days and 6 months. Costs were evaluated using national sources and quality-adjusted life years were calculated using the area under the curve approach. Incremental cost-effectiveness ratios were estimated using imputed datasets, with uncertainty explored through bootstrapping and the probability of cost-effectiveness illustrated using a cost-effectiveness acceptability curve across a range of willingness-to-pay thresholds. Result(s): A total of 2507 patients were allocated randomly: 1253 (50%) received total intravenous anaesthesia; and 1254 (50%) inhalational anaesthesia. Mean costs and quality-adjusted life years were similar across groups. Incremental cost was -145 (95%CI -1510-1220) and incremental quality-adjusted life years -0.001 (95%CI -0.008-0.005). Total intravenous anaesthesia showed a 56-57% probability of cost-effectiveness at standard willingness-to-pay thresholds. Sensitivity analyses, including complete-case and societal-perspective models, yielded consistent findings of equivalence. Discussion(s): Total intravenous and inhalational anaesthesia show comparable cost-effectiveness for adults aged >= 50 y undergoing major non-cardiac surgery. Given clinical equipoise and equivalent economic outcomes, anaesthetic choice should continue to be guided by patient factors, clinician expertise and organisational context. Further research may be justified given the large population undergoing major surgery. Copyright © 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. <59> Accession Number 2046508544 Title Early Enteral Levothyroxine as Rescue Therapy in Cardiac Surgery Patients With Delayed Neurologic Recovery: A Randomized Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3193-3203), 2026. Date of Publication: 01 Oct 2026. Author Elghareeb S.; Saleh M.; Abd Al Jawad M.; Monier A. Institution (Elghareeb, Saleh, Monier) Department of Anesthesiology, ICU and Pain Management, Ain Shams University, Cairo, Egypt (Abd Al Jawad) Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt Publisher W.B. Saunders Abstract Objectives: To evaluate the efficacy and safety of early enteral levothyroxine as rescue therapy for delayed neurologic and respiratory recovery in adults following on-pump cardiac surgery. Design and Setting: A single-center, randomized, double-blind, placebo-controlled trial conducted at Ain Shams University Hospitals (Cairo, Egypt). Participant(s): Seventy adult patients undergoing cardiac surgery with cardiopulmonary bypass who exhibited delayed recovery, defined as requiring mechanical ventilation for >48 hours or having a Glasgow Coma Scale (GCS) score <15 at 48 hours postoperatively. Intervention(s): Participants were randomized to receive either enteral levothyroxine (25-50 microg/d, titrated by body mass index) or an identical placebo from postoperative day 2 until intensive care unit (ICU) discharge. Measurements and Main Results: The primary outcome was the change in GCS score from intervention initiation (48 hours postoperatively) to ICU discharge. Secondary outcomes included cardiac function (ejection fraction), catecholamine requirements, 30-day mortality, hospital length of stay, and thyroid hormone levels. The levothyroxine group (n = 35) showed significantly greater neurologic recovery (adjusted mean difference [aMD] in GCS score, +7.81; 95% confidence interval [CI], 5.24-10.38; p < 0.001) with a 128% faster recovery rate (p < 0.001). Cardiac function improved (attenuated ejection fraction decline; aMD, +12.99%; p < 0.001) with 41% to 63% lower catecholamine needs (p <= 0.01). Treatment with levothyroxine was associated with a significantly lower 30-day mortality rate (14.3% v 45.7%; adjusted hazard ratio, 0.24 [95% CI, 0.09-0.65]; p = 0.005). Given the small number of events (n = 21), this finding should be considered exploratory. Hospital stay was longer in the levothyroxine group (13.1 days v 10.3 days, p = 0.005), attributed to survivorship bias. Levothyroxine normalized thyroid hormone levels, and each 1-pg/mL increase in free triiodothyronine correlated with a 2.1-point gain in GCS score (p < 0.001). Conclusion(s): Early enteral levothyroxine administration in cardiac surgery patients with delayed postoperative recovery was associated with significantly accelerated neurologic recovery and improved cardiac function. The observed reduction in 30-day mortality is hypothesis generating and requires confirmation in a larger, multicenter trial. These findings support further investigation into the integration of thyroid hormone replacement into perioperative care for this high-risk subgroup. Copyright © 2026 Elsevier Inc. <60> Accession Number 2048680140 Title Simultaneous Pancreas-Kidney Transplantation Versus Kidney Transplantation Alone in Type 1 Diabetes: Does Pancreas Transplantation Improve Clinical Outcomes? A Systematic Review and Exploratory Meta-Analysis. Source Medical sciences. 14(4) (no pagination), 2026. Article Number: 454. Date of Publication: 01 Aug 2026. Author Bellini M.I.; De Intinis C.; D'Andrea G.; D'Andrea V.; Vichi M. Institution (Bellini, De Intinis, D'Andrea) Sapienza University, Department of Surgery, Rome, Italy (D'Andrea, Vichi) Sapienza University, Department of Statistical Sciences, Rome, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Simultaneous pancreas-kidney transplantation (SPKT) restores both renal function and endogenous insulin secretion in selected patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD). Whether SPKT provides superior patient survival, kidney graft outcomes and cardiovascular benefit compared with kidney transplantation alone (KTA) remains debated, particularly when KTA is performed from a living donor. Method(s): A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE was searched using a predefined strategy including terms related to pancreas transplantation, kidney transplantation alone, T1DM, and ESRD/chronic kidney disease. Eligible studies included adult T1DM/ESRD populations comparing SPKT with KTA, including living-donor kidney transplantation (LDKT) and deceased-donor kidney transplantation (DDKT) and reporting clinically relevant outcomes. Full texts were reviewed and categorized as core comparative evidence, secondary/supportive evidence or excluded records. A quantitative synthesis was additionally performed for studies reporting directly comparable adjusted hazard ratios for patient mortality and kidney graft failure in the SPKT versus LDKT comparison. Result(s): Nineteen observational studies met the inclusion criteria and were included in the qualitative synthesis. SPKT consistently provided superior metabolic control and insulin independence when pancreas graft function was maintained. Compared with deceased-donor or mixed KTA cohorts, SPKT was frequently associated with more favorable long-term patient survival and cardiovascular outcomes in selected recipients. However, comparisons with LDKT yielded less consistent results, with several registry-based analyses reporting equivalent or superior kidney graft and survival outcomes after living-donor transplantation. Quantitative synthesis of the two studies providing directly comparable adjusted hazard ratios demonstrated a higher risk of patient mortality (HR 1.30, 95% CI 1.10-1.54) and kidney graft failure (HR 1.43, 95% CI 1.24-1.66) following SPKT compared with LDKT. Formal meta-analysis of SPKT versus DDKT was not feasible because of substantial heterogeneity in outcome definitions, statistical reporting methods and follow-up duration across studies. Conclusion(s): In adults with T1DM and ESRD, successful SPKT provides a durable metabolic advantage and may improve long-term outcomes compared with deceased-donor KTA in selected patients. Across analyses that included all transplanted recipients from the time of surgery (intent-to-treat), early perioperative risk is higher after SPKT but may be offset over time when pancreas graft function is maintained. Evidence does not support a universal survival superiority of SPKT over living-donor kidney transplantation. Our quantitative synthesis of intent-to-treat, transplant-date analyses indicates that LDKT is associated with lower risks of patient mortality and kidney graft failure compared with SPKT when a suitable living donor is available. Treatment decisions should be individualized, considering living-donor availability, anticipated waiting time and dialysis exposure, cardiovascular and surgical risk, and the likelihood of durable pancreas graft function, with greater weight given to contemporary cohorts. Copyright © 2026 by the authors. <61> Accession Number 2038550976 Title Preoperative Cannabis Use and Major Cardiopulmonary Complications Following Noncardiac Surgery: A Systematic Review. Source International Journal of Medical Science in Clinical Research and Review. 9(4) (pp 928-940), 2026. Date of Publication: 01 Jul 2026. Author Rashmi H.R.; Akshay B.; Shalini Y. Institution (Rashmi) Department of Anaesthesiology, Sri Chamundeshwari Medical College Hospital & Research Institute, Karnataka, India (Akshay, Shalini) Department of Anaesthesiology, Mysore Medical College and Research Institute, Karnataka, Mysuru, India Publisher International Journal of Medical Science in Clinical Research and Review (IJMSCRR) Abstract Background and objectives: Cannabis use is reported among roughly 18% of the United States (US) population, and an increasing proportion of surgical patients appears to present for anaesthesia with recent or daily exposure. Cannabis and its constituents may disturb cardiac rhythm, precipitate myocardial infarction, heart failure, and cerebrovascular events, and interact with antiplatelet and anaesthetic drugs. Whether preoperative cannabis use independently raises the risk of major perioperative complications in noncardiac surgery remains unclear. The review sought to synthesise, by outcome domain, adjusted observational evidence concerning associations between preoperative cannabis use or cannabis use disorder and major cardiovascular and pulmonary outcomes after noncardiac surgery. Method(s): A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations; the review was not prospectively registered. PubMed/MEDLINE, Embase, CENTRAL, Web of Science, Scopus, and Google Scholar were searched from inception to August 2026 and supplemented by backward and forward citation searching. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool within a prespecified confounding framework. Pooling was planned only when at least two genuinely independent cohorts reported sufficiently comparable adjusted estimates for the same outcome domain, using random-effects models with restricted maximum likelihood and the Hartung-Knapp correction. Certainty of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Result(s): Ten studies contributed 14 cohort analyses (12 noncardiac; two cardiac, reported narratively). No outcome domain satisfied the prespecified pooling criteria, so results are presented as outcome-specific narrative syntheses and no pooled estimate is reported. Active cannabis use disorder (CUD) appeared to be associated with increased odds of postoperative myocardial infarction after major elective surgery (adjusted odds ratio (OR) 1.88, 95% confidence interval (CI) 1.31-2.69). In a spine-surgery cohort of 423,978 patients, cannabis use appeared to be associated with thromboembolic events (OR 2.2, 95% CI 1.2-4.0) and with neurologic complications such as stroke and anoxic brain injury (OR 2.9, 95% CI 1.2-7.5). A national noncardiac cohort of 12,422 hospitalisations suggested higher composite complication and mortality rates in patients with CUD (7.73% vs 6.57%). No clear association with hypoxaemia or composite pulmonary complications emerged in the largest general-anaesthesia cohort (1,683 vs 32,838 patients) or in matched analyses after colectomy and abdominal wall reconstruction. Conclusion(s): Conclusion(s): Very-low-certainty observational evidence suggests that preoperative cannabis exposure may increase perioperative cardiovascular risk; however, evidence for major pulmonary complications remains inconclusive. Copyright © 2026 The Author(s). <62> Accession Number 2048930732 Title Impact of preoperative sarcopenia on the mortality risk in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. Source Journal of Thoracic Disease. 18(8) (no pagination), 2026. Article Number: 847. Date of Publication: 31 Aug 2026. Author Xu C.; Gao Y.; Pan Q.; Xu Z. Institution (Xu, Gao, Pan, Xu) Department of Cardiac Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1, West Huanghe Road, Huaian, China Publisher AME Publishing Company Abstract Background: The association of preoperative sarcopenia with risk of mortality among patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to clarify the impact of sarcopenia on the mortality risk in such patients. Method(s): PubMed, Embase and Web of Science databases were searched up to June 2, 2026. Primary outcome was the all-cause mortality and secondary outcomes were cardiovascular mortality and noncardiovascular mortality. Subgroup analyses based on the defined indicators of sarcopenia and study design were performed. Result(s): Thirteen studies with 6,865 patients were included and most studies were retrospective. Pooled results demonstrated that the presence of sarcopenia was significantly associated with increased risk of all-cause mortality [hazard ratio (HR) =1.55, 95% confidence interval (CI): 1.31-1.84, P<0.001]. Subgroup analyses based on the defined indicators (cross-sectional area: HR =1.55, P=0.04; skeletal muscle mass index: HR =1.41, P=0.002; psoas muscle area: HR =1.37, P=0.02; psoas muscle volume index: HR =1.77, P=0.003; psoas muscle index: HR =1.68, P<0.001) and study design (retrospective: HR =1.51, P<0.001; prospective: HR =2.69, P=0.02) manifested consistent results. Besides, presence of sarcopenia was also associated with increased risk of cardiovascular mortality (HR =1.14, 95% CI: 1.01-1.28, P=0.03), which was indicated by one available study. Conclusion(s): The presence of preoperative sarcopenia indicated higher risk of all-cause and cardiovascular mortality among patients undergoing TAVI. Copyright © AME Publishing Company. 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/. <63> Accession Number 2048930827 Title Prognostic role of triglyceride-glucose index and triglyceride-glucose body mass index in patients undergoing coronary artery bypass grafting: a systematic review and meta-analysis. Source Journal of Thoracic Disease. 18(8) (no pagination), 2026. Article Number: 879. Date of Publication: 31 Aug 2026. Author Chen D.; Wei X.; Sun H.; Meng J.; Huang Y.; Lu X.; Gao Y.; Xu Z.; Ma Y. Institution (Chen, Wei, Sun, Meng, Huang, Lu, Gao, Xu, Ma) Department of Cardiac Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China Publisher AME Publishing Company Abstract Background: The prognostic role of triglyceride-glucose (TyG) index and triglyceride-glucose body mass index (TyG-BMI) in patients undergoing coronary artery bypass grafting (CABG) remains unclear. This meta-analysis aimed to clarify prognostic value of TyG index and TyG-BMI among patients undergoing CABG. Method(s): Several databases were searched up to May 20, 2026. Primary prognostic outcomes included major adverse cardiovascular event (MACE) and major adverse cardiovascular and cerebrovascular event (MACCE). Secondary outcomes included all-cause mortality, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke, acute kidney injury (AKI), atrial fibrillation (AF), symptomatic graft failure (SGF) and cerebral infarction. Result(s): Fifteen studies with 16,185 cases were enrolled. The results demonstrated that elevated TyG index was related to increased risk of MACE [odds ratio (OR) =1.91, P<0.001] and MACCE (OR =1.67, P<0.001). Subgroup analysis indicated more significant association between TyG index and risk of MACE (OR =4.27, P=0.001) and MACCE (OR =1.71, P<0.001) among diabetic patients. Besides, TyG index was associated with the risk of all-cause mortality [hazard ratio (HR) =1.37, P=0.02], cardiac mortality (HR =2.59, P=0.001), nonfatal MI (OR =2.02, P=0.04), nonfatal stroke (OR =2.00, P<0.001), AF (OR =1.55, P<0.001), SGF (OR =2.987, P=0.003) and cerebral infarction (OR =1.93, P<0.001). Furthermore, elevated TyG-BMI was related to increased incidence of AKI (OR =1.03, P<0.001) among diabetic patients. Conclusion(s): Preoperative elevated TyG index was associated with worse clinical outcomes such as increased incidence of MACE and MACCE in patients undergoing CABG, especially among diabetes mellitus (DM) patients. Besides, higher TyG-BMI index indicated increased risk of AKI in diabetic patients. Copyright © AME Publishing Company. 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/. <64> Accession Number 2048854088 Title Effect of Perioperative Benzodiazepine Use on Postoperative Delirium in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. Source Anesthesiology Research and Practice. 2026(1) (no pagination), 2026. Article Number: 5856805. Date of Publication: 2026. Author Cunha M.S.K.; Faria H.S.; Barbosa L.M.; Nascimento L.R.D.; Ferreira C.H.O.; Santos K.D.A.D.; Bendaham L.C.A.R.; Silva A.K.B.; Neto A.P.M.; Amador W.F.O.; Neto I.Q.C.; Treml R.E.; Perete C.A. Institution (Cunha) Faculty of Medicine of Marilia, Sao Paulo, Marilia, Brazil (Faria) Federal University of Santa Maria, Rio Grande do Sul, Santa Maria, Brazil (Barbosa) Federal University of Minas Gerais, Minas Gerais, Belo Horizonte, Brazil (Nascimento) Amazonas State University, Amazonas, Manaus, Brazil (Ferreira) Federal University of Paraiba, Paraiba, Joao Pessoa, Brazil (Santos, Bendaham, Neto) Federal University of Roraima, Roraima, Boa Vista, Brazil (Silva) Federal University of Alagoas, Alagoas, Maceio, Brazil (Amador) Federal University of Campina Grande, Paraiba, Cajazeiras, Brazil (Neto) University of Wisconsin-Madison, Madison, United States (Treml) Department of Anesthesiology, Stanford School of Medicine, Stanford, CA, United States (Perete) Department of Anesthesiology, Albert Einstein Israelite Hospital, Sao Paulo, Sao Paulo, Brazil Publisher John Wiley and Sons Ltd Abstract Introduction: Cardiac surgery anesthesia is associated with risks such as postoperative delirium (POD) and stress-related responses. Benzodiazepines have been used perioperatively to reduce anxiety and promote hemodynamic control. However, their use may increase the risk of delirium, particularly in older adults. This systematic review and meta-analysis aims to evaluate the impact of perioperative benzodiazepine use on the incidence of POD in patients undergoing cardiac surgery. Method(s): We systematically searched for randomized controlled trials (RCTs) and observational studies comparing benzodiazepines with placebo or nonbenzodiazepine drugs in adults undergoing cardiac surgery. The primary outcome was POD incidence; secondary outcomes included mini-mental state examination (MMSE), ICU length of stay, and time to extubation. For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, while mean differences (MDs) were used for continuous outcomes. Analyses were performed using R 4.4.3. Result(s): Eight studies were included, comprising 36,301 patients, of whom 20,747 (68.5%) received benzodiazepines. Follow-up ranged from 1 day to 12 months. There were no significant differences between groups in the incidence of POD (OR 1.05; 95% CI: 0.88 to 1.25; p = 0.55; I2 = 83%). Similarly, there were no significant difference in MMSE score (MD -0.11; 95% CI: -3.17 to 2.95; p = 0.94; I2 = 70%), ICU length of stay (MD 4.72 h; 95% CI: -1.37 to 10.80; p = 0.13; I2 = 99%), and time to extubation (MD -0.53 h; 95% CI: -2.16 to 1.09; p = 0.52; I2 = 72%). Conclusion(s): Perioperative benzodiazepine use was not significantly associated with POD or with secondary outcomes in adults undergoing cardiac surgery. Copyright © 2026 Marcela da Silva Kazitani Cunha et al. Anesthesiology Research and Practice published by John Wiley & Sons Ltd. <65> Accession Number 2049133685 Title Comparing coronary angiography, intravascular ultrasound, and optical coherence tomography for percutaneous coronary intervention: A network meta-analysis. Source Radiography. 32(7) (no pagination), 2026. Article Number: 103565. Date of Publication: 01 Oct 2026. Author Saeed S.; Ali M.A.; Osama M.; Khan A.; Waseem M.H.; Alam U.; Ali S.; Hudaib M.; Shoaib A.; Abideen Z.U.; Khan S.; Siddique M.; Rehman M.E.U. Institution (Saeed, Khan, Rehman) Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Ali, Alam) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Osama) Department of Medicine, Hayatabad Medical Complex, Peshawar, Pakistan (Waseem) Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan (Ali) Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan (Hudaib) Department of Medicine, Fazaia Ruth Pfau Medical College, Karachi, Pakistan (Shoaib) Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan (Abideen) Department of Medicine, King Edward Medical University, Lahore, Pakistan (Khan) Department of Medicine, Saidu Medical College, Swat, Pakistan (Siddique) Department of Medicine, Saidu group of teaching Hospital, Swat, Pakistan Publisher W.B. Saunders Ltd Abstract Introduction: Percutaneous coronary intervention (PCI) is widely used for coronary revascularization, with invasive coronary angiography (ICA) remaining the conventional method for guiding stent implantation. However, ICA provides only a two-dimensional luminal assessment and may underestimate vessel size, lesion morphology, stent under expansion, malapposition, and edge complications. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide detailed intravascular assessment and may improve PCI optimization. Method(s): This systematic review and network meta-analysis of randomized controlled trials compared ICA-guided, IVUS-guided, and OCT-guided PCI. PubMed, Embase, and Cochrane Library were searched, with an updated search to April 10, 2026. Binary outcomes were analyzed using random-effects frequentist and Bayesian network meta-analysis. ICA-guided PCI was the reference treatment. Treatment ranking was assessed using SUCRA, and inconsistency was evaluated using node-splitting. Result(s): Thirty-three randomized trials including 25,315 participants were included. Compared with ICA-guided PCI, IVUS-guided PCI reduced target lesion revascularization, target vessel revascularization, major adverse cardiovascular events, and stent thrombosis. OCT-guided PCI reduced target lesion revascularization, all-cause death, cardiac death, target vessel myocardial infarction, and stent thrombosis compared with ICA. Myocardial infarction was directionally lower with both IVUS and OCT, although estimates were not statistically definitive. No clear difference was observed between IVUS and OCT for major clinical outcomes. Node-splitting analyses showed no significant inconsistency across treatment comparisons. Conclusion(s): Intravascular imaging-guided PCI was associated with improved outcomes compared with ICA-guided PCI. IVUS showed the most consistent benefit for repeat revascularization and major adverse cardiovascular events, whereas OCT ranked favorably for several safety outcomes. Current randomized evidence does not establish superiority of OCT over IVUS. Implications for practice: Intravascular imaging should be considered to optimize PCI, particularly in anatomically complex or high-risk coronary interventions. Copyright © 2026 The College of Radiographers <66> Accession Number 2038531836 Title Comparative Analysis of Pre-Operative Transthoracic and Intraoperative Transesophageal Echocardiography for Grading Aortic Stenosis in Adults Undergoing Elective Aortic Valve Replacement: A Single-Center Experience. Source Acta Medica International. 12(3) (pp 1039-1045), 2025. Date of Publication: 01 Jan 2025. Author Gujja S.; Arora V.; Yelagandula S.; Gandhi H.; Kumar J.S.; Sonune S.B. Institution (Gujja) Department of Cardiac Anaesthesia, Geetanjali Medical College & Hospital, Rajasthan, Udaipur, India (Arora, Kumar, Sonune) Department of Cardiac Anaesthesia, U.N. Mehta Institute of Cardiology and Research Centre, Gujarat, Ahmedabad, India (Yelagandula) Department of Pharmacy Practice, Geetanjali institute of pharmacy, Rajasthan, Udaipur, India (Gandhi) Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College), New Civil Hospital Campus, Asarwa, Gujarat, Ahmedabad, India Publisher Parsvnath Publishing House Abstract Background: Severe aortic stenosis necessitates precise preoperative evaluation to inform surgical decisions and ensure favourable patient outcomes. This study investigates the diagnostic discordance between pre-anaesthesia transthoracic echocardiography (TTE) and intraoperative transesophageal echocardiography (TEE) in patients undergoing elective aortic valve replacement (AVR) surgery. Material(s) and Method(s): A prospective randomized study enrolled 100 patients scheduled for AVR surgery due to aortic stenosis between January 2020 and December 2021. Pre-induction TTE and post-induction TEE examinations were compared. The study evaluated multiple parameters, including mean pressure gradient (PGm), peak jet velocity, aortic valve area (AVA) via continuity equation and planimetry, and dimensionless index (DI), across both TTE and TEE cohorts. Result(s): There were some apparent differences between measurements of TTE and TEE: A statistically significant difference in mean gradient across the aortic valve was noted while comparing TTE (57.16 +/- 5.72mm Hg) with TEE (39.59 +/- 5.97 mm Hg), which may have been a result of anesthetic effects. Similarly, the peak jet velocity in TTE was 506.06 +/- 19.41 cm/s, whereas it was 386.72 +/- 23.38 cm/s (P < 0.0001) for TEE. This shift saw 76% of the patients initially diagnosed with severe AS in TTE reassessed with moderate AS in TEE, showing that intraoperative situations played a big role. Using the continuity equation technique, the mean AVA for TTE and TEE were 0.84 cm2 and 0.83 cm2, respectively. PLANIMETRY AVA 0.88 +/- 0.046 cm2, in TTE, and 0.87 +/- 0.055 cm2, in TEE. Even if the valve area was decreased by 0.01 cm2 with both approaches, there was no statistical significance (P = 0.15). In TTE and TEE, the DI mean was 0.20 (P = 0.62). Continuity equation, planimetry, and DI techniques were used; all patients had significant AS in TTE and TEE. Conclusion(s): Intraoperative TEE measurements often demonstrated reduced peak aortic jet velocities and mean pressure gradients compared to preoperative TTE assessments in patients with severe aortic stenosis, leading to potential underestimation of stenosis severity.AVA measurement by planimetry, continuity equation, and DI methods demonstrated more reliability. Copyright © 2025 Acta Medica International Published by Parsvnath Publishing House. <67> Accession Number 2047594957 Title Artificial Intelligence for Predicting Perioperative Outcomes in Cardiac Surgery: A Systematic Review. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 21(3) (pp 210-216), 2026. Date of Publication: 01 May 2026. Author Ha J.; Vohra H.A. Institution (Ha, Vohra) University of Bristol, United Kingdom Publisher SAGE Publications Ltd Abstract Objective: Cardiac surgery carries a significant risk of complications and mortality. Artificial intelligence (AI), particularly machine learning (ML), is increasingly being explored to enhance perioperative risk prediction and support clinical decision-making. This systematic review evaluates the clinical applications, predictive performance, and limitations of AI models in cardiac surgery. Method(s): PubMed and Embase were searched for studies published between January 2020 and July 2025. Of 939 records identified, 178 studies met the inclusion criteria following screening and full-text review. Included studies applied AI to predict clinical outcomes in patients undergoing cardiac surgery. Key outcomes assessed were model performance metrics and their clinical utility. Result(s): Among the 178 included studies, 114 (64%) were conducted in the United States or China. Most studies (n = 168, 94%) used retrospective designs and focused on adult populations. Random forest (n = 82, 46%), logistic regression (n = 82, 46%), and eXtreme Gradient Boosting (n = 70, 39%) were the most frequently used algorithms. AI applications primarily targeted the prediction of postoperative complications (n = 102, 57%) and mortality (n = 70, 39%), with common outcomes including acute kidney injury and stroke. ML models consistently outperformed traditional clinical risk scores (n = 39). SHapley Additive exPlanations was the most common interpretability method (n = 66, 37%). Only 26% of studies included external validation, and just 19% adhered to TRIPOD guidelines. Conclusion(s): AI models demonstrate superior predictive performance in cardiac surgery compared with traditional risk scores, but concerns regarding validation, transparency, and generalizability must be addressed to enable implementation. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <68> Accession Number 2042877513 Title Reperfusion therapy for older patients with acute myocardial infarction and cardiogenic shock. Source Cardiovascular Revascularization Medicine. 90 (pp 57-62), 2026. Date of Publication: 01 Sep 2026. Author Kiyohara Y.; Minami K.; Freeman L.; Wilson Tang W.H.; Pinney S.P.; Yano Y.; Naito T.; Miyashita S. Institution (Kiyohara) Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, NY, United States (Minami) Medical Training Center, Saga University Hospital, Saga, Japan (Freeman) Department of Medicine, Ashikaga Red Cross Hospital, Tochigi, Japan (Wilson Tang) Department of Cardiovascular Medicine Heart, Vascular, and Thoracic Institute Cleveland Clinic Foundation, Cleveland, OH, United States (Pinney) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Yano, Naito, Miyashita) Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan (Miyashita) Department of Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States Publisher Elsevier Inc. Abstract Background Reperfusion therapy is the cornerstone of treatment for acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). However, older adults with AMI and CS face higher risks of adverse outcomes and procedure-related complications. Since this population is under-represented in clinical trials, the efficacy of reperfusion therapy remains unclear. We performed a meta-analysis to evaluate the impact of reperfusion therapy on mortality in older adults with AMI and CS. Methods We searched PUBMED and EMBASE through 4/1/2025 for studies comparing reperfusion therapy with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) and non-reperfusion therapy for AMI and CS in patients aged >=75 years. We included prospective and retrospective observational trials reporting clinical outcomes. The primary outcome was set as short-term mortality, and the secondary outcome was long-term mortality. We performed subgroup analysis of the primary outcome for patients with ST-segment elevation myocardial infarction and those without. Results Our search identified 14 eligible studies in a total of 4583 patients. Reperfusion therapy was associated with significantly reduced short-term mortality, compared with non-reperfusion therapy with high heterogeneity (odds ratio (OR): 0.47; 95% confidence interval (CI): 0.30-0.73, I 2 = 76.8%). There was no significant difference in long-term all-cause mortality between reperfusion and non-reperfusion therapy (OR: 0.66; 95% CI: 0.34-1.26, I 2 = 79.7%). The subgroup analyses were largely consistent with the main findings. Conclusions Reperfusion therapy was associated with reduced short-term mortality, compared to non-reperfusion therapy for older patients with AMI and CS. Reperfusion therapy showed a tendency towards reduced long-term mortality. Copyright © 2026 Elsevier Inc. <69> Accession Number 2047691138 Title Comparison of Paravertebral Block and Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(10) (pp 3323-3329), 2026. Date of Publication: 01 Oct 2026. Author Manici M.; Sincer Y.; Yaylak D.; Sogut M.S.; Darcin K.; Kalyoncu I.; Ozer K.B.; Tanju S.; Gurkan Y. Institution (Manici, Sincer, Yaylak, Sogut, Darcin, Kalyoncu, Gurkan) Department of Anaesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey (Ozer, Tanju) Department of Thoracic Surgery, Koc University Hospital, Istanbul, Turkey Publisher W.B. Saunders Abstract Objectives: To compare the analgesic efficacy of serratus posterior superior intercostal plane block (SPSIPB) versus thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracoscopic surgery (VATS), with a focus on postoperative opioid consumption and pain scores. Design(s): A prospective, randomized, controlled, single-center clinical trial. Setting(s): A tertiary university hospital. Participant(s): Sixty adult patients aged 18 to 80 years scheduled for elective VATS. Participants were randomized in a 1:1 ratio to receive either SPSIPB (n = 30) or TPVB (n = 30). Baseline characteristics were comparable between groups. Intervention(s): Prior to induction of general anesthesia, patients received either ultrasound-guided SPSIPB or TPVB using 30 mL of 0.25% bupivacaine. Measurements and Main Results: The primary outcome was cumulative 24-hour postoperative opioid consumption, expressed as oral morphine equivalents. Secondary outcomes included numeric rating scale (NRS, 0-10) for pain scores and the incidence of opioid-related adverse effects at 1, 3, 6, 12, and 24 hours after surgery. Twenty-four-hour opioid use was not significantly different between SPSIPB and TPVB (66.8 +/- 29.4 mg v 77.2 +/- 40.0 mg; mean difference -10.4 mg; 95% CI, -36.1 to 15.3; p = 0.439). No significant differences were seen in pain scores or opioid-related side effects at any assessed time point (p > 0.05). Conclusion(s): SPSIPB and TPVB were associated with similar postoperative opioid consumption, pain scores, and the incidence of adverse effects following VATS. Given its potentially simpler application, SPSIPB may serve as an effective alternative regional analgesic technique in thoracic surgery. Copyright © 2026 Elsevier Inc. <70> Accession Number 2048557146 Title Expanding the thoracic donor Pool: Ethical implications of contemporary donor selection and organ preservation strategies. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101047. Date of Publication: 01 Dec 2026. Author Melia-Saez F.J.; Gil-Marques B. Institution (Melia-Saez) Department of Anesthesiology and Pain Medicine, Hospital Universitari Francesc de Borja, Gandia, Spain (Melia-Saez, Gil-Marques) Faculty of Medicine and Health Sciences, Universidad Catolica San Vicente Martir, Valencia, Spain Publisher Elsevier Inc. Abstract Background: To address high waiting-list mortality and severe donor shortages in thoracic transplantation, clinical protocols have expanded donor selection criteria to include marginal, elderly, and controlled donation after circulatory death (cDCD) candidates. Concurrently, ex-vivo lung perfusion (EVLP), ex-vivo heart perfusion (EVHP), and normothermic regional perfusion (NRP) have reconfigured organ preservation. This study evaluates the clinical-ethical challenges triggered by these strategies to optimize graft utilization safely. Method(s): A systematic review was conducted evaluating peer-reviewed literature (2016-2026) following the PRISMA 2020 statement across PubMed/MEDLINE, Scopus, and Web of Science. Combined search strategies targeting intensive care logistics and thoracic transplantation were employed. Retrieved records were systematically screened at the title, abstract, and full-text levels according to predefined inclusion criteria. Peer-reviewed studies addressing Intensive Care Unit (ICU) donor management, withdrawal of life-sustaining treatment (WLST), and advanced thoracic procurement logistics were qualitatively analyzed. Result(s): Nineteen studies fulfilled all inclusion criteria. Expanding thoracic donor selection targets relies heavily on precise functional warm ischemia time (fWIT) management and the chronological independence of WLST decisions. While advanced in-situ NRP and ex-vivo EVLP/EVHP preservation techniques maximize cardiothoracic donor assessment and reconditioning, they introduce critical tensions regarding the Dead Donor Rule (DDR) and the definition of circulatory irreversibility. Conclusion(s): Safely expanding the thoracic donor pool requires strict operational separation between end-of-life care and procurement teams. Evolving bioethical frameworks serve as analytical safeguards, reinforcing systemic integrity by ensuring advanced preservation technologies respect the donor's bodily integrity and the transition of dying without compromising clinical governance. Copyright © 2026 <71> Accession Number 2038523441 Title Comparative study of intravenous clonidine versus fentanyl in attenuating hemodynamic response to laryngoscopy and tracheal intubation. Source Asian Journal of Medical Sciences. 17(8) (pp 17-22), 2026. Date of Publication: 02 Aug 2026. Author Tiwari A.K.; Dutta P.; Maurya P.; Rathour P.; Singh S. Institution (Tiwari) Department of Anaesthesia and Operation Theatre Technology, Atal Bihari Vajpayee Medical University, Uttar Pradesh, Lucknow, India (Dutta) Department of Physiology, PES University Institute of Medical Sciences and Research, Karnataka, Bengaluru, India (Maurya) Department of Anaesthesia and Operation Theatre Technology, DIT University, Uttarakhand, Dehradun, India (Rathour) Department of Anaesthesia and Operation Theatre Technology, Government Institute of Medical Sciences, Uttar Pradesh, Greater Noida, India (Singh) Department of Anaesthesia and Operation Theatre Technology, Gopal Narayan Singh University, Bihar, Jamuhar, India Publisher Manipal Pokhara College of Medical Science Abstract Background: Laryngoscopy and tracheal intubation trigger a transient sympathetic surge causing tachycardia and hypertension, which can be harmful in patients with comorbidities. Clonidine and fentanyl are used to attenuate this response, but comparative evidence on their effectiveness is limited. Aims and Objectives: The aim of the study is to evaluate and compare the effectiveness of intravenous (IV) clonidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. Material(s) and Method(s): A prospective, randomized study was conducted over 6 months involving 80 adult patients (American Society of Anaesthesiologists physical status I and II), aged 18-65 years, scheduled for non-cardiovascular elective surgeries under general anesthesia. Patients were randomly assigned to two groups: Group C received IV clonidine (4 mug/kg) and Group F received IV fentanyl (2 mug/kg) approximately 5 min before intubation. Hemodynamic parameters - systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO<inf>2</inf>) - were recorded at baseline, pre-intubation, during intubation, and at 1, 3, and 5 min post-intubation. Statistical analysis was performed using independent t-tests and one-way analysis of variance. Result(s): Both groups exhibited attenuation of hemodynamic responses. SBP at 5-min post-intubation was significantly lower in the fentanyl group (P=0.037). However, inter-group differences in DBP, MAP, HR and SpO<inf>2</inf> were not statistically significant. Intra-group analysis revealed transient fluctuations in SBP, DBP, and MAP post-intubation, with HR and SpO<inf>2</inf> remaining stable. Conclusion(s): Both IV clonidine and fentanyl are effective in blunting the hemodynamic response to laryngoscopy and intubation. The choice between the two may be guided by patient profile, comorbidities, and anesthetic context. Copyright © 2026 Asian Journal of Medical Sciences. <72> [Use Link to view the full text] Accession Number 2048825949 Title External Oblique Intercostal Plane Block for Postoperative Analgesia in Thoracoabdominal Procedures: A Systematic Review and Meta-Analysis. Source Clinical Journal of Pain. 42(8) (no pagination), 2026. Article Number: e1392. Date of Publication: 01 Aug 2026. Author Batista da Silva Neto E.; de Carvalho J.P.A.; Peregrino M.R.; de Souza Ferreira P.; Alves R.L.; de Araujo Azi L.M.T. Institution (Batista da Silva Neto, de Carvalho, Peregrino, de Souza Ferreira, Alves, de Araujo Azi) Federal University of Bahia, Brazil (Alves, de Araujo Azi) Department of Surgery and Anesthesiology, Federal University of Bahia, Salvador-BA, Brazil Publisher Lippincott Williams and Wilkins Abstract Objectives: - The primary objective of this review was to analyze the efficacy of External Oblique Intercostal Plane Block (EOIPB) in reducing the use of opioids in the postoperative period. Time and need for rescue analgesia, postoperative pain scores, and incidence of nausea and vomiting were also evaluated. Method(s): - The review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024622945). Randomized clinical trials that included adults undergoing thoracoabdominal surgery, comparing EOIPB with general anesthesia, multimodal anesthesia, or other regional blocks, were selected. Search was performed in May 2025 in PubMed, Embase, Scopus, and Cochrane Library databases, with no time or language restrictions. Certainty of the evidence was assessed using the GRADE system. Result(s): - Fifteen studies involving 899 patients were identified. Results indicated that EOIPB significantly reduced opioid consumption in the first 24 hours postoperatively, compared with standard analgesia (MD: -19.55; 95% CI: -28.50 to -10.60; P<0.0001, I 2=72%) and other regional blocks (MD: -13.15; 95% CI: -24.77 to -1.52; P=0.03, I 2=95%). Heterogeneity was considered moderate to high among studies, related to differences in samples, anesthetic protocols, and assessment methods. Outcomes associated with postoperative pain have a low to very low quality of evidence according to the GRADE method. Discussion(s): - The findings support the clinical potential of EOIPB as an effective strategy for postoperative pain control, but without an indication for adoption in clinical practice routine, limited to situations of failure of first-line techniques in analgesia, such as epidural anesthesia. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <73> Accession Number 651647399 Title Pulmonary artery catheters or central venous catheters for cardiac surgery: the PUMA Pilot randomised clinical trial. Source Anaesthesia. 81(10) (pp 1358-1366), 2026. Date of Publication: 01 Oct 2026. Author Perry L.A.; Segal R.; Larobina M.; Bellomo R.; Smith J.A.; Sin J.; Danial K.; McLean A.R.D.; Rong L.Q.; Gaudino M.; Schwann T.; Palumbo M.; O'Halloran L.; Chee B.; Patel J.; Silvers A.; Bennetts J.; Marasco S.; Coulson T.G.; Royse A.; See E.; Miles L.F. Institution (Perry, Sin, Danial, Chee, Patel) Victorian Cardiac Anaesthesia Research Laboratory, Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia (Perry, Sin, Danial, Palumbo, O'Halloran, Chee, Patel, Silvers) Department of Anaesthesia and Perioperative Medicine, Victorian Heart Hospital, Melbourne, VIC, Australia (Perry, Coulson, See, Miles) Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia (Segal) Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia (Larobina, Smith, Bennetts) Department of Cardiothoracic Surgery, Victorian Heart Hospital, Monash Health, Melbourne, VIC, Australia (Smith, Marasco) Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia (McLean) Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (McLean) MISCH (Methods and Implementation Support for Clinical Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia (Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA (Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA (Schwann) Department of Cardiovascular Surgery, Corewell Health, Royal Oak, MI, United States (Marasco) Cardiothoracic Unit, The Alfred, Melbourne, VIC, Australia (Coulson) Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, VIC, Australia (Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia (Royse) Department of Surgery, University of Melbourne, Melbourne, VIC, Australia (See) Departments of Intensive Care and Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia (Miles) Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia Abstract INTRODUCTION: Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available. METHOD(S): The PUMA Pilot was a multicentre, randomised, parallel assignment, open-label, pilot and feasibility trial conducted at three tertiary cardiac surgery centres. Eligible patients were adults undergoing coronary artery bypass grafting, aortic valve replacement or surgery on the aortic root or ascending aorta with or without aortic valve replacement, with a predicted surgical mortality of < 2%. Patients were allocated randomly to receive a pulmonary artery catheter or a central venous catheter inserted immediately before surgery. The primary feasibility outcome was protocol compliance, defined as receiving the assigned intervention without crossover. Secondary feasibility outcomes were eligibility rate; recruitment proportion and rate; data completeness; and rate of clinician refusal. RESULT(S): We screened 480 patients and 206 (43%) were eligible; 150/203 (74%) approached provided informed consent. Three of 206 (1%) eligible patients were not included due to clinician refusal. Of 149 patients who were randomised, 76 were assigned to the pulmonary artery catheter group and 73 to the central venous catheter group. For the primary feasibility outcome, 147 patients (99%) received the allocated intervention. Data were complete for 144 (97%) patients. Median (IQR [range]) days alive and at home at 30 days was 23.7 (21.9-24.7 [7.0-26.0]) in the pulmonary artery catheter group and 22.9 (20.8-23.9 [8.6-25.8]) in the central venous catheter group. Acute kidney injury occurred in 26/76 (34%) patients in the pulmonary artery catheter group and 14/73 (19%) in the central venous catheter group. DISCUSSION(S): A randomised trial of pulmonary artery catheters compared with central venous catheters in low-risk cardiac surgery is feasible. Such a trial would address significant practice variability and inform international guidelines. Copyright © 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. <74> Accession Number 2038531596 Title Safety of exercise after pulmonary endarterectomy: a systematic review. Source ERJ Open Research. 12(4) (no pagination), 2026. Article Number: 01449-2025. Date of Publication: 01 Jul 2026. Author Page A.; Mares K.; McCormack C. Institution (Page) Department of Physiotherapy, Royal Papworth Hospital, Cambridge, United Kingdom (Mares) School of Health Sciences, University of East Anglia, Norwich, United Kingdom (McCormack) Department of Sport Science and Nutrition, Faculty of Science and Engineering, Maynooth University, Kildare, Ireland (McCormack) National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland Publisher European Respiratory Society Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism, leading to high pulmonary arterial pressures. Pulmonary endarterectomy (PEA) surgery is the gold standard treatment for CTEPH, significantly improving patient outcomes. Post-operative cardiac remodelling is an important consideration, highlighting the need to balance early exercise with potential impacts on cardiac recovery. The objective of the present study was to investigate the safety and feasibility of early exercise interventions following PEA surgery for CTEPH, and to review the existing literature on early exercise interventions post-PEA. Methods A systematic review was conducted using the AMED, CINAHL, Embase and MEDLINE databases. Search terms included "pulmonary endarterectomy", "chronic thromboembolic pulmonary hypertension", "exercise", "exercise training", "mobility" and "rehabilitation". Studies were included if they involved adult patients with CTEPH who underwent PEA and participated in post-operative exercise interventions. Results The review identified studies with small, heterogeneous patient cohorts engaging in early post-operative exercise following PEA. Interventions included walking, cycling, dumbbell exercises and respiratory training. Safety measures, such as continuous monitoring of oxygen levels and heart rate, were implemented and no adverse events were reported. Improvements in exercise capacity and right heart measurements were observed, suggesting that early exercise is both safe and beneficial. Conclusion Early exercise interventions following PEA surgery appear safe and feasible, with potential benefits for exercise capacity and cardiac remodelling. Future research should include randomised controlled trials and qualitative studies to confirm these findings and assess impacts on patient quality of life. Copyright © The authors 2026. <75> Accession Number 2047440955 Title Accelerated Diagnostic Pathways for Suspected Acute Coronary Syndrome in Practice. Source Journal of the American College of Cardiology. 88(11) (pp 1211-1221), 2026. Date of Publication: 15 Sep 2026. Author Hatherley J.; Dakshi A.; Collinson P.; Miller G.; Bailey L.; Davies S.; Fearon H.; Meah N.; Frost F.; Raj R.; Ensor E.; Fisher M.; Goulden C.; Noori Z.; Salmon T.; Rawat A.; Hornby R.; Lambert A.; Sekulska K.; Ingram T.; Fitzgerald G.; Shaw M.; Khand A. Institution (Hatherley, Dakshi, Miller, Meah, Fisher, Goulden, Noori, Salmon, Rawat, Hornby, Ingram, Fitzgerald, Khand) Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom (Hatherley, Dakshi, Miller, Frost, Fisher, Khand) Institute of Ageing and Chronic Diseases, University of Liverpool, Liverpool, United Kingdom (Collinson) City St George's University of London, London, United Kingdom (Bailey, Davies, Fearon, Lambert, Sekulska) Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom (Frost, Shaw, Khand) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (Raj) Accident and Emergency Department, Royal Liverpool University Hospital, Liverpool, United Kingdom (Ensor) Accident and Emergency Department, University Hospital Aintree, Liverpool, United Kingdom Publisher Elsevier Inc. Abstract Background: For suspected acute coronary syndrome (ACS), guidelines recommend using high-sensitivity troponins (hs-cTn) in accelerated diagnostic pathways (ADPs) with 0/1-hour recommended over 0/3-hour ADP. However, implementation of these ADPs, with universal use of hs-cTns, has not been directly compared in randomized trials Objectives: This study sought to compare the efficiency and safety of the European Society of Cardiology (ESC) 0/1-hour and a 0/3-hour ADP when implemented in real-world clinical practice. Method(s): This pragmatic, randomized, noninferiority implementation trial compared the safety and efficiency of clinician decision making using these 2 pathways. To prevent incorporation bias, an independent hs-cTnI was used for formal adjudication using the fourth universal definition of myocardial infarction (MI). Efficiency was judged by the proportion of patients discharged within 4 hours. The safety endpoint was major adverse cardiac events (MACE) within 30 days (adjudicated index or representation type 1 MI, cardiovascular death, and urgent coronary revascularization) for those who were considered not to have ACS and discharged. The noninferiority margin, for absolute difference in sensitivity, between the ESC 0/1-hour and the 0/3-hour ADP was set at 3%, assessed with a 1-sided 97.5% CI. Result(s): From December 2021 to July 2024, of 13,983 screened 3,543 individual patients with suspected ACS were recruited and consented from 2 major emergency departments in North-West England, with 100% follow-up achieved for all representations to any national hospital. The median age was 60 years (IQR: 49.5-70.5 years), 53% were men, 6.7%, and 7.6% had adjudicated index type 1 MI and MACE within 30 days, respectively. The turnaround time from sample to result for central laboratory hs-cTnT was 81 minutes (IQR: 69-101 minutes). The proportion of patients discharged within 4 hours was relatively low and did not differ substantially (21.8% vs 19.2%, P = 0.07). In addition, the 0/1-hour pathway was noninferior for safety, in patients discharged, compared with the 0/3-hour pathway, absolute difference in sensitivity was +4.2% (1-sided 97.5% CI: -2.5) in favor of the 0/1-hour pathway. The calculated sensitivities were 93.7% (95% CI: 88.4%-97.1%) vs 89.5% (95% CI: 82.7%-94.3%), respectively. Conclusion(s): Implementation of the ESC 0/1-hour pathway failed to discharge significantly more patients within 4 hours of presentation compared with the 0/3-hour ADP. In addition, The ESC 0/1-hour was noninferior to the 0/3-hour hs-cTn pathway for safety of discharge, although safety for both pathways was less than that imputed by observational studies. This trial demonstrates that perceived benefits to emergency department efficiency of a reduced sampling interval are mitigated by central laboratory turnaround times as well as system constraints. (Pragmatic Randomised Trial of the ESC 0/1 Versus 0/3 Hour Troponin Pathway [MACROS2]; NCT05322395) Copyright © 2026 by the American College of Cardiology Foundation. Published by Elsevier. <76> Accession Number 2038572131 Title Does Concurrent Carotid Endarterectomy with Coronary Artery Bypass Grafting Improve Outcomes in Patients with Dual Arterial Disease? A Systematic Review and Meta-Analysis. Source Journal of Cardiovascular and Thoracic Research. 18(2) (pp 93-102), 2026. Date of Publication: 2026. Author Santos K.; Scremin G.M.; Patel N.; Zakani A.; Maris M.I.; Plonek T. Institution (Santos, Patel) New Vision University School of Medicine, Tbilisi, Georgia (Santos, Plonek) Medisch Spectrum Enschede, Enschede, Netherlands (Scremin) Pontifical Catholic University of Parana, Curitiba, Brazil (Zakani) Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco (Maris) Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy of Timisoara, Timisoara, Romania Publisher Tabriz University of Medical Sciences Abstract Patients with coexisting carotid and coronary artery disease face a complex surgical decision regarding whether to undergo coronary artery bypass grafting (CABG) alone or combined with carotid endarterectomy (CEA). Evidence remains conflicting, with some studies suggesting stroke reduction from a combined approach while others report increased perioperative morbidity without a survival advantage, contributing to weak ACCF/AHA and ESC/EACTS guideline recommendations. We conducted a systematic review and meta-analysis of randomised controlled trials and propensity-matched studies comparing CABG alone versus CABG+CEA. Five studies involving 23,916 patients were included, of whom 29% underwent combined surgery. CABG+CEA was associated with a significantly higher incidence of perioperative stroke (OR 1.5; 95% CI 1.1-2.0; P = 0.03), but no significant differences were observed in 30-day mortality, major adverse cardiovascular events, myocardial infarction, or hospital length of stay. These findings indicate that adding CEA to CABG increases stroke risk without providing a clear survival benefit, supporting guideline recommendations for a selective, risk-based strategy. Until higher-quality evidence becomes available, concurrent CEA+CABG should be reserved for carefully selected patients in whom the anticipated benefits outweigh potential harms. Copyright © 2026 The Author(s). <77> Accession Number 2048941629 Title Perioperative Inspiratory Muscle Training Improves Functional Recovery in Heart Valve Replacement: A Meta-Analysis of Randomised Controlled Trials. Source ANZ Journal of Surgery. (no pagination), 2026. Date of Publication: 2026. Author Tjahjono C.T.; Mayangsari V.; Rayyan M.I.R.; Larasati S.; Rahman F.A.; Rizqa S.U.; Hasya A.; Ramadhitya A.; Mata L.P.S.; Asfa A.F.W.; Saputra P.B.T. Institution (Tjahjono, Mayangsari, Rayyan) Division of Cardiovascular Prevention and Rehabilitation, Department of Cardiology and Vascular Medicine, Universitas Brawijaya - Dr. Saiful Anwar General Academic Hospital, Malang, Indonesia (Rayyan, Larasati, Rahman, Rizqa, Hasya, Ramadhitya, Mata, Asfa) Faculty of Medicine, Universitas Jember, Jember, Indonesia (Saputra) Department of Cardiology and Vascular Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Publisher John Wiley and Sons Inc Abstract Background: Heart valve replacement is associated with a high risk of respiratory dysfunction and postoperative pulmonary complications (PPCs). This meta-analysis of randomised controlled trials (RCTs) specifically aims to evaluate the effectiveness of perioperative inspiratory muscle training (IMT) in this patient population. Method(s): A systematic search was conducted on ClinicalTrials.gov, PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random-effects meta-analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI). Result(s): A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6-min walk distance (6 MWD) (MD 49.91 m; 95% CI, 22.52-77.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H<inf>2</inf>O; 95% CI, 3.15-20.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56-0.90) compared to the control group. However, for secondary outcomes, including ICU and postoperative length of stay (LOS), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV<inf>1</inf>), no significant differences were observed. Subgroup analysis indicated greater clinical benefits of IMT in patients undergoing open surgery who received it postoperatively and integrated it into a rehabilitation bundle. Conclusion(s): IMT may improve 6 MWD and MIP and reduce the risk of PPCs in patients undergoing valve replacement. These findings suggest that IMT is a promising adjunct to perioperative cardiac rehabilitation (PROSPERO CRD420251172698). Copyright © 2026 Royal Australasian College of Surgeons. <78> Accession Number 649450750 Title Risk assessment tools for predicting transfusion in surgery: a systematic review and meta-analysis. Source Health technology assessment (Winchester, England). 30(63) (pp 1-38), 2025. Date of Publication: 01 Dec 2025. Author Seyahian A.; Taylor-Rowan M.; Nevill C.; Mulholland R.; Roxburgh C.; Brunskill S.; Cooper N.; Noel-Storr A.; Sutton A.J.; Wu O.; Quinn T.J. Institution (Seyahian, Taylor-Rowan, Mulholland, Wu) Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom (Nevill, Cooper, Sutton) Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom (Roxburgh) School of Cancer Science, University of Glasgow, Glasgow, United Kingdom (Brunskill) NHS Blood Transfusion, Oxford, United Kingdom (Noel-Storr) School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom (Quinn) School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom Abstract Background: United Kingdom blood shortages necessitate better prediction of surgical blood requirement. We sought to assess the predictive accuracy of tools designed to identify those patients requiring blood transfusion within the perioperative period. Method(s): We searched the Cochrane library, EMBASE, MEDLINE, ClinicalTrials.gov and WHO trials portal, 2000-July 2023. We included studies that developed and/or validated prediction tools for blood requirement during the early perioperative period (48 hours). Risk of bias was evaluated using the Prediction model Risk Of Bias Assessment Tool. We pooled area under receiver operating curve and calibration data via random effects meta-analysis. We evaluated certainty of evidence of any estimates using the Grading of Recommendations Assessment, Development and Evaluation framework. We used meta-regression to describe associations between included variables/tool characteristics with tool accuracy. Result(s): We included 50 papers, describing 67 unique prediction tools. Most tools were at high risk of bias, with limited external validation. Discrimination (area under receiver operating curve) of prognostic models ranged from 0.49 to 0.96. Only two surgery-specific tools, the McClusky Index (liver transplant surgery) and Papworth Bleeding Risk Score (cardiothoracic surgery), had sufficient data to enable pooling of discrimination measures. The McClusky Index's pooled area under receiver operating curve: 0.74 (95% CI 0.61 to 0.84) and Bleeding Risk Score's area under receiver operating curve: 0.68 (95% CI 0.49 to 0.82) were both rated 'very low' certainty by Grading of Recommendations Assessment, Development and Evaluation. Pooling calibration data was not possible for any prediction tools. Meta-regression suggested that fewer included variables, longer time from surgery and independent validation studies were all associated with lower accuracy. Limitation(s): There were insufficient studies to assess overall tool performance via meta-analysis in other surgical subgroups beyond cardiothoracic surgery and liver transplant. Our study population is also predominantly made up of elective surgeries which may make our results less generalisable to emergency settings. Future work: Implementation and cost-effectiveness studies are needed to evaluate how promising tools could be applied to clinical practice and the economic impact such tools could have upon the service. Conclusion(s): Despite the availability of multiple potential tools, available data suggest none are currently suitable for predicting blood transfusion in surgical practice. Our summary of the data comes with caveats around the quality of the included papers and the limited number of tools with more than one reported external validation. Funding(s): This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159933. <79> Accession Number 2045249305 Title Beta-Blockers in Patients with Myocardial Infarction and No Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Source Canadian Journal of Cardiology. 42(9) (pp 2248-2259), 2026. Date of Publication: 01 Sep 2026. Author Kawtharany H.; Rayyan A.; Mestarihi A.; Hamarsha Q.; Choaib A.; Azzam M.; Arora S. Institution (Kawtharany) Department of Internal Medicine, St Louis University School of Medicine, St Louis, MO, United States (Rayyan, Mestarihi) Department of Internal Medicine, College of Medicine, University of Central Florida / HCA North Florida, Gainesville, FL, United States (Hamarsha, Choaib, Azzam) Evidence-Based Practice and Impact Center, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States (Arora) Division of Cardiology, St Louis University Hospital/SSM Health, St Louis, MO, United States Publisher Elsevier Inc. Abstract Background beta-Blockers have an established role in patients with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) <40%. In those with LVEF >40%, emerging new trials have inconsistent results. We conducted a meta-analysis to evaluate the outcomes of beta-blocker therapy compared with no beta-blocker therapy in patients with MI and LVEF >40%. Methods We searched PubMed, Embase, and CENTRAL for randomized controlled trials (RCTs) published after 2000. Meta-analyses estimated hazard ratio (HR) or risk ratio (RR) with 95% confidence intervals (CIs) using RevMan web. Results Five RCTs (N = 19,826) met the inclusion criteria, with 9892 patients (49.8%) randomized to beta-blockers and 9934 (50.2%) to no beta-blockers. All trials enrolled patients with MI and LVEF >40%. Meta-analysis demonstrated that beta-blockers were not associated with significant reduction in all-cause mortality (HR 0.98, 95% CI 0.85-1.13), cardiac mortality (HR 1.16, 95% CI 0.89-1.51), unplanned coronary revascularization (HR 1.01, 95% CI 0.87-1.17), or malignant ventricular arrhythmia (RR 0.87, 95% CI 0.51-1.48). beta-Blockers were associated with a trend toward lower MI (HR 0.88, 95% CI 0.77-1.00) and new-onset heart failure (HF) (HR 0.82, 95% CI 0.63-1.07). beta-Blockers were not associated with an increase in symptomatic atrioventricular block (HR 1.06, 95% CI 0.83-1.34) or stroke (RR 1.16, 95% CI 0.9-1.48). Conclusion In patients with MI with LVEF >40%, beta-blockers were not associated with a significant effect on any outcome; beta-blockers were associated with a trend toward lower MI and HF. Registration PROSPERO CRD420251139242. Copyright © 2026 Canadian Cardiovascular Society. <80> Accession Number 2048458099 Title Association of adipokines with major adverse cardiovascular events following acute myocardial infarction: a systematic review and meta-analysis. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 725. Date of Publication: 01 Dec 2026. Author Nadira A.; Sunita S.; Alparisi B.D.; Fayza A.C.; Rahmatika N.S.; Karisa P.; Sylviana N.; Syamsunarno M.R.A.A. Institution (Nadira, Rahmatika) Master Study Program of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, West Java, Bandung, Indonesia (Sylviana, Syamsunarno) Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, West Java, Bandung, Indonesia (Nadira, Sunita, Alparisi, Fayza, Rahmatika, Karisa, Sylviana, Syamsunarno) Cardiometabolic Working Group Study, Faculty of Medicine, Universitas Padjadjaran, West Java, Bandung, Indonesia (Sunita, Karisa) Doctoral Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Bandung, Indonesia (Fayza) Bachelor Study Program, Faculty of Medicine, Universitas Padjadjaran, West Java, Bandung, Indonesia (Sunita) Department of Medical Laboratory Technology, Poltekkes Kemenkes Bengkulu, Bengkulu, Indonesia (Alparisi) Clinical Professional Program, RSUD Arifin Achmad, Faculty of Medicine, Universitas Riau, Pekanbaru, Riau, Indonesia Publisher BioMed Central Ltd Abstract Background: Major adverse cardiovascular events (MACEs) remain a leading cause of poor prognosis following acute myocardial infarction (AMI). Emerging evidence suggests that adipose tissue-derived adipokines may provide additional information on cardiometabolic risk beyond conventional anthropometric measures. This systematic review and meta-analysis aimed to evaluate the association between circulating adipokines, specifically adiponectin and visfatin, and the occurrence of MACE among patients with AMI. Method(s): A systematic search of PubMed/MEDLINE, Scopus, and Cochrane Library was performed from inception to identify cohort studies reporting adiponectin or visfatin levels in adult AMI patients with and without MACE during follow-up. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated. Result(s): Five cohort studies (n = 707 AMI patients) conducted across China, Taiwan, Japan, and Poland, with follow-up durations ranging from 2 to 43 months, were included. Adiponectin levels were lower in MACE patients (MD=-2.85 [95% CI -5.42 to -0.27, p = 0.03]; I2 = 94%), while visfatin levels were significantly higher in the MACE group (MD = 2.99 [95% CI 1.51 to 4.47, p < 0.0001]; I2=0%). Conclusion(s): Lower adiponectin and higher visfatin levels are associated with MACE occurrences in AMI patients, whereas BMI did not demonstrate significant discriminatory value. Copyright © The Author(s) 2026. <81> Accession Number 2048024980 Title Comparison of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with prior chest radiation: a systematic review and meta-analysis of 11,572 patients. Source Future Cardiology. 22(8) (pp 865-874), 2026. Date of Publication: 2026. Author Ntoumaziou A.; Xenos D.; Sagris M.; Chatziioannou A.; Krokidis M.; Tzoumas A. Institution (Ntoumaziou) Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Xenos) Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States (Sagris) 1st Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Chatziioannou, Krokidis) 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece (Tzoumas) Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, United States Publisher Taylor and Francis Ltd. Abstract Background: Cardiac complications from prior oncologic therapies and radiation are being increasingly recognized and patients with symptomatic severe aortic valve disease and a history of prior chest radiation represent a high-risk group in which the best management approach has not yet been established. Method(s): A systematic search of PubMed, Scopus, and Cochrane identified studies comparing outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with a history of prior chest radiation. Result(s): Nine studies comprising 11,572 patients were included in this meta-analysis. There were no significant differences between TAVR and SAVR in postoperative mortality (OR: 0.70; 95% CI 0.44-1.13, p = 0.147) or 1-year mortality (OR: 1.04; 95% CI 0.71-1.53, p = 0.84). TAVR was associated with significantly lower rate of postoperative major bleeding (OR: 0.38; 95%CI: 0.25-0.57, p < 0.01), acute kidney injury (AKI) (OR: 0.51; 95%CI: 0.27-0.97, p: 0.04), postoperative atrial fibrillation (OR: 0.20 95%CI: 0.16-0.24, p: <0.01) and respiratory complications (OR: 0.39; 95%CI: 0.24-0.63, p < 0.01) compared to SAVR. The incidence of postoperative permanent pacemaker insertion (OR: 2.27; 95%CI: 1.79-2.87, p < 0.01) and at least moderate aortic regurgitation (OR: 4.44 (95%CI: 2.93-6.73), p < 0.01) were higher among the patients undergoing TAVR. Conclusion(s): TAVR in patients with a history of prior radiation was associated with a lower risk for postoperative complications albeit at an increased risk for pacemaker insertion in the postoperative period compared to SAVR. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <82> Accession Number 2041126758 Title Robotic-assisted versus video-assisted thoracoscopic surgery for non-small-cell lung cancer: A systematic review and meta-analysis of prospective studies. Source Surgical Practice. 30(3) (pp 182-193), 2026. Date of Publication: 01 Aug 2026. Author Ausath Z.F.; Tjiaman M.P.; Zaidan M.Z.; Furqon M.A.; Faisal H.K.P. Institution (Ausath, Tjiaman, Zaidan) Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia (Furqon) Department of Cardiothoracic and Vascular Surgery, Persahabatan Hospital, Jakarta, Indonesia (Faisal) Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia-Persahabatan Hospital, Jakarta, Indonesia Publisher John Wiley and Sons Inc Abstract Introduction: Lung cancer is one of the most commonly encountered cancers, with about 85% of cases classified as non-small cell lung cancer (NSCLC). Video-assisted thoracoscopic surgery (VATS) has certain limitations such as rigid instrument movement and poor hand-eye coordination. On the other hand, robotic-assisted thoracic surgery (RATS) has emerged, offering potential advantages such as a wider range of instrument manoeuvrability. However, the comparative outcomes between the two remain debated. This review aims to evaluate the outcomes of RATS compared with VATS in patients with NSCLC. Method(s): This systematic review and meta-analysis was conducted following the Cochrane Handbook for Systematic Reviews of Interventions 6.2 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The search was performed on PubMed, Cochrane, Science Direct and Scopus starting from 22 September 2024. Result(s): A total of eight studies involving 1580 NSCLC patients were included in this research. RATS demonstrated a higher number of dissected lymph node stations (mean difference [MD] 1. 34, CI 0.87-1.82, p <.00001, I2 = 87%) and better 3-year disease-free survival compared with VATS (MD 2.19, CI 1.21-3.95, p =.009, I2 = 47%). Subgroup analyses, including only randomized controlled trials (RCTs) or studies focusing exclusively on lobectomy, showed that RATS outperformed VATS in the number of dissected lymph node stations (p <.05). Conclusion(s): RATS is non-inferior to VATS and demonstrates superiority in the number of dissected lymph node stations in all analyses. Copyright © 2025 College of Surgeons of Hong Kong. <83> Accession Number 2048776858 Title Aspirin Hypersensitivity in Acute Coronary Syndrome: Literature Review and Case Report. Source European Cardiology Review. 21(Supplement 1) (pp 1-1), 2026. Article Number: 26. Date of Publication: 2026. Author Luis Valle M.V.; Castro A.; De La Eranueva D.; De La Hoz C. Institution (Luis Valle, Castro, De La Eranueva, De La Hoz) Hospital Universitario Central de Asturias, Oviedo, Spain Publisher Radcliffe Medical Media Abstract Background: Aspirin plays a central role in the treatment of acute coronary syndromes (ACS), significantly reducing thrombotic complications. However, aspirin hypersensitivity, although uncommon, presents a serious therapeutic challenge. Rapid desensitisation is recommended in selected cases, but allergic reactions may still limit its success. Objective(s): To review current evidence on the management of aspirin hypersensitivity in ACS and illustrate the clinical decision-making process through a representative case involving failed desensitisation and alternative therapeutic planning. Method(s): A literature review was conducted using PubMed and Scopus (2000-2025), focusing on the prevalence, pathophysiology, and management strategies for aspirin hypersensitivity in ACS. A case of aspirin hypersensitivity in high-risk non-ST elevation ACS is presented to contextualise the clinical challenges. Case report: A 78-year-old man was admitted to the cardiology ward with high-risk non-ST elevation ACS, evidenced by myocardial injury biomarkers and regional wall motion abnormalities in the left anterior descending artery territory. Due to a prior history of cutaneous allergic reactions to aspirin, the patient was initially treated with clopidogrel monotherapy. A desensitisation protocol was initiated prior to planned coronary angiography. However, during the first step (10 mg aspirin), the patient developed angioedema ofthe lower lip, prompting immediate termination of the protocol. As a result, only diagnostic coronary angiography was performed, revealing severe left main and triple-vessel disease. Given the extent and complexity of coronary artery disease, the case was reviewed in a multidisciplinary heart team meeting. Surgical revascularisation was selected as the optimal therapeutic strategy, and the patient was referred for coronary artery bypass grafting (CABG), staying with clopidogrel in monotherapy. Discussion(s): Aspirin desensitisation is often feasible and safe, but not always successful. In cases where hypersensitivity persists, careful risk- benefit assessment is essential. In selected patients, surgical revascularisation may offer a safer and more definitive option when DAPT cannot be achieved pharmacologically. Conclusion(s): Aspirin hypersensitivity in ACS remains a complex clinical dilemma. This case highlights the importance of multidisciplinary decisionmaking in optimising outcomes for high-risk patients with limited pharmacologic options. Copyright © (2026), The Author(s) 2026. This work is open access and is licensed under CC BY-NC 4.0. Users may copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly. <84> Accession Number 2048470179 Title Perioperative anesthesia management for a child with congenital adrenal cortical hyperplasia undergoing thoracoscopic repair of atrial septal defect: a case report and literature review. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 513. Date of Publication: 01 Dec 2026. Author Wang J.; He S.; Pang X.; Zhang W. Institution (Wang, He, Pang, Zhang) Department of Anesthesiology, Mianyang 404 Hospital, Sichuan, Mianyang, China Publisher BioMed Central Ltd Abstract Background: Congenital adrenal cortical hyperplasia (CAH) includes a group of autosomal recessive genetic disorders characterized by impaired synthesis of adrenal corticosteroid hormones. The clinical manifestations associated with CAH commonly include electrolyte imbalance, refractory hypotension, metabolic acidosis, hypoglycemia, and adrenal crisis. The coexistence of endocrine insufficiency and cardiopulmonary abnormalities complicates clinical management in children with CAH undergoing thoracoscopic atrial septal defect (ASD) repair for congenital heart disease. Although thoracoscopic procedures have advantages because of their minimally invasive nature, they also involve risks such as pneumothorax, low-tidal-volume ventilation, and postural changes, which may aggravate hemodynamic fluctuations. These factors considerably increase the difficulty of perioperative management and the risk of complications. Therefore, precise and individualized perioperative anesthesia management is essential. To maintain hemodynamic and respiratory function and ensure surgical safety, comprehensive preoperative assessment, standardized glucocorticoid stress replacement, optimized anesthesia strategies, advanced multi-dimensional monitoring, and careful maintenance of circulatory and internal environmental stability are required. Case presentation: This article describes a clinical case of a 21-month-old infant diagnosed with CAH complicated by ASD. After assessment by a multidisciplinary team (MDT), an individualized perioperative anesthesia strategy was developed and applied. Thoracoscopic ASD repair was successfully performed through comprehensive management, including preoperative correction of electrolyte imbalance, intraoperative hormone replacement therapy, continuous monitoring of the internal milieu and hemodynamic stability, and postoperative optimization of pain control and anti-infective therapy. No significant complications occurred during the perioperative period. Conclusion(s): Effective perioperative management should address insufficient and excessive secretion of adrenal cortical hormones, as well as the effects of long-term exogenous hormone therapy in children with CAH undergoing cardiac surgery. In addition, maintenance of endocrine homeostasis and hemodynamic stability is critical for reducing the risk of adverse events. This case further suggests that the clinical value of management lies in integrating endocrine preparation with cardiac anesthesia and postoperative surveillance, rather than in any single isolated intervention. Copyright © The Author(s) 2026. <85> Accession Number 2048897728 Title Targeting inflammation to prevent conduction injuries following TAVI: A systematic review and meta-analysis of glucocorticoid therapy. Source Cardiovascular Revascularization Medicine. (no pagination), 2026. Date of Publication: 2026. Author Suruagy-Motta R.F.O.; Calheiros C.D.O.S.; Silva J.A.; Borges M.C.M.; Freitas D.E.S.; Vieira L.L.P.; Aguiar-Barros A.B.P.; Firmino M.M.R.; de Moraes S.R.R.; Filho A.A.M.R.; Dall'Orto C.; Fernandes J.R.C.; Cervone A.C.; Filho E.M.; Stone G.W. Institution (Suruagy-Motta, Calheiros, Silva, Borges, Freitas, Vieira, Aguiar-Barros, Firmino, de Moraes) Cesmac University Center, AL, Maceio, Brazil (Filho, Cervone) Dante Pazzanese Institute of Cardiology, SP, Sao Paulo, Brazil (Dall'Orto) Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Bahia, Teixeira de Freitas, Brazil (Fernandes) Heart Institute, University of Sao Paulo, SP, Sao Paulo, Brazil (Filho) Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher Elsevier Inc. Abstract Introduction Cardiac conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI), associated with worse outcomes. Glucocorticoids have been proposed to reduce conduction injury by limiting inflammation and edema. Aims To assess whether peri-procedural glucocorticoid therapy reduces conduction complications compared to standard care in TAVI patients. Methods Systematic review and meta-analysis following Cochrane Handbook and PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library were searched through 2026. Randomized controlled trials and observational studies evaluating peri-procedural glucocorticoids in adults undergoing TAVI were included. Random-effects models estimated pooled risk ratios (RRs) with 95% confidence intervals (CIs). Results Nine studies (8841 patients) were analyzed. Glucocorticoid therapy did not reduce pacemaker implantation (RR 0.91, 95% CI 0.73-1.14), new-onset left bundle branch block (RR 0.94, 95% CI 0.71-1.24), or acute kidney injury (RR 1.10, 95% CI 0.69-1.74). Mortality did not differ between groups (RR 0.94, 95% CI 0.61-1.45). Conversely, glucocorticoids were associated with increased bleeding (RR 1.39, 95% CI 1.01-1.90) and vascular complications (RR 1.86, 95% CI 1.36-2.55). Conclusion Peri-procedural glucocorticoid therapy does not reduce conduction-related complications following TAVI and is associated with increased bleeding and vascular complications. These findings suggest caution regarding routine glucocorticoid use in contemporary TAVI practice. Copyright © 2026 Elsevier Inc. <86> Accession Number 2049041794 Title Mechanisms, outcomes, and management of heart failure-associated dysphagia: a scoping review - revised marked. Source Heart and Lung. 80 (no pagination), 2026. Article Number: 102930. Date of Publication: 01 Nov 2026. Author Velasco J.-L.P.; Cazares S.; Luo K.; Wung S.-F. Institution (Velasco) Alumna, The University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ, United States (Velasco) Nurse Practitioner, Small Valley Healthcare Partners, 4743 N. 1st Avenue, Tucson, AZ, United States (Cazares) Nurse Navigator, Banner University Medical Center Tucson, 3838 N. Campbell Avenue, Tucson, AZ, United States (Luo) Alumna, University of Washington, College of Nutritional Sciences, 1901 Chelan Lane, Seattle, WA, United States (Wung) University of California Davis Betty Irene Moore School of Nursing, 2570 48th St., Sacramento, CA, United States Publisher Elsevier Inc. Abstract Background: More than 20% of patients with heart failure (HF) experience dysphagia, or difficulty swallowing. Although a previous review identified several risk factors and highlighted the bidirectional relationship between dysphagia and sarcopenia, it focused primarily on older hospitalized adults, leaving important knowledge gaps across the broader HF population. Method(s): A scoping review was conducted using four electronic databases: PubMed, CINAHL, Embase, and Google Scholar, to identify studies involving adult patients with HF and dysphagia. No restrictions were placed on publication date, study duration, or geographical region. Result(s): Thirty-six articles met the inclusion criteria. Key mechanisms of HF-associated dysphagia (HFAD) included cardiomegaly-induced esophageal compression, esophageal dysmotility, and stricture formation. HFAD was associated with adverse outcomes, including dehydration, malnutrition, aspiration, prolonged hospitalization, non-home discharge, and mortality. Reported risk factors included advanced age, systemic inflammation, poor nutritional status, reduced functional independence, female sex, polypharmacy, prolonged hospitalization, dementia, prior cardiac surgeries, and valvular heart disease. Clinical presentations ranged from sudden to gradual onset and included dysphagia, globus sensation, and hoarseness. Reported management strategies included nutritional support, swallowing rehabilitation, HF optimization, pharmacologic therapy, procedural interventions, and follow-up monitoring. Conclusion(s): HFAD appears to be a common yet underrecognized comorbidity among individuals with HF and is associated with substantial adverse outcomes. Although early recognition and multidisciplinary management may be beneficial, evidence regarding optimal screening and treatment approaches remain limited. Further research is needed to establish standardized definitions, diagnostic criteria, screening approaches, and management pathways. Copyright © 2026 Elsevier Inc. <87> Accession Number 2044393185 Title A history that matters: a systematic review and meta-analysis on prior heart failure hospitalization and outcomes after transcatheter aortic valve implantation. Source Journal of Echocardiography. 24(3) (pp 149-161), 2026. Date of Publication: 01 Sep 2026. Author Ahmed M.; Kumar A.; Ridham F.N.U.; Azad I.F.; Lohana R.R.; Qadir Z.; Kumari M.; Moosani F.; Saleh S.; Shaikh A.S.; Dito A.; Alam M. Institution (Ahmed, Kumar, Ridham, Azad, Qadir, Kumari, Moosani, Saleh, Shaikh, Dito) Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan (Lohana) Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan (Alam) Department of Cardiology, The Texas Heart Institute, Baylor College of Medicine, Houston, TX, United States Publisher Springer Abstract Aortic stenosis in older adults often requires valve replacement and transcatheter aortic valve implantation (TAVI) is an option with good outcomes. However, recent hospitalizations due to heart failure (HF) may worsen results. This systematic review and meta-analysis adhering to PRISMA guidelines. We systematically searched PubMed, Cochrane Library and Scopus from database inception until July 2025. Data were analyzed by Review Manager using Risk Ratio (RRs) and 95% confidence interval (95% CIs) were used, and result was considered significant when the p-value is less than 0.05. Our primary outcome was 30-day mortality. Secondary outcomes included long-term mortality, major vascular complication, stroke, bleeding complications, pacemaker implantation, acute kidney injury (AKI) and long-term hospitalization. We included six studies, consisting of a population of 3,800 in the group with recent HF hospitalization and 12,949 in the group without recent HF hospitalization. Our pooled estimate shows a significantly higher rate of mortality in 30-day in the patients with group with recent HF hospitalization compared to the patients without recent HF hospitalization (RR: 2.28; 95% CI: [1.84-3.61]; p = 0.00001; I2 = 40%). Among the secondary outcomes, long-term mortality (RR = 1.75; 95% CI: [1.53-2.01]; p < 0.00001, I2 = 43%), stroke (RR = 1.30; 95% CI: [1.01-1.68]; p = 0.04, I2 = 0%), bleeding complications (RR = 1.36; 95% CI: [1.18-1.56]; p = 0.00001, I2 = 0%), AKI (RR = 1.42; 95% CI: [1.117-1.74]; p = 0.0005, I2 = 23%) and long-term hospitalization (RR = 1.39; 95% CI: [1.09-1.78]; p = 0.007, I2 = 93%) were associated with higher risk in the patients with recent HF hospitalization as compared to the patients without prior HF hospitalization. While major vascular complication and pacemaker implantation were statistically insignificant. Patients with recent HF hospitalization had significantly higher 30-day mortality, long-term mortality, stroke, bleeding complications, AKI and long-term hospitalization than those without recent hospitalization. Copyright © Japanese Society of Echocardiography 2026. <88> Accession Number 2038177480 Title SAPIEN 3 versus Myval transcatheter heart valves for transcatheter aortic valve implantation (COMPARE-TAVI 1): a multicentre, randomised, non-inferiority trial. Source The Lancet. 405(10487) (pp 1362-1372), 2025. Date of Publication: 19 Apr 2025. Author Terkelsen C.J.; Freeman P.; Dahl J.S.; Thim T.; Norgaard B.L.; Mogensen N.S.B.; Tang M.; Eftekhari A.; Povlsen J.A.; Poulsen S.H.; Pedersen L.; Hjort J.; Ellert J.; Christiansen E.H.; Sorensen H.T.; Nissen H. Institution (Terkelsen, Thim, Norgaard, Povlsen, Poulsen, Christiansen) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Hjort) Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (Tang) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Freeman, Eftekhari) Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (Dahl, Mogensen, Ellert, Nissen) Department of Cardiology, Odense University Hospital, Odense, Denmark (Pedersen, Sorensen) Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark Publisher Elsevier B.V. Abstract Background: Transcatheter aortic valve implantation (TAVI) is a guideline-directed treatment for severe aortic stenosis and degenerated aortic bioprostheses. When new transcatheter heart valve (THV) platforms for TAVI are launched, they should be compared with best-in-practice contemporary THVs for their short-term and long-term performance. The COMPARE-TAVI 1 trial was designed to provide a head-to-head comparison of the SAPIEN 3 or SAPIEN 3 Ultra THVs and the Myval or Myval Octacor THVs. Method(s): This multicentre, all-comers, randomised, non-inferiority trial was done at three university hospitals in Denmark. Eligible patients were aged 18 years or older, scheduled for transfemoral TAVI, and eligible for treatment with SAPIEN 3 THVs or Myval THVs. Patients were randomly assigned (1:1) to treatment with SAPIEN 3 (29 mm diameter) or SAPIEN 3 Ultra (20 mm, 23 mm, or 26 mm diameter) THVs or Myval or Myval Octacor THVs (20-32 mm diameter). The TAVI procedure was performed according to local practice and under local anaesthesia unless leaflet laceration was performed. The primary endpoint was a composite of death, stroke, moderate or severe aortic regurgitation, or moderate or severe haemodynamic THV deterioration at 1 year according to Third Valve Academic Research Consortium criteria. All patients assigned to THV treatment were included in the intention-to-treat analysis, and all patients who were treated as randomly assigned were included in the per-protocol analysis. With an expected event rate of 13%, the prespecified non-inferiority margin was 5.3%. This trial is registered with ClinicalTrials.gov, NCT04443023, and is closed to accrual. Finding(s): Between June 15, 2020, and Nov 3, 2023, 1031 patients were enrolled. Enrolment was paused twice because of patent-related legal proceedings. Of 1031 patients, 517 patients were randomly assigned to SAPIEN 3 THVs and 514 to Myval THVs. The median patient age was 81.6 years (IQR 77.6-85.0), and 415 (40%) of 1031 patients were female and 616 (60%) were male. The primary endpoint occurred in 67 (13%) of 517 patients randomly assigned to SAPIEN 3 THVs versus 71 (14%) of 514 patients randomly assigned to Myval THVs (risk difference -0.9% [one-sided upper 95% CI 4.4%]; p<inf>non-inferiority</inf>=0.019). Interpretation(s): Myval THVs were non-inferior to SAPIEN 3 THVs in terms of a 1-year composite endpoint of death, stroke, moderate or severe aortic regurgitation, or moderate or severe haemodynamic THV deterioration. Funding(s): Meril Life Sciences, Vingmed Denmark, the Danish Heart Foundation, and the Central Denmark Region. Copyright © 2025 Elsevier Ltd <89> Accession Number 2046657431 Title Computed tomography-derived low muscle status and clinical outcomes after isolated coronary artery bypass grafting: A systematic review and meta-analysis with implications for perioperative nutrition risk stratification. Source Nutrition and Health. 32(5) (pp 1511-1523), 2026. Date of Publication: 01 Sep 2026. Author Zhou Z.; Sun T.; Zhao J.; Wang Y.; Wu W. Institution (Zhou, Sun, Zhao, Wang, Wu) Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China Publisher SAGE Publications Ltd Abstract Background and aims: Computed tomography (CT)-derived measures of low muscle quantity and quality may indicate reduced physiologic reserve, but their prognostic value after isolated coronary artery bypass grafting (CABG) is uncertain. We conducted a PRISMA-guided systematic review and conservative meta-analysis of adjusted estimates to examine associations between preoperative CT-derived low muscle status and outcomes after isolated CABG. Method(s): We searched PubMed, Embase, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov from inception to December 23, 2025. Cohort studies of adults undergoing isolated CABG were eligible if they assessed preoperative low muscle status using CT (dual-energy X-ray absorptiometry eligible) and reported mortality and/or postoperative complications. Overlapping cohorts were excluded. Adjusted hazard ratios (HRs) were pooled using random-effects meta-analysis (restricted maximum likelihood) with the Hartung-Knapp-Sidik-Jonkman adjustment. Result(s): Four independent cohorts (n-=-3931) met inclusion criteria and used CT-based definitions spanning lumbar and thoracic muscle quantity/quality measures. Three cohorts (n-=-3452) contributed adjusted estimates for long-term mortality. Across studies, the direction of association was unfavorable, but quantitative synthesis was exploratory and highly uncertain (pooled HR 2.71, 95% confidence interval 0.38-19.40; I2-=-92.3%; approximate 95% prediction interval 0.47-15.6). Secondary outcomes were too heterogeneous for pooling and were summarized narratively. Conclusion(s): Preoperative CT-derived low muscle status may serve as a pragmatic vulnerability flag in isolated CABG when CT is already available, but current pooled evidence for long-term mortality remains exploratory, highly heterogeneous, and statistically imprecise. Standardized measurement, more comparable adjustment strategies, and harmonized outcome reporting are needed before broader clinical translation. Copyright © The Author(s) 2026 <90> Accession Number 2046550893 Title Machine learning vs. traditional methods for predicting postoperative cardiac complications after non-cardiac surgery: a systematic review and Bayesian network meta-analysis. Source Anaesthesia. 81(10) (pp 1415-1427), 2026. Date of Publication: 01 Oct 2026. Author Dhaliwal S.; Chen S.; Papas C.; Hughes I.; Cavalucci D.; O'Rourke N. Institution (Dhaliwal, Hughes) Gold Coast Hospital and Health Service, Southport, QLD, Australia (Chen, Papas) Goulburn Valley Health, Shepparton, VIC, Australia (Cavalucci, O'Rourke) The Wesley Hospital, Auchenflower, QLD, Australia Publisher John Wiley and Sons Inc Abstract Introduction: Accurate prediction of peri-operative cardiac complications is critical to optimise pre-operative decision-making. Traditional risk prediction scores, such as the Revised Cardiac Risk Index, show only modest discrimination. Machine learning can model complex, non-linear relationships but their predictive performance compared with traditional scores remains unclear. Method(s): We performed a systematic review and Bayesian network meta-analysis. The primary outcome was postoperative adverse cardiac events following non-cardiac surgery. Prediction models were assessed relative to the Revised Cardiac Risk Index. As many studies evaluated multiple versions of each model type, the highest performing ('best version') and lowest performing ('worst version') results were analysed. Models were ranked using the surface under the cumulative ranking curve (SUCRA). Result(s): Thirteen studies evaluating 54 models and 927,113 patients were included. Machine learning approaches generally outperformed traditional risk scores. Automated machine learning ranked highest (SUCRA 96.6) showed the greatest improvement in the best version analysis (mean difference (MD) 0.28 (95%CrI 0.16-0.40)) and remained superior in the sensitivity analysis (MD 0.30 (95%CrI 0.14-0.45)). Gradient boosting models showed superior performance over the Revised Cardiac Risk Index across analysis (best version: MD 0.20 (95%CrI 0.14-0.26), worst version: MD 0.18 (95%CrI 0.12-0.25), SUCRA 82.4). The Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest score outperformed the Revised Cardiac Risk Index in the best version analysis (MD 0.16 (95%CrI 0.01-0.32)). Between-study heterogeneity was low. None of the included studies externally validated their machine learning models and only six were judged to be at low risk of bias. Discussion(s): Most machine learning models showed better discrimination than traditional risk scores, with automated machine learning and gradient boosting models ranking highest. However, study quality, calibration reporting and absence of external validation limit immediate clinical adoption. Prospective, multicentre evaluation is required before integration of these models into peri-operative practice. Copyright © 2026 Association of Anaesthetists. <91> Accession Number 2049028761 Title Percutaneous Vacuum-Assisted Debulking of Infected and Non-Infected Left-Sided Cardiac Masses Using the AngioVac System: A Systematic Review of Published Case Reports and Case Series. Source Journal of Clinical Medicine. 15(17) (no pagination), 2026. Article Number: 6669. Date of Publication: 01 Sep 2026. Author Bratosin F.; DeSanctis J.; Simeunovic G. Institution (Bratosin, DeSanctis, Simeunovic) Corewell Health West, Department of Infectious Disease, Grand Rapids, MI, United States (DeSanctis, Simeunovic) Michigan State University, College of Human Medicine, Grand Rapids, MI, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Left-sided intracardiac masses (infected vegetations and non-infected thrombotic/tumor lesions) are traditionally managed with surgery in many cases, but procedural risk can be prohibitive. We systematically reviewed published experience with the AngioVac system for percutaneous debulking of left-sided cardiac masses. Method(s): PubMed, Scopus, and Web of Science were searched for reports through November 2025, supplemented by hand-searching of congress abstract supplements; records were screened and assessed independently by two reviewers. Adult patients undergoing AngioVac removal of infected or non-infected left-sided cardiac masses were included. The primary effectiveness endpoint was technical success (>=70% debulking without conversion to open surgery). Safety outcomes included procedure-related complications. Data were synthesized descriptively due to heterogeneous designs and reporting. Patient-level and study-level data were distinguished a priori, pooled means were weighted by the number of patients contributed by each report, and pre-specified sensitivity analyses addressed possible patient overlap between reports from the same institution and exclusion of a non-intracardiac (aortic arch) target. Result(s): A total of 30 studies were included (predominantly single-patient reports, 90.0%). The pooled cohort comprised 42 patients; 23/42 (54.8%) had infective endocarditis (IE) and 45.2% had non-infected masses. Mean age was 62.9 years (range 30.0-86.0); sex distribution was female 47.6%, male 42.9%, and not reported 9.5%. All 42 patients were deemed to be at a prohibitively high risk of surgery. Access was mainly transseptal (29/42, 69.0%) or transapical (8/42, 19.0%). Mass size was reported in 23/42 (54.8%), with mean 23.3 mm, median 20.0 mm, and range 11.0-57.0 mm. Technical success was achieved in 35/42 (83.3%); residual mass occurred in 6/42 (14.3%) and one patient had cardiac perforation requiring conversion to open heart surgery (1/42, 2.4%). Procedure-related complications included valvular dysfunction (paravalvular leak or progressive mitral regurgitation), cardiac perforation, and cerebral infarctions (4/42, 9.5%). There were two deaths (2/42, 4.8%) after successful debulking, one in-hospital with recurrent embolic events and septic shock, and the other 4 months after the procedure following procedure-related progressive mitral regurgitation. Complications clustered in transapical procedures (3/8, 37.5% vs. 0/29 transseptal; p = 0.007) and in fungal endocarditis (2/2; p = 0.012). New clinically apparent embolic events occurred in 2/42 (4.8%), both in patients without documented cerebral protection, the choice of which to apply in the total population was unrelated to mass size (mean 23.5 vs. 23.2 mm). Estimates were stable in sensitivity analyses (technical success 32/38, 84.2% after maximal-overlap de-duplication; 31/37, 83.8% restricted to strictly intracardiac targets). Length of stay was reported in 8/42 (19.0%) with a median of 3.5 days (range 1.0-30.0). Conclusion(s): In published, highly selected non-surgical candidates, left-sided AngioVac debulking achieved >=70% mass reduction in 83% of the 42 patients, with 4.8% mortality and one patient (2.4%) converting to emergency surgery. Because the evidence consists almost entirely of single-patient reports subject to publication bias, and because technical success is operator-reported and did not preclude death, these data do not support substituting debulking for a guideline-indicated operation. The technique is best positioned as a bridge or palliative strategy, with transapical access and fungal aetiology identified as signals warranting particular caution. Copyright © 2026 by the authors. <92> Accession Number 2049050227 Title A Reassessment of Prophylactic Antibiotics in Low-Infection-Risk Electrophysiology Procedures. Source PACE - Pacing and Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Sileshi R.M.; Mathes K.; Kosuri S.; Gupta A.; Phillips N.; Pimentel R.; Emert M.; Soma S.; Ramirez R.; Dendi R.; Reddy M.; Sheldon S.H.; Atrouni W.E.; Baddour L.M.; Noheria A. Institution (Sileshi, Gupta, Phillips, Pimentel, Emert, Soma, Ramirez, Dendi, Reddy, Sheldon, Noheria) Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States (Mathes) The University of Kansas School of Medicine, Kansas City, KS, United States (Kosuri) Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS, United States (Atrouni) Division of Infectious Diseases, The University of Kansas Medical Center, Kansas City, KS, United States (Baddour) Departments of Medicine and Cardiovascular Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, United States Publisher John Wiley and Sons Inc Abstract Certain electrophysiology (EP) procedures are associated with minimal tissue disruption and do not involve permanent transvenous leads. As a result, these interventions carry a lower risk of device- or procedure-related infection. These procedures include placement of implantable cardiac monitors, leadless pacemakers, and left atrial appendage occlusion devices, as well as catheter ablation procedures in patients with preexisting cardiac implantable electronic device or prosthetic valve. Due to lack of clear guidelines regarding the use of prophylactic antibiotics in these procedures, clinical practice is variable. Therefore, we conducted a review of literature to evaluate the practice of prophylactic antibiotic administration and infection rates in low-infection-risk EP procedures. Available data indicate that periprocedural infection rates are low regardless of antibiotic use. Due to their observational design and limited power, existing studies are, however, insufficient to determine the benefit of routine antibiotic administration. At the same time, unnecessary antibiotic use may contribute to antimicrobial resistance and disrupt the patient's gut microbiome. Adequately powered randomized controlled trials are needed to determine whether routine prophylactic antibiotic administration is justified for low-infection-risk EP procedures. Copyright © 2026 The Author(s). Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC. <93> Accession Number 2048972790 Title Immersive Virtual Reality for Procedural Pain and Anxiety During Postoperative Wound Dressing in Cardiac Surgery ICU Patients: A Quasi-Experimental Study. Source Nursing in Critical Care. 31(5) (no pagination), 2026. Article Number: e70642. Date of Publication: 01 Sep 2026. Author Algendy A.A.; Mohamed M.G.; Allam Z.A.; El Nagar R.I.; Mohammed M.A.A.; Pazhanivelu V.; Bahgat Z.F. Institution (Algendy) Critical Care & Emergency Nursing, Faculty of Nursing, Cairo University, Giza, Egypt (Algendy, Pazhanivelu, Bahgat) College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Al-Ahsa, Saudi Arabia (Algendy, Pazhanivelu, Bahgat) King Abdullah International Medical Research Center (KAIMRC), Al-Ahsa, Saudi Arabia (Algendy, Pazhanivelu, Bahgat) Ministry of the National Guard - Health Affairs, Al-Ahsa, Saudi Arabia (Mohamed) Adult Health Nursing, Faculty of Nursing, Sohag University, Sohag, Egypt (Allam, El Nagar) Critical Care and Emergency Nursing, Faculty of Nursing, Tanta University, Tanta, Egypt (Allam) Critical Care Nursing, Nursing Department, Faculty of Applied Medical Science in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia (Mohammed) Critical Care Nursing, Faculty of Nursing, Beni-Suef University, Beni Suef, Egypt (Bahgat) Medical Surgical Nursing, Faculty of Nursing, Tanta University, Tanta, Egypt Publisher John Wiley and Sons Inc Abstract Background: Postoperative wound dressing procedures are a common source of pain and anxiety among intensive care unit (ICU) patients following cardiac surgery. Virtual Reality Distraction Therapy (VRDT) has emerged as a promising non-pharmacological intervention for symptom management; however, evidence regarding its use during postoperative wound care in critically ill cardiac surgery patients remains limited. Aim(s): To evaluate the effect of Virtual Reality Distraction Therapy on physiological parameters, pain intensity, anxiety levels and patient satisfaction during wound dressing procedures among ICU patients following cardiac surgery. Study Design: A one-group pretest-posttest quasi-experimental study was conducted among 50 adult patients admitted to the Cardiothoracic Intensive Care Unit at Tanta University Hospital. Participants received routine postoperative care in addition to VRDT during three consecutive wound dressing sessions. Physiological parameters, pain intensity and anxiety levels were assessed before the intervention, immediately after dressing and 15 min post-dressing. Patient satisfaction with the VR experience was evaluated on the final dressing day. Data were analysed using repeated-measures analysis of variance, paired-samples t-tests, Friedman tests and Pearson correlation coefficients, with a significance level of p < 0.05. Result(s): Among the 50 enrolled participants who completed the study, VRDT significantly reduced pain intensity (mean difference = -2.44, 95% CI -2.72 to -2.16) and anxiety scores (mean difference = -17.76, 95% CI -18.84 to -16.68) during dressing procedures. Improvements were also observed in selected physiological parameters, particularly respiratory rate and oxygen saturation, while cardiovascular parameters remained stable throughout the intervention period. Most participants reported high levels of satisfaction with the VR experience and expressed willingness to reuse and recommend the intervention. Significant positive correlations were identified between pain intensity and anxiety levels across assessment periods. Conclusion(s): The findings suggest that VRDT may be a feasible and acceptable non-pharmacological adjunct for reducing pain and anxiety during postoperative wound dressing procedures among ICU patients following cardiac surgery. The intervention demonstrated potential benefits in enhancing patient comfort and procedural experiences. Further randomized controlled trials with larger multicentre samples are recommended to confirm these findings and establish the effectiveness of VRDT in critical care practice. Relevance to Clinical Practice: Virtual Reality Distraction Therapy (VRDT) may provide a feasible and acceptable non-pharmacological adjunct to routine postoperative wound care for cardiac surgery patients in intensive care units. Integrating VRDT into nursing practice has the potential to reduce procedural pain and anxiety, improve patient comfort and satisfaction and support more patient-centred care during painful dressing procedures. Copyright © 2026 British Association of Critical Care Nurses. <94> Accession Number 2038565327 Title Stroke volume variation-guided goal-directed fluid therapy versus central venous pressure-guided fluid management in off-pump coronary artery bypass grafting: A randomised comparison of vasopressor requirement and postoperative renal outcomes. Source International Journal of Medical Anesthesiology. 9(7) (pp 47-51), 2026. Date of Publication: 01 Jul 2026. Author Hurtado I.; Sinisterra G.; Perea J. Institution (Hurtado, Sinisterra, Perea) Department of Cardiac Anaesthesiology, Bucaramanga Research Centre for Cardiac Sciences, Bucaramanga, Colombia Publisher AkiNik Publications Abstract Leading cardiac anaesthesiologists have argued for over a decade that dynamic indices of fluid responsiveness should replace static pressure-based targets in cardiac surgery, yet central venous pressure (CVP) remains the default guide in many centres worldwide. This randomised, single-blind research compared stroke volume variation (SVV)-guided goal-directed fluid therapy (GDFT) with CVP-guided conventional fluid management in 70 patients undergoing off-pump coronary artery bypass grafting (OPCAB) at Bucaramanga Research Centre for Cardiac Sciences, Bucaramanga, Colombia between November 2024 and June 2025. The main outcomes were intraoperative vasopressor requirement and postoperative acute kidney injury (AKI) by KDIGO criteria within 72 hours. The SVV-guided group received markedly less crystalloid (1340 +/- 92 versus 2050 +/- 125 mL; p < 0.001), required less norepinephrine (0.04 +/- 0.02 versus 0.08 +/- 0.03 mcg/kg/min; p < 0.001) and had a lower AKI incidence (8.6% versus 25.7%; p = 0.049). SVV-guided GDFT in OPCAB surgery reduces fluid overload, vasopressor demand and early postoperative renal injury compared with CVP-guided management. Copyright © 2026, AkiNik Publications. All rights reserved. <95> Accession Number 2049042586 Title Molecular Mechanisms of Intimal Hyperplasia in Saphenous Vein Grafts After Coronary Artery Bypass Grafting. Source Cells. 15(17) (no pagination), 2026. Article Number: 1520. Date of Publication: 01 Sep 2026. Author Lazovic D.M.; Cvetkovic D.; Kocica M.K.; Nesic S.; Ivanisevic D.; Aleksic V.; Kocica M.J.; Klac J.; Grujic D.; Jovicic V.; Juricic S. Institution (Lazovic, Cvetkovic, Ivanisevic, Aleksic, Kocica, Grujic, Jovicic) Clinic for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia (Lazovic, Cvetkovic, Kocica, Ivanisevic, Jovicic) Faculty of Medicine, University of Belgrade, Belgrade, Serbia (Kocica, Nesic) Center for Anesthesiology, Reanimatology and Intensive Care Medicine, University Clinical Center of Serbia, Belgrade, Serbia (Klac, Juricic) Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Coronary artery disease is a leading cause of morbidity and mortality in modern medicine. In contrast, surgical myocardial revascularization via coronary artery bypass grafting (CABG) remains the gold standard of treatment for complex multivessel disease. The great saphenous vein remains the most frequently used conduit due to its availability and technical simplicity, but its long-term patency is significantly inferior to that of arterial grafts. The primary pathological process responsible for vein graft failure is intimal hyperplasia, which represents a complex response of the vascular wall to surgical trauma, vein arterialization, inflammation, and hemodynamic stress. This process is characterized by endothelial dysfunction, inflammatory cell activation, proliferation and migration of vascular smooth muscle cells, and extracellular matrix remodeling. Underpinning these alterations are numerous molecular pathways, including NF-kappaB, MAPK, PI3K/Akt, TGF-beta, and mTOR signaling, as well as substantial contributions from oxidative stress, cytokines, growth factors, and microRNAs. Contemporary research indicates that the phenotypic transformation of vascular smooth muscle cells constitutes the central event in the development of intimal hyperplasia. Understanding the cellular and molecular mechanisms underlying this disease's onset enables the development of novel therapeutic strategies to preserve long-term graft patency. This review paper aims to provide a systematic overview of current knowledge regarding the molecular and cellular mechanisms of intimal hyperplasia development in vein grafts following CABG. Copyright © 2026 by the authors. <96> Accession Number 2049252655 Title Effect of Influenza Vaccination on Major Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Critical Pathways in Cardiology. (pp 1-48), 2026. Date of Publication: 2026. Author Shahid M.W.; Hameed A.; Naseem A.; Sajjad F.; Shah M.H.; khan H.; Khan A.J.; Usman M.T.; Ullah Y.; Abeer H.; Shakeel M.; Khan A.; Tariq M.; Darwesh M.S.; Shah Zaib Khan M.; Afridi A.; Khattak F.; Haq A.U.; Abid H. Institution (Shahid, Naseem, Sajjad, Ullah, Shakeel, Darwesh, Afridi, Khattak, Haq) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Hameed) Department of Medicine, Sahiwal medical college, Sahiwal, Pakistan (Shah) Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan (khan) Department of Medicine, Khyber Girls Medical College, Peshawar, Pakistan (Khan) Department of Medicine, St. Luke's Hospital, Chesterfield, Pakistan (Usman) Department of Medicine, Gajju Khan Medical College, Swabi, Pakistan (Abeer) Department of Medicine, KMU Institute of medical sciences, Kohat, Pakistan (Khan) Department of Medicine, Loralai Medical College, Balochistan, Pakistan (Tariq) Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan (Shah Zaib Khan) Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan (Abid) Department of Medicine, Indiana University School of Medicine, Indiana, United States Publisher Lippincott Williams and Wilkins Abstract Cardiovascular disease remains the leading global cause of mortality despite advances in preventive therapies. Influenza infection is increasingly recognized as a trigger for acute cardiovascular events, prompting interest in influenza vaccination as a potential cardioprotective intervention in high-risk patients. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of influenza vaccination on cardiovascular outcomes in adults with established cardiovascular disease. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until October 2025. Seven studies were included after the final screening. Outcomes were reported as all cause mortality, myocardial infarction, major adverse cardiovascular events and heart failure related hospitalization. Interstudy heterogeneity was assessed using I2 and X2 statistics. Statistical calculations were performed using Review Manager 5.4.1, with a p-value of < 0.05 indicating statistical significance. Seven randomized controlled trials including 12, 224 participants were analyzed. Influenza vaccination significantly reduced major adverse cardiovascular events and cardiovascular mortality. A borderline reduction was observed for myocardial infarction and all-cause mortality. No significant differences were found for stroke, coronary revascularization, or heart failure-related hospitalization. Heterogeneity was low for most primary outcomes. The routine use of influenza vaccination as an effective adjunctive strategy in secondary cardiovascular prevention is supported by the fact that it significantly lowers cardiovascular mortality and major cardiovascular events in patients with established heart disease. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <97> Accession Number 2048938691 Title Personalizing myocardial revascularization strategies in the setting of acute myocardial infarction. Source Expert Review of Cardiovascular Therapy. (no pagination), 2026. Date of Publication: 2026. Author Mandala A.; Gabara L.; Curzen N.; Jabbour R.J. Institution (Mandala, Gabara, Curzen, Jabbour) Coronary & Structural Heart Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (Curzen, Jabbour) Faculty of Medicine, University of Southampton, Southampton, United Kingdom (Jabbour) Imperial College London, London, United Kingdom Publisher Taylor and Francis Ltd. Abstract Introduction: Revascularization post myocardial infarction is a complex interplay of patient and anatomical factors. There is a growing number of interventional tools providing both physiological and anatomical delineation of disease burden which can help determine the method and extent of revascularization. A tailored approach is required taking into consideration shared decision making, co-morbidities, and evolving treatment options. Areas covered: This review article explores the wide array of revascularization techniques of both the culprit lesion and non-culprit lesions in the setting of acute myocardial infarction. A scoping literature review was undertaken of the PubMed database using keywordshighlighted below. Expert opinion: Prompt and durable revascularization of the infarct-related coronary artery remains the cornerstone of treatment for acute myocardial infarction. Specifically, timely restoration of normal flow and implantation of a DES during the index procedure remains the gold standard; however, deferred treatment and novel devices such as DCB may have an emerging role. Despite much evidence, complete revascularization of non-culprit coronary artery disease in acute myocardial infarction is still the subject of contention. Copyright © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. <98> Accession Number 2049176443 Title Pre- and post-dilatation in transcatheter aortic valve implantation with self-expanding valves: a systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1883882. Date of Publication: 2026. Author Soh B.W.T.; Pollock A.; Butler D.; McInerney A.; McEvoy J.W.; Mylotte D. Institution (Soh, Butler, McInerney, McEvoy, Mylotte) Department of Cardiology, University Hospital Galway, Galway, Ireland (Soh, McEvoy, Mylotte) School of Medicine, University of Galway, Galway, Ireland (Pollock) Department of Cardiology, Tallaght University Hospital, Dublin, Ireland Publisher Frontiers Media SA Abstract Introduction - Pre-dilatation balloon aortic valvuloplasty (PRE-BAV) and post-dilatation (POST-DIL) are commonly used during transcatheter aortic valve implantation with self-expanding valves (SEV-TAVI) to facilitate device delivery and optimize valve expansion, but both may increase procedural complications. Methods - We conducted a systematic review and meta-analysis to evaluate outcomes associated with PRE-BAV and POST-DIL compared with direct implantation (DIRECT) and valves left as deployed (AS-DEPLOYED), respectively. Eleven studies (nine observational, two randomised; 24, 143 patients) were included for PRE-BAV and five observational studies (7, 526 patients) for POST-DIL. Key outcomes included mortality, stroke, permanent pacemaker implantation, and moderate or greater paravalvular leak (PVL2+). Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were used to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results - Compared with DIRECT, PRE-BAV was not associated with differences in mortality, stroke, pacemaker implantation, or PVL2+, but randomised data showed a reduced need for POST-DIL (OR 0.43; 95% CI 0.24-0.74). Compared with AS-DEPLOYED, observational series suggested that POST-DIL was linked to higher 30-day mortality (OR 1.39; 95% CI 1.18-1.63), increased PVL2+ (OR 3.76; 95% CI 2.13-6.63), and more frequent surgical conversion (OR 1.22; 95% CI 1.06-1.41), with no differences in stroke or pacemaker implantation. Discussion - PRE-BAV was not associated with increased adverse outcomes and may reduce the need for post-dilatation, whereas the adverse outcomes observed with POST-DIL in observational studies are most likely explained by confounding by indication rather than a causal effect. Further adequately powered randomised trials are needed to define the optimal balloon dilatation strategy in SEV-TAVI. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD42024610604. Copyright © 2026 Soh, Pollock, Butler, McInerney, McEvoy and Mylotte. <99> Accession Number 2049259681 Title "Heart in a Box, " a Novel Organ Care System for Heart Transplantation. Source Cardiology in Review. (no pagination), 2026. Date of Publication: 2026. Author Kallash M.; Frishman W.H. Institution (Kallash) From the Department of Medicine, Montefiore Medical Center, Bronx, NY, United States (Frishman) Department of Medicine, School of Medicine, New York Medical College, Valhalla, NY, United States (Frishman) Department of Medicine, Westchester Medical Center, Valhalla, NY, United States Publisher Lippincott Williams and Wilkins Abstract As the global burden of heart failure continues to rise, heart transplantation-the only definitive therapy for heart failure-has become a major focus of clinical research aimed at increasing the availability of suitable donor allografts. Historically, heart transplantation has been limited to the availability of hearts obtained from donors after brain death within relatively short distances. The TransMedics Organ Care System (OCS) Heart is a novel technology that allows for portable extracorporeal nonischemic perfusion of the heart after the circulatory death of the donor. Often referred to as "Heart in a Box, " the OCS Heart is a potential major advancement in heart transplantation because of its ability to preserve the heart in a metabolically active state after the circulatory death of the donor, allowing for longer-distance transport compared to traditional cold storage methods. Numerous randomized controlled trials studying the efficacy of the OCS Heart technology from donors after circulatory death compared to traditional cold storage methods from donors after brain death demonstrated noninferiority. By allowing for preservation after circulatory death and for longer transport times, the OCS Heart can potentially significantly expand the donor pool and increase the number of heart transplants. The major limitations of its use include the expensive costs of operation, the increased level of training required for personnel, and the risk of technological malfunctions compared to traditional cold storage methods. Nevertheless, the OCS Heart is poised as a critical development in the field of heart transplantation, with an expectation that adoption rates for its use will increase in the coming years. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <100> Accession Number 652170188 Title Minimally invasive versus conventional extracorporeal circulation in cardiac surgery: A meta-analysis of 41 randomized controlled trials. Source Perfusion. (pp 2676591261488596), 2026. Date of Publication: 11 Sep 2026. Author Motawea K.R.; Ahmed M.S.; Khalil M.; Ibrahim M.; Abdelkader Y.; Pelletier M.; El Diasty M.; Elgudin Y.; Sabik J.F.; Abu-Omar Y. Institution (Motawea, El Diasty, Elgudin, Sabik, Abu-Omar) Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (Ahmed, Abdelkader) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Khalil) Department of Internal Medicine, UConn Health, Farmington, CT, United States (Ibrahim) Department of Cardiovascular Medicine, Banner University Medical Center, Phoenix, AZ, United States (Pelletier) Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, United States Abstract ObjectiveWe aimed to compare postoperative clinical outcomes between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) in patients undergoing cardiac surgery.MethodsWe performed a meta-analysis of randomized controlled trials comparing MiECC and CECC in adult cardiac surgery. A literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane library databases from inception to July 2026 to identify relevant studies. Primary outcomes included mortality, myocardial infarction, atrial fibrillation, stroke, acute kidney injury, delirium, transfusion requirements, ICU length of stay, ventilation duration, and hospital length of stay.ResultsForty-one RCTs with a total of 5215 patients (2652 in MiECC group, and 2563 in CECC group) were included. MiECC was associated with decreased myocardial infarction (RR = 0.50, 95% CI [0.34, 0.73], p-value = 0.0004), atrial fibrillation (RR = 0.82, 95% CI [0.72, 0.93], p-value = 0.002), stroke (RR = 0.50, 95% CI [0.27, 0.93], p-value = 0.03), delirium (RR = 0.42, 95% CI [0.24, 0.73], p-value = 0.002), chest tube drainage (RR = -123.27, 95% CI [-165.41, -81.13], p-value <0.00001), units of transfused RBC (MD = -0.67, 95% CI [-0.84, 0.49], p-value <0.00001), ICU length of stay (MD = -0.99, 95% CI [-1.42, 0.56], p-value <0.00001), hospital length of stay (MD = -0.61, 95% CI [-1.09, -0.12], p-value = 0.01) and ventilation duration (MD = -2.71, 95% CI [-3.72, -1.69], p-value <0.00001) compared to CECC. However, no significant differences were observed between both groups in terms of mortality, transient ischemic attack, acute kidney injury, reoperation for bleeding, and platelet transfusions.ConclusionMiECC may provide myocardial and neurological protection, better hemostasis, and faster early postoperative recovery compared to CECC, supporting its adoption as a preferred perfusion strategy in cardiac surgery. <101> Accession Number 2049014305 Title Risk factors for leg wound infection after conventional and no-touch vein harvesting: insights from a multicentre randomised trial. Source Scandinavian Cardiovascular Journal. 60(1) (no pagination), 2026. Article Number: 2730710. Date of Publication: 2026. Author Unosson H.; Dalen M.; Jensevik Eriksson K.; Hultkvist H.; James S.; Jeppsson A.; Kimose H.H.; Modrau I.S.; Ragnarsson S.; Sartipy U.; Thelin S.; Vikholm P.; Friberg O. Institution (Unosson, Friberg) Department of Cardiothoracic and Vascular Surgery, Orebro University Hospital, Orebro, Sweden (Unosson) Faculty of Medicine and Health, School of Health Sciences, Orebro University, Orebro, Sweden (Dalen, Sartipy) Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden (Dalen, Sartipy) Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Jensevik Eriksson, James) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (Hultkvist) Department of Cardiothoracic and Vascular Surgery, Linkoping University Hospital, Linkoping, Sweden (Hultkvist) Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linkoping University, Linkoping, Sweden (James) Department of Medical Sciences, Uppsala University, Cardiology, Sweden (Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Jeppsson) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Kimose, Modrau) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Kimose, Modrau) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Ragnarsson) Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden (Ragnarsson) Department of Clinical Sciences, Lund University, Lund, Sweden (Thelin, Vikholm) Department of Thoracic Surgery, Uppsala University Hospital, Uppsala, Sweden (Thelin, Vikholm) Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Sweden (Friberg) Faculty of Medicine and Health, School of Medical Sciences, Orebro University, Orebro, Sweden Publisher Taylor and Francis Ltd. Abstract Objectives: To identify patient- and procedure-related risk factors for surgical site infection following open saphenous vein graft harvesting for coronary artery bypass grafting, using either conventional or no-touch techniques. Design(s): We conducted a sub-study of the SWEDEGRAFT multicentre randomised trial (ClinicalTrials.gov: ID NCT03501303) comparing conventional and no-touch saphenous vein harvesting for coronary artery bypass grafting. The outcome was leg wound infection, defined as a wound healing disturbance requiring antibiotic treatment. Univariable and multivariable logistic regression assessed associations between prespecified covariates and infection. Result(s): Of 900 patients, 860 were followed up at 3 months. The proportion of patients with leg wound infections was 12.0%. In the adjusted analysis, covariates independently associated with leg wound infection were the use of the no-touch harvesting technique (adjusted OR 2.78; 95% CI 1.75-4.44) and left ventricular ejection fraction <30% (adjusted OR 3.66; 95% CI 1.29-10.38). Female sex showed a numerically higher risk that did not reach statistical significance (adjusted OR 1.76; 95% CI 0.98-3.16). No significant statistical interaction was found between sex or diabetes mellitus and vein harvest technique regarding the risk of infection. There were significant differences in leg wound infections among the participating centres. Conclusion(s): The no-touch vein harvesting technique and poor left ventricular systolic function were independently associated with infectious complications at the vein harvest site after coronary artery bypass grafting. The findings also suggest that female patients may be at higher risk, although the estimate was imprecise. These results could be helpful, should a selective use of the no-touch technique be desired. Clinical Registration Number: ClinicalTrials.gov: ID NCT03501303. Copyright © 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. <102> Accession Number 2049028835 Title Robotic Coronary Artery Bypass Grafting: A Narrative Review of Techniques, Evidence, and Future Directions. Source Journal of Clinical Medicine. 15(17) (no pagination), 2026. Article Number: 6677. Date of Publication: 01 Sep 2026. Author Aranda-Michel E.; Duda M.M.; Verdi K. Institution (Aranda-Michel, Duda, Verdi) Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States (Verdi) Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract This narrative review summarizes the published literature on robotic coronary revascularization, encompassing robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB), totally endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularization (HCR). These are distinct procedures that differ in operative access, conduit harvesting, use of cardiopulmonary bypass (CPB), and typical patient selection, and are treated as such throughout this review rather than as interchangeable techniques. A structured, non-systematic literature search of PubMed/MEDLINE and major cardiothoracic surgical journals was performed. Articles were selected by the authors based on relevance, methodological quality, and recency. This is explicitly a narrative rather than a systematic review, and no PRISMA methodology was applied. In observational series from experienced centers, RA-MIDCAB and TECAB are associated with low perioperative mortality (0-2.8%), high early left internal thoracic artery (LITA)-to-left anterior descending (LAD) graft patency (>95%), and shorter hospital stay than conventional sternotomy coronary artery bypass grafting (CABG) in selected patients. HCR extends robotic revascularization to selected patients with multivessel and left main disease. However, nearly all of this evidence derives from retrospective, single-center, or registry-based observational studies performed at high-volume expert centers in selected patient populations, and comparative claims against conventional CABG are vulnerable to selection bias and residual confounding. Robotic coronary revascularization is a feasible option that has been reproduced across a growing number of high-volume centers for carefully selected patients, but current evidence does not support broad claims of superiority over conventional CABG, and outcome data remain concentrated among a limited number of expert programs. Prospective multicenter and randomized data, standardized outcome definitions, and structured training pathways are needed to define its long-term role in coronary revascularization. Copyright © 2026 by the authors. <103> Accession Number 652167443 Title Emerging Longer-Term Evidence on Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis in Low-Risk Patients: A Call for Caution. Source The Annals of thoracic surgery. (no pagination), 2026. Date of Publication: 09 Sep 2026. Author Sousa Uva M.; Milojevic M.; Marin-Cuartas M.; Kaul S.; De Caterina R.; Redberg R.; Heuts S.; Doenst T.; Dayan V.; Siepe M.; Badhwar V.; Falk V.; Borger M.A.; Myers P.O.; Sadaba R. Institution (Sousa Uva) Department of Cardio-thoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal; RISE-Health, Porto Medical School, University of Porto, Portugal (Milojevic) Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland (Marin-Cuartas, Borger) University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany (Kaul) Department of Cardiology, Cedars-Sinai Medical Centre, Los Angeles, CA, United States (De Caterina) Division of Cardiology, Pisa University Hospital and University of Pisa, Pisa, Italy (Redberg) Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, United States (Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands (Doenst) Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany (Dayan) Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay (Siepe) Department of Cardiac Surgery, Inselspital, University of Bern, University Hospital Bern, Bern, Switzerland (Badhwar) Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, United States (Falk) Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Charite University Medicine Berlin, Germany; DZHK (German Center for Cardiovascular Research) partner site, Berlin, Germany (Myers) Department of Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland (Sadaba) Department of Cardiac Surgery, Navarra University Hospital, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain Abstract The expanding use of transcatheter aortic valve implantation (TAVI) in low-risk patients with severe aortic stenosis, including populations underrepresented in pivotal trials and often beyond established guideline recommendations, makes extended follow-up from TAVI versus surgical aortic valve replacement (SAVR) trials central to assessing valve durability and late adverse events and to informing lifetime management strategy. Although Evolut Low Risk 6- to 7-year follow-up showed no statistically significant difference in the primary composite of death or disabling stroke, the signals of later mortality accrual, more myocardial infarction events, and higher aortic valve reintervention rates with TAVI raise concerns about durability and stability of the early treatment effect. In PARTNER 3, 7-year outcomes appeared broadly similar when comparing the reported composite endpoints, but their interpretation is limited by heterogeneous endpoint construction, non-prespecified hierarchical analysis, incomplete follow-up, and the influence of post hoc vital-status ascertainment on late mortality estimates. In an intermediate-risk population, PARTNER 2A showed lower 10-year survival and higher aortic valve reintervention rates with TAVI than with SAVR. Together with the presented UK-TAVI, meta-analyses, and large observational studies, these findings underscore uncertainty about durability and reintervention burden of TAVI and future treatment strategies. By integrating extended follow-up from pivotal trials with other new data, this review calls for a more rigorous and transparent long-term evidence framework before further expanding TAVI, particularly in younger, low-risk patients. Treatment decisions should remain individualized within a structured Heart Team framework, with explicit discussion of expected survival, anatomical suitability, valve durability, reintervention options, and lifetime-management implications. Copyright © 2026. Published by Elsevier Inc. <104> Accession Number 2049011110 Title Intracardiac bone cement embolism and cardiac injury: a systematic review of 116 reported cases. Source Journal of Cardiothoracic Surgery. 21(1) (no pagination), 2026. Article Number: 693. Date of Publication: 01 Dec 2026. Author Shim H.; Jeon C.; Lee S.S.; Cho Y.; Kim S.W.; Chung J.W.; Baek J. Institution (Shim) Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, United States (Jeon) Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, South Korea (Lee) Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Changwon Hanmaeum Hospital, Changwon, South Korea (Cho) Medical library, College of Medicine, Yeungnam University, Daegu, South Korea (Kim) Medical Research Center, College of Medicine, Yeungnam University, Daegu, South Korea (Chung) Division of Cardiovascular and Thoracic Surgery, College of Medicine, University of Kentucky, Lexington, KY, United States (Baek) Department of Thoracic and Cardiovascular Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, South Korea Publisher BioMed Central Ltd Abstract Background: Intracardiac bone cement embolism (BCE) is a rare but potentially serious complication of spinal augmentation. Clinical awareness remains limited because these events occur at the interface of spine and cardiothoracic specialties. This study synthesizes a collection of strictly intracardiac BCE cases to describe reported clinical features, injury patterns, and management strategies. Method(s): A systematic search of PubMed, Embase, and Cochrane (from inception through 2025) identified 116 unique cases after a two-tier adjudication process to eliminate duplicates. Reporting quality was assessed using a modified Joanna Briggs Institute checklist. Result(s): The median patient age was 69 years, and 75.9% were female. Most embolic events followed vertebroplasty (67.2%) or kyphoplasty (26.7%). Chest pain (59.5%) and dyspnea (54.3%) were the most common symptoms. Diagnostic yield was high for echocardiography (96.0%) and computed tomography (CT) (93.8%) but lower for chest X-ray (63.4%). Linear cement fragments were frequently associated with perforation (46.6%), most often involving the right ventricle (70.9%). Surgical retrieval was reported in 65.5% of cases, with concomitant structural repair in 19.2%. No deaths were attributable to surgical retrieval, whereas delayed diagnosis or treatment refusal led to fatal outcomes. Conclusion(s): Published reports suggest that intracardiac BCE may behave as a mechanically hazardous condition with a substantial risk of perforation. The recurring patterns observed across studies highlight the importance of timely recognition and careful management. These descriptive findings may help inform clinical awareness and generate hypotheses for future investigation. Copyright © The Author(s) 2026. <105> Accession Number 2049188290 Title Effectiveness of exercise-based prehabilitation on pre and postoperative outcomes of patients undergoing cardiac surgery-An umbrella review of systematic reviews. Source European Journal of Cardiovascular Nursing. 25(6) (pp 1110-1127), 2026. Date of Publication: 01 Sep 2026. Author Sahu S.R.; Iyer L.C.; Rai G.; Padmakumar R.; Babu A.S. Institution (Sahu, Babu) Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal, India (Iyer) Department of Physiotherapy, MGM College of Physiotherapy, Maharashtra, Navi Mumbai, India (Rai) Department of Cardiovascular & Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India (Padmakumar) Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India Publisher Oxford University Press Abstract Aims: Individuals undergoing cardiac surgery are becoming older, frailer, and less mobile. Prehabilitation has shown to improve postoperative outcomes by optimizing preoperative physical function. This umbrella review aims to pool the systematic reviews assessing the effectiveness of exercise-based prehabilitation in cardiac surgery. Methods and Results: The review followed the PRIOR checklist. PubMed, Embase, CINAHL, Cochrane library, Scopus, Web of science, ProQuest NAHD, ProQuest HMC, Open Grey and MedNar were searched using relevant keywords from inception to 16th December, 2024. Two reviewers screened and extracted data from the included reviews and assessed primary study overlap with the corrected covered area. Methodological quality of the reviews was evaluated with the A MeaSurement Tool to Assess systematic Reviews-2 scale. Certainty of evidence was assessed using a previously developed criteria for overview of reviews. Six systematic reviews with 30 unique trials and 6705 participants were included. The interventions assessed included breathing exercises, inspiratory muscle training, and exercise training. Prehabilitation reduced length of hospital stay, postoperative pulmonary complications, and clinically improved functional capacity with a very low to moderate certainty of evidence. However, there was uncertainty regarding the effects pertaining to adverse events and quality of life. The methodological quality of all reviews was critically low. The primary trials scored poorly in the domains of selection and detection bias. Conclusion(s): Exercise-based prehabilitation might reduce length of hospital stay and postoperative complications, and improve functional capacity. However, the quality of evidence is poor, and individual discretion is required before implementing them into practice. Registration: PROSPERO: CRD42023480100. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <106> Accession Number 2038599184 Title Mitral Valve Repair Versus Replacement in Mitral Regurgitation: A Systematic Review and Meta-analysis. Source International Journal of Medical and Biomedical Studies. 10(8) (pp 137-145), 2026. Date of Publication: 14 Aug 2026. Author Dineshkumar A.P.; Upadhyay H.; Golani C. Institution (Dineshkumar) GMERS Medical College, Vadnagar, India (Upadhyay, Golani) GMERS Medical College, Gujarat, Vadnagar, India Publisher IJMBS Publication Abstract Background: Mitral regurgitation (MR) is one of the most frequently encountered valvular heart diseases and is associated with substantial morbidity, mortality, and impaired quality of life. Surgical treatment primarily consists of mitral valve repair (MVr) or mitral valve replacement (MVR). Repair preserves the native valve and subvalvular apparatus and has generally been associated with favorable postoperative outcomes, although uncertainty remains regarding its comparative long-term effectiveness across different MR etiologies. [1-4] Objective: To systematically evaluate and compare clinical outcomes following mitral valve repair and mitral valve replacement in adult patients with mitral regurgitation. Method(s): A systematic review and meta-analysis was performed according to PRISMA principles. PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from database inception to the latest available date. Randomized controlled trials and observational comparative studies involving adult patients with MR undergoing surgical repair or replacement were eligible. Primary outcomes were long-term all-cause mortality and freedom from reoperation. Secondary outcomes included perioperative mortality, left ventricular ejection fraction (LVEF), major adverse cardiac and cerebrovascular events (MACCE), procedure-related complications, and functional outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analysis was performed using hazard ratios (HRs), risk ratios (RRs), and mean differences (MDs), as appropriate. Result(s): Seven studies were included, comprising one randomized controlled trial and six observational comparative studies. The included evidence represented degenerative, ischemic, and mixed MR populations. Mitral valve repair demonstrated a trend toward improved long-term survival compared with replacement (pooled HR 0.74, 95% CI 0.47-1.17), although the confidence interval crossed unity. Perioperative mortality was generally lower following repair, while preservation of left ventricular function was also generally favorable. However, recurrent MR and reoperation were more frequent in some patients undergoing repair, particularly in ischemic MR. [1,3,5-7] Conclusion(s): The available evidence suggests a potential long-term survival advantage with mitral valve repair compared with replacement, particularly in degenerative MR. However, the pooled survival estimate did not demonstrate a statistically significant difference, and interpretation is limited by heterogeneity and the predominance of observational evidence. Surgical strategy should therefore be individualized according to MR etiology, ventricular function, valve anatomy, durability of repair, and surgical expertise. Copyright © 2026, IJMBS Publication. All rights reserved. <107> Accession Number 652166491 Title Transcatheter vs Surgical Replacement of Degenerated Bioprosthetic Aortic Valve: A Meta-Analysis of Propensity-Score-Matched Studies. Source Heart, lung & circulation. (no pagination), 2026. Date of Publication: 09 Sep 2026. Author Ebrahimi P.; Taheri M.; Mahalleh M.; Soleimani H.; Taheri H.; Moradi A.; Sattartabar B.; Taebi M.; Bhia I.; Pirdehghan R.; Anafje M.; Alkhouli M.; Tajdini M.; Mohsen A.; Elgendy I.; Siegel R.J.; Mandegar M.H.; Hosseini K. Institution (Ebrahimi) Department of Cardiology, University Hospitals Birmingham, Birmingham, UK; Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK (Taheri) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Mahalleh, Sattartabar, Taebi) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Soleimani) Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK; Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran (Taheri, Siegel) Cedars-Sinai Medical Center, Los Angeles, CA, United States (Moradi) Internal Medicine, Blake Hospital, University of South Florida, Morsani College of Medicine, Bradenton, FL, United States (Bhia) Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Pirdehghan, Anafje) Rajaei Cardiovascular Medical and Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Alkhouli) Mayo Clinic Alix School of Medicine, Department of Cardiovascular Medicine, AZ, United States (Tajdini) Johns Hopkins University School of Medicine, Baltimore, MD, United States (Mohsen) Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA (Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States (Mandegar) Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Hosseini) Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran Abstract INTRODUCTION: Degeneration of bioprosthetic aortic valves is a common late complication. While redo surgical aortic valve replacement (redo-SAVR) has traditionally been the standard of care, transcatheter valve-in-valve implantation (ViV-TAVR) has emerged as a less invasive alternative. This meta-analysis aimed to compare outcomes between ViV-TAVR and redo-SAVR using propensity-score-matched studies. METHOD(S): A systematic search of Cochrane CENTRAL, Scopus, MEDLINE (via PubMed) Embase, and Scopus was conducted from inception through to 1 September 2024. Propensity-score matched cohort studies comparing ViV-TAVR and redo-SAVR were included. Risk ratios (RRs) and mean differences (MDs) or standardised mean differences (SMD), as appropriate, were pooled using a random-effects model. RESULT(S): Thirteen propensity score-matched studies encompassing 16,223 patients (8,463 ViV-TAVR; 7,760 redo-SAVR) with a weighted mean follow-up of 16.6 months were included. Compared to redo-SAVR, ViV-TAVR was associated with significantly lower short-term all-cause mortality (RR: 0.47; 95% confidence interval [CI]: 0.34-0.66; p<0.0001), major bleeding (RR: 0.45; 95% CI: 0.33-0.59), acute kidney injury (RR: 0.56; 95% CI: 0.38-0.84), and shorter hospital stay (SMD: -0.79; 95% CI: -1.00 to -0.57). ViV-TAVR was also associated with a significantly lower incidence of new-onset atrial fibrillation (RR: 0.22; 95% CI: 0.13-0.37) but higher post-procedural mean transvalvular gradients (SMD: 0.45; 95% CI: 0.20-0.69). No significant differences were observed in 1- or >=2-year mortality, stroke/transient ischaemic attack, myocardial infarction, permanent pacemaker implantation, or early readmission. Results remained consistent across sensitivity and subgroup analyses. CONCLUSION(S): ViV-TAVR offers significant short-term benefits over redo-SAVR, including lower early mortality and shorter hospitalisation. Long-term clinical outcomes remain comparable, while postprocedural mean gradients are higher after ViV-TAVR, underscoring the need for randomised trials and individualised patient selection to guide treatment decisions for degenerated bioprosthetic valves. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. <108> Accession Number 2049197883 Title Mental Health and Substance Use Disorders in Advanced Heart Failure Patients Undergoing VAD Implantation and Cardiac Transplantation: How Much do We Know?. Source Current Cardiology Reviews. 22(6) (no pagination), 2026. Article Number: E1573403X386810. Date of Publication: 2026. Author Nair N.; Grzyb C.; Du D.; Mahesh B. Institution (Nair) Division of Cardiology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States (Nair, Grzyb) Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States (Du) Department of Industrial, Manufacturing, and Systems Engineering, Texas Tech University, Lubbock, TX, United States (Mahesh) Division of Cardiothoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States Publisher Bentham Science Publishers Abstract Introduction: Patients who undergo cardiac transplantation or implantation of LVADs are significantly affected by mental health disorders and substance use problems, which can negatively impact their compliance and quality of life. There is a paucity of research regarding mental health and substance abuse disorders in the post-LVAD implant/ cardiac transplant population. This narrative review will focus on the knowledge gaps Methods: A qualitative review was performed by conducting a literature search using PubMed and Google Scholar. Adults 18 years and older with LVAD or cardiac transplant were included. The keywords used were anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorders in LVAD patients, and anxiety, depression, mood disorder, panic disorder, PTSD, and adjustment disorder in heart transplant patients. No geographical parameters were used in the search. All papers retrieved were reviewed qualitatively, and relevant information obtained was synthesized to arrive at the results and conclusions presented in this review. Result(s): This narrative review showed that anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorder exist in patients undergoing advanced surgical therapies (durable LVADs and cardiac transplantation). Most of the relevant studies are retrospective chart analyses done in single centers. Incidence and prevalence vary widely. Discussion(s): This review highlights the importance of mental health surveillance in patients undergoing LVAD and cardiac transplantation to enhance outcomes by improving behavioral health and compliance. Conclusion(s): There are no granular guidelines to address psychosocial evaluation in this population. The current literature does not help to distinguish any differences mechanical support would have on the psychology of these patients as compared to cardiac transplantation. Knowledge gaps exist in risk assessment and risk stratification of patients, which need further investigation. Copyright 2026, Bentham Science Publishers <109> Accession Number 2049168046 Title Sivelestat Sodium versus Standard Care for Prevention of Postoperative Lung Injury and Acute Respiratory Distress Syndrome in Adult Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass:A Systematic Review and Meta-Analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Shahbaz H.; Rayyan S.M.; Iqbal M.; Shahzaib M.; Azan Ali M.; Saif H.; Khan S.H.; Tahir M.A.; Khan M.H.; Niazi A.S. Institution (Shahbaz, Rayyan, Iqbal, Shahzaib, Azan Ali, Khan) Ayub Medical College, Abbottabad, Pakistan (Saif) Khyber Medical College, Peshawar, Pakistan (Khan) Khyber Medical University, Peshawar, Pakistan (Tahir) Abbottabad International Medical College, Abbottabad, Pakistan (Niazi) General Medical Council, United Kingdom Publisher W.B. Saunders Abstract Background: Cardiopulmonary bypass (CPB) during cardiac surgery induces a systemic inflammatory response that can result in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), with high associated mortality. Sivelestat sodium, a selective neutrophil elastase inhibitor, targets this pathway, but its perioperative efficacy remains uncertain. This study aimed to evaluate the efficacy and safety of perioperative sivelestat sodium versus standard care in adults undergoing cardiac surgery with CPB. Method(s): PubMed, Embase, and Cochrane databases were searched from inception to May 2026, following PRISMA guidelines (PROSPERO registered). Randomized controlled trials and observational cohort studies were included. The primary outcome was the incidence of ARDS; secondary outcomes included all-cause mortality, arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, duration of mechanical ventilation, and intensive care unit ICU length of stay (LOS). Random-effects models were used, with Peto odds ratio (OR) for sparse data. Heterogeneity was assessed using the I2 statistic, and certainty was evaluated using GRADE. Result(s): Six studies (2 RCTs, 4 cohort studies; n = 834 patients) were included, all from East Asia. Pooled estimates favored sivelestat across outcomes but were not statistically significant due to heterogeneity. ARDS incidence (k = 2) showed a Peto OR of 0.19 (95% confidence interval [CI], 0.03-1.16; I2 = 91.3%). Mortality (k = 5) yielded an OR of 0.69 (95% CI, 0.35-1.39; I2 = 36.7%), with 1 RCT showing significant benefit. Mechanical ventilation duration and ICU LOS were reduced but not significantly so. Evidence certainty was very low. Conclusion(s): Sivelestat shows consistent directional benefit in CPB-associated pulmonary outcomes, but heterogeneity limits statistical significance. Larger multicenter RCTs are needed to confirm efficacy and define clinical use. Copyright © 2026 Elsevier Inc. <110> Accession Number 2049188389 Title Nurse-led acute care post-operative interventions in adult cardiac surgery: a systematic review. Source European Journal of Cardiovascular Nursing. 25(6) (pp 1094-1107), 2026. Date of Publication: 01 Sep 2026. Author Matthews S.; Fredericks S.; Delaney L.; Abbs M.; Guiriba G.M.; Nasrawi D.; Wynne R. Institution (Matthews, Delaney, Abbs, Guiriba, Wynne) Centre for Quality & Patient Safety in the Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, 1 Geringhap Street, Geelong, Vctoria, Australia (Matthews, Guiriba, Wynne) Western Health, Majorca Street, St Albans, VIC, Australia (Matthews, Fredericks, Delaney, Abbs, Guiriba, Nasrawi, Wynne) Cardiac Surgery International Nursing & Allied Professional Research Network (Fredericks) Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, Canada (Nasrawi) Faculty of Health, Southern Cross University, Locked Bag 4, Coolangatta, QLD, Australia Publisher Oxford University Press Abstract Aims: The primary aim of this systematic review was to identify nurse-led clinical interventions evaluated in randomized controlled trials (RCTs) for adults who had undergone cardiac surgery. The secondary aim was to assess the effectiveness of these interventions on post-operative clinical and patient-reported outcomes during the acute inpatient phase. Methods and Results: A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute (JBI) methodology and PRISMA guideline for reporting. Eligible studies were RCTs of adult (>=18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Of 2690 records, 19 RCTs were eligible, representing 13 countries, and 3142 participants. Risk of bias varied, with only two low-risk trials. Interventions were grouped into seven domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care; infection prevention; respiratory and pulmonary function; and post-operative recovery, mobilization, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. Conclusion(s): Nurse-led inpatient interventions contribute meaningfully to inpatient post-operative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCTs. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty. Registration: PROSPERO-CRD420251063851. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. <111> Accession Number 652166176 Title Risk-Score Guided Estimation of Absolute Benefit From Beta-blockers after Myocardial Infarction in Patients Without Heart Failure. Source European heart journal. Quality of care & clinical outcomes. (no pagination), 2026. Date of Publication: 10 Sep 2026. Author Caglar H.; Holmager T.; Kristensen A.M.D.; Bakken A.; Rykind-Eriksen F.; Deeg P.; Andresen K.; Maeng M.; Oie E.; Atar D.; Munkhaugen J.; Prescott E. Institution (Caglar, Holmager, Kristensen, Rykind-Eriksen, Prescott) Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark (Bakken, Atar) Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway (Deeg) Department of Cardiology, Ostfold Hospital Trust Kalnes, Norway (Andresen) ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway (Maeng) Department of Cardiology, Aarhus University Hospital, Denmark (Oie, Atar) Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (Oie) Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway (Munkhaugen) Department of Medicine, Drammen Hospital, Vestre Viken Trust, Norway (Munkhaugen) Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Norway Abstract AIMS: To assess whether a modified clinical risk-score can stratify baseline risk and estimate expected absolute benefit from beta-blocker therapy in post-MI (myocardial infarction) patients with LVEF (left ventricular ejection fraction) >=40%. METHOD(S): This substudy of the BETAMI-DANBLOCK trial included patients with a recent MI and LVEF >=40% who were randomized to beta-blocker or no beta-blocker therapy. A modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) was constructed, and patients were categorized as low-, intermediate-, or high-risk. The primary outcome was a composite of all-cause mortality, new-MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia. Treatment effects across TRS-2P strata were estimated using Cox proportional hazards and Fine-Gray subdistribution hazard models. Three-year absolute risk reduction (ARR) and number needed to treat (NNT) were calculated for each risk stratum. RESULT(S): Among 5558 patients, 38.4% were classified as low-risk, 52.8% as intermediate-risk, and 8.8% as high-risk. Event rates increased stepwise with higher modified TRS-2P, with no evidence of heterogeneity in the relative treatment effects across risk-strata (hazard ratios: 0.88, 0.81 and 0.88, respectively). However, the score translated the modest relative effects into clinically distinct absolute benefits: Three-year ARR was 1.4% (NNT=72 [95% CI: 41 to 361]) in low-risk, 2.1% (NNT=47 [95% CI: 27 to 239]) in intermediate-risk, and 3.6% (NNT=28 [95% CI: 16 to 140]) in high-risk patients. CONCLUSION(S): The modified TRS-2P stratified baseline risk and provided estimates of absolute beta-blocker benefit, supporting further evaluation of individualized, risk-guided treatment after MI in patients with LVEF >=40%. 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 <112> Accession Number 2048930817 Title STOPBANG vs STOPBWANG. Source Lung India. 43(5) (pp 612-613), 2026. Date of Publication: 29 May 2026. Author Haldar A.K.; Dhar R.; Maity S.; Biswas B.; Krishnan S.; Bhattacharya A. Institution (Haldar) Consultant Pulmonologist, Department of Pulmonology, CK Birla Hospitals, CMRI, West Bengal, Kolkata, India (Dhar) Director & HOD, Department of Pulmonology, CMRI Hospital, West Bengal, Kolkata, India (Maity) Department of Physiotherapy, Institute of Sleep Sciences, West Bengal, Kolkata, India (Biswas, Krishnan) Consultant Pulmonologist, CMRI Hospital, West Bengal, Kolkata, India (Bhattacharya) Consultant Critical Care Physician, Respiratory Intensive Care Unit, CMRI Hospital, West Bengal, Kolkata, India Publisher Wolters Kluwer Medknow Publications Abstract Dear Editor, We appreciate the thoughtful and clinically grounded comments on our article, 'STOPBANG vs STOPBWANG: Comparative predictive performance for obstructive sleep apnoea severity and oxygen desaturation in an Indian cohort', and we welcome the opportunity to address the points raised.[1] Our primary objective was to evaluate whether incorporating waist circumference into the STOP-Bang framework improves the prediction of OSA severity and nocturnal desaturation in an Indian cohort with a predominantly visceral adiposity phenotype. In our study of 662 polysomnography-confirmed patients, the STOPBWANG model demonstrated a statistically higher area under the curve (AUC) (0.88) than STOP-Bang (0.849) for predicting OSA, with the difference confirmed by DeLong's test (P = 0.012), indicating a modest but significant gain in discrimination. This finding is directionally consistent with available Asian data suggesting that central adiposity-based measures may better capture OSA risk than neck circumference alone in South Asian populations.[2] Regarding the concern about false positives and downstream consequences, we agree that any screening tool must be interpreted within the clinical and health-system context in which it is deployed. In our cohort, a substantial proportion of patients without OSA had a waist circumference greater than 36 inches, and this is explicitly reported in the manuscript. STOP-Bang itself is designed as a high-sensitivity, low-to-moderate specificity tool to minimise missed OSA, as reflected in large meta-analyses where AUCs around 0.8-0.86 are accompanied by high sensitivity but modest specificity in highrisk populations. The addition of waist circumference in STOPBWANG preserves this high-sensitivity, triage-oriented role rather than serving as a standalone diagnostic test. As with standard STOP-Bang, we emphasised that positive screens should be prioritised and contextualised by clinical judgement, comorbidities, and resource availability, especially in low- and middleincome settings where polysomnography access is constrained.[3] With respect to the 36-inch waist cut-off, we agree that anthropometric norms in India are heterogeneous and differ across regions and between rural and urban populations. Our choice of the cohort median was explicitly framed as an internally datadriven threshold to explore the incremental value of central obesity within this specific urban referral population, similar to prior work that has used population-specific BMI or neck circumference thresholds to optimise STOP-Bang performance. We did acknowledge the limited generalisability of this cut-off beyond comparable urban tertiary-care cohorts and highlighted the need for external validation and calibration in other Indian subpopulations, including rural and non-metropolitan settings. Our intent was not to propose 36 inches as a universal Indian waist threshold, but to demonstrate that integrating waist into the model improves discrimination in a real-world Indian sample and to motivate further multicentric work.[4] On the issue of questionnaire length and practicality, we recognise that STOP-Bang has been criticised for being cumbersome in certain Asian outpatient settings, and that questionnaire fatigue is a valid concern. However, comparative data from sleep and perioperative clinics suggest that STOP-Bang remains feasible in routine practice when deployed as part of structured screening workflows, even in cardiovascular and surgical populations with high patient throughput. The shift from eight to nine items is relatively small in absolute terms, and in many of the settings where our cohort was drawn from, questionnaires were administered with staff assistance rather than being entirely self-completed, which mitigates attrition risk. That said, we agree that implementation studies evaluating completion rates, time burden, and user acceptability of STOPBWANG versus STOP-Bang in unsupervised, patientcompleted formats across different Indian practice environments are an important next step, and we have called for such pragmatic evaluations.[5] We also appreciate the insightful comment on the limited contribution of the Epworth Sleepiness Scale (ESS) in our models. Our findings align with broader evidence that ESS has variable performance across phenotypes and may underdetect sleepiness in metabolic, obesitydriven OSA, including in South and East Asian cohorts. Rather than viewing this as a limitation, we concur that it reflects a phenotypic signal: in centrally obese, cardiometabolicrisk populations, OSA often presents with nonsleepiness phenotypes, and functional scales like ESS may fail to capture disease severity or risk. Our data, together with existing literature, support the notion that structural/anthropometric markers such as BMI, neck circumference, and waist circumference may be more informative than subjective sleepiness scales in this phenotype. We agree that future work should more explicitly characterise this metabolic-OSA phenotype and formally compare phenotypic clusters where ESS contributes meaningfully versus those where its incremental value is minimal.[6] Finally, we would like to emphasise that our intention was not to replace clinical judgment or existing tools, but to contribute incremental, Indiaspecific evidence on how modifying a widely used instrument may better reflect the central obesity pattern that is common in our population. The modest but statistically significant improvement in AUC, the preservation of a high-sensitivity screening role consistent with global STOP-Bang validation studies, and alignment with calls from Asian data to explore waist-based modifications together support the core conclusion that adding waist circumference is a rational and evidencebased step in Indian cohorts. We agree that questions of generalisability, optimal cut-offs, workflow burden, and phenotypespecific interpretation warrant further multicentric and implementation research, and we are grateful that your letter has helped highlight these directions.[2] We thank the authors for their thoughtful appraisal and for engaging constructively with our work. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Copyright © 2026 Indian Chest Society <113> Accession Number 2049160340 Title Impact of resistance training on sternal integrity and functional recovery following median sternotomy: A systematic review and meta-analysis. Source Formosan Journal of Surgery. (no pagination), 2026. Date of Publication: 2026. Author Agarwal P.; Chahal A.; Sharma N.; Rai R.H.; Sidiq M.; Sharma J.; Shanazarovna B.S.; Djumaniyazova M.K.; Sharma A. Institution (Agarwal) Sikkim Professional College of Physiotherapy, Sikkim Professional University, Sikkim, Tadong, India (Chahal) Department of Physiotherapy, Galgotias Multi-disciplinary Research and Development Cell (G-MRDC), Galgotias University, Uttar Pradesh, Greater Noida, India (Sharma) Department of Health Science, Uttaranchal College of Health Sciences, Uttaranchal University, Uttarakhand, Dehradun, India (Rai) School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India (Sidiq) Physiotherapy Department, Tishk International University, Erbil, Iraq (Sharma) Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Uttar Pradesh, Greater Noida, India (Shanazarovna) Department of Romanic-Germanic Philology, Mamun University, Uzbekistan (Djumaniyazova) Department of Pedagogy and Psychology, Pedagogy faculty, Urgench State University, Uzbekistan (Sharma) Department of Physiotherapy, Graphic Era College of Paramedical Sciences, Graphic Era (Deemed to be University), Uttarakhand, Dehradun, India Publisher Wolters Kluwer Medknow Publications Abstract Background: - A common surgical technique for cardiac procedures is median sternotomy, which necessitates a lengthy recuperation period to guarantee sternal integrity and functional restoration. Although restricted motions are frequently emphasized in traditional rehabilitation, the role of Resistance Training (RT) in post-sternotomy recovery remains a subject of discussion. Objective(s): - To evaluates the impact of resistance training on sternal integrity and functional recovery following median sternotomy, analysing its safety and efficacy in improving postoperative outcomes. Method(s): - Following PRISMA guidelines, five databases (PubMed, Cochrane, PEDro, Scopus and Google Scholar) were searched from December 2024 to February 2025 for studies combining two key concepts: resistance training and median sternotomy post cardiac surgery. Two reviewers independently completed study selection, data extraction and risk of bias assessment using Review Manager Version 5.4.1. Result(s): - Total 17 full-text articles with 2, 186 participants with a mean age of 65.48+-5.2 were qualified for the review. Meta-analysis was conducted where two or more studies reported the same units of outcome measurements. Patients experienced improved cardiovascular fitness (20% VO<inf>2</inf> peak gain), increased muscular strength (10-20% hand grip strength) and increased mobility (15-30% in 6MWT). Pain levels decreased by 20-50% highlighting improved postoperative comfort. Conclusion(s): - For post-sternotomy rehabilitation, resistance training is concluded to be a safe and efficient method that promotes functional recovery without affecting sternal integrity. To maximise rehabilitation recommendations for patients undergoing heart surgery, future studies should concentrate on standardised training protocols. (PROSPERO Registration ID: CRD420251003347) Copyright © 2026 Taiwan Surgical Association. Published by Wolters Kluwer Health, LLC. on behalf of Taiwan Surgical Association. <114> Accession Number 2049175843 Title Clinical outcomes of early vs. late extubation following cardiac surgery: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (pp 1-15), 2026. Article Number: 1913348. Date of Publication: 26 Aug 2026. Author Dairi M.S.; Thalib H.I.; Khan S.; Jamal A.; Alghamdi S.M.; Aldhahir A.M.; Alqarni A.A.; Oyelade T.; Khalid I.; Bawazeer S.S.; Aziz A.; Alwafi H. Institution (Dairi) Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Thalib, Khan, Jamal) Batterjee Medical College, Jeddah, Saudi Arabia (Alghamdi) Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia (Aldhahir) Respiratory Therapy Program, Department of Nursing, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia (Alqarni) Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia (Oyelade) School of Medicine, Keele University, Stoke-on-Trent, Keele, United Kingdom (Oyelade) Division of Medicine, University College London, London, United Kingdom (Khalid) Alfaisal University, Riyadh, Saudi Arabia (Khalid) King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Bawazeer) Department of Surgery, College of Medicine, Al-Qunfudah, Umm Al-Qura University, Makkah, Saudi Arabia (Aziz) Health Informatics Specialist Digitization Department Dallah Health Co, Riyadh, Saudi Arabia (Alwafi) Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia Publisher Frontiers Media SA Abstract Objective - This systematic review and meta-analysis evaluated clinical outcomes associated with earlier vs. later extubation in adults undergoing cardiac surgery. Methods - A systematic review and meta-analysis were conducted following PRISMA guidelines, with the study registered in PROSPERO. We searched PubMed, Scopus, Web of Science, CENTRAL, and EBSCO from inception until April 2025. Two reviewers independently screened studies. We included observational and interventional studies comparing early vs. late extubation following cardiac surgery in adult patients. Primary outcomes were all-cause mortality, length of intensive care unit (ICU) stay, length of hospital stay, reintubation, postoperative pneumonia, and postoperative renal failure requiring continuous renal replacement therapy (CRRT). Secondary outcomes included mediastinal bleeding requiring re-exploration, tracheostomy, and hospital or ICU readmission. Risk of bias in randomized trials was assessed using the Cochrane Risk of Bias tool, while the Newcastle-Ottawa Scale (NOS) was used for observational studies. Data synthesis was performed using Review Manager version 5.4. For continuous outcomes, pooled effect estimates were expressed as mean differences (MDs). For dichotomous outcomes, pooled odds ratios (ORs) with corresponding 95% CIs were calculated. Random-effects models were used as the primary analysis. A subgroup analysis based on extubation threshold ( <= 6 h or >6 h) was conducted. Statistical heterogeneity was assessed using the Chi-square test and the I 2 statistic. Results - A total of 237 records were identified, of which only 19 studies (18 observational and one randomized trial) were included in this meta-analysis. Earlier extubation was associated with lower odds of mortality (OR 0.09, 95% CI 0.04-0.23), reintubation (OR 0.22, 95% CI 0.07-0.70), postoperative pneumonia (OR 0.20, 95% CI 0.09-0.45), renal failure requiring CRRT (OR 0.10, 95% CI 0.06-0.17), postoperative tracheostomy (OR 0.01, 95% CI: 0.00-0.03), and hospital or ICU readmission (OR 0.25, 95% CI 0.07-0.86). Conclusions - In adults undergoing cardiac surgery, earlier extubation was associated with favorable postoperative outcomes including lower mortality, shorter ICU and hospital stays, and lower rates of reintubation, postoperative pneumonia, tracheostomy, CRRT, and hospital or ICU readmission. However, future randomized trials and prospective studies are warranted as the available evidence was predominantly observational and clinically heterogeneous. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261361735, identifier: CRD420261361735. Copyright © 2026 Dairi, Thalib, Khan, Jamal, Alghamdi, Aldhahir, Alqarni, Oyelade, Khalid, Bawazeer, Aziz and Alwafi. <115> Accession Number 2049021234 Title Outcomes and Complications of Total Joint Arthroplasty in Heart Transplant Recipients: A Systematic Review. Source Journal of Clinical Medicine. 15(17) (no pagination), 2026. Article Number: 6794. Date of Publication: 01 Sep 2026. Author Koskiniotis A.; Komnos G.A.; Koutalos A.; Hantes M.; Karachalios T.; Varitimidis S.; Stefanou N. Institution (Koskiniotis, Komnos, Koutalos, Hantes, Karachalios, Varitimidis, Stefanou) Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis, Larissa, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Heart transplantation has evolved into a life-saving intervention for thousands of patients with end-stage disease worldwide. Advances in surgical techniques and immunotherapy have increased life expectancy in this specific patient group, resulting in the emergence of degenerative diseases such as osteoarthritis. Concurrently, due to the frequent administration of corticosteroids to transplant recipients, the rates of joint osteonecrosis remain high. This review aims to evaluate the final functional outcomes as well as the complications of patients with a history of heart transplantation who underwent total hip, knee, or shoulder arthroplasty. Method(s): A systematic review of the literature was conducted according to PRISMA guidelines. The primary objective of the study was the improvement of various functional scores at the final clinical follow-up, as well as the recording of postoperative complication rates. Result(s): A total of 19 retrospective studies were included in the review, including small case series. Among the studies specifically evaluating functional outcomes, patients demonstrated statistically significant improvement in final clinical scores and quality of life. However, regarding complication rates, 12 out of the 19 articles identified a higher ratio compared to the general population, involving either systemic (e.g., renal failure), musculoskeletal (periprosthetic fracture, infection), or cardiac-related adverse events concerning the graft. Conclusion(s): According to the data analyzed in this systematic analysis, total arthroplasty of major joints demonstrates consistent potential to significantly improve the daily life and functional status of transplant patients. However, evidence regarding overall safety remains heterogeneous. Copyright © 2026 by the authors. <116> Accession Number 652166438 Title Effect of Influenza Vaccination on Major Cardiovascular Events and Mortality: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Critical pathways in cardiology. (no pagination), 2026. Date of Publication: 09 Sep 2026. Author Shahid M.W.; Hameed A.; Naseem A.; Sajjad F.; Shah M.H.; Khan H.; Khan A.J.; Usman M.T.; Ullah Y.; Abeer H.; Shakeel M.; Khan A.; Tariq M.; Darwesh M.S.; Shah Zaib Khan M.; Afridi A.; Khattak F.; Haq A.U.; Abid H. Institution (Shahid, Naseem, Sajjad, Ullah, Shakeel, Darwesh, Afridi, Khattak, Haq) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Hameed) Department of Medicine, Sahiwal medical college, Sahiwal, Pakistan (Shah) Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan (Khan) Department of Medicine, Khyber Girls Medical College, Peshawar, Pakistan (Khan) Department of Medicine, St. Luke's Hospital, Chesterfield, United Kingdom (Usman) Department of Medicine, Gajju Khan Medical College, Swabi, Pakistan (Abeer) Department of Medicine, KMU Institute of medical sciences, Kohat, Pakistan (Khan) Department of Medicine, Loralai Medical College, Balochistan, Pakistan (Tariq) Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan (Shah Zaib Khan) Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan (Abid) Department of Medicine, Indiana University School of Medicine, IN, United States Abstract Cardiovascular disease remains the leading global cause of mortality despite advances in preventive therapies. Influenza infection is increasingly recognized as a trigger for acute cardiovascular events, prompting interest in influenza vaccination as a potential cardioprotective intervention in high-risk patients. We aimed to conduct a systematic review and meta-analysis to evaluate the effect of influenza vaccination on cardiovascular outcomes in adults with established cardiovascular disease. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until October 2025. Seven studies were included after the final screening. Outcomes were reported as all cause mortality, myocardial infarction, major adverse cardiovascular events and heart failure related hospitalization. Interstudy heterogeneity was assessed using I2 and X2 statistics. Statistical calculations were performed using Review Manager 5.4.1, with a p-value of < 0.05 indicating statistical significance. Seven randomized controlled trials including 12,224 participants were analyzed. Influenza vaccination significantly reduced major adverse cardiovascular events and cardiovascular mortality. A borderline reduction was observed for myocardial infarction and all-cause mortality. No significant differences were found for stroke, coronary revascularization, or heart failure-related hospitalization. Heterogeneity was low for most primary outcomes. The routine use of influenza vaccination as an effective adjunctive strategy in secondary cardiovascular prevention is supported by the fact that it significantly lowers cardiovascular mortality and major cardiovascular events in patients with established heart disease. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <117> Accession Number 2049149460 Title Ketamine for Analgosedation in Mechanically Ventilated Adults: A Double-Blind Randomized Trial. Source Critical Care Medicine. (no pagination), 2026. Date of Publication: 2026. Author Casamento A.J.; Ghosh A.N.; Said S.; Eastwood G.; Peck L.; Young H.; Otto M.; McKenna H.; Stevens M.; Pandey D.; Jahanabadi H.; Jones D.A.; Warrillow S.; Spano S.; Maeda A.; Chan J.W.; Bellomo R.; Serpa Neto A. Institution (Casamento, Eastwood, Peck, Young, Otto, McKenna, Jones, Warrillow, Spano, Maeda, Chan, Bellomo, Serpa Neto) Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia (Casamento, Ghosh, Said, McKenna) Department of Intensive Care, Northern Hospital, Melbourne, VIC, Australia (Casamento, Ghosh, Eastwood, Jones, Warrillow, Bellomo, Serpa Neto) Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia (Eastwood, Jones, Bellomo, Serpa Neto) Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Stevens, Pandey, Jahanabadi, Bellomo, Serpa Neto) Data Analytics Research and Evaluation (DARE) Center, Austin Hospital, Melbourne, VIC, Australia (Stevens, Pandey, Jahanabadi) Business Intelligence Unit, Austin Hospital, Melbourne, VIC, Australia (Maeda, Serpa Neto) Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil (Bellomo) conceptualization, methodology, and project administration, United States Publisher Lippincott Williams and Wilkins Abstract Objectives: - The role of ketamine for analgosedation in the ICU remains unclear. This study aimed to assess the efficacy of low-dose ketamine infusion for adjunct analgosedation in adults receiving mechanical ventilation. Design(s): - A prospective, double blind, randomized, placebo-controlled trial. Setting(s): - The study was conducted at two university-affiliated ICUs in Melbourne, Australia, between September 2022 and December 2024. Patient(s): - Adult patients receiving mechanical ventilation in the ICU who were also receiving opioid infusion for analgosedation (excluding cardiac surgical patients). Intervention(s): - Patients were randomized to receive low-dose ketamine infusion (0.15 mg/kg/hr) or placebo during the period of mechanical ventilation. Measurements and Main Results: - The primary outcome was the hourly dose of opioids. Secondary outcomes included, among others, delirium, as well as ventilator, ICU, and hospital-free days to day 28. A total of 538 patients were screened for inclusion. Of these, 413 patients were ineligible based on exclusion criteria. A further five patients had consent withdrawn, leaving 120 patients (59 ketamine and 61 placebo) included for primary analysis. The median (interquartile range) hourly dose of opioids in fentanyl equivalents was 64 microg/hr (36-89 microg/hr) in the ketamine group and 77 microg/hr (47-100 microg/hr) in the placebo group (median difference, -13.0 [95% credible interval, -26.6 to 2.4]; probability of benefit, 95.1%). There were no differences between groups for most of the secondary outcomes, including delirium and significant adverse events. Conclusion(s): - Low-dose ketamine infusion appeared safe and was associated with a reduction in hourly opioid requirements in ICU patients receiving mechanical ventilation. Larger randomized controlled trials are required to assess effects on other patient-centered outcomes. Copyright © 2026 by the Society of Critical Care Medicine and Wolters Kluwer Health, LLC. All Rights Reserved. <118> Accession Number 2049172021 Title Multitarget mechanisms and clinical integration of traditional Chinese medicine in cardiac rehabilitation: a narrative review. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1895271. Date of Publication: 2026. Author Zhang Y.; Zhang J.; Deng S.; Zhao L.; Yu X. Institution (Zhang, Deng, Zhao) Department of Rehabilitation and Pain Medicine, West China Hospital of Sichuan University-Ziyang Hospital (Ziyang Central Hospital), Sichuan, Ziyang, China (Zhang) Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University-Ziyang Hospital (Ziyang Central Hospital), Sichuan, Ziyang, China (Yu) Department of Rehabilitation Medicine, Sichuan University West China Hospital Tibet People's Government in Chengdu Office Branch, Sichuan, Chengdu, China Publisher Frontiers Media SA Abstract Cardiovascular diseases (CVD) are a major global public health burden. Annually in the United States, over one million patients undergo arduous cardiac rehabilitation (CR) after experiencing cardiovascular events such as myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting, cardiac valve surgery, and heart transplantation. Although CR can reduce mortality, it fails to fully address residual risks, including chronic inflammation, autonomic dysfunction, and psychological disorders. Meanwhile, low patient participation and completion rates remain a major clinical challenge. Traditional Chinese medicine (TCM) shows multi-target cardioprotective effects that can effectively complement CR. This review focuses on the theoretical compatibility, multi-target mechanisms, and clinical application of TCM integrated with CR. Clinically, TCM effectively compensates for the limitations of conventional CR. Traditional Chinese exercise (TCE) acts as an optimal bridging therapy to facilitate safe rehabilitation initiation in deconditioned populations prior to standard aerobic training. The application of Chinese herbal medicine (CHM) in complex metabolic and psychological comorbidities refractory to conventional pharmacotherapy yields prominent advantages in CR. During inpatient and early outpatient rehabilitation, acupuncture and acupoint stimulation modulate autonomic function, relieving postoperative angina and myocardial ischemia without increasing cardiac burden. Despite promising prospects, inconsistent syndrome classification standards and inadequate high-grade evidence remain obstacles to its global clinical adoption. This review therefore elaborates on the theoretical rationale and clinical evidence to promote the integration of TCM-CR as a novel holistic regimen for CVD rehabilitation. Copyright © 2026 Zhang, Zhang, Deng, Zhao and Yu. <119> Accession Number 2049274709 Title Bempedoic Acid and First and Recurrent Limb Outcomes in Statin-Intolerant Patients With Peripheral Artery Disease: Insights From the CLEAR Outcomes Trial. Source Circulation. 154(11) (pp 966-975), 2026. Date of Publication: 18 Aug 2026. Author Bonaca M.P.; Canonico M.E.; Li N.; Sasiela W.J.; Nissen S.E.; Lincoff A.M.; Nicholls S.J. Institution (Bonaca, Canonico) CPC Clinical Research, University of Colorado School of Medicine, Aurora, United States (Bonaca, Canonico) Department of Medicine, University of Colorado, Aurora, United States (Li, Sasiela) Esperion Therapeutics, Inc, Ann Arbor, MI, United States (Nissen, Lincoff) Department of Cardiovascular Medicine and Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland Clinic, OH, United States (Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC, Australia Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Patients with peripheral artery disease (PAD) are at high risk of major adverse limb events (MALE) and major adverse cardiovascular events (MACE). Recently, bempedoic acid was shown to reduce MACE in primary and secondary prevention patients. Whether bempedoic acid reduces the risk of MALE in patients with PAD is unknown. METHOD(S): - CLEAR Outcomes (Cholesterol Lowering via Bempedoic Acid [ETC1002], an ACL-Inhibiting Regimen) randomized 13 970 patients to bempedoic acid 180 mg or placebo from December 22, 2016, to August 14, 2019. The trial primary end point was MACE-4, defined as death resulting from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. A clinical history of PAD was reported by investigators at baseline. Two blinded vascular medicine specialists independently adjudicated MALE, including adverse events indicating worsening PAD symptoms leading to revascularization, chronic limb-threatening ischemia, and acute limb ischemia. Outcomes were assessed as time to first event and total (including recurrent) events with a negative binomial approach. RESULT(S): - A total of 1624 of the enrolled patients (mean+/-SD age, 63.9+/-9.9 years; 915 [56.3%] female) had PAD at baseline. In patients with PAD in the placebo group, 69 (8.3%) had MALE over a median of 40.6 months, with rate of recurrent events of 4.0%/y. Bempedoic acid reduced the risk of MALE by 36% (hazard ratio, 0.64 [95% CI, 0.44-0.93]; P=0.018). Bempedoic acid reduced total MALE by 45% (relative risk, 0.55 [95% CI, 0.35-0.85]; P=0.007). First MACE-4 or MALE was reduced overall by 13% (hazard ratio, 0.87 [95% CI, 0.80-0.95]) with consistent effects with PAD (hazard ratio, 0.82 [95% CI, 0.64-1.04]) and without PAD (hazard ratio, 0.87 [95% CI, 0.79-0.86]; P<inf>interaction</inf>=NS) but not statistically significant within the PAD subgroup alone. Total MACE-4 or MALE was reduced (relative risk, 0.81 [95% CI, 0.73-0.90]) overall with consistent effects in PAD (relative risk, 0.71 [95% CI, 0.54-0.95]) and without PAD (relative risk, 0.82 [95% CI, 0.73-0.92]; P<inf>interaction</inf>=NS). CONCLUSION(S): - Patients with PAD are at high risk of MALE and MACE. Bempedoic acid reduces both MACE and MALE in patients with atherosclerotic vascular disease, with notable absolute benefits in patients with PAD. These findings support (1) the importance of lowering low-density lipoprotein cholesterol in patients with PAD to reduce overall vascular risk and (2) the benefits of bempedoic acid in this population. Copyright © 2026 American Heart Association, Inc. <120> Accession Number 2049229107 Title Sex differences in postoperative atrial fibrillation and posterior left pericardiotomy: Subanalysis of the Posterior Left Pericardiotomy for the Prevention of AtriaL Fibrillation After Cardiac Surgery trial. Source Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Gregg A.C.; Rong L.Q.; Sandner S.; Kim J.; Heise R.; Ingason A.B.; Krieger K.; Girardi L.N.; Redfors B.; Gaudino M. Institution (Gregg, Sandner, Ingason, Krieger, Girardi, Redfors, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States (Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States (Sandner) Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Kim, Heise, Redfors) Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States (Redfors) Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden (Redfors) Department of Cardiology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden Publisher Elsevier Inc. Abstract Background: This post hoc analysis of the Posterior Left Pericardiotomy for the Prevention of AtriaL Fibrillation After Cardiac Surgery (PALACS) trial examined the association between sex and postoperative atrial fibrillation characteristics after cardiac surgery. Method(s): In PALACS, patients undergoing cardiac surgery were randomized to posterior left pericardiotomy or no intervention. This analysis stratified participants by sex, evaluating differences in postoperative atrial fibrillation incidence, duration, burden, postoperative in-hospital length of stay, and pericardial effusions. Result(s): All 420 PALACS patients were included, consisting of 24% (102/420) female patients. Postoperative atrial fibrillation occurred in 22% (22/102) of female patients and 25% (81/318) of male patients (P = .51). Female sex was associated with a lower postoperative atrial fibrillation risk (adjusted odds ratio, 0.47, 95% CI, 0.24-0.87, P = .02). Posterior left pericardiotomy reduced the risk of postoperative atrial fibrillation (adjusted odds ratio, 0.46 95% CI, 0.28-0.76, P = .003), without difference by sex (p<inf>interaction</inf> = .59). No sex differences were observed in postoperative atrial fibrillation duration or burden. Female patients had longer postoperative in-hospital length of stay (median 7 [interquartile range, 5-8] days vs 6 [interquartile range, 5-7] days, P = .005); however, sex was not independently associated with hospitalization length (adjusted beta 1079, 95% CI, -448 to 2605, P = .17). Pericardial effusion incidence and size did not differ by sex. Moderate (>10 mm) posterolateral pericardial effusion was associated with higher postoperative atrial fibrillation incidence (adjusted odds ratio, 2.98, 95% CI, 1.07-8.16, P = .03), without sex difference (p<inf>interaction</inf> = .61). Conclusion(s): In PALACS, female patients had a lower adjusted risk of postoperative atrial fibrillation; however, the clinical course of postoperative atrial fibrillation was similar between sexes. Posterior left pericardiotomy reduced postoperative atrial fibrillation incidence without evidence of sex-specific heterogeneity. Copyright © 2026 The American Association for Thoracic Surgery <121> Accession Number 2049203328 Title One-Year Outcomes of Myval Versus Contemporary Transcatheter Heart Valves in Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Source Cardiology in Review. (pp 1-10), 2026. Date of Publication: 2026. Author Al-Harbi F.A.; Alanazi A.K.; Algoblan N.A.; Aldhafeeri S.S.; Alrashoodi L.B.; Alamer M.A.; Alquraishi O.F.; Alresaini A.A.; Almutiq N.M.; Aljibreen M.S.; Alwabili L.F.; Kolko N. Institution (Al-Harbi, Alanazi, Algoblan, Aldhafeeri, Alrashoodi, Alamer, Alresaini, Almutiq, Aljibreen, Alwabili) From the Department of Medicine, College of Medicine, Qassim University, Buraidah, Saudi Arabia (Alquraishi) Department of Medicine, College of Medicine, Qassim University, Onaizah, Saudi Arabia (Kolko) Department of Cardiology, Prince Sultan Cardiac Center, Qassim, Saudi Arabia Publisher Lippincott Williams and Wilkins Abstract The Myval and Myval Octacor transcatheter heart valves (THVs) are newer-generation balloon-expandable devices for transcatheter aortic valve implantation (TAVI) in severe aortic stenosis (AS), but comprehensive synthesis of 1-year outcomes incorporating recent randomized data remains limited. We searched PubMed/MEDLINE, Embase, and CENTRAL through June 2026 for randomized controlled trials and propensity-matched or adjusted observational studies comparing Myval/Myval Octacor with contemporary THVs in adults undergoing transfemoral TAVI for severe symptomatic AS. The primary outcome was 1-year all-cause mortality; secondary outcomes included cardiovascular death, stroke, new permanent pacemaker implantation (PPI), mean transvalvular gradient, effective orifice area, and moderate-to-severe aortic regurgitation. Random-effects meta-analyses generated pooled risk ratios (RRs) and mean differences with 95% confidence intervals. Five studies (2 randomized trials, 3 propensity-matched/adjusted cohorts; 2327 patients: 1107 Myval, 1220 contemporary THV recipients) were included. At 1 year, Myval showed comparable outcomes to contemporary THVs for all-cause mortality (RR 0.89, 0.66-1.21), cardiovascular death (RR 0.92, 0.55-1.55), and stroke (RR 1.41, 0.91-2.18), with similar new PPI rates (RR 0.82, 0.47-1.42). Among randomized trials, Myval had lower mean transvalvular gradients (MD -1.28 mm Hg, -1.73 to -0.82) and larger effective orifice area (mean difference +0.15 cm2, 0.09-0.20) than SAPIEN, with no significant difference in moderate-to-severe aortic regurgitation (RR 1.28, 0.19-8.71). Myval demonstrated comparable all-cause mortality, cardiovascular death, stroke, and PPI rates to contemporary THVs at 1 year, along with favorable hemodynamics versus SAPIEN, supporting Myval as an effective contemporary TAVI platform; longer-term studies are needed to confirm durability and clinical outcomes. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <122> Accession Number 2049229931 Title Anticoagulant Regimen for Nonvalvular Atrial Fibrillation in the Elderly and Frail Population. Source American Journal of Cardiology. 277 (pp 73-84), 2026. Date of Publication: 15 Oct 2026. Author Scalia L.; Gatto L.; Agnello F.; Calderone D.; Celeski M.; Popolo Rubbio A.; Prati F.; Testa L.; Capodanno D.; Barbanti M. Institution (Scalia, Agnello, Barbanti) Department of Cardiology, Umberto I Hospital, Enna, Italy (Gatto, Prati) Cardiovascular Department, San Giovanni Addolorata Hospital, Rome, Italy (Gatto, Prati) Department of Cardiovascular Sciences, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy (Agnello, Barbanti) Faculty of Medicine and Surgery, University of Enna "Kore", Enna, Italy (Calderone) Invasive Cardiology, Department of Cardiology, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (Celeski) Department of Cardiology, Fabrizio Spaziani Hospital, Frosinone, Italy (Popolo Rubbio, Testa) Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy (Capodanno) Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy Publisher Elsevier Inc. Abstract Anticoagulant therapy is the cornerstone of stroke prevention in atrial fibrillation (AF), yet its management in elderly and frail patients remains particularly challenging. This review aims to summarize current evidence, guideline recommendations, and future perspectives regarding the optimal anticoagulant strategy in this vulnerable population. A narrative review of pivotal randomized clinical trials and major real-world registries was conducted, focusing on outcomes of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients aged >=75 years or meeting frailty criteria. Across studies, DOACs consistently demonstrated similar or superior efficacy compared with VKAs for the prevention of stroke and systemic embolism, with a substantially lower risk of intracranial hemorrhage. Apixaban and edoxaban, particularly at adjusted doses, showed the most favorable balance between thromboembolic protection and bleeding risk. Conversely, switching stable elderly patients from long-term VKAs to DOACs, as in the FRAIL-AF trial, was associated with an early excess of clinically relevant nonmajor bleeding. Frailty, multimorbidity, renal impairment, and polypharmacy remain critical modifiers of both efficacy and safety, underlining the need for individualized dosing and regular renal function monitoring. Recent European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) and the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines recommend DOACs as the preferred treatment for nonvalvular AF, emphasizing comprehensive risk assessment and shared decision-making. Emerging agents, such as factor XI inhibitors, offer a promising approach to minimizing bleeding risk in the elderly, though confirmation of their efficacy against ischemic events remains to be fully established. In elderly and frail patients with AF, DOACs represent the first-line anticoagulant therapy when appropriately dosed and monitored. A personalized, multidisciplinary approach incorporating frailty assessment, renal evaluation, and patient preference is essential to optimize outcomes. Future trials specifically enrolling very old and severely frail patients are urgently needed to close existing evidence gaps. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <123> Accession Number 2049236286 Title Propofol-Supplemented Cardioplegic Solution Effect on Myocardial Protection: A Systematic Review and Bayesian Meta-analysis of Randomized Controlled Trials. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Rios Esparza R.A.; Rodriguez Milan R.; Abbas M.S.; Ahmad A.; Quiroz de la Rosa D.; Retana E.P.; Fuentes Puga V. Institution (Rios Esparza, Retana) Instituto de Ciencias Biomedicas, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez, Mexico (Rodriguez Milan) Universidad Autonoma Metropolitana Unidad Xochimilco, Ciudad de Mexico, Mexico (Abbas, Ahmad) Gomal Medical College, Khyber Medical University, Peshawar, Pakistan (Quiroz de la Rosa) Universidad Autonoma de Guadalajara, Guadalajara, Mexico (Fuentes Puga) Cardiovascular Anesthesiology, Hospital Universitario Jose E. Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico Publisher W.B. Saunders Abstract Objectives: To determine the probability of a clinically relevant reduction in postoperative myocardial injury following the use of propofol-supplemented cardioplegia. Design(s): Systematic review and Bayesian meta-analysis. Setting(s): Perioperative cardiac surgery. Participant(s): Adult patients (N = 523) undergoing cardiac surgery requiring cardiopulmonary bypass. Intervention(s): Propofol-supplemented cardioplegic solution versus standard cardioplegia. Measurements and Main Results: The primary endpoint was postoperative troponin levels. A Bayesian hierarchical random-effects model using weakly informative priors yielded a pooled standardized mean difference (SMD) of -0.05 (95% credible interval [CrI], -0.33 to 0.24). The posterior probability of any reduction in postoperative troponin levels (SMD < 0) was 70.8%. Secondary endpoints showed similarly uncertain evidence of benefit, including postoperative creatinine levels (SMD, -0.06; 95% CrI, -0.71 to 0.46; probability of benefit, 59.8%), serious complications (risk ratio [RR], 0.77; 95% CrI, 0.18 to 2.28; probability of benefit, 70.3%), and postoperative arrhythmias (RR, 0.96; 95% CrI, 0.51 to 1.62; probability of benefit, 56.4%). Conclusion(s): Current evidence suggests moderate posterior probabilities of benefit across endpoints. However, substantial uncertainty remains regarding the magnitude and direction of the true treatment effects. These findings do not provide convincing evidence to support routine addition of propofol to standardized cardioplegic protocols, and the use of propofol-supplemented cardioplegia should remain at the discretion of the heart surgery team. Copyright © 2026 The Authors <124> Accession Number 2049252033 Title Prophylactic Surgical Left Atrial Appendage Closure in Bioprosthetic Aortic Valve Replacement: Short-Term Outcomes of Randomized Controlled LAA-CLOSURE Trial. Source Journal of the American Heart Association. 15(17) (no pagination), 2026. Article Number: e046654. Date of Publication: 2026. Author Kiviniemi T.; Halfw F.; Munguira J.B.; Zindovic I.; Malmberg M.; Olsson C.; Perrotta S.; Van Schaagen F.; Suwalski P.; Hartikainen J.; Hanke T.; Guillermo R.C.; Speekenbrink R.G.H.; Bustamante E.; Erixon C.; Gunn J.; Bjurbom M.; Jeppsson A.; Oei F.; Wietsm N.E.; Dahlberg S.; Lip G.; Lehto J.; Vasankari T.; Airaksinen J.; Van Putte B. Institution (Kiviniemi, Malmberg, Gunn, Lehto, Vasankari, Airaksinen) Turku University Hospital, University of Turku, Finland (Halfw, Speekenbrink, Wietsm) Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, Netherlands (Halfw, Speekenbrink, Wietsm) University of Twente, TechMed Centre, Enschede, Netherlands (Munguira, Bustamante) Hospital Clinico Universitario de Valladolid, Valladolid, Spain (Zindovic, Erixon, Dahlberg) Department of Clinical Sciences, Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden (Olsson, Bjurbom) Karolinska University Hospital and the Karolinska Institutet, Stockholm, Sweden (Perrotta, Jeppsson) Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Jeppsson) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Van Schaagen, Oei) University Medical Center Rotterdam, Rotterdam, Netherlands (Suwalski) Ministry of Interior and Administration, Center of Postgraduate Medical Education, National Medical Institute, Warsaw, Poland (Hartikainen) Kuopio University Hospital, and University of Eastern Finland, Kuopio, Finland (Hanke) Asklepios Klinik Harburg, Hamburg, Germany (Guillermo) Hospital Universitario, La Princesa, Madrid, Spain (Lip) Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom (Van Putte) St. Antonius ziekenhuis, Nieuwegein, Netherlands Publisher American Heart Association Inc. Abstract BACKGROUND: Surgical closure of the left atrial appendage (LAA) reduces stroke risk in patients with atrial fibrillation (AF) undergoing cardiac surgery. We evaluated the safety and efficacy of prophylactic LAA closure during bioprosthetic surgical aortic valve replacement in patients without prior AF. METHOD(S): In this investigator-initiated, academic, randomized, open-label, multicenter LAA-CLOSURE (Left Atrial Appendage CLOSURE for the Prevention of Thromboembolisms in Patients Undergoing Aortic Bioprosthesis Surgery) trial, 921 patients without prior AF undergoing bioprosthetic surgical aortic valve replacement with or without concomitant surgery were randomized and 904 patients included in the modified intention-to-treat analysis (prophylactic LAA closure, n=445; or usual care, n=459). Median age was 73 years (interquartile range, 69-76), 34.8% were women, and 49% had concomitant coronary artery disease. The primary end point was a composite of cardiovascular death, stroke, or systemic embolism at 30 days. RESULT(S): The primary end point occurred in 10 of 434 (2.2%) patients in the LAA closure group and 14 of 452 (3.1%) patients in the control group; however, the treatment effect changed direction at =7 days. In the time-split Cox regression model, hazard ratios were 2.4 (95% CI, 0.62-9.4; P=0.20) between 0 and 7 days and 0.29 (95% CI, 0.080-1.0; P=0.056) between 7 and 30 days. No closure-related serious complications or differences in bleeding were observed. Postoperative AF occurred in 205 of 445 (46.1%) versus 184 of 459 (40.1%) patients (relative risk, 1.1 [95% CI, 0.99-1.3]; P=0.07), and AF at discharge in 40 of 445 (9.2%) versus 34 of 459 (7.7%) patients (relative risk, 1.2 [95% CI, 0.77-1.8]; P=0.44), in the closure and control groups, respectively. CONCLUSION(S): Prophylactic LAA closure during bioprosthetic surgical aortic valve replacement was safe and did not increase bleeding. 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. <125> Accession Number 2048972295 Title Methylprednisolone for heart surgery in pediatric patients: a meta-analysis of randomized trials. Source Scientific Reports. 16(1) (no pagination), 2026. Article Number: 28170. Date of Publication: 01 Dec 2026. Author Barboza J.J.; Rivera-Lozada O.; Bonilla-Asalde C.; Morales-Olivera J.A.; Alvarez J.F.; Flores-Palacios R. Institution (Barboza, Rivera-Lozada, Bonilla-Asalde) Vicerrectorado de Investigacion, Universidad Senor de Sipan, Chiclayo, Peru (Morales-Olivera) Facultad de Medicina, Doctorado en Ciencias Clinicas, Universidad de La Sabana, Chia, Colombia (Alvarez) NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (Flores-Palacios) Universidad Nacional Jorge Basadre Grohmann, Tacna, Peru Publisher Nature Research Abstract Perioperative corticosteroids, particularly methylprednisolone, have been used for decades in pediatric cardiac surgery to attenuate the systemic inflammatory response associated with cardiopulmonary bypass. This systematic review and meta-analysis evaluated the efficacy and safety of perioperative methylprednisolone in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. This systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO CRD420251231338). We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL from inception to November 2025 for randomized controlled trials comparing perioperative intravenous methylprednisolone with placebo or standard care in patients aged < 18 years undergoing cardiac surgery with cardiopulmonary bypass. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The primary outcome was all-cause in-hospital or 30-day mortality. Secondary outcomes included mechanical ventilation duration, cardiac intensive care unit length of stay, postoperative infections, and hyperglycemia. Random-effects models with Paule-Mandel estimator and Hartung-Knapp confidence intervals were used to pool risk ratios and mean differences. We included eight randomized controlled trials (1,735 pediatric patients; 867 on methylprednisolone, 868 controls). Overall, methylprednisolone was not associated with reduced mortality compared with control (RR 0.66, 95% CI 0.35-1.25; I2 = 0%; 6 trials, 1,586 patients). However, methylprednisolone reduced the duration of mechanical ventilation (MD - 0.27 days, 95% CI - 0.46 to - 0.09; I2=0%; 5 trials) but significantly increased the risk of hyperglycemia (RR 2.28, 95% CI 1.38-3.78; I2=45.0%; 6 trials). No differences were observed in infection rates (RR 1.06, 95% CI 0.68-1.66; I2=0%; 5 trials) or ICU length of stay (MD - 0.13 days, 95% CI - 0.51 to 0.25; I2=0%; 5 trials). Perioperative methylprednisolone was not associated with reduced overall mortality in pediatric cardiac surgery. Among secondary outcomes, methylprednisolone was associated with a modest reduction in mechanical ventilation duration but with a significantly increased risk of postoperative hyperglycemia. These findings indicate that any potential benefit in ventilatory outcomes should be weighed against the higher metabolic risk. Further research is required to determine whether any patient subgroups may derive net clinical benefit from its use. Copyright © The Author(s) 2026. <126> Accession Number 2048937940 Title TAVI in low-risk severe aortic stenosis: evidence, controversies, and lifetime treatment strategy. Source Expert Review of Cardiovascular Therapy. (no pagination), 2026. Date of Publication: 2026. Author Wright K.; Rahman A.; Penny G.; Mohanarajan M.; Philip A.S.; Harky A. Institution (Wright) Acute Internal Medicine, Barnsley Hospital NHS Foundation Trust, Barnsley, United Kingdom (Rahman) School of Medicine, New Vision University, Tbilisi, GA, United States (Penny) Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom (Mohanarajan) School of Medicine, European Medical University, Dnipro, Ukraine (Philip) Barts and the London School of Medicine and Dentistry, School of Medicine, London, United Kingdom (Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom Publisher Taylor and Francis Ltd. Abstract Transcatheter aortic valve implantation (TAVI) has expanded from a treatment for inoperable and high-risk aortic stenosis to an established therapeutic option for selected patients at low surgical risk. This review focuses on the outcomes of major trials comparing TAVI to traditional surgical aortic valve replacement (SAVR), highlighting outcomes and potential complications when considering lifetime valve management as we move into the younger population. A literature search of PubMed using terms such as 'transcatheter aortic valve replacement' and 'low surgical risk' was used to identify relevant publications from within the last 10 years. Recent randomized trials and follow-up studies suggest that, in appropriately selected low-risk patients, TAVI and SAVR provide broadly comparable mid-term outcomes for cardiovascular mortality, stroke, and valve re-intervention. However, important differences remain. TAVI is consistently associated with lower rates of new-onset atrial fibrillation but higher rates of permanent pacemaker implantation and paravalvular aortic regurgitation. As TAVI moves into younger and asymptomatic populations, unresolved questions remain around valve durability, coronary access, redo strategies, and lifetime valve management, highlighting the central role of multidisciplinary heart-team assessment in selecting the optimal lifetime therapeutic strategy. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <127> Accession Number 652158670 Title Candida Bloodstream Infection in Left Ventricular Assist Device Recipients: Case Series and Review of the Literature. Source Medical mycology. (no pagination), 2026. Date of Publication: 08 Sep 2026. Author Sama J.; Butt S.; A A.E.A.; Rao R.; Shariff M.; Misra R.K.; Saleem K.; Modi S.; Guglin M.; Ilonze O.J. Institution (Sama, A, Rao, Shariff, Modi, Ilonze) Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, United States (Butt, Misra) Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, United States (Saleem) Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, United States (Guglin) Rutgers Health Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States Abstract Candida bloodstream infection (C-BSI) is a rare infection in patients with left ventricular assist devices (LVADs). We aim to describe the characteristics and outcomes of C-BSI. We performed a retrospective search for C-BSI in patients with LVADs at our institution from January 2012 to May 2024. We then performed a literature review using the keywords 'fungemia ventricular assist device', 'candidemia ventricular assist device', 'Candida bloodstream infection ventricular assist device,' or 'Candida endocarditis ventricular assist device' from 1990 to 2024. Clinical characteristics and outcomes were extracted. We identified three institutional cases along with 21 additional cases from the literature. The incidence of candidemia was 3.1% (3/97) and 1.8% (16/867), respectively, in the case series and literature review. Mean age was 45.6 years (range 19-73 years), and average body mass index (BMI) was 31.8 kg/m2. There was a 100% mortality rate in our cohort and 62.5% in the literature review cohort. Among the surviving patients in the literature review, 66.7% underwent heart transplantation, and 33.3% were discharged on antifungal therapy. 41.2% experienced right heart failure, with four requiring temporary mechanical circulatory support post-operatively. Obesity was present in 75.0% of patients, and 42.1% had an LVAD-related infection. C-BSI developed after an average of 426 days of LVAD support, with 33.3% occurring within 30 days postoperatively. The average duration of C-BSI was 29 days. Candida auris was the most common species. C-BSI is a rare fatal complication in LVAD patients. Obesity, delayed sternal wound closure, and right heart failure may contribute to these poor outcomes. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. 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 infor <128> Accession Number 2048929562 Title Transesophageal Echocardiography and Clinical Significance of Giant Eustachian Valve during Cardiac Surgery: A Narrative Review. Source Journal of Cardiovascular Echography. 36(4) (pp 366-374), 2026. Date of Publication: 2026. Author Shitole A.B.; Salve G.G.; Patil A.P.; Patil S.S.; Munigial R.; Ghorpade A.; Sravanti T.S. Institution (Shitole, Patil, Munigial, Sravanti) Department of Cardiac Anaesthesia, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed to-be University), Karnataka, Belagavi, India (Salve, Ghorpade) Department of Cardiovascular and Thoracic Surgery, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed to-be University), Karnataka, Belagavi, India (Patil) Department of Epidemiology and Biostatistics, KLE Academy of Higher Education and Research (Deemed to-be University), Karnataka, Belagavi, India Publisher Wolters Kluwer Medknow Publications Abstract The Eustachian valve (EV), an embryologic remnant of the right valve of the sinus venosus located at the inferior vena cava (IVC)-right atrial (RA) junction, is typically a small and clinically insignificant structure. However, a prominent, large, or giant EV can present important challenges during cardiac surgery and cardiopulmonary bypass (CPB). This review summarizes the perioperative implications, echocardiographic identification, and management strategies associated with large EVs in adult cardiac surgical patients. A narrative literature review was conducted using PubMed, Scopus, and Embase databases from inception to March 2026. Available evidence indicates that large EVs may obstruct IVC cannula flow, resulting in inadequate venous drainage and suboptimal CPB performance. The increasing adoption of minimally invasive cardiac surgery (MICS) has further highlighted the importance of EV recognition, as prominent valves may impede guidewire passage and femoral venous cannula positioning, compromising venous return during CPB. Large EVs may also increase the risk of right atrial or IVC injury during cannulation and facilitate paradoxical embolism by directing venous blood flow toward a patent foramen ovale. In addition, prominent EVs are frequently misidentified on transesophageal echocardiography (TEE) as right atrial thrombi, tumors, vegetations, or intracardiac devices, potentially leading to diagnostic confusion and inappropriate interventions. Intraoperative two-dimensional and three-dimensional TEE, particularly the mid-esophageal bicaval view, remains the most reliable modality for identification. Real-time TEE-guided cannulation, careful surgical planning, selective prophylactic resection, and meticulous de-airing strategies can minimize associated complications. Routine pre-CPB TEE assessment and standardized management algorithms may improve procedural safety and perioperative outcomes in this uncommon but clinically significant anatomical variant. Copyright © 2026 Journal of Cardiovascular Echography <129> Accession Number 652156285 Title Machine Learning for Mortality Prediction in Infective Endocarditis: A Systematic Review and Meta-Analysis. Source Cardiology in review. (no pagination), 2026. Date of Publication: 09 Sep 2026. Author Choudhary V.; Jain M.; Tamanna F.; Gohil R.; Mandalapu N.; Gara S.; Vadiyala M.R.; Chilingarashvili G.; Popat A.; Desai R.; Sharma S. Institution (Choudhary) From the Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States (Jain) Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, United States (Tamanna) Department of Internal Medicine, St. John's Episcopal Hospital, Far Rockaway, NY, United States (Gohil) Department of Internal Medicine, Kasturba Medical College, Manipal, Udupi, Karnataka, India (Mandalapu) Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, United States (Gara) Department of Primary Care and Behavioral Health, Aspire Indiana Health, Indianapolis, IN, United States (Gara) Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States (Vadiyala) Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States (Chilingarashvili) Department of Critical Care Medicine, Cooper University Hospital, Camden, NJ, United States (Popat) Department of Cardiology, Sanford Health, Marshfield Clinic, WI, United States (Desai) Independent Researcher, Outcomes Research, Atlanta, GA; and (Sharma) Department of Cardiology, Guthrie Robert Packer Hospital, Sayre, PA, United States Abstract Infective endocarditis (IE) continues to be an often fatal condition despite improvements in cardiac surgical procedures and antibiotic therapy, and conventional scoring tools show poor generalizability. Machine learning (ML) addresses these limitations by capturing complex, nonlinear clinical relationships, outperforming conventional scores in predictive accuracy, though prior ML work in IE has focused on diagnosis. A PRISMA-compliant systematic review and meta-analysis of PubMed (Supplemental Digital Content, https://links.lww.com/CIR/A251) and Scopus (through April 2026) evaluated supervised ML models predicting all-cause mortality in adult IE patients; study quality and reporting were appraised using PROBAST and TRIPOD. Eight studies (5503 patients, mean age 53.85) were included in qualitative synthesis, of which 5 contributed area under the receiver operating characteristic curve (AUC) or C-index estimates for pooling via random-effects models, stratified into in-hospital/early and 6-month mortality subgroups. Seven studies were retrospective, and 1 was prospective. ML models, especially ensemble approaches such as Random Forest and gradient boosting, demonstrated strong discriminative performance across all cohorts, with AUC reflecting the ability to distinguish patients who died from those who survived, and outperformed conventional models. Pooled AUC was 0.85 (95% confidence interval [CI], 0.81-0.89) for in-hospital/early mortality (I2 = 35.3%) and 0.85 (95% CI, 0.82-0.88) for 6-month mortality (I2 = 0%). Dominant predictor domains varied by clinical context; multisystem physiologic markers characterized general IE cohorts, dynamic and laboratory variables enhanced intensive care unit-based predictions, and procedural and anatomical factors defined surgical and transcatheter aortic valve replacement model performance. Risk of bias was identified in 4 studies. ML models showed strong discriminative performance for IE mortality prediction, with ensemble methods outperforming conventional approaches by capturing its multivariate heterogeneity. Clinical adoption remains limited; future efforts should prioritize multicenter prospective validation, longitudinal data integration, and development of interpretable frameworks for bedside adoption. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <130> Accession Number 2049188323 Title Prehabilitation for patients with mild to moderate frailty undergoing coronary artery and valve surgery: a pilot randomized controlled trial. Source European Journal of Cardiovascular Nursing. 25(6) (pp 1197-1206), 2026. Date of Publication: 01 Sep 2026. Author Li P.W.C.; Yu D.S.F.; Chan D.T.L.; Ho C.K.L.; Lam S.C.C.; Chiu P.K.C.; Wan S.H.Y.; Lam L.; Hung N. Institution (Li, Yu) School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 5/F., 3 Sassoon Road, Pokfulam, Hong Kong (Chan, Ho, Wan) Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong (Lam, Chiu) Department of Medicine, Queen Mary Hospital, Hong Kong (Lam, Hung) Physiotherapy Department, Queen Mary Hospital, Hong Kong Publisher Oxford University Press Abstract Aims: Although prehabilitation is increasingly studied to address preoperative frailty in cardiac surgery candidates, most interventions overlook recommended exercise principles for frailty. This study evaluated the feasibility and effects of a frailty-specific prehabilitation programme on health outcomes in frail patients undergoing cardiac surgery. Methods and Results: Adult patients with mild to moderate frailty scheduled for elective coronary or valve surgery were randomized to prehabilitation (n = 26) or usual care (n = 25). The programme combined education, nutritional optimization, stress management, and individualized resistance-focused exercise training via centre-based, home-based, and online sessions over at least 4 weeks. Primary outcome was functional capacity. The prehabilitation group showed significant improvements in functional capacity measured by the Short Physical Performance Battery at 1 day before surgery (beta = 0.99; 95% confidence interval [CI] = 0.08-1.90; P = 0.032) and 3-month post-intervention (beta = 1.04; 95% CI = 0.05-2.03; P = 0.040). Frailty level measured by Fried criteria showed significant reductions at 1 day before surgery (P = 0.005) and at 3-month follow-up (P = 0.043), with large effect sizes (Hedges' g = 0.92-1.18). Health-related quality of life measured by the MacNew Questionnaire improved significantly at 1-month (P = 0.006) and 3-month post-intervention (P = 0.007), with large effect sizes (Hedges' g = -0.89 to -0.96). The programme demonstrated high feasibility (89% adherence) and safety (minimal adverse events). No significant differences were found in biomarkers or clinical events, unplanned readmission, or length of stay. Conclusion(s): This frailty-specific prehabilitation programme is feasible and safe for cardiac surgical patients, demonstrating improvements in functional capacity, frailty, and quality of life. A full-scale trial is warranted to confirm its efficacy and guide clinical implementation. Registration: ClinicalTrials.gov Identifier: NCT06323317 Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. <131> Accession Number 652154212 Title Development of Pre and Postoperative Rehabilitation Education Materials for Individuals Undergoing Coronary Artery Bypass Graft Surgery. Source Journal of the Hong Kong College of Cardiology. Conference: 10th Asian Preventive Cardiology and Cardiac Rehabilitation Conference. Hong Kong Hong Kong. 32(4 Supplement) (pp 26), 2025. Date of Publication: 01 Jul 2025. Author Sahu S.; Hegde N.; Hanakanahalli N.; Tharakan R.; Ramachandran P.; Rai G.; Babu A. Institution (Sahu, Hegde, Hanakanahalli, Tharakan, Babu) Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, India (Ramachandran) Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India (Rai) Department of Cardiothoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India Publisher Medcom Limited Abstract Objective: Patient education is an essential core component of cardiac rehabilitation. However, there is a lack of systematically developed and objectively assessed education materials for patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to create an evidence-based, contextually relevant patient education material on physiotherapy and cardiac rehabilitation for individuals undergoing CABG surgery. Method(s): A systematic literature search was followed by a thematic analysis of identified education materials. The identified themes were mapped with the recent European Society of Cardiology guidelines for prevention of cardiovascular disease. Two separate manuals were developed, one for preoperative education and the second for postoperative rehabilitation. The manuals were assessed for their readability with the Flesch Kincaid Readability Age (FKRA) formula and optimised to achieve a score of 6 - 8 as per the recommendations of the American Thoracic Society. Ten reviewers, including clinical experts and patients, assessed the understandability and actionability of the materials with the Patient Education Materials Assessment Tool for printable materials. Result(s): Among the eight identified education materials, only one explained the development of their manual, and three evaluated their materials. Two of them objectively assessed their materials with two different tools, while the other study conducted a qualitative evaluation by nurses and patient representatives. Most of the education materials were from high-income countries. After thematic analysis, 9 and 15 themes were included in the preoperative and postoperative manuals, respectively. The preoperative and postoperative materials achieved FKRA scores of 6.43 and 6.47, respectively. The understandability of the preoperative and postoperative materials was scored at 88.20+9.17 and 90.12+10.12, respectively. The actionability of both materials was scored at 93.12+13.70. Conclusion(s): Two education manuals, one for prehabilitation and one for postoperative cardiac rehabilitation, were developed with adequate readability, optimal understandability and actionability, and contextual relevance to patients undergoing CABG surgery (Table presented). <132> Accession Number 652154489 Title Effects of a Progressive Moderate-to-High (ProMoHi) Intensity Aerobic and Resistance Training in a Hybrid Cardiac Rehabilitation Exercise Program (CREP) on Physical Function, Psychological Status, Health Status and Quality of Life in Patients post-CABG: Protocol for a Randomised Controlled Trial. Source Journal of the Hong Kong College of Cardiology. Conference: 10th Asian Preventive Cardiology and Cardiac Rehabilitation Conference. Hong Kong Hong Kong. 32(4 Supplement) (pp 18-19), 2025. Date of Publication: 01 Jul 2025. Author Ahmad A.; Mohd Tahir F.T.M. Institution (Ahmad) Department of Physiotherapy, National Heart Institute (Institut Jantung Negara-IJN), Kuala Lumpur, Malaysia (Ahmad, Mohd Tahir) Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia Publisher Medcom Limited Abstract Background: Cardiac rehabilitation for post-CABG patients is evolving, with traditional centre-based programs demonstrating benefits but struggling with low participation rates. While promising home-based alternatives offer potential, their lack of standardized protocols limits widespread adoption. The Hybrid Cardiac Rehabilitation Exercise Program (CREP) integrates elements from both models to enhance patient engagement and adherence. Nevertheless, monitoring exercises and implementing hybrid components remain limited, particularly in low-resource countries like Malaysia. Aim(s): This prospective randomized controlled trial aims to assess the safety, feasibility, efficacy and adherence of individualised progressive moderate-to-high aerobic and resistance training in a Hybrid CREP in post-CABG patients. Method(s): Participants aged 18 and older scheduled for CABG surgery due to coronary artery disease will be recruited preoperatively and randomized 1:1 into either the Hybrid ProMoHi or standard care (i.e., centre-based CREP) group, postoperatively. Primary outcomes including exercise capacity, muscular strength, and quality of life, will be evaluated using the 6-Minute Walk Test, Unsupported Upper Limb Exercise Test, Jamar Handgrip Test, 30-Second Sit-to-Stand Test, and EuroQol-5D-5L. Secondary measures will include safety and feasibility, health status, and psychological parameters using the HADS questionnaire. Assessments will occur at baseline (preoperatively), at 2, 6, and 10 weeks postoperatively. Discussion(s): This RCT will have been the first to explore the safety and feasibility, efficacy and adherence to the hybrid CREP in a Malaysia setting. The findings of this RCT are expected to facilitate the design and implementation of a Hybrid CREP in any resource-limited country like Malaysia. <133> 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. (no pagination), 2026. Date of Publication: 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. 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 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. <134> Accession Number 2049158206 Title Pharmacological Strategies for Postoperative Pain Control in Patients Undergoing Cardiac Surgery: A Mixed Methods Systematic Review of Clinical Efficacy, Opioid Consumption, Patient Experience, and Nursing Care. Source Journal of Indian College of Cardiology. 18(3) (pp 157-159), 2026. Date of Publication: 01 Sep 2026. Author Rajendran S.; Kuppusamy K.; Jayakumar S. Institution (Rajendran) Department of Medical Surgical Nursing, Vinayaka Mission's College of Nursing, Karaikal, Puducherry, Vinayaka Mission's Research Foundation (DU), Tamil Nadu, Salem, India (Kuppusamy) Department of Child Health Nursing, Vinayaka Mission's College of Nursing, Karaikal, Puducherry, Vinayaka Mission's Research Foundation (DU), Tamil Nadu, Salem, India (Jayakumar) Department of Mental Health (Psychiatric) Nursing, Amrita College of Nursing, Amrita Vishwa Vidyapeetham, Kerala, Kochi, India Publisher Wolters Kluwer Medknow Publications Abstract ABSTRACT - Postoperative pain following cardiac surgery remains a major challenge that can delay recovery, increase opioid use, and hinder rehabilitation. This systematic review evaluated mixed methods evidence on pharmacological pain management strategies and their integration with nursing care in adult patients undergoing cardiac surgery. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, and Google Scholar was conducted from database inception to December 2025 following PRISMA 2020 guidelines. Four mixed methods studies met the inclusion criteria. Pharmacological interventions included opioids, paracetamol, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, dexmedetomidine, and multimodal analgesic regimens. These approaches were associated with reduced postoperative pain, 15-38% lower opioid consumption, shorter intensive care unit stays, and improved rehabilitation. Qualitative findings emphasized patients' concerns regarding opioid dependence and sedation while highlighting the importance of nurse-led education and individualized pain assessment. Overall, multimodal opioid-sparing analgesic strategies integrated with patient-centered nursing care appear to enhance postoperative recovery after cardiac surgery, although further high-quality mixed methods research is required to strengthen the evidence. Copyright © 2026 Journal of Pharmacy and Bioallied Sciences <135> Accession Number 2049134069 Title Cardiac arrhythmias during cardiopulmonary testing as predictors of an unfavorable early postoperative course in patients with chronic thromboembolic pulmonary hypertension. Source Profilakticheskaya Meditsina. 29(4) (pp 61-66), 2026. Date of Publication: 2026. Author Loginova I.Y.; Klinkova A.S.; Porotnikova S.S.; Kamenskaya O.V. Institution (Loginova, Klinkova, Porotnikova, Kamenskaya) E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation Publisher Media Sphera Publishing Group Abstract Objective. To study the impact of cardiac arrhythmias in patients with chronic thromboembolic pulmonary hypertension during the early post-operative period. Materials and methods. During this research, 194 patients with chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy, were examined. Patients were divided into two groups: the 1st group - 48 patients with detected cardiac arrhythmias (CAs) in the form of ventricular arrhythmias (VAs) during a cardiopulmonary exercise testing (CPET), the 2nd group - 146 patients in whom CAs were not registered during CPET. Results. Patients in the 1st group had CAs as single and paired ventricular extrasystoles. There was a shorter duration of CPET and a smaller proportion of patients in the 1st group who reached the anaerobic threshold in addition to significant disruption of pulmonary gas exchange and cardiovascular reactivity compared to the 2nd group. The early post-operative period in patients of the 1st group was different from that of patients of the 2nd group by a higher proportion of patients with the development of acute renal failure and new cases of CAs as well as the longest hospital stay. The revealed VAs during CPET increase the risk of developing CAs in the early post-operative period - OR 3.59 (2.41-6.84; p=0.002) and prolongate the length of hospital stay - OR 2.75 (2.01-4.58; p=0.03). Conclusion. Ventricular arrhythmias in patients with chronic thromboembolic pulmonary hypertension detected during cardiopulmonary exercise testing negatively affect the early post-operative period, increasing the risk of cardiac arrhythmias after surgery and length of hospitalization. The introduction of methods of screening and prevention of cardiac arrhythmias at the stage of preoperative preparation of patients will potentially improve treatment effectiveness and quality of life after surgery. Copyright © I.Yu. Loginova, A.S. Klinkova, S.S. Porotnikova, O.V. Kamenskaya <136> Accession Number 652142415 Title Disparities in Access to and Outcomes of Minimally Invasive Surgery Across Individual Characteristics: A Scoping Review. Source Surgical Endoscopy. Conference: 2026 SAGES Annual Meeting. Tampa United States. 40(2 Supplement) (pp S684), 2026. Date of Publication: 01 May 2026. Author Johnson S.; Sands M.; Fazal Z.A.; Campbell K.; Patel N.; Erhunmwunsee L. Institution (Johnson) Meharry Medical College, United States (Sands, Fazal, Patel) Intuitive Surgical, United States (Campbell) Department of Population and Public Health Sciences, Keck School of Medicine, USC, United States (Erhunmwunsee) Department of Surgery, Department of Population Science, City of Hope, United States Publisher Springer Abstract Introduction: Minimally invasive surgery (MIS) is associated with improved clinical outcomes compared to open surgery for various procedures. Despite its growing adoption, disparities in access to MIS persist. The objective of this review is to synthesize existing evidence on disparities in MIS utilization and outcomes, highlight evidence gaps, and inform future investigations and policy interventions. Methods and procedures: We searched PubMed and Scopus for English-language peer-reviewed literature from January 1, 2020, to October 28, 2024, investigating access to and outcomes of MIS in equity-seeking populations-groups historically or systemically denied equal access to healthcare, employment, education, and other opportunities. We included studies consisting of patients >= 18 years in the United States and defined MIS as soft tissue procedures performed using laparoscopy, video-assisted thoracoscopic surgery (VATS), and/or robotic-assisted surgery. Title/abstracts and full texts were independently screened by two reviewers using Laser AI, with conflicts resolved by consensus. Study characteristics (design, disparity measures, and outcome measures) and both clinical and non-clinical outcomes were extracted from included articles using Microsoft Excel. The disparity domains examined in each study were then categorized by surgical specialty. Their distribution across specialties was summarized and visualized in a bubble plot to highlight patterns and trends across studies. This protocol is registered on OSF Registries. Result(s): After title/abstract screening for 2,943 references, 265 met eligibility criteria for full-text screening, and 88 were included in the review. The included studies comprised 11,647,821 patients, with a median of 22,349 patients per study. Most studies were retrospective cohort (n = 79) followed by cross sectional (n = 6), prospective cohort (n = 2), and one case-control study. Surgical specialties represented included general surgery (n = 41), cardiothoracic (n = 11), gynecology (n = 24), urology (n = 9), ENT (n = 1), and surgical oncology (n = 2). Disparity domains investigated across studies, in descending order, included Race/Ethnicity, Payor status, SES/Income, Urbanicity/Rurality, Sex, and Other (e.g., language). Conclusion(s): While a growing body of literature on disparities in MIS exists, it remains concentrated in a few specialties narrowly focused on single domains of disparity. Further research is needed to standardize disparity-domain definitions, investigate intersectionality, and link MIS access differences to risk-adjusted clinical and patient-reported outcomes across specialties. Finally, incorporating global perspectives will be essential for a more comprehensive understanding of MIS disparities. <137> Accession Number 2048830496 Title Clinical efficacy of video double-lumen tube for one-lung ventilation in thoracic surgery: a meta-analysis of randomized controlled trials. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1819031. Date of Publication: 2026. Author Jiang L.; Wu X.; Yuan Y.; Li Y.; Yang G.; Zhang D. Institution (Jiang, Wu, Yuan, Li, Yang, Zhang) Department of Anesthesiology, Hebei General Hospital, Hebei, Shijiazhuang, China Publisher Frontiers Media SA Abstract Background - Double-lumen tube (DLT) is generally regarded as the gold standard for one-lung ventilation during thoracic surgery. Compared with DLT, video double-lumen tube (VDLT) has an integrated camera, allowing continuous visualization of its position in the trachea. However, the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery is unclear. This meta-analysis aims to evaluate the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery. Methods - The PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, WanFang, and CBM databases were searched for relevant studies from inception to July 2025. This meta-analysis used RevMan and Stata software to implement statistical analysis. The primary outcome was the intubation time. Sensitivity analysis and Egger's test were performed to evaluate the stability of the results and the publication bias. Results - Eighteen studies involving 1, 332 patients were included. For the primary outcome intubation time, extreme and unexplained between-study heterogeneity was observed (I2 = 99%). A random-effects model was applied, and the pooled result suggested a trend toward shorter intubation time in the VDLT group (MD = -102.68 [95% CI: -123.71 to -81.66], p < 0.00001). Meta-analysis also revealed that the VDLT group exerted a higher first-attempt success rate (OR = 8.04, 95% CI [2.17 to 29.74], p = 0.002), lower mean arterial pressure (MD = -16.85 [95% CI: -21.67 to -12.02], p < 0.00001) and heart rate (MD = -11.32 [95% CI: -19.80 to -2.85], p = 0.009) after intubation, a shorter repositioning time after dislodgement (MD = -50.91 [95% CI: -67.30 to -34.52], p < 0.00001), and a lower incidence of sore throat (OR = 0.62, 95% CI [0.39 to 0.98], p = 0.04). No significant differences regarding the incidence of dislodgement during positioning and surgery, quality of lung collapse, or the incidence of hoarseness after surgery were noted between the 2 group. Conclusion - Compared with the DLT, VDLT may provide modest clinical advantages of a shorter intubation time, higher first-attempt success rate, lower mean arterial pressure and heart rate after intubation, shorter repositioning time after dislodgement, and lower incidence of sore throat. However, the primary outcome of intubation time is limited by extreme between-study heterogeneity that could not be explained. Standardized multicenter international randomized trials are warranted to confirm the clinical efficacy of VDLT. Systematic review registration - , Identifier: CRD420251138139. Copyright © 2026 Jiang, Wu, Yuan, Li, Yang and Zhang. <138> Accession Number 2048960392 Title Does weight-adjusted dosing improve outcomes over fixed-volume bupivacaine in transversus thoracic muscle plane block for cardiac surgery? A prospective randomised controlled trial. Source Indian Journal of Anaesthesia. 70(8) (pp 954-957), 2026. Date of Publication: 01 Aug 2026. Author Singh A.; Kapoor D.; Garg S.; Khanna S. Institution (Singh, Kapoor) Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, Punjab, India (Garg) Department of Cardiothoracic and Vascular Surgery, Neelam Hospital, Rajpura, Punjab, India (Khanna) Department of General Surgery, Government Medical College and Hospital, Chandigarh, Punjab, India Publisher Wolters Kluwer Medknow Publications <139> Accession Number 652143637 Title Perioperative Cardiac Events Following Bariatric Surgery: A Meta-analysis of Nearly One Million Patients Reveals Procedure-Specific Risks-on Behalf of TROGSS (The Robotic Global Surgical Society). Source Surgical Endoscopy. Conference: 2026 SAGES Annual Meeting. Tampa United States. 40(2 Supplement) (pp S431), 2026. Date of Publication: 01 May 2026. Author Rivero-Moreno Y.; Zevallos A.; Estrada A.; Mendez G.; Vidal C.; Alvarez J.; Bellorin O.; Camacho D.; Oviedo R. Institution (Rivero-Moreno, Estrada, Camacho) Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, United States (Zevallos) Loma Linda University Medical Center, United States (Mendez) Universidad de Oriente, United States (Vidal) Universidad Autonoma de Baja California, United States (Alvarez) Universidad Central de Venezuela, Venezuela (Bellorin) Hollyname Medical Center, United States (Oviedo) Department of Surgery, Nacogdoches Medical Center, University of Houston, Tilman J. Fertitta Family College of Medicine, Sam Houston State University College of Osteopathic Medicine, United States Publisher Springer Abstract Introduction: Perioperative myocardial infarction (PMI) is the most common cardiac complication associated with postoperative morbidity and mortality; however, its overall incidence is not well documented. This study aimed to determine the incidence of PMI across different types of metabolic and bariatric surgery (MBS) procedures and to identify associated risk factors. Method(s): A systematic review and meta-analysis were conducted by searching the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and ScienceDirect for studies published from inception through March 2025. The search strategy included the Studies reporting the incidence of PMI in patients undergoing any bariatric procedure were included. Studies with overlapping populations were excluded. Binary endpoint effects were compared using pooled odds ratios (OR) with 95% confidence intervals (CI), employing a random-effects model. Result(s): A total of 2,497 records were identified, with 27 studies ultimately included, encompassing 976,903 patients. The majority of patients were female (n = 703,370; 72.6%), with a mean age of 48.6 +/- 7.4 years and a mean BMI of 48.5 +/- 5.2. From six different countries, 98% (n = 957,523) of the patients were from the USA. The most common procedures reported were sleeve gastrectomy (SG) (n = 539,623; 56.9%) followed by Roux-en-Y gastric bypass (RYGB) (n = 408,028; 43%). A total of 855 PMIs were recorded, representing a pooled incidence of 0.193% (95% CI = 0.18 - 0.2). The incidence of PMI was lower in studies involving patients from the USA compared to those from other countries (0.081% vs. 0.4%, p < 0.001). The incidence of PMI was positively correlated with mean patient age (r = 0.417, p = 0.043), mean BMI (r = 0.578, p = 0.005), and a history of cardiac surgery (r = 0.883, p = 0.008). Patients undergoing RYGB had a higher risk of PMI compared to those undergoing SG (OR = 1.51, 95% CI = 1.10-2.07). Conclusion(s): Perioperative myocardial infarction is an important complication following MBS despite its low incidence. The frequency of PMI is lower among the USA bariatric patients compared to those from other countries. Factors such as age, higher BMI, a history of cardiac surgery, and undergoing RYGB instead of SG are associated with an increased risk of PMI. <140> Accession Number 652144676 Title Recent Trials of Left Atrial Appendage Closure versus Oral Anticoagulants: An Optimistic View. Source Thrombosis and haemostasis. (no pagination), 2026. Date of Publication: 06 Sep 2026. Author Camm A.J. Institution (Camm) City St George's University of London, Division of Cardiac and Vascular Sciences, United Kingdom of Great Britain and Northern Ireland, London, United Kingdom Abstract Abstract: Thrombus formation in atrial fibrillation mostly occurs in the left atrial appendage (LAA). LAA closure (LAAC) seems logical to reduce thrombo-embolic AF-related stroke. Early device trials, which predominantly compared LAAC against oral anticoagulant (OAC) with warfarin, showing after 5 years less bleeding and possibly similar ischemic stroke rates with LAAC. New trials (CHAMPION-AF, OPTION, CLUSTER-AF and ASAP TOO) comparing LAAC versus direct OACs, or standard of care for the OAC-intolerant, have reported apparently discordant results, most probably related to the patient phenotype than LAAC itself. Recent meta-analyses, which include new trials have shown that overall, LAAC is followed by less clinically-relevant bleeding but more ischemic but not total strokes. Longer follow-up offsetting penalties related to the implant procedure, more expert implantation and reduced device-related thrombosis should increase the comparative value of LAAC. Meanwhile, LAAC offers therapeutic relief for OAC-intolerant patients or for those wh, understand the outcomes of LAAC and prefer device rather than medical therapy. A change in guideline recommendations should now be considered. Copyright Thieme. All rights reserved. <141> Accession Number 2049106739 Title Hypotension Prediction Index versus Mean Arterial Pressure Alarm for Preventing Intraoperative Hypotension in Elective Non-Cardiac Surgery: A Randomized Controlled Trial. Source Anesthesiology. (pp 1-40), 2026. Date of Publication: 2026. Author Florax A.A.; Mulder M.P.; van Ieperen R.P.; Fresiello L.; Donker D.W.; Potters J.-W. Institution (Florax) Department of Anesthesiology, Medisch Spectrum Twente, Enschede, The Netherlands & Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, Netherlands (Mulder) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, Netherlands (van Ieperen) Department of Anesthesiology, Medisch Spectrum Twente, Enschede, Netherlands (Fresiello) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, Netherlands (Donker) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands & Intensive Care Center, University Medical Center Utrecht, Utrecht, Netherlands (Potters) Department of Anesthesiology, Medisch Spectrum Twente, Enschede, The Netherlands & Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, Netherlands Publisher Lippincott Williams and Wilkins Abstract Background: - Intraoperative hypotension is common during surgery and has been retrospectively associated with acute kidney injury, myocardial injury, and increased mortality. The Hypotension Prediction Index was developed to support proactive blood pressure management, but shows a strong correlation with mean arterial pressure. Observational data suggest that a mean arterial pressure alarm set at 72 mmHg may perform similarly to the default Hypotension Prediction Index alarm (>85). We hypothesized that a 72 mmHg mean arterial pressure alarm is non-inferior to the Hypotension Prediction Index in preventing intraoperative hypotension. Method(s): - In this single-center, blinded, randomized controlled trial, adults undergoing moderate- or high-risk elective non-cardiac surgery with continuous arterial pressure monitoring were assigned to either a mean arterial pressure alarm (<72 mmHg) or a Hypotension Prediction Index alarm (>85). The primary outcome was the area under the threshold for mean arterial pressure <65 mmHg. Secondary outcomes included the incidence and severity of hypo- and hypertension, duration of active alarms, incidence of acute kidney and myocardial injury, 30-day mortality, hospital length of stay, and cumulative dosages of vasoactive medication and fluids. Result(s): - 143 participants were included in the final analysis. The median area under the hypotension threshold was 3.75 [0.00-22.62] mmHgmin in the mean arterial pressure group and 4.00 [0.00-19.00] mmHgmin in the Hypotension Prediction Index group. After log-transformation, the mean difference was 0.03 (95% CI: -0.24 to 0.29), with the lower bound remaining above the predefined non-inferiority margin (-0.4). No differences were observed in secondary hemodynamic metrics, alarm characteristics, patient outcomes, or administered medications and fluids. Conclusion(s): - A mean arterial pressure alarm of 72 mmHg is non-inferior to the Hypotension Prediction Index >85 in preventing intraoperative hypotension. Given its simplicity and broad availability, a MAP alarm of 72 mmHg represents a pragmatic and cost-effective alternative for proactive blood pressure management. Copyright © 2026 American Society of Anesthesiologists. All Rights Reserved. <142> Accession Number 652142414 Title Robotic Repair of Post-CABG Incisional Hernia with Retrieval of Retained Epicardial Pacing Wire. Source Surgical Endoscopy. Conference: 2026 SAGES Annual Meeting. Tampa United States. 40(2 Supplement) (pp S715), 2026. Date of Publication: 01 May 2026. Author Holland H.; Tan W.H. Institution (Holland, Tan) Medical College of Wisconsin, United States Publisher Springer Abstract Subxiphoid incisional hernias can develop following median sternotomy, particularly after CABG. We present a case of symptomatic upper midline incisional hernia repaired robotically with removal of retained epicardial pacing wire. Our patient is a 74-year-old male who previously underwent CABG via median sternotomy who presented with a symptomatic incisional hernia. Preoperative imaging confirmed a fat-containing subxiphoid upper midline hernia along with a retained epicardial lead traversing the hernia. The patient underwent robotic subxiphoid incisional hernia repair with preperitoneal placement of mesh and removal of retained epicardial lead. Postoperatively, he was discharged on the day of his procedure without complications. <143> Accession Number 652143809 Title Neurodevelopmental screening in children with congenital heart disease: The Necker Children's Hospital cardiac neurodevelopmental center follow-up. Source Archives of Cardiovascular Diseases. Conference: 22nd Medical-Surgical Annual Congress of the FCPC. Nantes France. 119(8-9 Supplement) (pp S253), 2026. Date of Publication: 01 Aug 2026. Author Derridj N.; Huguet H.; Camacho A.; Plassard A.C.; Martins S.; Bajolle F.; Bonnet D.; Calderon J. Institution (Derridj, Camacho, Plassard, Bajolle, Bonnet, Calderon) Cardiologie pediatrique et congenitale, M3C-Pediatric Cardiology, Necker-Enfants-Malades, AP-HP, University of Paris, Paris, France (Huguet, Martins) Epidemiologie et biostatistiques, CHU de Montpellier, Montpellier, France Publisher Elsevier Masson s.r.l. Abstract Introduction Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental impairments. A systematic neurodevelopmental screening program was implemented at the Necker Children's Hospital. We aimed to describe screening outcomes according to a previously published theoretical neurodevelopmental risk classification and to identify associated risk factors. Methods Neurodevelopmental screening was conducted during pediatric cardiology visits at Necker Children's Hospital (January 2024-September 2025) using parent-completed ASQ-3, M-CHAT, and SDQ questionnaires with standard cut-offs. Children were classified into four theoretical neurodevelopmental risk groups, and outcomes were compared across groups using multivariable logistic regression within risk strata. Results A total of 255 children with isolated CHD were included (mean age 23 +/- 19 months; 55% male) and 21% were born preterm. Overall, 69% underwent open-heart surgery and 40% required neonatal surgery. According to theoretical neurodevelopmental risk, 29% were classified as very high risk, 27% high risk, 31% moderate risk, and 13% low risk. Overall, 68% screened positive on the ASQ-3 and 25% on the M-CHAT; among children completing the SDQ (n = 31), 65% showed elevated behavioral risk. Screening outcomes did not differ across risk categories in the overall cohort; however, after exclusion of preterm-born children, severe ASQ impairment (>=1 severe domain) was observed in 49%, 35%, 36%, and 33% across the predefined neurodevelopmental risk groups, showing a non-significant trend toward higher rates in the very high-risk group (P = 0.10). In the high/very high-risk no perinatal or surgical determinants were associated with increased neurodevelopmental impairment. In the moderate/low-risk groups, longer cardiopulmonary bypass duration was associated with positive ASQ-3 screening (OR 5.84, 95% CI [1.12-30.47], P = 0.04). Conclusion Nearly 70% of children with isolated CHD screened positive for neurodevelopmental impairments in a systematic screening program. Although the theoretical risk stratification provides a relevant framework, voluntary participation likely enriched the cohort with families expressing developmental concerns, potentially attenuating differences between risk groups. Integrating standardized questionnaires into routine cardiology follow-up appears effective in identifying vulnerable children, including those classified as moderate or low risk. <144> Accession Number 652140828 Title Comments on "Axillary Versus Sternotomy Access in Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis". Source Innovations (Philadelphia, Pa.). (pp 15569845261474555), 2026. Date of Publication: 05 Sep 2026. Author Ozcelik S. Institution (Ozcelik) Department of Cardiovascular Surgery, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey <145> Accession Number 652145578 Title Residual Surgical Left Atrial Appendage Leaks: Thromboembolic Risk and Anatomy-Tailored Percutaneous Closure Strategies. Source Pacing and clinical electrophysiology : PACE. (no pagination), 2026. Date of Publication: 06 Sep 2026. Author Kivrak A.; Dogan M.; Coteli C.; Keresteci A.H.; Ates A.H.; Canpolat U.; Yorgun H.; Sahiner M.L.; Kaya E.B.; Aytemir K. Institution (Kivrak, Coteli, Ates, Canpolat, Yorgun, Sahiner, Kaya, Aytemir) Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey (Dogan) Kozluk State Hospital, Batman, Turkey (Keresteci) Department of Cardiology, Sincan Training and Research Hospital, Ankara, Turkey (Yorgun) Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Limburg, Netherlands Abstract BACKGROUND: Atrial fibrillation is a leading cause of cardioembolic stroke, and the left atrial appendage (LAA) is the principal source of thrombus formation in non-valvular disease. Surgical LAA exclusion is commonly performed during cardiac surgery, but incomplete closure resulting in a residual communication is not uncommon and may carry ongoing thromboembolic risk. Unlike peri-device leaks after transcatheter closure, residual surgical leaks are anatomically and mechanistically distinct, typically arising through a central, fibrotic ostium with a variable residual pouch, and no validated management pathway currently exists. METHOD(S): We conducted a structured literature search of PubMed/MEDLINE, Embase, the Cochrane Library, and Google Scholar for reported cases and surgical subgroups in which residual leaks after surgical LAA ligation or amputation were managed percutaneously. Because the evidence was predominantly observational and case-based, findings were synthesized narratively rather than as a formal meta-analysis. RESULT(S): Across 37 reported percutaneous procedures identified from case reports, small series, and registry surgical subgroups, closure strategies comprised vascular plugs and septal occluders, dedicated LAA occlusion devices, non-barbed disc-based occluders in anatomically high-risk cases, and endocardial radiofrequency ablation for uncrossable fibrotic leaks. Acute success was high, although outcome reporting was heterogeneous and long-term data were limited. CONCLUSION(S): Residual surgical LAA leaks are an underrecognized, anatomically distinct entity. We propose an anatomy-tailored management framework integrating leak traversability, adjacent vascular anatomy, ostial morphology, and residual pouch depth; given the limited evidence, this should be regarded as hypothesis-generating, and prospective multicenter data are needed. Copyright © 2026 Wiley Periodicals LLC. <146> Accession Number 2048791981 Title A Systematic Review of Aortic Valve Repair With Geometric Ring Annuloplasty: Clinical Implications With a Meta-Analysis of Aortic Insufficiency. Source Cardiology in Review. (no pagination), 2025. Date of Publication: 2025. Author Tejada B.; Phillip A.F.; Fountos D.M.; Ali M.M.; Yibas K.; Sehgal V. Institution (Tejada, Fountos, Ali, Yibas, Sehgal) From the CUNY School of Medicine, New York, NY, United States (Phillip) Washington University in St. Louis, St. Louis, MO, United States Publisher Lippincott Williams and Wilkins Abstract This systematic review aimed to consolidate current literature on the use, outcomes, and clinical implications of Hemispherical Aortic Annuloplasty Reconstructive Technology (HAART) geometric ring annuloplasty (GRAP) for both tricuspid aortic valve and bicuspid aortic valve repair (AVr). A systematic search of Pubmed, Embase, and Google Scholar (2015-2025) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Included studies involved adult patients undergoing AVr with HAART rings and reporting follow-up aortic insufficiency. Quality was assessed using Risk of Bias in Non-Randomized Studies (ROBINS-I). Data on patient demographics, surgical details, aortic insufficiency grade, mean aortic valve gradient, and reoperations were extracted and analyzed. Nine studies (410 patients: 219 tricuspid valves and 191 bicuspid valves) met the inclusion criteria. GRAP, often with adjunctive procedures, significantly reduced aortic insufficiency in tricuspid, bicuspid, and overall cohorts. Post repair gradients were generally below 15 mm Hg. The overall reoperation rate was 5.37% (22 patients), with tricuspid aortic valve cohorts at 5.48% and bicuspid aortic valve cohorts at 4.2%. Reasons included progressive aortic insufficiency and ring-related issues. GRAP with the HAART system is an effective AVr technique for tricuspid and bicuspid pathologies, showing promising mid-term outcomes. Further long-term data are needed. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <147> Accession Number 2048984384 Title Investigation of the hemodynamic, cardioprotective, and anti-inflammatory efficacy of electroacupuncture in patients undergoing coronary artery bypass graft surgery: A randomized, controlled trial. Source Journal of Cardiothoracic and Vascular Anesthesia. Conference: Journal of Cardiothoracic and Vascular Anesthesia. Maastricht Netherlands. 40(10 Supplement) (pp 8), 2026. Date of Publication: 01 Sep 2026. Author Orak Y.; Kirisci M.; Acipayam M.; Orak F.; Tolun F.I.; Dogru F.; Saglam A.; Yildiz S.; Doganer A. Institution (Orak, Kirisci, Acipayam, Orak, Tolun, Saglam, Doganer) Kahramanmaras Sutcu Imam University, ONIKISUBAT, Turkey (Dogru) Malatya Turgut Ozal University, Battalgazi, Turkey (Yildiz) Private Doctor's Office, Cankaya, Turkey Publisher W.B. Saunders Abstract Introduction: Electroacupuncture (EA) is a combination of traditional Chinese acupuncture and modern electrical techniques, which has been shown to be beneficial in the treatment of patients with cardiovascular disease (1). The Pressure Recording Analytical Method (PRAM) is based on the mathematical analysis of arterial pressure profile modifications. Method(s): This prospective, randomized, and controlled study was conducted in patients undergoing coronary artery surgery under cardiopulmonary bypass. A total of 104 patients were included in the study. Patients were randomly assigned (1:1) to two parallel groups: the control group (n=52) and the acupuncture group (n=52).No intervention was performed in the control group. In the acupuncture group, electroacupuncture was applied to the LU2, LU7, and PC6 points for 30 minutes in the preoperative holding room 24 hours prior to surgery and immediately before the operation.The hemodynamic, cardioprotective, and anti-inflammatory effects of EA were investigated at different time points: before aortic cross-clamping (T0);1 hour after removal of aortic cross-clamping (T1);6 hours after removal of aortic cross-clamping (T2);12 hours after removal of aortic cross-clamping (T3); and 24 hours after removal of aortic cross-clamping (T4).The Troponin I value was our primary outcome. Ischemia-Modified Albumin (IMA), Interleukin-6, Interleukin-10, and hemodynamic parameters were our secondary outcomes. Result(s): The study was completed by 104 patients. At T0, the troponin I value was significantly lower in the acupuncture group (p=0.010). At T0 and T2, IMA values were significantly lower in the acupuncture group (p=0.044, p=0.041). Regarding baseline hemodynamic parameters, baseline dicrotic pressure was lower in the acupuncture group (p=0.042). At the 20th minute post-sternotomy, dicrotic pressure and mean arterial pressure (MAP) values were lower in the acupuncture group (p=0.041, p=0.049). Systemic vascular resistance at the 30th minute was found to be lower in the acupuncture group (p=0.025). The pulse pressure variation value at the 40th minute was lower in the acupuncture group (p=0.019). Following weaning from cardiopulmonary bypass, both pulse pressure variation and stroke volume variation at the 20th minute were lower in the acupuncture group (p=0.019, p=0.020). The pulse pressure variation value at the 30th minute was lower in the acupuncture group (p=0.007). Both stroke volume at the 40th and 60th minutes were lower in the acupuncture group (p=0.042, p=0.037). The arterial elastance value at the 60th minute was found to be higher in the acupuncture group (p=0.035). Conclusion(s): A study demonstrated that preoperative EA treatment was associated with reduced postoperative troponin I release. Our study has demonstrated that preoperative acupuncture application has, albeit partially, favorable effects on intraoperative hemodynamics, Troponin I, and IMA evaluated via the PRAM method. To our knowledge, this is the first study in the literature to demonstrate the hemodynamic effects evaluated by the PRAM method and the effects on IMA of EA in cardiac surgery. Copyright © 2026 <148> Accession Number 2048925261 Title GLP-1 receptor agonists beyond glycemic control: integrated cardio-renal-metabolic protection across the cardiovascular kidney metabolic continuum. Source Cardiovascular Diabetology - Endocrinology Reports. 12(1) (no pagination), 2026. Article Number: 60. Date of Publication: 01 Dec 2026. Author Elsayed A.; Ayoub W.J.; Elsayed N.; Stephens J.; Udongwo N.; Elsayed Y.; Ghali J.K. Institution (Elsayed) Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States (Elsayed, Elsayed) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Ayoub, Elsayed) Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI, United States (Stephens, Udongwo, Ghali) Department of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States (Elsayed) Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt Publisher BioMed Central Ltd Abstract Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have undergone a fundamental repositioning, once defined by their glycemic effects, they are now established as multi-organ protective agents operating across the cardiovascular-kidney-metabolic (CKM) continuum with benefits that extend substantially beyond glucose lowering, though the precise contribution of glycemic versus non-glycemic mechanisms varies by outcome and population. Major cardiovascular and renal outcome trials; LEADER, REWIND, AMPLITUDE-O, SELECT, FLOW, and SOUL, collectively demonstrate 13-20% reductions in major adverse cardiovascular events (MACE) and meaningful attenuation of chronic kidney disease (CKD) progression in both diabetic and non-diabetic populations. Exploratory mediation analyses from SELECT suggest that a substantial fraction of cardiovascular benefit is not explained by measured cardiometabolic risk factor changes, a finding that is hypothesis-generating and informs ongoing mechanistic investigation. This narrative review synthesizes mechanistic and clinical evidence for integrated GLP-1RA CKM protection, evaluates combination strategies with Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors, and confronts the implementation gap that separates extraordinary trial efficacy from modest real-world uptake, with rigorous distinction between RCT-level evidence, observational findings, and mechanistic hypotheses. We propose a CKM Disease-Modification Framework as a conceptual scaffold for clinical decision-making, rather than treating cardiovascular, renal, and metabolic risk as separate targets requiring sequential intervention. This framework positions GLP-1RAs as upstream disease-modifying agents whose early deployment across the continuum, guided by dominant comorbidity rather than glycemic status, offers the greatest opportunity for organ protection. Taken together, the evidence positions GLP-1RAs not as adjuncts to standard cardiometabolic care, but as a foundational pillar of it, one whose population-level impact is currently constrained not by biology but by cost, access, and awareness. Copyright © The Author(s) 2026. <149> Accession Number 2048853787 Title Virtual reality for reducing pain, anxiety, and distress in children, adolescents, and young adults with cancer: a systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Psychiatry. 17 (no pagination), 2026. Article Number: 1852113. Date of Publication: 2026. Author Yi S.; Fan Y.; Ren J.; Zheng Z.; Wang T.; Bai J. Institution (Yi, Bai) Department of Radiation Oncology, The People's Hospital of Huantai, Shandong, Zibo, China (Fan) Department of Psychiatry, The People's Hospital of Huantai, Shandong, Zibo, China (Ren, Zheng, Wang) Department of Pediatrics, The People's Hospital of Huantai, Shandong, Zibo, China Publisher Frontiers Media SA Abstract Background - Needle-related procedures are a significant source of pain, anxiety, and distress for children with cancer. This systematic review and meta-analysis aimed to evaluate the effectiveness of virtual reality (VR) as a distraction intervention for reducing these outcomes in pediatric oncology patients undergoing needle-related procedures. Methods - A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL was conducted from database inception to March 23, 2026. We included randomized controlled trials (RCTs) evaluating the effect of VR (immersive or non-immersive) compared to standard care or active distraction in pediatric oncology patients (aged <=21 years) undergoing needle-related procedures. The primary outcome was self-reported pain. Secondary outcomes included parent-reported pain, nurse-reported pain, self-reported fear, parent-reported fear, nurse-reported fear, self-reported anxiety, parent-reported anxiety, distress, procedure duration, and heart rate. Meta-analyses were performed using random-effects models. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results - Ten RCTs enrolling 536 participants were included. VR significantly reduced self-reported pain (Standardized Mean Difference [SMD] = -0.99, 95% Confidence Interval [CI]: -1.37 to -0.61, p = 0.001, I2 = 71.7%), parent-reported pain (SMD = -1.10, 95% CI: -1.66 to -0.54, p < 0.001, I2 = 83.6%), and nurse-reported pain (SMD = -1.00, 95% CI: -1.92 to -0.08, p = 0.025, I2 = 80.0%). Significant reductions were also observed in self-reported fear (Weighted Mean Difference [WMD] = -1.10, 95% CI: -1.50 to -0.70, p < 0.001, I2 = 58.0%), parent-reported fear (WMD = -1.31, 95% CI: -1.58 to -1.03, p < 0.001, I2 = 7.1%), nurse-reported fear (WMD = -1.15, 95% CI: -1.55 to -0.75, p < 0.001, I2 = 0.0%), self-reported anxiety (SMD = -1.06, 95% CI: -1.63 to -0.49, p = 0.002, I2 = 79.9%), parent-reported anxiety (SMD = -1.59, 95% CI: -2.24 to -0.95, p < 0.001, I2 = 51.5%), and distress (SMD = -0.35, 95% CI: -0.67 to -0.03, p = 0.032, I2 = 19.6%). VR also significantly shortened procedure duration (WMD = -0.76 minutes, 95% CI: -1.34 to -0.19, p = 0.009, I2 = 0.0%) but had no significant effect on heart rate (WMD = 1.57, 95% CI: -3.51 to 6.64, p = 0.544, I2 = 80.3%). The overall risk of bias was low risk for five studies, some concerns for four studies, and high risk for one study. Conclusion - The available evidence suggests that VR may reduce pain, fear, anxiety, and distress and may shorten procedure duration in pediatric oncology patients undergoing needle-related procedures. These findings should be interpreted cautiously because several outcomes were based on few small trials and substantial heterogeneity was present. Larger multicenter RCTs are needed before routine implementation can be recommended. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42026134853. Copyright © 2026 Yi, Fan, Ren, Zheng, Wang and Bai. <150> Accession Number 2038548360 Title A randomised trial of carbon dioxide flushing to reduce vascular brain injury in patients undergoing TAVI. Source EuroIntervention. 22(16) (pp 883-890), 2026. Date of Publication: 17 Aug 2026. Author Khawaja S.A.; Hanna L.; Singh A.; Lucarelli C.; Garg P.; Malik I.; Hadjiloizou N.; Ruparelia N.; Hartley A.; Khamis R.; Shin M.S.; Gibbs R.; Mikhail G.W. Institution (Khawaja, Hanna, Singh, Lucarelli, Garg, Malik, Hadjiloizou, Ruparelia, Hartley, Khamis, Shin, Gibbs, Mikhail) Imperial College Healthcare NHS Trust, London, United Kingdom (Khawaja, Hanna, Lucarelli, Khamis, Gibbs, Mikhail) Imperial College London, London, United Kingdom Publisher Europa Group Abstract BACKGROUND: Stroke remains a significant concern in patients undergoing transcatheter aortic valve implantation (TAVI). Despite advances in TAVI technology and techniques, stroke rates have remained unchanged, with trials of cerebral embolic protection devices failing to reduce rates. The concept of air emboli has not been previously investigated in TAVI procedures. We hypothesised that gaseous emboli could play a significant role in TAVI and that carbon dioxide (CO<inf>2</inf>) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI. AIMS: We aimed to demonstrate the neuroprotective benefits of CO<inf>2</inf> flushing in TAVI patients. METHOD(S): INTERCEPTavi is a single-centre, blinded, randomised controlled pilot trial that studied the effects of flushing TAVI valves with CO<inf>2</inf> versus conventional saline on neurological outcomes post-TAVI, assessed using magnetic resonance imaging (MRI) and transcranial Doppler (TCD). Patients with aortic stenosis were randomised after obtaining vascular access. Periprocedural TCD assessed solid and gaseous emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here, we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD outcomes. RESULT(S): A total of 60 patients were recruited and randomised 1:1 to CO<inf>2</inf> and saline flushing (TAVI-CO<inf>2</inf>) versus saline flushing only (TAVI-S). CO<inf>2</inf> flushing significantly reduced the average number of lesions per patient (TAVI-CO<inf>2</inf>: 4 lesions/patient vs TAVI-S: 8.5 lesions/patient; p=0.031). The total infarct area was numerically lower in the TAVI-CO<inf>2</inf> group (40.32 mm2 vs 93.20 mm2), although this did not reach statistical significance (p=0.111). Similarly, TCD showed fewer microembolic signals in the TAVI-CO<inf>2</inf> arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5). CONCLUSION(S): INTERCEPTavi is a pioneering, first-in-human randomised trial that demonstrated that CO<inf>2</inf> flushing of the TAVI valve reduces the number of cerebral lesions measured on MRI. CO<inf>2</inf> flushing is an accessible, costeffective method that can be easily implemented in any catheter laboratory to provide neurological advantages. Copyright © 2026, Europa Group. All rights reserved. <151> Accession Number 2049137423 Title Divergent management of a distal left main coronary artery aneurysm presenting as non-ST-elevation myocardial infarction: surgical vs. medical strategy in two cases-a case report. Source European Heart Journal - Case Reports. 10(9) (no pagination), 2026. Article Number: ytag629. Date of Publication: 01 Sep 2026. Author Balsak H.I.; Celik O.; Dogan V.; Demir C.; Basaran O. Institution (Balsak, Celik, Dogan, Basaran) Department of Cardiology, Mugla Sitki Kocman University, Mugla, Turkey (Demir) Department of Cardiology, Mentese State Hospital, Mugla, Turkey Publisher Oxford University Press Abstract Background: Left main coronary artery (LMCA) aneurysms are exceedingly rare, found in ~0.1% of coronary angiograms, and acute coronary syndromes are an uncommon first presentation. When the aneurysm involves the distal LMCA and its bifurcation, percutaneous covered-stent treatment is generally not feasible, leaving surgical and medical therapy as the only realistic options, with no controlled data to favour either. Case summary: We report two male patients presenting with non-ST-elevation myocardial infarction and thrombosed distal LMCA aneurysms. Both patients were evaluated by a multidisciplinary heart team but received divergent therapeutic strategies. Case 1 (44-year-old male) underwent surgical revascularization with coronary artery bypass grafting and aneurysm ligation following unsuccessful percutaneous recanalization of the left circumflex artery. Case 2 (65-year-old male) declined surgery and was managed medically with intensive antiplatelet and anticoagulation therapy. Both remained asymptomatic during three months of follow-up. Discussion(s): This case series underscores the diagnostic and therapeutic complexity of thrombosed distal LMCA aneurysms. Although surgical exclusion of the aneurysmal sac may, on anatomical grounds, be hypothesized to reduce the risk of recurrent thromboembolism, medical management remains a legitimate option in selected patients who decline or are unsuitable for surgery. The risk of recurrent thrombosis in medically managed patients remains incompletely characterized, and the short follow-up in our cases limits long-term conclusions. In the absence of randomized controlled trials, management decisions must be individualized through multidisciplinary heart team discussion, incorporating aneurysm size, morphology, thrombus burden, clinical presentation, and patient preferences. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. <152> Accession Number 2048906920 Title Effect of the orexin receptor antagonist, suvorexant, on sleep architecture in the early postoperative period following cardiac surgery: a randomized controlled trial. Source Critical Care. 30(1) (no pagination), 2026. Article Number: 459. Date of Publication: 01 Dec 2026. Author Wongtangman K.; reddy Janga S.; Azimaraghi O.; Khandaker R.; Khera T.; Leff J.; Forest S.J.; Suleiman A.; Tam C.; Spindel S.; DeYoung P.N.; Malhotra A.; Subramaniam B.; Eikermann M. Institution (Wongtangman, Azimaraghi, Khandaker, Leff, Suleiman, Tam, Eikermann) Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY, United States (Wongtangman) Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (reddy Janga, Khera, Subramaniam) Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, Israel (Forest, Spindel) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States (DeYoung, Malhotra) Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA, United States (Eikermann) Klinik fur Anasthesiologie und Intensivmedizin, Universitat Duisburg- Essen, Essen, Germany Publisher BioMed Central Ltd Abstract Background: Patients recovering from cardiac surgery in the intensive care unit (ICU) do not sleep well. Commonly used sedative-hypnotic medications can disrupt sleep architecture and increase the risk of delirium in critically ill patients after surgery. The orexin receptor antagonist suvorexant, improves sleep onset and duration in patients with chronic insomnia. We hypothesized that suvorexant improves sleep onset and duration while also reducing the incidence of delirium after cardiac surgery. Method(s): This multicentric, double-blind, randomized controlled trial was conducted at two university-based cardiac ICUs. One hundred adult patients were enrolled after admission to the ICU following cardiac surgery. Enrollment occurred between March 2020 and February 2025. Participants were randomized to receive either a once daily oral dose of suvorexant 20 mg or placebo. Treatment began on the first night after extubation and continued until hospital discharge or for a maximum of seven days, whichever occurred first. Sleep was recorded using an electroencephalography (EEG) monitor (SedLine, Masimo Corp., California, USA) on the first night after extubation and was scored blindly by an experienced registered polysomnographic technologist. The primary outcome was wakefulness after persistent sleep onset (WASO). Sleep onset was defined as the first 30-second epoch classified by rapid eye movement (REM) or non-REM stages 1, 2, 3 after lights off. Wakefulness was defined as an awake period of 30s or longer. Sleep questionnaires were administered and delirium screenings were conducted every morning until hospital discharge. Result(s): One hundred patients were randomized to receive suvorexant (n = 49) or placebo (n = 51). EEG analysis indicated that neither the median [inter-quartile range] nighttime WASO (200.7 [112.1, 328.4] minutes vs. 184.2 [80.4, 304.2] minutes; p = 0.33) nor total sleep time (224.0 [112.0, 379.0] minutes vs. 253.0 [68.0, 420.0] minutes; p = 0.92) differed significantly between the groups. There was no significant difference in rescue medication (melatonin, dexmedetomidine, benzodiazepine) utilization between the groups. Subjective sleep quality, incidence of delirium, and delirium-free days did not differ between the two groups. Trial registration number: Clinical Trials Registry no. NCT04092894, Registration Date 09/17/2019. Conclusion(s): Among patients recovering in the ICU who underwent cardiac surgery with cardiopulmonary bypass, the suvorexant treatment did not affect wakefulness after sleep onset or post-operative delirium. Copyright © The Author(s) 2026. <153> Accession Number 652137046 Title 32nd Annual Scientific Congress of the Hong Kong College of Cardiology. Source Journal of the Hong Kong College of Cardiology. Conference: 32nd Annual Scientific Congress of the Hong Kong College of Cardiology. Hong Kong Hong Kong. 32(2 Supplement) (no pagination), 2025. Date of Publication: 01 Mar 2025. Author Anonymous Publisher Medcom Limited Abstract The proceedings contain 62 papers. The topics discussed include: miRNA-146a and miRNA-499: a potential early biomarkers in coronary artery disease patients; prehabilitation before cardiac surgeries for patients with mild to moderate frailty; use of a decision aid for patients considering prosthetic heart valve selection: a randomized controlled trial; sudden unexplained death in the young and molecular autopsy service in Hong Kong - familial clinical screening and needs; metformin associated lower risk of dementia among heart failure patients: a population-based retrospective cohort study; speeding up echocardiographic examination by automated generation of 2D imaging views from 3D volumetric data using machine learning; homocysteine impairs perivascular adipose tissue function: revealing the role of epoxyeicosatrienoic acids; impact of prolonged visit intervals on patients with medical diseases: a prospective study in Hong Kong; a digital solution to enhance the transitional care for patients with heart failure: a randomized controlled trial.; prognostic impact of vascular disease in valvular heart surgery: a multi-center study; clinical analysis of complete left bundle branch block after transcatheter closure of ventricular septal defects in 25 child patients; and a long-term follow-up study of percutaneous stent implantation for residual pulmonary artery stenosis after complicated congenital heart disease. <154> Accession Number 2049001927 Title Effect of Perioperative Oral Ascorbic Acid in Combination with Beta Blockers in Comparison to Beta Blockers Alone on Atrial Fibrillation in Elective Off Pump Coronary Artery Bypass Grafting. Source International Journal of Current Pharmaceutical Review and Research. 18(6) (pp 738-743), 2026. Date of Publication: 01 Jan 2026. Author Banerjee S.; Majumder S.; Dasghara A.; Gupta S.D. Institution (Banerjee) Department of Cardiac Anesthesia Nilratansircar Medical College and Hospital, West Bengal, Kolkata, India (Majumder, Dasghara) Department of Cardiac Anesthesia Nil Ratan Sircar Medical College and Hospital, West Bengal, Kolkata, India (Gupta) Department of Cardiac Anesthesia Nil Ratan Sircar Medical College, West Bengal, Kolkata, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Introduction: Atrial fibrillation is a common postoperative complication after CABG, mainly linked to oxidative stress and inflammation, occurring in 30-50% of patients. Risk factors include age, diabetes, hypertension, and heart disease. Vitamin C, an antioxidant, may reduce POAF by limiting oxidative injury and improving endothelial function. Despite beta-blocker use, additional prevention is needed, warranting further studies on vitamin C therapy. Aim(s): The aim of this study is to determine the effect of oral ascorbic acid in combination with beta-blockers on the incidence of postoperative atrial fibrillation in patients undergoing elective off-pump CABG. The objectives are to assess and compare the effectiveness of perioperative oral ascorbic acid with beta-blockers versus betablockers alone in preventing atrial fibrillation in these patients, and to evaluate any adverse events occurring in both treatment groups. Material(s) and Method(s): This randomized controlled single-blinded study was conducted in the Department of Cardiac Anaesthesia, NRSMCH, Kolkata, over 18 months (August 2024-February 2025). The study included 100 patients undergoing elective CABG. Participants were allocated to receive oral ascorbic acid with beta-blockers or beta-blockers alone, and outcomes were compared for POAF incidence. Result(s): The study groups were comparable in baseline, comorbidities, perioperative variables, echocardiographic parameters, and medication use. Postoperative atrial fibrillation was significantly lower in Vitamin C group (6% vs 28%, p=0.003). Other outcomes including transfusion, ventilation, ICU stay showed no significant difference. Conclusion(s): The study concluded that oral ascorbic acid with beta-blockers is more effective than beta-blockers alone in preventing postoperative atrial fibrillation after off-pump CABG. Older age, diabetes mellitus, and postoperative blood transfusion were identified as independent risk factors for developing atrial fibrillation. Copyright © 2025 This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. <155> 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, 2 x 2 factorial randomized trial, 160 children (<18 years) 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 30 min 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 30 min of OLV (PaO<inf>2</inf>/FiO<inf>2</inf>: 256.4 +/- 60.3 vs. 201.3 +/- 65.0 mmHg; p = 0.022), reduced median mechanical ventilation duration (45 vs. 102.5 min; p < 0.001), and shortened hospital length of stay (7 vs. 11 days; 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. <156> Accession Number 2049138028 Title ESC quality indicators for post-myocardial infarction care: transition and chronic coronary syndrome phases: Developed in collaboration with the European Association of preventive cardiology of the ESC. Source European Journal of Preventive Cardiology. 33(11) (pp 1940-1949), 2026. Date of Publication: 01 Aug 2026. Author Gencer B.; Follonier C.; Abdelrahman A.; Rossello X.; Sionis A.; Wilhelm M.; Koskinas K.C.; Moholdt T.; Panagiotakos D.; Dendale P.; Biondi-Zoccai G.; Ahrens I.; Krychtiuk K.A.; Salzwedel A.; Cavarretta E.; Vrints C.; Andreotti F.; Gale C.P.; Pedretti R.F.E.; Davos C.H.; Aktaa S. Institution (Gencer) Preventive Cardiology Unit, Service of Cardiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, Switzerland (Follonier) Service of General Internal Medicine and Service of Cardiology, Geneva University Hospitals, Geneva, Switzerland (Abdelrahman) Interventional Cardiology, University Hospital of Wales, Leeds, United Kingdom (Rossello) Cardiology Department, University Hospital of Son Espases, Institut D'Investigacio Sanitaria Illes Balears (IDISBA), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain (Sionis) Acute and Intensive Cardiac Care Unit, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain (Wilhelm) Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (Koskinas) Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland (Moholdt) Department of Circulation and Medical Imaging, Norwegian University if Science and Technology, Trondheim, Norway (Panagiotakos) School of Health Sciences & Education, Harokopio University of Athens, Athens, Greece (Dendale) Department of Cardiology, Jessa Hospital and Hasselt University Faculty of Medicine and Life Sciences, Hasselt, Belgium (Biondi-Zoccai, Cavarretta) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (Biondi-Zoccai) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Ahrens) Department of Cardiology and Medical Intensive Care, Hospital of Cologne, Cologne, Germany (Krychtiuk) Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, Vienna, Austria (Salzwedel) Department of Rehabilitation Medicine, University of Postdam, Postdam, Germany (Cavarretta) Advanced Cardiovascular Therapies, Bambino Gesu Children Hospital, IRCCS, Rome, Italy (Vrints) Department of Cardiology, Antwerp University Hospital, Edegem, Belgium (Vrints) Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium (Andreotti) Cardiovascular Science Department, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy (Andreotti) CardioThoracic Department, Catholic University Medical School, Rome, Italy (Gale) Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (Pedretti) School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy (Pedretti) Cardiology Unit, Hospital of Erba, CO, Erba, Italy (Davos) Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece (Aktaa) Centre for Heart Valve Innovation, St Paul's Hospital, Vancouver, BC, Canada Publisher Oxford University Press Abstract Aims: We aimed to develop the European Society of Cardiology (ESC) quality indicators (QIs) for myocardial infarction (MI), from 1 year after hospital discharge, corresponding to transition to the chronic coronary syndrome phases. Methods and Results: We collaborated with the European Association of Preventive Cardiology (EAPC) and developed QIs for the long-term management of patients following MI. We applied the ESC methodology for QI development by (i) determining key domains of post-MI care; (ii) developing candidate QIs by performing a systematic review of the literature, and (iii) selecting the final set of QIs using a modified Delphi approach. In total, 18 QIs were identified across seven domains of care including (i) structural framework, (ii) risk assessment and follow-up, (iii) pharmacological management, (iv) rehabilitation, behavioural, and preventive interventions, (v) coronary revascularization, (vi) clinical outcomes, and (vii) patient-reported outcomes. Conclusion(s): We present the ESC QIs from 1 year after hospitalization for MI, to standardize and address gaps in care for this high-risk group. These QIs are supported by evidence from contemporary literature, endorsed by expert consensus, and aligned with the 2024 ESC guidelines on the management of chronic coronary syndromes. Lay summary: Measures to evaluate and improve the long-term management of patients following a heart attack are needed. In this paper, we identified key aspects of care that can help clinicians, decision-makers and patients improve the quality of care, from one year after a heart attack onwards, and help address inequalities and variations in clinical practice. Copyright © The European Society of Cardiology 2025. 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) <157> Accession Number 652137028 Title Prehabilitation before cardiac surgeries for patients with mild to moderate frailty. Source Journal of the Hong Kong College of Cardiology. Conference: 32nd Annual Scientific Congress of the Hong Kong College of Cardiology. Hong Kong Hong Kong. 32(2 Supplement) (no pagination), 2025. Date of Publication: 01 Mar 2025. Author Li P.W.C.; Yu D.S.F.; Ho C.K.L.; Chan D.T.L.; Lam S.C.C.; Wan S. Institution (Li, Yu, Chan) The University of Hong Kong, Hong Kong (Ho, Chan, Lam, Wan) Queen Mary Hospital, Hong Kong Publisher Medcom Limited Abstract Background: Preoperative frailty is a strong prognostic indicator for adverse health outcomes in cardiac surgical patients. Intervening at the preoperative period through prehabilitation is gaining increasing research attention in the recent decade. However, an effective prehabilitation intervention for cardiac surgical patients is yet to be established. This study aimed to examine the preliminary effects and feasibility of a frailty-specific prehabilitation intervention for mild-to-moderately frail patients who were scheduled for elective cardiac surgeries. Method(s): This mixed-methods study comprised a pilot randomised controlled trial and a qualitative study. Adult patients with a Clinical Frailty Scale score between 4 and 6, scheduled for an elective coronary artery bypass grafting surgery and/or valve repair/replacement, and without contraindications for exercise were randomized in a 1:1 ratio to receive the prehabilitation intervention or usual care. The intervention, delivered through a hybrid mode (hospital- and home-based), comprised preoperative education, nutritional optimization, stress management, and a multi-component exercise training with 3 sessions/week and 60 minutes/session. The exercise training lasted at least 4 weeks and maintained throughout the preoperative period. Physical performance, frailty status, cardiac-related functional status, health-related quality of life (HRQoL), psychological outcomes, serum albumin and C-reactive protein (CRP) were measured at baseline (T0), one-day before surgery (T1), postoperative 1- (T2) and 3-month (T3). Result(s): Thirty participants (mean age: 66.0 +/- 8.1 years) were randomly allocated to the prehabilitation (n = 16) or control (n = 14) group. The intervention was feasible, acceptable and safe with no severe adverse events being recorded. The lost to follow-up rate was 5.9%, and the overall attendance was 95%. By using generalized estimating equation modelling, the prehabilitation group showed significantly improved physical performance, frailty status and psychological outcomes than the control group at T1. The prehabilitation group showed better HRQoL, higher albumin and lower CRP than the control group at T1, but not statistically significant. Data for T2 and T3 are yet to be collected. Participants gave positive comments about the intervention, and particularly highlighted the supervised exercise training increased their motivation to exercise and confidence to overcome fears. Two participants expressed the preference for exclusive home-based training. Conclusion(s): This ongoing trial shows that the prehabilitation intervention is feasible and safe for patients prior to cardiac surgeries. It has the potential to improve patients' physical performance, frailty status and psychological outcomes. A full-scale trial with longer-term followup, and including clinical and health service utilization outcomes is warranted. <158> Accession Number 2044477838 Title Workflow-based Framework to Aid with High-Definition Intravascular Ultrasound-Optimised Coronary Stenting: Introducing IVUS 123 Essentials. Source Interventional Cardiology: Reviews, Research, Resources. (no pagination), 2026. Article Number: e03. Date of Publication: 2026. Author Walsh S.J.; Cavalcante R.; Croce K.; Hanratty C.G.; Hashim H.; Joshi F.; Kalra S.; Kirtane A.; Maehara A.; McEntegart M.; Riley R.F.; Spratt J.C. Institution (Walsh) Cardiology Department, Belfast Health and Social Care Trust, Royal Victoria Hospital, Northern Ireland, Belfast, United Kingdom (Cavalcante) Boston Scientific, Maple Grove, MN, United States (Cavalcante) Cardiology Department, Hospital Sao Camilo, Sao Paulo, Brazil (Croce) Division of Cardiovascular Medicine, Brigham and Women's Hospital, MA, Boston, United States (Hanratty) Cardiology Department, Mater Private Hospital, Dublin, Ireland (Hashim) Cardiology Department,, MedStar Washington Hospital Center, Washington, DC, United States (Joshi) Cardiology Department, Golden Jubilee National Hospital, Scotland, Glasgow, United Kingdom (Kalra) Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada (Kirtane, Maehara, McEntegart) Cardiology Department, Cardiovascular Research Foundation, New York, NY, United States (Riley) Cardiology Department, Overlake Medical Center, Bellevue, WA, United States (Spratt) Cardiology Department, St George's Hospital, University of London, London, United Kingdom (Walsh) Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Rd, Northern Ireland, Belfast, United Kingdom Publisher Radcliffe Medical Media Abstract Intravascular ultrasound (IVUS) has been in clinical use for more than three decades. Despite evidence that supports the application of the technology from multiple registries, randomised trials and meta-analyses, adoption remains low. Potential barriers to the adoption of IVUS are a lack of understanding as to how to accurately interpret images and how to incorporate it into clinical workflow. To address this, this paper summarises evidence-based protocols for the application of IVUS during percutaneous coronary intervention (PCI) into an easily understood workflow. Standardisation of approaches and wider adoption of IVUS-optimised PCI should improve patient outcomes and PCI durability. Copyright: © The Author(s) 2026. This work is open access and is licensed under CC-BY-NC 4.0. Users may copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly. <159> Accession Number 652137030 Title Use of a Decision Aid for Patients Considering Prosthetic Heart Valve Selection: A Randomized Controlled Trial. Source Journal of the Hong Kong College of Cardiology. Conference: 32nd Annual Scientific Congress of the Hong Kong College of Cardiology. Hong Kong Hong Kong. 32(2 Supplement) (no pagination), 2025. Date of Publication: 01 Mar 2025. Author Jiang H.; Bai X.; Cheng Z.; Wei Q.; Yang Z. Institution (Jiang) Cardiovascular Department, Chongqing Medical University Affiliated Children's Hospital, Chongqing, China (Bai) Guizhou Nursing Vocational and Technical College, Guizhou, China (Cheng, Wei, Yang) Guizhou Provincial People's Hospital, Guizhou, China Publisher Medcom Limited Abstract Background: This study evaluated the impact of decision support on the selection of heart valve types for first-time patients undergoing heart valve replacement under the background of Chinese culture, in order to assist patients in participating in treatment decisions. Method(s): In a single-blind randomized controlled trial (RCT), 123 patients with heart valve replacement from a tertiary Grade A hospital in southern China were randomly assigned to receive routine care (n=61) or a combination of routine care and decision support counseling program (n=62). With the support of the Ottawa Support Framework, health education, tailored information and value clarification exercises were included in this program in order to stimulate patients' subjective initiative and value-based preferences for participating in heart valve type selection, and to explore and resolve participation barriers through procedural problem-solving. The primary outcome is the decision participation 4-5 days after the decision, while the secondary outcomes (including decision readiness, decision conflict, heart valve knowledge, decision satisfaction, and medication adherence) were measured at baseline, immediately before the decision, 4-5 days after the decision, and 6 months after discharge. Outcome(s): The average age of participants is 51.16 years old (8.61 years old). Most participants resided in rural residences (62.60%). Compared with the control group, the intervention group had significantly lower actual scores in decision-making participation (1.22 +/- 0.18 vs 2.11 +/- 0.48, P<0.001) (reverse scoring). Further, the decision readiness score (39.26 +/- 6.01, P<0.001), heart valve knowledge score (2.81 +/- 0.47, P<0.001), decision satisfaction score (68.69 +/- 6.3, P<0.001) and medication compliance score (6.79 +/- 0.64, P<0.01) showed greater improvement after intervention. Meanwhile, the decrease in decision conflict score (8.89 +/- 3.46, P<0.001) is more significant. Process evaluation reveals potential intervention mechanisms and background factors that affect intervention effectiveness, such as living conditions and environmental factors. Conclusion(s): Decision support is effective in improving the decision-making participation of patients undergoing heart valve replacement, indicating that the subjective initiative of patients could be increased through reasonable intervention methods, which can maximize the patient's participation and decision-making power in treatment decision-making, and achieve maximum benefits. <160> Accession Number 2049125582 Title Effectiveness of intraoperative blood recovery in surgical patients at risk of transfusion: A rapid review. Source Hematology, Transfusion and Cell Therapy. 48(4) (no pagination), 2026. Article Number: 106517. Date of Publication: 01 Oct 2026. Author Uchimura L.Y.T.; Yonekura T.; Quintans J.R.; Figueiro M.F.; Murador P.; de Carvalho M.A. Institution (Uchimura, Yonekura, Quintans, Figueiro) Hcor, Sao Paulo, Brazil (Murador, de Carvalho) Coordenacao-Geral de Sangue e Hemoderivados (CGSH), Departamento de Atencao Especializada e Tematica (DAET), Secretaria de Atencao Especializada a Saude (SAES), Ministerio da Saude do Brazil, Brazil (de Carvalho) Centro de Hematologia e Hemoterapia (Hemocentro-UNICAMP), Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil Publisher Elsevier Editora Ltda Abstract Background: Allogeneic blood transfusion is widely used to manage surgical blood loss but carries risks, such as infections and transfusion reactions, and is affected by blood shortages. Intraoperative blood recovery (cell salvage) may reduce the need for donor blood, improving patient safety and resource availability. This rapid review evaluated its clinical effectiveness, safety, and costs in surgical patients at risk of transfusion. Method(s): Following the Cochrane rapid review guidelines, PubMed, the Virtual Health Library, and the Cochrane Library were searched for systematic reviews, randomized and non-randomized trials, and observational studies published between 2004 and October 2024. Eligible studies compared intraoperative blood recovery with allogeneic transfusion or no intervention in surgical patients. Outcomes included transfusion requirements, clinical safety, hospital indicators, and costs. Study quality was assessed using the AMSTAR-2 and Joanna Briggs Institute tools. Result(s): Fifty-two studies across multiple surgical specialties were included. Intraoperative blood recovery consistently reduced allogeneic transfusion requirements in orthopedic, obstetric, gastrointestinal, and pediatric cardiac surgeries. Evidence was mixed for cardiac, thoracic, and vascular surgeries. Safety profiles were favorable, with no significant adverse events directly attributed to intraoperative blood recovery. Some studies reported reductions in infection rates and hospital stay. Cost analyses (n = 16) yielded mixed results, with eight studies showing cost savings due to reduced transfusion needs. Conclusion(s): Intraoperative blood recovery is effective and safe in reducing allogeneic transfusions, especially in high-blood-loss surgeries. Cost-effectiveness is context-dependent. Implementation should prioritize high-risk procedures and align with patient blood management strategies. Copyright © 2026 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular <161> Accession Number 2048907359 Title Effect of programmed intermittent paravertebral analgesia on postoperative neurocognitive disorders in elderly patients undergoing video-assisted thoracoscopic surgery: a randomized controlled trial. Source European Journal of Medical Research. 31(1) (no pagination), 2026. Article Number: 1219. Date of Publication: 01 Dec 2026. Author Wang L.; Sun Y.; Wang F.; Gao G.; Chen B.; Liu T.; Liu W. Institution (Wang, Sun, Wang, Gao, Chen, Liu, Liu) Department of Anesthesiology, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institution, Capital Medical University, No. 97 Ma Chang, Tongzhou District, Beijing, China Publisher BioMed Central Ltd Abstract Background: Perioperative neurocognitive disorders (PND) refer to neurocognitive abnormalities detected during the perioperative periods and can significantly impede patient recovery. Thoracic surgery is a highly invasive procedure and is linked to an increased risk of PND. Although paravertebral block (PVB) is effective in providing postoperative analgesia following thoracic procedures, robust evidence linking PVB to lower PND risk remains limited. Objective(s): This study aimed to evaluate the efficacy of programmed intermittent paravertebral analgesia (PIPA) on delayed neurocognitive recovery (dNCR) at postoperative 3 days in elderly patients undergoing video-assisted thoracoscopic surgery (VATS). Method(s): This prospective, randomized controlled trial enrolled 228 elderly patients scheduled for elective VATS of the lungs. Patients were randomly assigned to one of two postoperative analgesia groups: the paravertebral block group (Group P), which received paravertebral infusion of 0.2% ropivacaine hydrochloride at 300 mL, or the intravenous patient-controlled analgesia group (Group I), which received sufentanil (2 mug/kg, diluted to 100 mL). Result(s): A total of 190 patients were included in the primary complete-case analysis. The incidence of delayed neurocognitive recovery (dNCR) at 72 h postoperatively was significantly lower in the Group P compared to the Group I (33.3% vs. 55.3%, RR = 0.404 [0.224, 0.727], p = 0.002). The sensitivity analysis incorporating all 228 randomized patients with 72-h cognitive data confirmed this finding (Group P 32.5% vs. Group I 52.6%, p = 0.003), and the effect remained robust after adjustment for age and baseline MoCA score (adjusted OR = 0.43, 95% CI 0.25-0.76, p = 0.004). Furthermore, the incidence of dNCR at 30 days (12.5% vs. 25.5%, p = 0.022) and postoperative neurocognitive disorder at 3 months (5.2% vs. 19.1%, p = 0.003) postoperatively showed statistically significant differences between the Group P and the Group I. Regarding acute pain, both active (3 [2, 4] vs. 3 [2, 5], p = 0.037) and coughing (4 [3, 5] vs. 4 [4, 5], p = 0.015), Numeric Rating Scale (NRS) scores at 24 h postoperatively were significantly lower in the Group P than Group I. At 3 months postoperatively, resting NRS scores remained significantly lower in the Group P (1 [0, 2] vs. 2 [0, 2], p = 0.033). Additionally, the incidence of neuropathic pain (20.2% vs 34.0%, p = 0.03) and chronic postsurgical pain (3.2% vs. 11.7%, p = 0.025) at 3 months was significantly reduced in the Group P compared to the Group I. Conclusion(s): In elderly patients undergoing VATS, PIPA was associated with a lower incidence of MoCA-defined dNCR and postoperative neurocognitive disorder, as well as lower incidences of chronic postsurgical pain and neuropathic pain, compared with conventional opioid-based intravenous analgesia. Trial registration: The study was registered in the Chinese Clinical Trial Registry on June 30, 2022 (ChiCTR2200061670). Copyright © The Author(s) 2026.

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