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Total documents retrieved: 117 Results Generated From: Embase <1980 to 2026 Week 18> Embase Weekly Updates (updates since 2026-04-24) - (117 records) <1> Accession Number 2044383443 Title Preoperative alcohol use disorders and adverse outcomes in surgical patients: A systematic review and meta-analysis. Source Journal of Clinical Anesthesia. 111 (no pagination), 2026. Article Number: 112194. Date of Publication: 01 Apr 2026. Author Rajapakse N.; Rubenzahl E.; Saripella A.; Lee J.W.; Mansouri S.; Fan S.; Englesakis M.; Chung F. Institution (Rajapakse, Rubenzahl, Mansouri, Chung) Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Saripella, Chung) Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (Lee) Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada (Fan) Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (Englesakis) Library & Information Services, University Health Network, Toronto, ON, Canada (Chung) Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada Publisher Elsevier Inc. Abstract Objective To evaluate the association between preoperative unhealthy alcohol use (UAU), including alcohol use disorder and hazardous/risky alcohol use, and postoperative outcomes in adult surgical patients. Methods The Ovid MEDLINE, Embase, and Cochrane databases were searched for English-language studies involving adults undergoing surgery. Eligible studies compared patients with preoperative UAU to those with no UAU and reported at least one postoperative outcome within 12 months. Preoperative alcohol exposure was determined using validated assessment tools or self-reported alcohol use disorder. Random-effects meta-analyses were conducted to calculate risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Results Thirty-five studies (n = 18,472,205) met inclusion criteria, and 35 studies were included in the meta-analyses. Preoperative alcohol use disorder was associated with a higher risk of respiratory complications (RR 2.59, 95% CI 1.51-4.45; P = 0.0005), infections/wound complications (RR 1.71, 95% CI 1.37-2.15; P < 0.0001), longer length of hospital stay (mean difference 0.76 days, 95% CI 0.24-1.29; P = 0.004), and higher in-hospital mortality (RR 1.67, 95% CI 1.21-2.29; P = 0.002). Conclusion Surgical patients with alcohol use disorder were associated with worse postoperative outcomes, including higher rates of respiratory complications and infections, longer length of hospital stay and increased in-hospital mortality. These findings support screening for alcohol use and preoperative optimization including cessation support and postoperative monitoring. Copyright © 2026 The Authors. <2> Accession Number 2044940522 Title Cerebral Embolic Protection Devices (CEPDs) During Transcatheter Aortic Valve Implantation (TAVI): A Meta-Analysis of Randomized Controlled Trials. Source Clinical Cardiology. 49(4) (no pagination), 2026. Article Number: e70309. Date of Publication: 01 Apr 2026. Author Gbreel M.I.; Badran A.S.; Hassan M.; Balata M. Institution (Gbreel) Faculty of Medicine, October 6 University, Giza, Egypt (Badran) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hassan) Theodor Bilharz Research Institute, Giza, Egypt (Balata) Department of Cardiology, University Hospital Rostock, Rostock, Germany Publisher John Wiley and Sons Inc Abstract Aims: Transcatheter aortic valve implantation (TAVI) is associated with procedure-related stroke. Cerebral embolic protection devices (CEPDs) are designed to reduce the risk of embolic debris reaching the brain; however, the evidence supporting their efficacy remains controversial. We aim to evaluate the efficacy and safety of CEPDs in patients undergoing TAVI. Method(s): Major databases were systematically searched up to April 2025. Only randomized controlled trials (RCTs) were included and critically appraised using the Cochrane Risk of Bias (ROB-2) tool. We calculated risk ratios (RRs) with the 95% confidence intervals for the outcomes, and trial sequential analysis (TSA) was conducted to reduce the risk of false-positive results due to random errors. Result(s): Eight RCTs (11,589 patients) were analyzed. No significant difference was observed in overall stroke incidence between CEPD and control groups (0.92 (95% CI: 0.75-1.14; p = 0.40, I2 = 0%), including disabling and non-disabling strokes. Device-specific analyses showed a non-significant reduction in disabling stroke with the Sentinel device. All-cause mortality, transient ischemic attacks, bleeding, acute kidney injury, delirium, and pacemaker implantation rates were similar between groups. CEPD use was linked to a transient improvement in cognitive function (MoCA scores) at 2-5 days post-TAVI, but this effect was not sustained at later follow-ups. TSA indicated that current evidence is insufficient to definitively refute CEPD efficacy. Conclusion(s): CEPDs show no significant reduction in overall, disabling, or non-disabling stroke, nor in all-cause mortality post-TAVI. Trial Registration: This meta-analysis was registered on PROSPERO. No.: CRD420251026208. Copyright © 2026 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC. <3> Accession Number 2045079298 Title Adjunctive Eptifibatide Administration in ACS Patients Undergoing Percutaneous Coronary Intervention: A Randomized Comparison of Bolus-only Versus Standard Therapy. Source American Heart Journal Plus: Cardiology Research and Practice. 65 (no pagination), 2026. Article Number: 100781. Date of Publication: 01 May 2026. Author Baharvand F.; Dadras M.; Salari A.; Parvaneh S.; Ashouri A.; Mirrazeghi F.; Aris A.; Jenab Y. Institution (Baharvand, Dadras, Salari, Parvaneh, Ashouri, Mirrazeghi, Aris) Department of Cardiology, Cardiovascular Diseases Research Center, Guilan University of Medical Sciences, Heshmat Hospital, Rasht, Iran, Islamic Republic of (Jenab) Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Elsevier Inc. Abstract Background: Guidelines do not recommend routine glycoprotein IIb/IIIa inhibitors (GPIs), reserving them for high thrombotic-risk or bailout cases. Most acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) are already on dual antiplatelet therapy (aspirin plus clopidogrel). GPIs thus act as adjunctive therapy, providing short-term platelet inhibition. The optimal strategy, bolus-only versus bolus-plus-infusion, remains uncertain, especially in patients at higher bleeding risk. Objective(s): To evaluate whether bolus-only eptifibatide provides ischemic protection comparable to standard bolus-plus-infusion while reducing bleeding in ACS patients undergoing PCI. Method(s): In this open-label, randomized trial, 183 ACS patients on aspirin and clopidogrel undergoing PCI received bolus-only eptifibatide (Group A, n = 102) or bolus plus continuous infusion (Group B, n = 81) and were followed for 90 days. The primary outcome, major adverse cardiac events (MACE), included cardiac death, recurrent myocardial infarction, stent thrombosis, or repeat target-vessel revascularization. Secondary endpoints included left ventricular function, mechanical/electrical complications, and bleeding. Major bleeding was defined by TIMI criteria; minor bleeding included clinically apparent non-life-threatening events. Result(s): MACE rates were similar (2.0% vs. 2.5%; p = 0.87). No major bleeding occurred. Left ventricular ejection fraction improved in both groups without significant difference (p = 0.52). Minor bleeding was lower in the bolus-only group (1.0% vs. 8.6%; p = 0.02). Electrical complications were infrequent and comparable. Conclusion(s): In ACS patients on dual antiplatelet therapy, bolus-only eptifibatide provides ischemic protection comparable to bolus-plus-infusion while reducing minor bleeding, supporting a simplified adjunctive strategy in high thrombotic-risk patients undergoing PCI. Copyright © 2026 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <4> Accession Number 2042353720 Title Left atrial appendage closure in patients with hereditary hemorrhagic telangiectasia and atrial fibrillation: a prospective study and systematic review. Source European Journal of Internal Medicine. 147 (no pagination), 2026. Article Number: 106695. Date of Publication: 01 May 2026. Author Torres-Iglesias R.; Teruel L.; Sanchez-Corral M.A.; Cerda P.; Villanueva B.; Gamundi E.; Pelaez P.; Moreno-Lopes S.; Iriarte A.; Alba E.; Portillo A.; Gomez-Lara J.; Ribas J.; Riera-Mestre A. Institution (Torres-Iglesias, Sanchez-Corral, Cerda, Villanueva, Pelaez, Moreno-Lopes, Iriarte, Alba, Portillo, Ribas, Riera-Mestre) HHT Unit. Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain (Torres-Iglesias, Cerda, Villanueva, Pelaez, Moreno-Lopes, Iriarte, Riera-Mestre) Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain (Torres-Iglesias, Cerda, Villanueva, Iriarte, Portillo, Ribas, Riera-Mestre) Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (Torres-Iglesias, Riera-Mestre) Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain (Teruel, Sanchez-Corral, Gomez-Lara) Cardiology Department. Hospital Universitari de Bellvitge, Barcelona, Spain (Gamundi) Cytology and Hematology Laboratory, Anatomic Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain (Alba) Angioradiology Unit, Radiology Department. Hospital Universitari de Bellvitge, Barcelona, Spain (Portillo) Otorhinolaringology Department. Hospital Universitari Bellvitge, Barcelona, Spain (Ribas) Pneumology Department. Hospital Universitari de Bellvitge, Barcelona, Spain Publisher Elsevier B.V. Abstract Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disease with a high risk of iron deficiency anemia secondary to epistaxis and gastrointestinal bleeding. Atrial fibrillation (AF) is associated with a high risk of ischemic stroke and oral anticoagulation therapy is indicated for its prevention. Percutaneous left atrial appendage closure (LAAC) is recommended to prevent stroke in patients with AF and high risk of bleeding such as HHT patients. However, double antiplatelet therapy at first, followed by long-term single antiplatelet therapy, is also recommended after the procedure to prevent device-related thrombus (DRT), which most HHT patients cannot tolerate. This prospective observational study describes 36 HHT patients with AF, 23 of whom underwent LAAC. To prevent DRT, simple antiplatelet therapy was indicated for 3 months if tolerated. In addition, a systematic review on LAAC in HHT patients was performed to compare our results with what has been previously reported. A total of 57 HHT patients with AF and LAAC were analysed. Although only 12.3% tolerated long-term simple antiplatelet therapy, none presented DRT during follow-up. Three ischemic events were reported but only one of them appears to be partially related to AF in a patient with significant leakage peri-device. In conclusion, percutaneous LAAC is a safe and potentially effective strategy for preventing ischemic stroke in HHT patients with AF. A simplified and personalized antiplatelet regimen was not associated with DRT or ischemic events. Copyright © 2025. Published by Elsevier B.V. <5> [Use Link to view the full text] Accession Number 2044545389 Title Letter by Huang et al Regarding Article, "Electronic Provider Notification to Facilitate the Recognition and Management of Severe Aortic Stenosis: A Randomized Clinical Trial". Source Circulation. 153(1) (pp e1-e1), 2026. Date of Publication: 06 Jan 2026. Author Huang Q.; Jian X. Institution (Huang, Jian) Coronary Care Unit, The Second People's Hospital of Foshan, China (Q.H., X.J.). Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China Publisher Lippincott Williams and Wilkins <6> Accession Number 2044461695 Title Thoracic paravertebral block with liposomal bupivacaine versus ropivacaine for postoperative analgesia in thoracic surgery: a randomized controlled study. Source Journal of Thoracic Disease. 18(3) (no pagination), 2026. Article Number: 196. Date of Publication: 31 Mar 2026. Author Sun Y.; Chen B.; Liu T.; Wang L.; Gao G.; Kang W.; Liu W. Institution (Sun, Chen, Liu, Gao, Liu) Department of Anesthesiology, Beijing Tuberculosis and Thoracic Tumor Research Institution, Beijing, China (Sun, Chen, Liu, Gao, Liu) Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, China (Wang) Department of Pharmacology, Beijing Chest Hospital, Capital Medical University, Beijing, China (Wang) Department of Pharmacology, Beijing Tuberculosis and Thoracic Tumor Research Institution, Beijing, China (Kang) Department of Disease Prevention and Control, Beijing Chest Hospital, Capital Medical University, Beijing, China (Kang) Department of Disease Prevention and Control, Beijing Tuberculosis and Thoracic Tumor Research Institution, Beijing, China Publisher AME Publishing Company Abstract Background: Paravertebral block is a highly effective regional analgesic technique for thoracic surgery. Liposomal bupivacaine (LB) significantly extends the duration of analgesia. However, the efficacy of LB for thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracic surgery (VATS) remains unclear. This trial aimed to evaluate the analgesic efficacy of TPVB with LB following VATS. Method(s): In this prospective, randomized controlled trial, patients scheduled for VATS were randomly assigned (1:1) to receive either LB or ropivacaine. All patients received a standardized multimodal analgesic regimen, which included a preoperative ultrasound-guided TPVB and patient-controlled intravenous analgesia. The primary outcome was the Numerical Rating Scale (NRS) score for pain during coughing at 24 hours postoperatively. Result(s): Among 100 patients undergoing VATS, paravertebral analgesia with LB provided superior pain control compared to ropivacaine. At 24 hours postoperatively, the LB group demonstrated significantly lower median cough NRS pain scores [median: 4 (IQR, 3, 6) vs. 6 (IQR, 5, 7); median difference: -2; P=0.001], as well as reduced resting [2 (IQR, 1, 3) vs. 4 (IQR, 2, 6); P=0.001] and active [3 (IQR, 1, 5) vs. 4.5 (IQR, 3.75, 6.00); P=0.002] NRS pain scores. These analgesic benefits persisted at 48 hours and 72 hours for cough pain (P=0.001 and P=0.02, respectively). The LB group also exhibited a lower incidence of vomiting (4% vs. 26%) and dizziness (14% vs. 36%), along with reduced vasopressor requirements (20% vs. 46%). Conclusion(s): Preoperative administration of LB for TPVB effectively reduced postoperative pain in patients undergoing VATS and was associated with a lower incidence of vomiting and dizziness. Copyright © AME Publishing Company. <7> Accession Number 2042446505 Title Diabetes does not modify the renal-protective effect of intravenous amino acids infusion after cardiac surgery. Source Journal of Endocrinological Investigation. 49(5) (pp 1163-1172), 2026. Date of Publication: 01 May 2026. Author Consonni M.; Fresilli S.; Kotani Y.; Garofalo E.; Bradic N.; Scandroglio A.M.; Ti L.K.; Comis M.; Oriani A.; Pisano A.; Belletti A.; Guarracino F.; Losiggio R.; Redaelli M.B.; Pontillo D.; Arangino C.; Pruna A.; Federici F.; D'Amico F.; Silvetti S.; Labanca R.; Ferrod F.; Pittella G.; Corbo F.; Ranucci M.; Cortegiani A.; Paternoster G.; Bove T.; Longhini F.; Monaco F.; Zangrillo A.; Piemonti L. Institution (Consonni, Fresilli, Scandroglio, Oriani, Belletti, Losiggio, Pontillo, Pruna, D'Amico, Labanca, Corbo, Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (Kotani) Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan (Garofalo, Longhini) Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy (Bradic) Clinic of Anesthesiology, Resuscitation and Intensive Care, University Hospital Dubrava, Zagreb, Croatia (Bradic) Department of Nursing, University North, Varazdin, Croatia (Ti) Department of Anaesthesia, National University Hospital, Lower Kent Ridge Road, Singapore (Comis, Ferrod) S.C. Anestesia e Rianimazione Cardiovascolare, A.O.Ordine Mauriziano, Umberto I di Torino, Turin, Italy (Pisano) Cardiac Anesthesia and ICU, AORN "Dei Colli", Monaldi Hospital, Naples, Italy (Guarracino) Department of Cardiothoracic Anaesthesia and IC, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (Redaelli) General and Neurosurgical Intensive Care Units, ASST Sette Laghi, Ospedale Di Circolo, Varese, Italy (Redaelli) Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy (Arangino) Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy (Federici) UOC Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy (Silvetti) Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, IRCCS Cardiovascular Network, Genova, Italy (Pittella) Cardiovascular Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy (Ranucci) Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy (Cortegiani) Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy (Cortegiani) Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Analgesia, Palermo, Italy (Paternoster) Department of Health Sciences, University of Basilicata, Potenza, Italy (Paternoster) Anesthesia and ICU, San Carlo Hospital, Potenza, Italy (Bove) Department of Basic Biotechnological Sciences, Intensive Care Peri- Operative Clinics, Universita Cattolica del Sacro Cuore, Rome, Italy (Bove) Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (Monaco) Departement. of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy (Monaco) Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola, Bologna, Italy (Zangrillo, Piemonti) School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (Piemonti) Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy (Losiggio) Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Milan, Italy Publisher Springer Science and Business Media Deutschland GmbH Abstract Purpose: Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the high prevalence of patients with diabetes and their increased susceptibility to renal injury, this study aimed to assess whether the renal-protective effect of AA infusion is maintained in this population. Method(s): This post-hoc subgroup analysis examined patients with diabetes included in the multinational, double-blind, randomized, placebo-controlled PROTECTION trial. Participants were randomized to receive a continuous intravenous infusion of AA (2 g/kg of the ideal body weight per day; up to 72 h) or placebo during the perioperative period of cardiac surgery. Result(s): Among 644 patients with diabetes (AA n = 309; placebo n = 335), the incidence of any-stage AKI was 43.3% in the AA group versus 47.8% in the placebo group, with no significant interaction observed compared to patients without diabetes (interaction p = 0.82). Similarly, stage 3 AKI occurred in 2.3% of patients in AA group versus 4.8% in the placebo group, with no interaction detected (interaction p = 0.65). Conclusion(s): The beneficial effect of perioperative AA infusion has similar magnitude and direction among patients with or without diabetes. These findings support the use of AA infusion as a renal-protective strategy for all patients undergoing cardiac surgery. Trial registration number: ClinicalTrials.gov NCT03709264 - registered on October 17th, 2018. Copyright © The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE) 2026. <8> Accession Number 2045129277 Title Neurodevelopmental outcomes after cardiac surgery for congenital heart disease in India: A narrative review. Source Indian Heart Journal. (no pagination), 2026. Date of Publication: 2026. Author Bakhshi S.; Faisal N.V.; Naim M.Y.; Gupta S.K. Institution (Bakhshi) Department of Pediatrics, Children's Hospital of Michigan, Detroit, United States (Faisal, Gupta) Department of Cardiology, AIIMS, New Delhi, India (Naim) Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States Publisher Elsevier B.V. Abstract Neurodevelopmental outcomes among survivors post-surgery for congenital heart disease (CHD) in India remain insufficiently characterized. Structured searches in PubMed and Google Scholar for studies on neurodevelopmental outcomes published between January 2000 and December 2025 identified six studies from India: five single-centre and one multicentric cohort. Across studies, early motor delay was reported in 14-33% of children and mental or cognitive delay in 15-24%. Risk factors included syndromic association, prolonged postoperative illness, and socioeconomic disadvantage. Long-term, longitudinal, and regionally representative data remain sparse. Integration of structured neurodevelopmental follow-up into CHD care is needed. Copyright © 2026 Cardiological Society of India <9> Accession Number 650614956 Title Effects of individualized PEEP titration on intraoperative cardiac output in thoracoscopic lung surgery: a prospective randomized trial. Source Scientific reports. 16(1) (no pagination), 2026. Date of Publication: 12 Mar 2026. Author Zhu M.; Song T.; Bao Q.; Wang J.; Wang W.; Song Z.; Tan J. Institution (Zhu, Song, Bao, Wang, Wang, Song, Tan) Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China (Wang, Song, Tan) Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, China Abstract Personalized positive end-expiratory pressure (PEEP) based on pulmonary compliance may improve intraoperative hemodynamics and postoperative outcomes in thoracic surgery. This study aimed to evaluate the effect of individualized, compliance-guided PEEP titration on cardiac output (CO) and postoperative pulmonary complications (PPCs) in patients undergoing video-assisted thoracoscopic pulmonary resection. In this prospective randomized controlled trial, 80 patients scheduled for thoracoscopic pulmonary resection were allocated to either an individualized PEEP group (Group N) or a fixed PEEP group (Group C). Group N received dynamic PEEP titration starting at 15 cmH2O, adjusted to optimize compliance; Group C received a fixed PEEP of 5 cmH2O. Hemodynamic parameters including CO, heart rate (HR), and systemic vascular resistance (SVR) were recorded at five time points: baseline after admission (T1), 20 min after initiating two-lung ventilation (T2), 30 min following PEEP implementation (T10), 60 min post-PEEP adjustment (T11), and upon completion of one-lung ventilation (T12). PPCs and postoperative pneumonia incidence were also recorded. Seventy-six patients completed the study (n = 38 per group). At T11, T12, Group N showed significantly higher CO than Group C. The optimal PEEP range for compliance was 7-13 cmH2O. Compared to 5 cmH2O PEEP of individualized PEEP during OLV resulted in better lung compliance, lower driving pressure, and higher mean airway pressure, without differences in peak airway pressure or PETCO2. Postoperative pulmonary complications (PPCs) occurred more frequently in Group C (42.1% vs. 13.2%, p = 0.004). No significant differences were observed in overall SVR trends between groups, except at T11, T12. Compliance-guided individualized PEEP improves cardiac output and may reduce postoperative pulmonary complications in patients undergoing thoracoscopic lung resection. This approach holds promise for enhancing perioperative respiratory and hemodynamic stability.Trial registration: ChiCTR2100048201, intervention study, registered on 04/07/2021. Copyright © 2026. The Author(s). <10> [Use Link to view the full text] Accession Number 2044139603 Title Comparison of Fasting and Nonfasting Regimens Outcomes Before Catheterization Laboratory Procedures: A Systematic Review and Meta-Analysis. Source Critical Pathways in Cardiology. 25(1) (pp e0402), 2026. Date of Publication: 01 Mar 2026. Author Shojaei S.; Mousavi A.; Radkhah H.; Mahalleh M.; Rahmati S.; Soltani P.; Farooqi M.A.; Ashrafi M.M.; Bozorgi S.J.; Moradi A.; Askari M.K.; Nasir K.; Almandoz J.P.; Hakim D.; Kuno T.; Hosseini K. Institution (Shojaei, Mousavi, Mahalleh, Rahmati, Soltani, Ashrafi, Bozorgi, Hosseini) Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Shojaei, Mousavi, Mahalleh, Rahmati, Soltani, Ashrafi, Bozorgi, Hosseini) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Radkhah) Internal Medicine Department, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Farooqi) Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, United States (Moradi) Blake Hospital, HCA Healthcare, University of South Florida, Morsani College of Medicine, Bradenton, Florida, United States (Askari) Department of Medicine, Assistant Professor Clerkship Director Internal Medicine, University of Toledo, OH, United States (Nasir) Division Cardiovascular and Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States (Almandoz) Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States (Hakim) Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States (Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, United States Publisher Lippincott Williams and Wilkins Abstract Guidelines recommend fasting before catheterization laboratory (cath lab) procedures. However, recent studies question the necessity of fasting, suggesting that fasting may not provide significant clinical benefits. This study aims to evaluate the existing evidence between outcomes for patients with fasting and nonfasting regimens. We conducted a comprehensive search for randomized controlled trials comparing fasting and nonfasting protocols before cath lab procedures. Outcomes included hypoglycemia, aspiration pneumonia, contrast nephropathy, all-cause mortality, and cardiovascular mortality. A random effects meta-analysis was performed to derive odds ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis included 8 randomized controlled trials with a total of 3068 participants: 1544 in the fasting group and 1524 in the nonfasting group. Compared with fasting, nonfasting was not associated with significant differences in hypoglycemia (OR = 0.77, 95% CI, 0.44-1.34), aspiration pneumonia (OR = 1.33, 95% CI, 0.38-4.72), contrast nephropathy (OR = 1.82, 95% CI, 0.88-3.75), all-cause mortality (OR = 1.29, 95% CI, 0.51-3.28), or cardiovascular mortality (OR = 0.94, 95% CI, 0.22-4.05). Nonfasting regimens show no significant differences in safety outcomes compared with fasting, suggesting it may be implemented to improve patient experience without compromising safety. Larger trials are needed to confirm the safety of nonfasting regimens. Summary of outcomes (CEID, cardiac implantable electronic device; PCI, percutaneous coronary intervention; TAVR, transcatheter aortic valve replacement). The design features graphical elements sourced from Servier Medical Art, which are provided by Servier under the Creative Commons Attribution 4.0 unported license. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <11> [Use Link to view the full text] Accession Number 2044029869 Title Comparison of the effect of neostigmine and sugammadex on postoperative delirium in surgical patients: A systematic review and meta-analysis. Source Medicine (United States). 105(10) (no pagination), 2026. Article Number: e46373. Date of Publication: 06 Mar 2026. Author Shin H.W.; Choi Y.J.; You H.S.; Lee J.H.; Jang Y.K. Institution (Shin, You, Lee, Jang) Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, South Korea (Choi) Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, South Korea Publisher Lippincott Williams and Wilkins Abstract Background: - Postoperative delirium (POD) frequently occurs in elderly surgical patients and is associated with adverse outcomes. This review aimed to evaluate whether sugammadex, a selective neuromuscular blockade reversal agent, reduces postoperative delirium-incidence (POD-I) compared with neostigmine. Method(s): - PubMed, EMBASE, and Cochrane CENTRAL were searched up to May 2025 for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) comparing sugammadex and neostigmine regarding to POD-I. Primary outcome was POD-I, with subgroup analyses according to postoperative period (within 24 hours vs after postoperative 1 day) and the type of anticholinergic coadministered with neostigmine (atropine vs glycopyrrolate). Secondary outcome was perioperative changes in Mini-Mental State Examination scores (preoperative vs postoperative). Analyses were performed separately for RCTs and NRCTs using RevMan 5.4. Result(s): - Twelve studies (7 RCTs, n = 759; 5 NRCTs, n = 50, 115) were included. In RCTs, sugammadex significantly reduced POD-I compared with neostigmine (risk ratio (RR), 0.67; 95% confidence interval (CI), 0.49-0.91; I2 = 0%; P = .008). Subgroup analysis of RCTs on POD-I within the 1st 24 hours postoperatively showed a significantly lower incidence in the sugammadex group (RR, 0.64; 95% CI, -0.45 to 0.90; P = .010). Subgroup analysis of RCTs by coadministered anticholinergics did not significantly influence POD-I (atropine: RR, 0.67; P = .06; glycopyrrolate: RR, 0.66; P = .06). In contrast, subgroup analysis of NRCTs on POD-I showed no significant difference between the groups (RR, 1.15; 95% CI, 0.88-1.50; I2 = 82%; P = .33). Preoperative and postoperative Mini-Mental State Examination scores in RCTs were similar between groups (preoperative: mean difference 0.03, P = .78; postoperative: mean difference 0.75, P = .12). Conclusion(s): - Sugammadex is associated with a reduced incidence of POD compared to neostigmine, particularly within the 1st 24 hours after surgery, based on consistent findings from RCTs. This benefit was not observed in NRCTs. Further well-designed RCTs using standardized delirium assessments are required. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc. <12> Accession Number 2036904960 Title Percutaneous coronary intervention for stable late ST-elevation myocardial infarction with symptoms onset between 12 and 72 h - A systematic review. Source Cardiovascular Revascularization Medicine. 78 (pp 1-9), 2025. Date of Publication: 01 Sep 2025. Author Fatima S.; Harinstein M.E.; Hussain M.; Pacella J.J. Institution (Fatima) Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve Medical University, United States (Harinstein, Pacella) Heart and Vascular Institute, University of Pittsburgh Medical Center, United States (Hussain) Department of Medicine, Allied Hospital, Faisalabad, Pakistan Publisher Elsevier Inc. Abstract Background: There exists clinical equipoise regarding whether and when an invasive approach should be preferred over conservative treatment in the management of stable late ST-elevation myocardial infarction (STEMI) presenting within 12 to 72 h of symptom onset. Objective(s): To perform a systematic review to identify the most effective treatment strategy between percutaneous coronary intervention (PCI) and medical therapy in stable late STEMI presenters by comparing their respective outcomes as well as determine the optimal timing of PCI by evaluating the outcomes of urgent versus non-urgent PCI approach in this patient population. Method(s): PubMed, Embase, and Cochrane databases were queried from inception until March 2024 for studies comparing the outcomes of PCI versus medical therapy, as well as urgent versus non-urgent PCI, in stable late STEMI patients presenting with symptom onset within 12-72 h. Quality of the studies and risk of bias were assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria and the Cochrane Risk of Bias (ROBINS-I 2016) tool, respectively. Result(s): A total of 8 studies were included in this systematic review that met the inclusion criteria. Among these, 5 studies (1 randomized controlled trial (RCT), 1 post-hoc analysis, and 3 observational studies) with an aggregate of 3820 participants compared PCI and medical therapy in stable late STEMI presenters. They found that PCI was associated with statistically significant better short- and long-term outcomes by lowering all-cause mortality, recurrent myocardial infarction (MI), and infarct size, and by improving myocardial salvage index (P < 0.001). Similarly, a non-statistically significant improvement was seen in the events of cardiac death, heart failure, and revascularization as well as ejection fraction percentage with PCI (P > 0.05). The other 3 studies, involving 1270 participants, were observational and compared urgent versus non-urgent PCI and did not find any statistically significant difference in clinical outcomes between the two approaches (P > 0.05). The included studies were significantly heterogeneous in methodologies, follow-up intervals, and reporting of outcomes. Most of the studies provided moderate quality of evidence and had moderate to serious risk of bias. Conclusions and relevance: Revascularization through PCI is associated with superior short- and long-term outcomes compared to medical therapy in stable late STEMI patients presenting within 12-72 h of symptom onset. However, the optimal timing of PCI needs further investigation. Copyright © 2024 Elsevier Inc. <13> Accession Number 650462485 Title Machine learning for the prediction of acute kidney injury post cardiac surgery: a systematic review and meta-analysis. Source BMC medical informatics and decision making. 26(1) (no pagination), 2026. Date of Publication: 03 Mar 2026. Author Aftab R.A.; Butt Z.A.; Ibrahim B.; Kun L.S. Institution (Aftab) Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia (Aftab) School of Health, Science and Society, University of Suffolk, Ipswich, United Kingdom (Butt, Ibrahim) Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia (Kun) Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia <14> Accession Number 2041797594 Title Self-expanding or balloon-expandable transcatheter aortic valve replacement in patients with small aortic annulus: A systematic review and meta-analysis. Source Indian Heart Journal. 78(2) (pp 79-88), 2026. Date of Publication: 01 Mar 2026. Author Attachaipanich T.; Kaewboot K.; Attachaipanich S. Institution (Attachaipanich) Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States (Kaewboot) Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Attachaipanich) Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan Publisher Elsevier B.V. Abstract Background: A small aortic annulus presents unique hemodynamic challenges during transcatheter aortic valve replacement (TAVR), increasing the risk of prosthesis-patient mismatch (PPM) and suboptimal valve performance. This study aimed to compare the efficacy and safety of self-expanding valves (SEVs) versus balloon-expandable valves (BEVs) in patients with a small aortic annulus. Method(s): A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to June 1, 2025. Studies comparing clinical outcomes of SEVs and BEVs in patients with a small aortic annulus were included. Result(s): Thirty-eight studies involving 19,421 participants were included. No significant difference in all-cause mortality was observed between SEVs and BEVs from in-hospital to 5-year follow-up. SEVs were associated with a significantly lower risk of PPM at discharge (OR 0.34, 95 % CI 0.28-0.42), 30 days (OR 0.31, 95 % CI 0.21-0.47), and 1 year (OR 0.25, 95 % CI 0.15-0.42). However, SEVs were associated with a higher risk of in-hospital paravalvular leakage (PVL) (OR 1.95, 95 % CI 1.39-2.74), moderate-to-severe PVL (OR 2.48, 95 % CI 1.91-3.22), and permanent pacemaker implantation (PPI) both in-hospital and at 30 days. These findings remained consistent across sensitivity analyses limited to new-generation valves and propensity score-matched or randomized studies. Conclusion(s): SEVs offer favorable hemodynamic advantages and lower risks of PPM and valve dysfunction compared to BEVs, with no difference in survival. However, these benefits must be weighed against the increased risks of PVL and PPI. Individualized valve selection remains essential to optimizing outcomes in TAVR patients. Copyright © 2025 Cardiological Society of India <15> Accession Number 650617091 Title Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 randomized trial. Source BMC medical education. 26(1) (no pagination), 2026. Date of Publication: 14 Mar 2026. Author Oliveira-Santos M.; Guerreiro C.; Lobo B.; Marinho A.V.; Borges-Rosa J.; Guardado J.; Santos E.O.; Costa M.; Goncalves L.; Bogle R.; Dudek D.; Pires-Morais G.; Marques J.S.; Khokhar A.A. Institution (Oliveira-Santos, Marinho, Borges-Rosa, Costa, Goncalves) Servico de Cardiologia, Unidade Local de Saude de Coimbra, Coimbra, Portugal (Oliveira-Santos, Lobo, Borges-Rosa, Goncalves) Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal (Oliveira-Santos, Santos, Marques) 3D CardioSolutions, Coimbra, Portugal (Guerreiro, Pires-Morais) Servico de Cardiologia, Unidade Local de Saude de Gaia/Espinho, Vila Nova de Gaia, Portugal (Guardado, Marques) Unidade Cardiovascular, Riachos, Portugal (Bogle) Department of Cardiology, Epsom & St Helier University Hospitals NHS Trust, St George's, Surrey, United Kingdom (Dudek) Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (Marques) Servico de Cardiologia, Unidade Local de Saude de Santa Maria, Lisboa, Portugal (Khokhar) Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark <16> Accession Number 2044823230 Title Transcutaneous Auricular Vagus Nerve Stimulation and Pectoral-Intercostal Fascial Block for the Prevention of Chronic Postsurgical Pain in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A 2x2 Factorial, Double-Blinded, Randomized Clinical Trial. Source Clinical Interventions in Aging. 21 (no pagination), 2026. Article Number: 583971. Date of Publication: 2026. Author Cui S.; Yan L.; Huang P.; Yang H.; Liang W.; Huang L. Institution (Cui, Yan, Huang, Liang, Huang) Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, China (Yang) Division of Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China (Yang) Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, China (Yang) Hebei Key Laboratory of Forensic Medicine, Hebei Medical University, Shijiazhuang, China (Huang) Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Hebei Medical University, Shijiazhuang, China (Huang) Key Laboratory of Clinical Neurology, Ministry of Education, Hebei Medical University, Shijiazhuang, China Publisher Dove Medical Press Ltd Abstract Background: Chronic postsurgical pain (CPSP) is common after off-pump coronary artery bypass grafting (OPCABG) in elderly patients. This trial investigated the efficacy of perioperative transcutaneous auricular vagus nerve stimulation (taVNS) and pectoral-intercostal fascial block (PIFB) for CPSP prevention. Method(s): In this 2x2 factorial trial, 260 elderly patients (>=60 years) undergoing OPCABG were randomized to taVNS + ropivacaine PIFB, taVNS + placebo PIFB, sham taVNS + ropivacaine PIFB, or sham taVNS + placebo PIFB groups. The primary outcome was CPSP incidence at 3 months postoperatively. Several secondary outcomes were evaluated. Logistic regression was employed to analyze risk factors associated with CPSP. Lastly, mediation analyses were performed to explore the mediating factors between interventions and CPSP. Result(s): The overall incidence of CPSP was 34.6%. No interaction was found between taVNS and PIFB. Compared with sham taVNS, taVNS significantly reduced CPSP incidence (28.6% vs 40.9%, P = 0.036), alleviated acute pain and improved recovery quality. PIFB did not reduce overall CPSP incidence (30.2% vs 38.8%, P = 0.143), though it alleviated acute pain on postoperative day 1 and reduced moderate-to-severe CPSP. Risk factors for CPSP included preoperative anxiety, pain catastrophizing, acute postoperative pain, and high IL-6 levels. Mediation analysis indicated taVNS's benefits were partially mediated by reducing acute pain (19.3%) and IL-6 (20.4%). Conclusion(s): Perioperative taVNS significantly reduced CPSP incidence and enhanced postoperative recovery in elderly OPCABG patients, partly mediated by alleviating acute pain and inflammation. Single-shot PIFB showed limited preventive effect on overall CPSP. Copyright © 2026 Cui et al. <17> Accession Number 2041420751 Title Cerebral embolic protection devices in transcatheter aortic valve implantation: An updated meta-analysis of randomized controlled trials. Source Indian Heart Journal. 78(2) (pp 72-78), 2026. Date of Publication: 01 Mar 2026. Author Mansouri E.S.; Queiroga F.; Ghasemi M.; Barbosa L.M.; Pinilla J.; Faizan M.A.; Ardebili S.F.Z.; Jena N.; Gomes W. Institution (Mansouri) Department of Internal Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Queiroga) Department of Medicine, Emory University, Atlanta, United States (Ghasemi) Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Barbosa) Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (Pinilla) CES University, School of Medicine, Medellin, Colombia (Faizan) Gomal Medical College, Khyber Medical University, Peshawar, Pakistan (Ardebili) Charles University, Faculty of Medicine in Hradec Kralove, Czechia (Jena) Department of Interventional Cardiology, Marshall University, Huntington, WV, United States (Gomes) INC Hospital, Department of Interventional Cardiology, Curitiba, Brazil Publisher Elsevier B.V. Abstract Background: Cerebral embolic protection devices (CEPD) have been designed to prevent embolization to the cerebral circulation during transcatheter aortic valve replacement (TAVR). However, the efficacy and safety of CEPD in stroke prevention in TAVR remains uncertain. Method(s): PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing CEPD vs. control for patients undergoing TAVR. Risk ratios (RR) with 95 % confidence intervals (CI) were pooled with a random-effects model. Result(s): Our meta-analysis included eight RCTs with 11,596 patients, of whom 5946 (51 %) were randomized to the CEPD group. There was no significant difference in the incidence of any stroke (3.51 % vs. 3.64 %; RR 0.91; 95 % CI 0.75-1.1; p = 0.33; I2 = 0 %) between groups. Similarly, CEPD did not significantly reduce the incidence of all-cause mortality (0.82 % vs. 0.67 %; RR 1.13; 95 % CI 0.74-1.74; p = 0.57; I2 = 0 %) Conclusion(s): Among patients undergoing TAVR, CEPD did not significantly reduce stroke incidence or all-cause mortality. Copyright © 2025 Cardiological Society of India <18> Accession Number 2034706678 Title Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis. Source Journal of Clinical Medicine. 14(10) (no pagination), 2025. Article Number: 3280. Date of Publication: 01 May 2025. Author Rybaczek M.; Mariak Z.; Grabala P.; Lyson T. Institution (Rybaczek, Mariak, Grabala, Lyson) Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, Bialystok, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Method(s): A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Result(s): Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of -4.68 (95% CI: -8.77; -0.59, p = 0.032). However, a high heterogeneity (I2 = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusion(s): Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Copyright © 2025 by the authors. <19> Accession Number 2032790215 Title Safety and efficacy of cerebral embolic protection systems in transcatheter aortic valve replacement: a systematic review and meta-analysis. Source Expert Review of Cardiovascular Therapy. 22(12) (pp 681-688), 2024. Date of Publication: 2024. Author Kheyrbek M.; Alsabti S.; Niroula S.; Ahmad E.; Choucair M.; Bhatia U.; Wernette A.; Chhabra K.; Strubchevska K.; Hanson I.; Halalau A. Institution (Kheyrbek, Alsabti, Niroula, Ahmad, Choucair, Bhatia, Wernette, Chhabra, Strubchevska, Halalau) Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States (Hanson) Department of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States (Hanson, Halalau) Oakland University William Beaumont School of Medicine, Rochester, MI, United States Publisher Taylor and Francis Ltd. Abstract Background: Stroke is a potential complication of Transcatheter Aortic Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic Protection Systems (CEPS) to reduce the incidence of stroke after TAVR have been conflicting. Method(s): Multiple databases were searched for studies comparing TAVR with or without CEPS and that reported on the primary outcome of periprocedural stroke. Two authors individually screened the titles, the abstracts and the full texts using Covidence. Risk of bias was assessed using Cochrane's ROB-2 and ROBINS-I tools. Result(s): A total of 15 studies (3 randomized controlled trials, 7 national registries, and 5 cohort studies) met the eligibility criteria and were included in our review. CEPS was associated with lower rates of periprocedural stroke [OR 0.71 (95% CI 0.55, 0.93) p = 0.012], as well as lower rates of mortality [OR 0.60 (95% CI 0.49, 0.74) p < 0.001]. There was no significant difference between the two groups in the incidence of acute kidney injury [OR 0.91 (95% CI 0.82, 1.01) p = 0.087], major vascular complications [OR 0.97 (95% CI 0.83, 1.14) p = 0.734], and major life-threatening bleeding [OR 0.89 (95% CI 0.73, 1.07) p = 0.222]. Conclusion(s): Our findings suggest that the use of CEPS in TAVR is associated with a lower risk of periprocedural stroke and mortality. Registration: The PROSPERO identification number is CRD42022374055. Copyright © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. <20> Accession Number 2044590308 Title Heart Transplantation in Patients with Congenital Heart Disease: A Review of Long-term Outcomes. Source Indian Journal of Transplantation. 20(1) (pp 3-8), 2026. Date of Publication: 01 Jan 2026. Author Cicaric N. Institution (Cicaric) Clinic for Cardiology, University Clinical Centre Kragujevac, Kragujevac, Serbia (Cicaric) Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Publisher Wolters Kluwer Medknow Publications Abstract Congenital heart disease (CHD) represents the most prevalent form of birth defect worldwide and has emerged as a leading indication for pediatric heart transplantation. With significant advances in surgical palliation, a growing number of patients with complex CHD are surviving into adulthood, but many ultimately develop heart failure or experience failure of previous palliative surgeries, necessitating transplantation. Heart transplantation in CHD patients is uniquely challenging due to anatomic complexity, prior surgical scarring, and high rates of pretransplant sensitization, all of which contribute to higher perioperative risk and variable long-term outcomes compared to non-CHD recipients. In this review, we performed a comprehensive literature search using PubMed, Scopus, and Web of Science databases, focusing on studies published from 2000 to 2024, and included relevant international guidelines and registry data to synthesize the current knowledge on indications, surgical strategies, immunologic considerations, and posttransplant outcomes in CHD. Unlike prior reviews that have largely focused on Western cohorts, this review integrates the global data with a particular emphasis on low- and middle-income countries (LMICs) such as India, highlighting disparities in access, outcomes, and future directions for equitable care. There is an urgent need for strategies to improve the early identification and referral of candidates, personalized immunosuppression protocols, advanced surgical simulation tools, and robust data collection from LMIC to inform global practice and improve outcomes. Investing in capacity building and adapting international best practices to the local context could substantially enhance the survival and quality of life for CHD transplant recipients worldwide. Copyright © 2026 Indian Journal of Transplantation. <21> Accession Number 2044968972 Title Ultrasound-Guided Superficial Versus Deep Continuous Serratus Anterior Plane Block in Patients Undergoing Thoracotomy for Lung Surgery: A Randomized Controlled Trial. Source Annals of Cardiac Anaesthesia. 29(2) (pp 180-185), 2026. Date of Publication: 01 Apr 2026. Author Raghupathy R.; Negi S.L.; Biswas I.; Singh H.; Mandal B.; Gourav K.P.; Sharma A. Institution (Raghupathy) Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Negi, Biswas, Mandal, Gourav) Department of Cardiac Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Singh) Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Sharma) Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Publisher Wolters Kluwer Medknow Publications Abstract Background: Thoracic surgery is considered to be one of the most painful surgical procedures; therefore, providing adequate analgesia in the perioperative period is crucial. Inadequate pain control impedes deep breathing, which further leads to atelectasis and pneumonia. The optimal analgesic protocol that allows adequate postoperative pain control and facilitates fast recovery of this population has yet to be determined. The serratus anterior plane (SAP) block is a new procedure that is relatively easier to perform and safer, compared with other modalities. Material(s) and Method(s): Patients undergoing lung resection surgery via thoracotomy at a single center were randomized to undergo either superficial or deep SAP block with 0.4 mL/kg of bupivacaine 0.25%, following which 20-gauge peripheral nerve block catheter was placed above or below the serratus anterior muscle plane and continuous bupivacaine 0.125% infusion at the rate of 5-7 mL/h was initiated up to 24 hours in intensive care unit (ICU). The primary outcome was the total opioid consumption during the first 24 h in the ICU. Secondary outcomes were the severity of pain in the visual analog scale (VAS) score, patient satisfaction score, ICU stay duration, and the incidence of postoperative nausea and vomiting (PONV). Result(s): A total of 36 participants were randomized to each group, and the baseline characteristics were comparable between the groups. The total postoperative opioid consumption during the first 24 h in ICU was lower in deep SAP block (60.00 +/- 68.22) compared to superficial SAP block (85.31 +/- 68.40), but it was not statistically significant (P > 0.303). The VAS score, time to first rescue analgesia, patient satisfaction score, incidence of PONV, and the length of ICU stay were comparable between the two groups (P > 0.05). Conclusion(s): There was lower opioid consumption in the continuous deep SAP block compared to the superficial SAP block at 24 hours; however, the difference was not statistically significant. Continuous analgesia through an indwelling catheter is safe and an effective method for the management of postoperative pain in lung resection surgery. Copyright © 2026 Annals of Cardiac Anaesthesia. <22> Accession Number 2030680225 Title Exploring heart rate variability in polycystic ovary syndrome: implications for cardiovascular health: a systematic review and meta-analysis. Source Systematic Reviews. 13(1) (no pagination), 2024. Article Number: 194. Date of Publication: 01 Dec 2024. Author Mirzohreh S.T.; Panahi P.; Heidari F. Institution (Mirzohreh, Panahi) Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of (Heidari) Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of Publisher BioMed Central Ltd Abstract Objectives: Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. It has significant implications for female endocrine function, reproductive health, and metabolic disturbances, including insulin resistance, impaired glucose tolerance, and dyslipidemia. Studies have shown that decreased heart rate variability (HRV), a marker of autonomic dysfunction, is associated with adverse cardiovascular events. Recent research has focused on investigating autonomic function in PCOS, and some studies have suggested altered autonomic drive in these patients. The aim of this systematic review and meta-analysis was to evaluate cardiac autonomic function by analyzing HRV in women with PCOS. Method(s): This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI). Result(s): Seventeen articles were included in the final analysis, varied in quality, ranging from a "low" to a "high risk of bias". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases. Conclusion(s): The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group. Copyright © The Author(s) 2024. <23> Accession Number 2044968974 Title The Effect of Dexmedetomidine on Hemodynamic Response during Double-Lumen Tube Insertion: A Randomized Controlled Trial. Source Annals of Cardiac Anaesthesia. 29(2) (pp 191-198), 2026. Date of Publication: 01 Apr 2026. Author Govind M.R.H.; George G.; Vithayathil R.; Gowri M.; Rao V.M.; Sahajanadanan R.; Kuppuswamy B. Institution (Govind) Department of Anaesthesia, Christian Medical College and Hospital, Tamil Nadu, Vellore, India (George) Department of Anaesthesia, Bangalore Baptist Hospital, Karnataka, Bengaluru, India (Vithayathil) Department of Anaesthesia, Bedford Hospital South Wing, Bedford, United Kingdom (Gowri) Department of Biostatistics, Christian Medical College and Hospital, Tamil Nadu, Vellore, India (Rao) Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Tamil Nadu, Vellore, India (Sahajanadanan) Department of Anaesthesia, Sultan Qaboos Cancer Centre and Research Centre and University, Seeb, Oman (Kuppuswamy) Department of Cardiac Anaesthesia, Christian Medical College and Hospital, Tamil Nadu, Vellore, India Publisher Wolters Kluwer Medknow Publications Abstract Background and Aim: Double-lumen tube (DLT) insertion, which is often necessary to isolate the lung in thoracic surgeries, causes a significant and prolonged stress response. This study aims to evaluate the effect of a single preinduction bolus of dexmedetomidine 0.5 mcg/kg on hemodynamic responses to DLT insertion and fiberoptic confirmation. Material(s) and Method(s): In this prospective randomized control trial, 60 patients coming for thoracic surgery requiring DLT insertion were recruited. Thirty were assigned to the dexmedetomidine group (A) and 30 to the placebo group (B). Group A received 0.5 mcg/kg dexmedetomidine, and Group B received normal saline over 10 min. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded at baseline, after study drug administration, just before intubation, at intubation, and thereafter at regular intervals up to 30 min. Usage of supplementary anesthetics and rescue medications was noted. Result(s): Patients in Group A had lower HR after study drug administration (P < 0.001), before intubation (P < 0.001), at intubation (P < 0.001), and at various other time points. Group A had lower SBP (P = 0.049) and DBP (P = 0.005) after study drug administration. Fewer patients in Group A required additional propofol (14 vs. 27) (P < 0.001) and lesser doses (21.3 vs. 41.0 mg) (P = 0.008). Lesser Group A patients required additional fentanyl (15 vs. 21) (P = 0.114). More patients in Group A required ephedrine (P = 0.038). Use of phenylephrine and atropine was comparable in both groups. Conclusion(s): Dexmedetomidine worked as an excellent adjuvant to anesthesia, providing good HR control and hemodynamic stability during DLT insertion and fiberoptic bronchoscopy confirmation. It decreases the overall anesthetic requirements and causes minimal side effects. Copyright © 2026 Annals of Cardiac Anaesthesia. <24> Accession Number 2045082230 Title Mckeown Esophagectomy: Minimally Invasive Robot-Assisted vs Conventional Technique - Systematic Review and Meta-Analysis of Randomized Clinical Trial. Source Surgical Innovation. (no pagination), 2026. Date of Publication: 2026. Author Neves A.D.; Comprido J.M.; Grillo I.T.C.; De Melo B.; Pompeu B.F. Institution (Neves) Department of Medicine, Ural State Medical University, Yekaterinburg, Russian Federation (Comprido) Department of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil (Grillo) Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina (De Melo) Department of Medicine, University of Santo Amaro, Sao Paulo, Brazil (Pompeu) Department of General Surgery, Heliopolis Hospital, Sao Paulo, Brazil (Pompeu) USCS- University of Sao Paulo Caetano do Sul, Sao Paulo, Brazil Publisher SAGE Publications Inc. Abstract Introduction: Currently, conventional minimally invasive esophagectomy (MIE) is the preferred surgical approach for esophageal cancer. Despite the increasing popularity of robot-assisted minimally invasive esophagectomy (RAMIE), its potential advantages over MIE are yet unknown. Method(s): We searched PubMed, Embase, and the Cochrane database for randomized controlled trials (RCTs) comparing RAMIE to MIE in patients with esophageal cancer that reported the outcomes of interest. Mean differences (MD) with 95% confidence intervals (CI) were collected. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Heterogeneity was assessed with I2 statistics. Result(s): We included three RCTs with 721 patients, of whom 364 (50,4%) underwent RAMIE. The number of dissected nodes increased in patients undergoing RAMIE (MD 3.72; 95% CI 1.07 to 6.37; P = 0.006). Similar results were observed in a subanalysis of the number of dissected thoracic nodes (MD 1.36 nodes; 95% Cl 0.12 to 2.61; P = 0.03), but not abdominal nodes (MD 0.30 nodes; 95% Cl -0.69 to 1.29; P = 0.55). RAMIE was associated with a reduction in blood loss (MD -47.76 mL; 95% Cl -70.06 to -25.46; P = <0.0001), thoracic operative time (MD -21.96 minutes; 95% Cl -33.82 to -10.10; P = 0.0003) and abdominal operative time (MD -15.10 minutes; 95% Cl -18.51 to -11.69; P = <0.00001) compared to MIE. Conclusion(s): This meta-analysis of RCTs found that, in patients with esophageal cancer, RAMIE increased the number of dissected nodes and reduced blood loss and operative time compared with MIE. Copyright © The Author(s) 2026 <25> Accession Number 2044635538 Title Bacterial air contamination and the protective effect of coverage for sterile surgical goods: A randomized controlled trial. Source American Journal of Infection Control. 54(5) (pp 589-589), 2026. Date of Publication: 01 May 2026. Author Cantu S.S. Institution (Cantu) University of Texas MD Anderson Cancer Center, Houston, TX, United States Publisher Elsevier Inc. <26> Accession Number 2044869803 Title Metabolic Conditioning for Renal Protection During Cardiopulmonary Bypass: A Narrative Review. Source Artificial Organs. (no pagination), 2026. Date of Publication: 2026. Author El Dsouki Y.; Hallak P.; Condello I.; Lorusso R. Institution (El Dsouki, Lorusso) Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (El Dsouki, Lorusso) Cardiovascular Research Centre Maastricht (CARIM), Maastricht, Netherlands (Hallak) Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Condello) School of Medicine and Surgery, University of Insubria, Varese, Italy Publisher John Wiley and Sons Inc Abstract Background: Acute kidney injury (AKI) remains one of the most frequent and prognostically relevant complications following cardiac surgery, even in the era of modern cardiopulmonary bypass (CPB) management and goal-directed perfusion. Cardiac surgery-associated AKI (CSA-AKI) is associated with increased postoperative morbidity, prolonged hospitalization, neurocognitive complications, and reduced early as well as long-term survival. Although optimization of macrocirculatory parameters and oxygen delivery has demonstrated benefits, renal injury often occurs despite apparently adequate perfusion and oxygenation. Recent evidence suggests that CPB-related metabolic stress and protein catabolism contribute to renal vulnerability. Indeed, intravenous amino acid administration has emerged as a novel metabolic strategy for renal protection. Material(s) and Method(s): This narrative review was informed by a structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library, covering publications from database inception through March 2025. Search terms included combinations of "acute kidney injury," "cardiac surgery," "cardiopulmonary bypass," "amino acids," "intravenous amino acid infusion," "renal protection," and "goal-directed perfusion". Randomized controlled trials, meta-analyses, systematic reviews, secondary analyses, and relevant narrative reviews published in English were considered. Particular emphasis was placed on high-quality evidence, including the PROTECTION randomized trial, contemporary meta-analyses, and consensus or expert reviews addressing cardiac surgery-associated acute kidney injury and perioperative metabolic interventions. Result(s): The literature search identified 124 records; 18 articles were included in the final narrative synthesis after title, abstract, and full-text evaluation. The selected literature comprised a multicenter randomized controlled trial, secondary analyses of randomized data, meta-analyses/systematic reviews, narrative or expert reviews, and observational or mechanistic studies addressing CSA-AKI. The evidence indicates that CSA-AKI results from an interaction between altered renal perfusion, inflammation, ischemia-reperfusion injury, and CPB-induced metabolic derangement. Intravenous amino acid infusion was consistently associated with reduced postoperative AKI incidence, particularly in patients with preexisting chronic kidney disease, without significant safety concerns. These findings support amino acid administration as a metabolic adjunct to goal-directed perfusion rather than a standalone intervention. Conclusion(s): Intravenous amino acid infusion is a recent strategy to reduce AKI in cardiac surgery. By targeting the CPB-induced metabolic stress, amino acid administration complements goal-directed perfusion and expands current AKI prevention paradigms beyond hemodynamic optimization alone. Future research should focus on CPB-specific timing, dosing strategies, and integration of metabolic support into multimodal AKI prevention bundles. Copyright © 2026 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <27> Accession Number 2035937041 Title The impact of heated humidified circuits on arterial oxygenation during one-lung ventilation in thoracic surgery: a randomized controlled trial. Source Journal of Anesthesia. 40(2) (pp 201-209), 2026. Date of Publication: 01 Apr 2026. Author Park S.-K.; Lee J.; Kim M.H.; Park J.; Kim H.-C. Institution (Park, Lee, Kim, Kim) Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea (Park) Department of Anesthesiology and Pain Medicine, Keimyung University College of Medicine, Seoul, South Korea Publisher Springer Abstract Purpose: One-lung ventilation (OLV) during thoracic surgery often disturbs systemic oxygenation. Hypoxic pulmonary vasoconstriction is influenced by body temperature; however, the effect of heated humidified circuits on hypoxic pulmonary vasoconstriction and arterial oxygenation during OLV remains unclear. This study aimed to investigate the impact of heated humidified circuits on arterial oxygenation during OLV for thoracic surgery, compared with conventional non-heated circuits. Method(s): Patients undergoing video-assisted thoracic surgery were randomly assigned to the heated humidified circuit or conventional breathing circuit group. During two-lung ventilation, tidal volume was set at 8 ml/kg with a fraction of inspired oxygen (FiO<inf>2</inf>) of 0.5, and during OLV, it was adjusted to 6 ml/kg with a FiO<inf>2</inf> of 1.0. Arterial blood gas measurements were obtained preoperatively, during two-lung ventilation, at 15, 30, 45, and 60 min after initiating OLV. The primary outcome was the partial pressure of oxygen in the arterial blood (PaO<inf>2</inf>) at 30 min after initiating OLV. Result(s): Ninety-seven patients were included in the final analysis. The heated humidified circuit group had significantly higher PaO at 30 min after initiating OLV than the control group (estimated mean [standard error], 211.3 [13.4] vs. 146.2 [13.2] mmHg; P = 0.004). The mean PaO<inf>2</inf> at 15 and 45 min was significantly higher in the heated humidified circuit group. Conclusion(s): Using heated humidified circuits significantly improves PaO<inf>2</inf> during OLV in patients undergoing thoracic surgery compared to conventional circuits. These findings suggest that heated humidified circuits can be considered as an option when hypoxemia persists despite other interventions. Copyright © The Author(s) under exclusive licence to Japanese Society of Anesthesiologists 2025. <28> Accession Number 2043652095 Title Low-density lipoprotein cholesterol lowering and risk of major adverse cardiovascular events in primary prevention trials: A meta-analysis. Source Journal of Clinical Lipidology. 20(4) (pp 738-749), 2026. Date of Publication: 01 Apr 2026. Author Kalra D.K.; Ray K.K.; Bajaj A.; Kushner P.R.; Wilcox M.L.; Dicklin M.R.; Kirkpatrick C.F.; Maki K.C. Institution (Kalra) Lipid Clinic and Division of Cardiology, University of Louisville School of Medicine, (Kalra), Louisville, KY, United States (Ray) Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, (Ray), London, United Kingdom (Bajaj) Department of Medicine, Perelman School of Medicine, University of Pennsylvania, (Bajaj), Philadelphia, PA, United States (Kushner) Department of Family Medicine, University of California Irvine Medical Center, (Kushner), Orange, CA, United States (Wilcox, Dicklin, Kirkpatrick, Maki) Midwest Biomedical Research, (Wilcox, Dicklin, Kirkpatrick, and Maki), Addison, IL, United States (Kirkpatrick) Kasiska Division of Health Sciences, Idaho State University, (Kirkpatrick), Pocatello, ID, United States (Maki) Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, (Maki), Bloomington, IN, United States Publisher Elsevier Ltd Abstract BACKGROUND Analyses of statin trials by the Cholesterol Treatment Trialists' Collaboration have suggested larger relative risk reduction (RRR) for major adverse cardiovascular events (MACE) per 1 mmol/L (38.7 mg/dL) low-density lipoprotein cholesterol (LDL-C) lowering in primary prevention than in secondary prevention. However, controversy remains about the value of LDL-C lowering in primary prevention. OBJECTIVE This meta-analysis examined the relationship between LDL-C reduction and MACE risk in primary prevention with statin and nonstatin LDL-C-lowering therapies in cardiovascular outcomes trials (CVOTs). METHODS PubMed and Cochrane Central Register of Controlled Trials were searched from inception through August 26, 2025. The primary endpoint was the pooled RRR vs controls for 4-point composite MACE (coronary heart disease death, nonfatal myocardial infarction, fatal and nonfatal stroke, and coronary revascularization) per 1 mmol/L LDL-C lowering. RESULTS Eleven CVOTs of solely primary prevention participants (n = 74,466) and 3 in which '80% of participants were primary prevention (n = 24,071) were identified (11 statin, 1 bempedoic acid, 1 ezetimibe, 1 statin+ezetimibe). In 13 trials, the pooled mean difference between groups in LDL-C reduction was 1.00 mmol/L (95% CI: 0.82-1.18 mmol/L) with a pooled estimate of 30% (relative risk: 0.70; 95% CI: 0.67-0.74) RRR for 4-point MACE per 1 mmol/L LDL-C reduction vs control. CONCLUSION In CVOTs of solely or predominantly primary prevention participants, each 1 mmol/L reduction in LDL-C was associated with a 30% RRR in 4-point MACE. These results strengthen the evidence and rationale for the benefits of LDL-C lowering in primary prevention. Copyright © 2026 The Authors. <29> Accession Number 2044968983 Title Comparison of Analgesic Efficacy of Intrathecal Morphine and Ultrasound-Guided Bilateral Erector Spinae Plane Block in Patients Undergoing Open Heart Surgery with Midline Sternotomy: An Open Label Randomized Control Trial. Source Annals of Cardiac Anaesthesia. 29(2) (pp 212-218), 2026. Date of Publication: 01 Apr 2026. Author Karuppiah V.; Kumar R.; Mohammed S.; Chouan A.; Kamal M.; Chhabra S.; Sharma A. Institution (Karuppiah) Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India (Kumar, Mohammed, Chouan, Kamal, Chhabra) Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India (Sharma) Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India Publisher Wolters Kluwer Medknow Publications Abstract Background and Aims: Intrathecal morphine (ITM) and erector spinae plane block (ESPB) decrease postoperative pain in standard cardiac surgery. In this study, we compared the analgesic efficacy of ITM and B/L ESPB in patients undergoing open heart surgeries. Method(s): After approval from the institutional ethics committee and written informed consent from patients scheduled for open heart surgeries, they were randomized into two groups: Group ITM patients received ITM (5 mcg/kg), whereas Group ESPB patients received bilateral ESP block (0.3 mL/kg of 0.5% ropivacaine on either side). The primary outcome was to compare postoperative fentanyl consumption during the first 24 hours of ICU stay after extubation. Secondary outcomes were postoperative VAS at rest and on cough during the first 24 hours, pre- and postoperative pulmonary function, and number of rescue analgesics. Quantitative variables were presented as mean (SD) or median (IQR). Categorical variables were expressed as numbers or percentages. Spirometry variables were compared over time between the groups using Friedman test. Result(s): The ITM group had significantly less median fentanyl consumption compared to the ESPB group during the first 24 hours postoperative period [0 (0-75) mug vs. 234 (160-336) mug (95% CI, 171.65, 255.38); P < 0.001]. The VAS score at rest and during cough was significantly better in the ITM group. FEV1 and FVC reduced postoperatively in both groups with significantly better values in the ITM group. Conclusion(s): ITM administered prior to induction provides superior postoperative analgesia compared to bilateral ESPB in patients undergoing open-heart surgery. It significantly reduces opioid requirements, improves patient satisfaction, and enhances postoperative pulmonary function. Copyright © 2026 Annals of Cardiac Anaesthesia. <30> Accession Number 2044893954 Title Comparative Outcomes of Transcatheter Edge-to-Edge Repair and Surgical Mitral Valve Repair or Replacement for Degenerative Mitral Regurgitation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. Source Catheterization and Cardiovascular Interventions. (no pagination), 2026. Date of Publication: 2026. Author Kurmasha Y.H.; Hamzah K.A.; Aljubori E.; Mohammed G.; Khan M.; Shweliya M.A.; Eladl H.H.; Al-Dhayani K.M.; Al-Waeli A.R.A.; Zainy H.J.; Al-Shammari A.S.; Sattar Y. Institution (Kurmasha, Aljubori, Mohammed, Zainy) Department of Internal Medicine, College of Medicine, University of Kufa, Najaf, Iraq (Hamzah) Department of Internal Medicine, Al-kindy College of Medicine University of Baghdad, Baghdad, Iraq (Khan) Department of Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan (Shweliya, Al-Shammari) Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq (Eladl) Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Al-Dhayani) Department of Internal Medicine, Faculty of Medicine, Amran University, Amran, Yemen (Al-Waeli) Department of Internal Medicine, Internal Medicine Department, Al-Karkh General Hospital, Baghdad, Iraq (Sattar) Camden Clark Medical Center, West Virginia University, Morgantown, WV, United States Publisher John Wiley and Sons Inc Abstract Traditionally, surgical mitral valve repair or replacement (SMVR) has been the mainstay of treatment for mitral regurgitation (MR), providing a long-lasting way to restore valve competence. On the other hand, transcatheter edge-to-edge repair (TEER) has emerged as an option, especially for high surgical risk patients, demonstrating favorable results from short-term to intermediate-term follow-up. This study aims to evaluate and compare the clinical outcomes of TEER versus SMVR in patients with degenerative mitral regurgitation (DMR). This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted until February 2, 2025. Relevant randomized controlled trials (RCTs) and cohort studies were included in the analysis. The data were extracted, and analysis was conducted using Review Manager (RevMan) version 5.3. Eight studies involving a total of 13,308 patients were included in the analysis. TEER showed a statistically significantly higher risk of 1-year mortality (RR 1.82, 95% CI: 1.04-3.19) and mitral reintervention at >= 1-year follow-up (RR 4.52, 95% CI: 3.46-5.91). However showing lower risk of new-onset AF (0.21, 95% CI: 0.07-0.67), blood transfusion (RR 0.21, 95% CI, 0.13-0.34), septicemia (RR 0.13, 95% CI: 0.02-0.70), AKI (RR 0.45, 95% CI: 0.24-0.86), shorter hospital stay (MD -4.44 days, 95% CI: -6.60 to -2.27), and ICU stay (MD -1.00 days, 95% CI: -1.13 to -0.88), when compared to the SMVR group. Survival at >= 2-year follow-up was significantly favored in the surgery group (RR 0.72, 95% CI: 0.56-0.93). No significant differences were observed regarding 30-day mortality (RR 0.99, 95% CI: 0.77-1.27), MR grade 1 (RR 1.16, 95% CI: 0.60-2.21), stroke (RR 1.06, 95% CI: 0.37-3.03), HF rehospitalization (RR 2.36, 95% CI: 0.82-6.81), and wound infection (RR, 0.45, 95% CI: 0.05-4.27). TEER was associated with a significantly lower rate of postoperative MR grade 0 (RR 0.20, 95% CI: 0.08-0.49), and significantly higher rates of MR grades 2 (RR 4.82, 95% CI: 1.87-12.40), 3 (RR 8.39, 95% CI: 3.69-19.09), and 4 (RR 4.20, 95% CI: 1.45-12.18), indicating inferior MR resolution. Although TEER is associated with a lower risk of septicemia and may reduce the risk of new-onset AF, hospital stay, and ICU stay, current evidence doesn't support the use of TEER as a substitute for surgery in patients with SMVR, as TEER may be associated with higher 1-year mortality and reduced long-term survival. Further controlled trials are needed to validate these findings and identify patient subgroups that may derive the greatest benefit from TEER. Copyright © 2026 Wiley Periodicals LLC. <31> Accession Number 2043491239 Title Transcatheter treatment of pure aortic regurgitation with the VitaFlowTM Liberty system: design & rationale of the prospective, multicenter, non-randomized TRAMPERS study. Source Future Cardiology. 22(3) (pp 229-236), 2026. Date of Publication: 2026. Author Yu J.; Zhu N.; Zhu L.; Pan X.; Zhu Z. Institution (Yu, Zhu) Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Yu, Zhu) Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Zhu) Department of Cardiology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China (Zhu) Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, China (Zhu) Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China (Pan) Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China Publisher Taylor and Francis Ltd. Abstract Severe pure native aortic regurgitation (PNAR), if untreated, carries a high mortality rate. Many patients are ineligible for surgical aortic valve replacement (SAVR) due to high risk. While transcatheter aortic valve replacement (TAVR) is an alternative, its application in PNAR is challenged by anatomical factors like the absence of calcification for anchoring. Dedicated transcatheter devices are not widely available, leading to the off-label use of self-expanding valves, though robust comparative evidence is lacking. The TRAMPERS trial is a prospective, multicenter, controlled, open-label clinical trial that aims to evaluate the safety and effectiveness of transfemoral TAVR using the VitaFlowTM Liberty self-expanding valve system compared to the J-Valve system in patients with severe PNAR. A total of 180 patients with severe PNAR will be enrolled across four centers in China and evaluated by a heart team. Patients will be allocated in a 1:1 ratio to the VitaFlowTM group (n = 90) or the J-Valve control group (n = 90). The primary endpoint is a composite of all-cause mortality, disabling stroke and rehospitalization for heart failure at 12 months post-procedure, assessed for non-inferiority. Secondary endpoints include procedural complications, clinical events, health status and cost-effectiveness. All endpoints are adjudicated according to VARC-3 criteria.Clinical Trial Registration:NCT06818084 (ClinicalTrials.gov). Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <32> Accession Number 2044044053 Title Transcatheter aortic valve replacement for mixed aortic valve disease: An updated meta-analysis and systematic review. Source American Journal of the Medical Sciences. 371(5) (pp 434-440), 2026. Date of Publication: 01 May 2026. Author Kidess G.G.; Hamza M.; Basit J.; Alraiyes M.; Alraies M.C. Institution (Kidess) Department of Internal Medicine, The University of Chicago Medical Center, Chicago, IL, United States (Hamza) Department of Hospital Medicine, Gurthrie Cortland Regional Medical Center, Cortland, NY, United States (Basit) Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Alraiyes) Department of Interventional Cardiology Research, Detroit Medical Center/Wayne State University, Detroit, MI, United States (Alraies) Cardiovascular Unit, Detroit Medical Center/Wayne State University, Detroit, MI, United States Publisher Elsevier B.V. Abstract Background: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with mortality rates comparable to pure aortic stenosis (PAS). While most TAVR complications also occur at similar rates between the MAVD and PAS populations, recent studies have shown conflicting results. Method(s): A systematic literature review was conducted on PubMed and Embase for studies on the outcomes of TAVR in MAVD from inception until May 2024. Primary outcomes were short- and long-term mortality. Secondary outcomes were paravalvular regurgitation (PVR), vascular and bleeding complications, pacemaker implantation, and cerebrovascular complications. A random-effects model was used to pool risk ratios (RR) and 95 % confidence intervals (CI). Result(s): Eleven observational studies, including 133,558 patients, were included in the analysis. There were no significant differences in primary endpoints (p > 0.05). MAVD was associated with a higher risk of paravalvular regurgitation (RR: 1.29, 95 % CI: 1.07-1.55) and higher risk of vascular complications (RR: 1.20, 95 % CI: 1.01-1.44). No significant differences were noted in other secondary outcomes (p > 0.05), although there was a nonsignificant trend towards a decreased risk of cerebrovascular complications associated with TAVR in MAVD patients. Conclusion(s): TAVR is an intervention with similar mortality and complication risk in MAVD and PAS patients. Future research is needed to further clarify the outcomes of TAVR in patients with MAVD, especially regarding cerebrovascular complications, long-term mortality, and the association of paravalvular regurgitation with mortality. Copyright © 2026 Southern Society for Clinical Investigation <33> Accession Number 2044968856 Title The Effect of Preoperative Oral Carbohydrate Loading on Insulin Resistance in Adult Patients Undergoing On-Pump Cardiac Surgery: A Randomized Controlled Trial. Source Annals of Cardiac Anaesthesia. 29(2) (pp 228-236), 2026. Date of Publication: 01 Apr 2026. Author Nur R.F.; Synthana M.R.; Kurnia Y.; Rudiarto K.M.; Alicia R.J.; Kurniawaty J.; Pratomo B.Y.; Deviatika F.E. Institution (Nur, Synthana, Kurniawaty, Pratomo) Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia (Kurnia) Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia (Rudiarto) Nutrition Installation, Dr. Sardjito Hospital, Yogyakarta, Indonesia (Alicia, Deviatika) Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia Publisher Wolters Kluwer Medknow Publications Abstract Background: Preoperative oral carbohydrate loading has been shown to reduce insulin resistance in various surgical fields, but its effect in cardiac surgery remains uncertain. This study aimed to evaluate whether preoperative carbohydrate loading can reduce insulin resistance in adults undergoing on-pump cardiac surgery. Method(s): A randomized controlled trial was conducted at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Fifty adults scheduled for elective cardiac surgery (January-May 2024) were randomized to receive either 400 mL of a 12.5% maltodextrin-based carbohydrate drink (CL group) or 400 mL of water 2 h before surgery (PL group). Blood glucose and insulin were measured at postinduction, 0 h, and 24 h postoperatively to calculate HOMA-IR, analyzed at a significance level of 0.05. Result(s): Blood glucose and HOMA-IR did not differ significantly between groups at any time point (all P > 0.05). Insulin was higher in the CL group than in the PL group at postinduction ((95%CI = -6.07 to - 0.42; P = 0.022)). In the PL group, insulin rose progressively (P < 0.05), while changes in the CL group were nonsignificant (P > 0.05). HOMA-IR increased from postinduction to 0 h in both groups (P < 0.05) but remained stable thereafter (P > 0.05). Conclusion(s): Preoperative oral carbohydrate loading did not significantly affect perioperative glucose or HOMA-IR in cardiac surgery. While insufficient to counteract the magnitude of CPB-induced insulin resistance, carbohydrate loading may modestly stabilize metabolic responses, as reflected by a flatter insulin trajectory. Copyright © 2026 Annals of Cardiac Anaesthesia. <34> Accession Number 2040286360 Title Coronary CT angiography versus invasive angiography for preoperative coronary assessment prior to valve surgery. Source Journal of Cardiovascular Computed Tomography. 20(2) (pp 198-200), 2026. Date of Publication: 01 Mar 2026. Author Bhatia K.; Contreras Yametti F.; Pedraza Garriga J.; Qureshi M.; Filtz A.; Lorenzatti D.; Johannesen J.; Gongora C.A.; Schenone A.L.; Slipczuk L. Institution (Bhatia, Contreras Yametti, Qureshi, Filtz, Lorenzatti, Johannesen, Gongora, Schenone, Slipczuk) Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, NY, United States (Pedraza Garriga) University Hospital Dr. Josep Trueta, Girona, Spain Publisher Elsevier Inc. <35> Accession Number 2044612875 Title Cost-utility of point-of-care viscoelastic hemostatic assays in the management of bleeding during cardiac surgery: A single-blinded prospective multicenter stepped wedge cluster randomized trial in French context. Source Anaesthesia Critical Care and Pain Medicine. 45(3) (no pagination), 2026. Article Number: 101704. Date of Publication: 01 May 2026. Author Vourc'h M.; Boissier E.; Lakhal K.; Grosjean S.; Labaste F.; Robin E.; Bougle A.; Mattei M.; Morel J.; Wurtz V.; Mertes P.-M.; Zlotnik D.; Lagier D.; Beurton A.; Rineau E.; Fischer M.-O.; May M.-A.; Medard A.; Guimbretiere G.; Durand-Zaleski I.; Pere M.; Rozec B.; Rigal J.-C. Institution (Vourc'h, Lakhal, Rozec, Rigal) Anesthesie et reanimation chirurgicale, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Vourc'h) INSERM CIC 0004 Immunologie et infectiologie, Nantes Universite, France (Boissier) Laboratoire d'hematologie, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Grosjean) Departement d'Anesthesie-Reanimation, Centre Hospitalier Universitaire de Dijon, LNC UMR1231, Universite Bourgogne Franche Comte, Dijon, France (Labaste) Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire de Toulouse; Inserm U1048, I2MC-Institut des Maladies Metaboliques & Cardiovasculaires, Universite Paul Sabatier, Toulouse, France (Robin) Department of Anesthesia and Reanimation, Centre Hospitalier Universitaire de Lille, Bd du Pr Jules Leclercq, Lille, France (Bougle) Department of Anesthesiology and Critical Care, DMU DREAM, Hopital La Pitie-Salpetriere, APHP 75013 Paris, France. GRC 29 - Groupe de Recherche Clinique en Anesthesie Reanimation medecine Perioperatoire, ARPE, Sorbonne Universite, Paris, France (Mattei) Anesthesie et Reanimation de Chirurgie Cardiaque, Centre Hospitalier Universitaire de Nancy, Nancy, France (Morel) Departement d'anesthesie reanimation, CHU St Etienne, 25 boulevard Pasteur, Saint Etienne, France (Wurtz) Departement d'Anesthesie-Reanimation, Hopital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France (Mertes) Service d'Anesthesie Reanimation, UMR_S 1255, Nouvel Hopital Civil - Centre Hospitalier Universitaire de Strasbourg, 83 rue Himmerich, Strasbourg, France (Zlotnik) Department of Anesthesiology and Intensive Care, Hopital Europeen Georges Pompidou, AP-HP 75015, Paris, France. INSERM UMR-S1140 "Innovations Therapeutiques en Hemostase", Universite Paris Cite, Paris, France (Lagier) Service d'Anesthesie Reanimation - CHU La Timone - APHM, UR 4264 - Centre Europeen de Recherche en Imagerie Medicale - Aix-Marseille Universite, Marseille, France (Beurton) Department of Cardiovascular Anesthesia and Critical Care, Centre Hospitalier Universitaire de Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Universite de Bordeaux, Pessac, France (Rineau) Department of anesthesiology and critical care, Angers University Hospital, Angers, France; Univ Angers, MITOVASC INSERM U1083 - CNRS 6015, Team CARME, Angers, France (Fischer) Institut Aquitain du Coeur, Clinique Saint Augustin, ELSAN 33074 Bordeaux, France. Pole Reanimations Anesthesie, Centre Hospitalier Universitaire de Caen, Caen, France (May) Anesthesie - Reanimation Chirurgicale, Centre Hospitalier Universitaire de Tours, Tours, France (Medard) Pole Anesthesie Reanimation, Chirurgie Cardio-vasculaire, Hopital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France (Guimbretiere) Department of thoracic and cardiovascular Surgery, l'Institut du Thorax, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Durand-Zaleski) Service d'epidemiologie clinique, URC-Eco AP-HP, Hotel Dieu. CRESS, Inserm, INRAE, universite Paris Cite, 75004 Paris, France; Sante Publique hopital Henri-Mondor, Universite Paris Est Creteil, Creteil, France (Pere) Plateforme de Methodologie et Biostatistique, Direction de la Recherche et de l'Innovation, Centre Hospitalier Universitaire, Nantes, France (Rozec) Nantes Universite, CNRS, INSERM, l'institut du thorax, Nantes, France Publisher Elsevier Masson s.r.l. Abstract Background: The IMOTEC study aims to determine whether a point-of-care viscoelastic hemostatic assay (VHA)-guided algorithm is cost-effective for the management of ongoing bleeding. Method(s): Stepped wedge cluster randomized trial, patient blinded, conducted at 16 French academic cardiac surgery centers from 01/2017 to 02/2020. Adults undergoing elective or urgent cardiac surgery with ongoing bleeding were enrolled during 2 successive inclusion periods: 1) transfusion guided on standard hemostasis tests (control period), and 2) transfusion using a VHA-guided algorithm. The primary objective was to estimate the efficiency of VHA based on the 1-year incremental cost-utility ratio (ICUR, primary outcome). Secondary outcomes included transfusion, postoperative complications, duration of stay in-hospital, reintervention, and mortality. Result(s): 1095 patients were randomized, and 1044 (95.3%) were analyzed. The mean utility was 0.60 (+/-0.30) in the VHA vs. 0.61 (+/-0.30) in the control period, adjusted difference, -0.01 [95% CI, -0.09 to 0.07]. The ICUR did not suggest that the VHA-guided algorithm was cost-effective. One-year mortality was 12.0% for VHA and 10.9% for control, Hazard Ratio, 1.69 [95% CI, 0.98-2.89], P = .06. The frequency of plasma and platelet transfusions was significantly lower in the VHA compared to the control period (respectively, 48.8% vs. 72.4%, P < 0.0001 and 52.3% vs. 74.1%, P = .0002), whereas fibrinogen administration was more frequent in the VHA period (58.4% vs. 47.0%, P = .002). The median in-hospital length of stay was significantly shorter in the VHA vs. control period: 11.0 days (8.0-18.0) vs. 14.0 (9.0-22.0), P = .02. Conclusion(s): The ICUR did not suggest that VHA was cost-effective in cardiac surgery patients with ongoing bleeding, compared with standard tests. Trial registration: Clinical trial submission: November 2, 2016Registry name: Cost-Utility Analysis of Management of Peri Operative Hemorrhage Following Cardiac Surgery With Cardiopulmonary Bypass (IMOTEC)ClinicalTrials. Copyright © 2025 The Author(s). Published by Elsevier Masson SAS on behalf of Societe Francaise d'Anesthesie et de Reanimation (SFAR). This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <36> Accession Number 2044832617 Title Impact of immunosuppressive therapy on non-melanoma skin cancer after solid organ transplantation: A critical systematic review. Source Transplant Immunology. 96 (no pagination), 2026. Article Number: 102384. Date of Publication: 01 Jun 2026. Author Abulail J.A.; Abu Husein S.; Al-Tamimia M.; Jaradat M.; Alhawamdeh S.; Elkhalili Z.; Esaid R.; Saleh T.; Al Shboul S. Institution (Abulail) Department of Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Abulail, Abu Husein, Al-Tamimia, Alhawamdeh, Elkhalili, Esaid, Saleh, Al Shboul) Department of Pharmacology and Public Health, Faculty of Medicine, The Hashemite University, Zarqa, Jordan (Jaradat) Plastic surgery department, Royal rehabilitation center, Royal medical services, Amman, Jordan (Saleh) Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, Arabian Gulf University, Manama, Bahrain Publisher Elsevier B.V. Abstract Recent advancements in immunosuppressive therapy have markedly reduced graft rejection rates post-transplantation and improved the life expectancy of solid organ transplant recipients. However, these improved long-term outcomes are accompanied by an increased risk of complications, of which skin malignancies remain significantly challenging. Unlike prior reviews that analyzed solid organ transplant recipients as a pooled population, we focused on examining the association between immunosuppressive therapy and the potential risk of non-melanoma skin cancer (NMSC) within organ-specific cohorts. This review provides a distinct perspective by emphasizing the role of induction and maintenance immunosuppressive therapy in the development of NMSC in individual transplant settings, particularly kidney, liver, lung, and heart transplantation, with brief reference to pancreas transplantation. Across organs, basiliximab was generally associated with a lower reported incidence of NMSC than T-cell depleting agents, although the strength and consistency of this association varied among organ types. In addition, calcineurin inhibitors were consistently associated with a higher incidence of NMSC across multiple organ-specific cohorts, whereas sirolimus and mycophenolate-based regimens were associated with a lower reported incidence in some cohorts. However, current data do not support routine modification of immunosuppression regimens solely for transplant recipients with NMSC. Greater emphasis should instead be placed on preventive strategies, including regular structured skin examinations and a dedicated post-transplant dermatology clinics for high-risk populations. Copyright © 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <37> Accession Number 2044608028 Title Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI): an investigator-initiated, multicentre, open-label, non-inferiority, randomised controlled trial. Source The Lancet. 407(10537) (pp 1429-1438), 2026. Date of Publication: 11 Apr 2026. Author Delewi R.; Aarts H.M.; Broeze G.M.; Hemelrijk K.I.; van Ginkel D.J.; Versteeg G.A.A.; Overduin D.C.; Beijk M.A.M.; Baan J.; Vis M.M.; Lemkes J.S.; de Winter R.J.; Dickinson M.G.; Kraaijeveld A.O.; Mokhles M.M.; Dessing T.C.; van der Harst P.; Leenders G.E.H.; van der Kley F.; Grundeken M.J.; Claessen B.E.P.M.; Tonino P.A.L.; Schotborgh C.E.; Meuwissen M.; van Houwelingen G.K.; Wykrzykowska J.J.; Amoroso G.; Vossenberg T.N.; Vriesendorp P.A.; van Royen N.; ten Berg J.M.; Tijssen J.G.P.; Voskuil M. Institution (Delewi, Aarts, Broeze, Hemelrijk, Grundeken, Claessen, Tijssen, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Aarts, Voskuil, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands (van Ginkel, ten Berg, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands (ten Berg, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Cardiovascular Research Institute Maastricht, Maastricht, Netherlands (Versteeg, van Royen, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands (Tonino, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, Netherlands (Tonino, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Biomedical Engineering, Technical University Eindhoven, Eindhoven, Netherlands (Schotborgh, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Haga Hospital, The Hague, Netherlands (Meuwissen, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Amphia Hospital, Breda, Netherlands (van Houwelingen, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands (Wykrzykowska, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Groningen UMC, Groningen, Netherlands (Amoroso, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, OLVG, Amsterdam, Netherlands (Vossenberg, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands (Vriesendorp, Delewi, Aarts, Broeze, Hemelrijk, van Ginkel, Versteeg, Overduin, Beijk, Baan, Vis, Lemkes, de Winter, Dickinson, Kraaijeveld, Mokhles, Dessing, van der Harst, Leenders, van der Kley, Grundeken, Claessen, Tonino, Schotborgh, Meuwissen, van Houwelingen, Wykrzykowska, Amoroso, Vossenberg, Vriesendorp, van Royen, ten Berg, Tijssen, Voskuil) Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands Publisher Elsevier B.V. Abstract Background Coronary artery disease is common in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to assess whether deferral of percutaneous coronary intervention (PCI) is non-inferior to routine PCI before TAVI in patients with coronary artery disease. Methods In this investigator-initiated, open-label, randomised controlled trial, done at 12 hospitals in the Netherlands, TAVI patients with coronary artery disease were randomly assigned in a 1:1 ratio to deferral of PCI or PCI before TAVI. Randomisation was done by use of a web-based system with random block sizes of 2 and 4, and stratification by presence of coronary artery disease involving proximal left anterior descending artery. The primary endpoint was a composite of all-cause mortality, myocardial infarction, stroke, and major bleeding at 1 year. Non-inferiority testing was done in the intention-to-treat population against the prespecified margin of 11 percentage points. The study is registered with ClinicalTrials.gov ( NCT05078619 ) and long-term follow-up is ongoing. Findings Between Oct 7, 2021, and Nov 19, 2024, 466 patients were enrolled: 233 were assigned to deferral of PCI and 233 to PCI before TAVI. Median age was 81 years (IQR 78-84), and 166 (36%) of 466 patients were female. The primary endpoint occurred in 56 (24%) of 233 patients in the deferral group as compared with 60 (26%) of 233 patients in the PCI group (rate difference -1.7% [95% CI -9.5 to 6.2]; hazard ratio 0.89 [95% CI 0.62-1.28]; p=0.0008 for non-inferiority; p=0.68 for superiority). Interpretation In patients with coronary artery disease undergoing TAVI, deferral of PCI was non-inferior to PCI before TAVI for the 1-year composite of all-cause mortality, myocardial infarction, stroke, and major bleeding. These findings suggest that an initial conservative strategy can be appropriate in selected patients, although patient-tailored treatment decisions remain essential. Funding ZonMw. Copyright © 2026 Elsevier Ltd. <38> Accession Number 2044927160 Title Anticoagulation Management in Hemodialysis Patients with Atrial Fibrillation: A Clinical Dilemma. Source Current Vascular Pharmacology. (no pagination), 2026. Date of Publication: 2026. Author Triantafyllidou M.; Stamellou E.; Roumeliotis S.; Leivaditis K.; Dounousi E. Institution (Triantafyllidou, Stamellou, Dounousi) Department of Nephrology, University Hospital of Ioannina, School of Health Sciences, University of Ioannina, Ioannina, Greece (Stamellou) Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany (Roumeliotis, Leivaditis) 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece Publisher Bentham Science Publishers Abstract Atrial Fibrillation (AF) is the most common cardiac arrhythmia and is increasingly prevalent among patients on haemodialysis (HD). It presents a significant clinical challenge due to the elevated risks of both thromboembolic and bleeding events. Although the shift from Vitamin K Antagonists (VKAs) to Direct Oral Anticoagulants (DOACs) is well established in the general population and in patients with moderate Chronic Kidney Disease (CKD), uncertainty persists in HD patients due to limited evidence. This review synthesizes current evidence on anticoagulation therapy in HD patients with AF, evaluating safety, efficacy, and clinical guidelines to inform evidence-based decision-making. We reviewed current evidence, including randomized controlled trials (RCTs), observational studies, meta-analyses, and systematic reviews, on anticoagulation in HD patients with AF. Relevant articles published up to December 2024 were identified via PubMed, Cochrane Library, and EMBASE. Key clinical guidelines (KDIGO, ESH, ACC/AHA/ACCP/HPS) were also included. Overall, evidence in HD patients remains heterogeneous. Small RCTs evaluating DOACS have methodological limitations and conflicting results. However, meta-analyses and large cohort studies show that VKAs do not significantly reduce ischemic stroke or mortality in this population and may increase haemorrhagic risk; poor time-in-therapeutic range is a recurring problem. In contrast, accumulating evidence increasingly favors DOACs, with signals of lower bleeding and at least comparable stroke prevention. Left atrial appendage occlusion (LAAO) is an emerging option that may reduce stroke risk without long-term anticoagulation. While definitive randomized evidence in HD remains lacking, the current data balance suggests a cautious preference for DOACs over VKAs. Further adequately powered RCTs in HD are needed to solidify these recommendations. Copyright 2026, Bentham Science Publishers <39> Accession Number 2044632928 Title Pharmacology and clinical use of plasma expanders: a 2026 update. Source Anaesthesia and Intensive Care Medicine. 27(4) (pp 227-234), 2026. Date of Publication: 01 Apr 2026. Author Teixeira J.P.; Wentowski C.C.; Nielsen N.D. Institution (Teixeira, Wentowski, Nielsen) University of New Mexico School of Medicine, Albuquerque, NM, United States (Teixeira, Wentowski, Nielsen) Rutgers University, New Brunswick, NJ, United States (Teixeira, Wentowski, Nielsen) University of New Mexico School of Medicine, Albuquerque, NM, United States Publisher Elsevier Ltd Abstract Plasma expanders are colloidal solutions that expand the circulating blood volume more than isotonic crystalloids. Though this physiologic effect is typically transient, colloids remain commonly though variably used in critical care and perioperative medicine worldwide. Our review of these agents begins by introducing the modified Starling model, which incorporates the fundamental physiologic role of the endothelial glycocalyx in transcapillary fluid movement. Next, we discuss each fluid's pharmacological properties and evidence base for use. Multiple trials suggest that albumin is a safe, albeit more expensive, alternative to crystalloids in intensive care, with secondary analyses suggesting harm in traumatic brain injury and possibly benefit in septic shock. Data to support the routine perioperative use of albumin are lacking, with recent trials in cardiac surgery showing no benefit or harm. Trials on hydroxyethyl starch in critical care demonstrate increased risk of kidney injury, coagulopathy, and possibly mortality. Recent trial data indicate that these harms may not equally apply to low-risk surgical patients, but, while an area of ongoing debate and study, no compelling evidence exists to support the routine perioperative use of hydroxyethyl starch. Finally, human trials on gelatins and dextrans are relatively scarce, making their use difficult to justify in most settings. Copyright A© 2026 Published by Elsevier Ltd. <40> Accession Number 2044823785 Title Association of S100B Serum Level With Postoperative Cognitive Dysfunction (POCD) in Non-Cardiac Surgery: A Meta-Analysis Study. Source Health Science Reports. 9(4) (no pagination), 2026. Article Number: e72400. Date of Publication: 01 Apr 2026. Author Asefi S.; Omidi P.; Jazi K.; Fateh A.; Zanjanbar D.B.; Sadeghi S.; Hajiesmaeili M. Institution (Asefi) School of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Omidi) Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of (Jazi) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Fateh) School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Islamic Republic of (Zanjanbar) Pharmaceutical Science Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran, Islamic Republic of (Zanjanbar) GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran, Islamic Republic of (Sadeghi) Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Hajiesmaeili) Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background and Aims: Postoperative cognitive dysfunction (POCD) is defined as a persistent decline in cognitive performance after a surgical procedure, for which no cause can be identified. S100B is a calcium-binding protein present in many organs, including the brain. Serum levels have been suggested to be related to POCD. The purpose of this systematic review and meta-analysis is to assess the association between S100B serum levels and cognitive dysfunction after non-cardiac surgeries. Method(s): We conducted a systematic search using PubMed/Medline, Scopus, Web of Science, and Google Scholar databases to identify studies. Studies measuring pre- and post-operative serum S100B levels in patients undergoing non-cardiac surgeries have been included. A random effects model was applied to determine the association of the levels of S100B with POCD. Result(s): Of 280 studies screened, 11 articles were eligible for further analysis. The pooled results for pre- and post-treatment outcomes showed no significant differences. The pooled odds ratios (OR) for POCD after non-cardiac surgeries were 1.77 (95% CI = 1.17-2.67). Subgroup analysis showed that noticeable differences among age (>= 65 and < 65 years) and continent (Asia vs. Europe) groups. The higher OR observed in the >= 65 years' group (OR = 1.94; 95% CI = 0.98-3.84), and studies from Europe (OR = 1.85; 95% CI = 0.79-4.33). Conclusion(s): Overall, current evidence shows that the serum level of S100B is associated with the occurrence of POCD. The S100B monitor may help in the early diagnosis of POCD and the development of preventive strategies. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <41> Accession Number 2044743091 Title Taoren Honghua Jian Regulate NLRP3 Inflammasome of Coronary Artery Disease Patients: A Multi-Center, Double-Blind, Randomized Controlled Trial. Source Vascular Health and Risk Management. 22 (no pagination), 2026. Article Number: 569054. Date of Publication: 2026. Author Du M.; Feng X.; Zhang N.; Mao M.; Du L.; Yang Y.; Li S.; Wang J.; Chang X.; Ding J.; Liu P.; Zhang Y.; Wang Y. Institution (Du, Feng, Zhang, Mao, Zhang, Li, Wang, Chang, Ding, Liu, Wang) Dependent of Cardiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China (Du) Department of Traditional Chinese Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, China (Yang) Department of Traditional Chinese Medicine, Shanggang Community Health Service Center of Shanghai Pudong New Area, Shanghai, China (Zhang) Intensive Care Unit, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China Publisher Dove Medical Press Ltd Abstract Objective: This multicenter, double-blind, randomized controlled trial sought to assess the clinical efficacy of Taoren Honghua Jian (THJ) in patients with coronary artery disease (CAD) exhibiting Qi stagnation and blood stasis syndrome, and investigated its effect on NLRP3 inflammasome expression in peripheral blood mononuclear cells (PBMCs). Method(s): One hundred and twenty eligible CAD patients from three Shanghai hospitals were randomized to receive either the THJ granule (18.3 g, twice daily) or placebo for four weeks, with a four-week follow-up. Traditional Chinese Medicine Syndrome Score (TCMSS), Seattle Angina Questionnaire (SAQ), and lipid levels were measured before and after treatments. NLRP3 inflammasome components were examined in PBMCs using quantitative PCR, whereas plasma inflammatory cytokines were detected using ELISA. Result(s): A total of 120 participants participated in the trial. The THJ group showed reduced TCMSS compared to the placebo group (P < 0.01). After four weeks of intervention, the THJ group scored considerably higher on five SAQ aspects compared to the placebo group (P < 0.01). However, lipid levels showed no significance. In PBMCs, THJ lowered mRNA expression of NLRP3 inflammasome components (NLRP3, ASC, caspase-1, IL-1beta, IL-18) (P < 0.01). Patients in the THJ group showed significantly lower plasma levels of IL-1beta, IL-2, and IL-18 following therapy compared to the placebo group (P < 0.01). Conclusion(s): THJ reduces angina symptoms and improves quality of life in CAD patients, which suggests that it suppresses NLRP3-related transcriptional activity and hence reduces pro-inflammatory cytokine production. These data suggest that THJ might be an effective adjuvant treatment for inflammation-driven coronary atherosclerosis. Copyright © 2026 Du et al. <42> Accession Number 2044560618 Title Does ventilator circuit disconnection during lateral positioning reduces the rate of double-lumen endotracheal tube displacement in thoracic surgery? a study protocol for a randomized controlled trial. Source Trials. 27(1) (no pagination), 2026. Article Number: 272. Date of Publication: 01 Dec 2026. Author Lv S.; Lv M.; Du W.; Zou Z.; Zheng K.; Qu J.; Han X.; Mao J. Institution (Lv, Lv, Du, Zou, Zheng, Han, Mao) Department of Anesthesiology and Perioperative Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, Jinan, China (Qu) Shandong First Medical University, Shandong, Jinan, China Publisher BioMed Central Ltd Abstract Background: Double-lumen endobronchial tube (DLT) displacement often occurs in patients undergoing thoracic surgery after lateral positioning. There are no clinical studies investigating the effect of disconnection of the breathing circuit with DLT on the incidence of displacement after lateral positioning. Therefore, the aim of this study is to investigate the effect of disconnection of the breathing circuit with DLT on the rate of DLT displacement after lateral positioning in patients undergoing thoracic surgery. Method(s): A single-blind, parallel-group, randomized controlled study will be conducted. We will recruit 256 patients who are scheduled to undergo elective thoracic surgery. The participants will be randomly allocated to the disconnected breathing circuit group and the connected breathing circuit group. The primary outcome is the rate of DLT displacement identified via the flexible bronchoscopy before and after lateral positioning. The secondary outcomes are the effect of lung collapse, peripheral oxygen saturation at 5 and 10 min after one-lung ventilation, and the length of stay in the post-anesthesia care unit (PACU). Discussion(s): Several studies have shown promising results in reducing the incidence of DLT displacement during lateral positioning. However, no studies have investigated the effect of the disconnection of the breathing circuit from the DLT on the rate of DLT displacement after lateral positioning. We expect that disconnecting the breathing circuit when changing the patient from supine to lateral position will avoid unintended tube traction, thus reducing the incidence of DLT displacement. Trial registration: The study protocol was registered at Clinical Trials (https://register.clinicaltrials.gov/) with registration number: NCT06182371 on November 21, 2023. Copyright © The Author(s) 2026. <43> Accession Number 2044833595 Title Tirzepatide therapy reduces subclinical leaflet thrombosis and paravalvular leak after transcatheter aortic valve replacement in obese patients: The TAVR-MET trial. Source Cardiovascular Revascularization Medicine. (no pagination), 2026. Date of Publication: 2026. Author Thirugnanam A.M.; Chandrakanth; Pruthvi Institution (Thirugnanam, Chandrakanth, Pruthvi) Department of Interventional Cardiology, TX Hospitals, Telangana, Hyderabad, India Publisher Elsevier Inc. Abstract Background Obesity is increasingly recognized as a critical modifier of outcomes following transcatheter aortic valve replacement (TAVR), predisposing patients to subclinical leaflet thrombosis (SLT), hypo-attenuated leaflet thickening (HALT), and paravalvular leak (PVL). Metabolic inflammation, endothelial dysfunction, and pro-thrombotic states associated with obesity contribute to impaired bioprosthetic valve healing. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated robust metabolic, anti-inflammatory, and vascular protective effects. However, its impact on post-TAVR valve performance has not been previously evaluated. Objectives To determine whether tirzepatide therapy initiated before TAVR and continued post-procedure reduces the incidence of HALT and PVL in obese patients undergoing TAVR. Methods TAVR-MET was a prospective, randomized, open-label, multicenter trial enrolling obese patients (BMI >= 30 kg/m2) undergoing transfemoral TAVR. Patients were randomized to tirzepatide therapy or standard care. The primary endpoint was HALT incidence at 6 months assessed by 4D-CT or transesophageal echocardiography (TEE). Secondary endpoints included PVL severity, major adverse valve events (MAVE), inflammatory biomarker changes, weight reduction, and bleeding outcomes. Results Among 260 randomized patients, tirzepatide therapy significantly reduced HALT incidence (8.4% vs 21.6%, p = 0.002) and >= mild PVL (10.7% vs 25.3%, p = 0.006) at 6 months. Tirzepatide was associated with marked reductions in CRP and body weight without an increase in major bleeding. Multivariable analysis identified tirzepatide use, CRP reduction >30%, and BMI <32 kg/m2 at follow-up as independent predictors of HALT absence. Conclusions Metabolic modulation with tirzepatide significantly improves post-TAVR valve healing and hemodynamics in obese patients. These findings introduce a novel cardio-metabolic strategy to reduce structural valve complications following TAVR. Trial summary: TAVR-MET study The TAVR-MET trial was a prospective, randomized, multicenter study designed to evaluate whether metabolic modulation with tirzepatide , a dual GIP/GLP-1 receptor agonist, could improve bioprosthetic valve outcomes following transcatheter aortic valve replacement (TAVR) in obese patients. Obesity is increasingly recognized as a key determinant of post-TAVR complications, particularly subclinical leaflet thrombosis (HALT) and paravalvular leak (PVL) , driven by chronic inflammation, endothelial dysfunction, and a prothrombotic state. Tirzepatide has demonstrated potent weight-reducing, anti-inflammatory, and vascular protective effects, but its role in structural valve outcomes had not previously been explored. The trial enrolled 260 obese patients (BMI >= 30 kg/m 2 ) undergoing transfemoral TAVR across eight high-volume centers. Participants were randomized to receive tirzepatide initiated four weeks before TAVR and continued for 12 months , or standard care alone. All patients received guideline-directed antithrombotic therapy. The primary endpoint was the incidence of HALT at six months assessed by advanced imaging. Secondary endpoints included PVL severity, major adverse valve events, inflammatory biomarker changes, weight reduction, and bleeding outcomes. At six months, tirzepatide therapy was associated with a significant reduction in HALT compared with standard care, as well as a marked decrease in >= mild paravalvular leak . These structural valve improvements were accompanied by substantial weight loss and significant reductions in systemic inflammatory markers , without an increase in major bleeding or adverse safety signals. Multivariable analysis confirmed tirzepatide use and inflammation reduction as independent predictors of improved valve outcomes. In conclusion, the TAVR-MET trial provides the first clinical evidence that targeted metabolic therapy can favorably influence bioprosthetic valve healing after TAVR . These findings support a novel cardio-metabolic strategy for improving post-TAVR outcomes in obese patients and highlight the importance of addressing metabolic inflammation alongside procedural excellence in contemporary structural heart interventions. Copyright © 2026 Elsevier Inc. <44> [Use Link to view the full text] Accession Number 2044255800 Title Pharmacokinetic Modeling of Ticagrelor and Ticagrelor Active Metabolite Removal by the DrugSorb-ATR Device in a Randomized Controlled Study of Patients Undergoing Cardiac Surgery. Source Journal of Cardiovascular Pharmacology. 87(2) (pp 105-113), 2026. Date of Publication: 01 Feb 2026. Author Mould D.R.; Sweeney K.R.; Prats J.; Fan W.; Schneider D.J.; Storey R.F.; Deliargyris E.N. Institution (Mould, Sweeney) Projections Research, Phoenixville, PA, United States (Sweeney) Sweeney Consulting, East Lyme, CT, United States (Prats) Elysis, LLC, Carlisle, MA, United States (Fan, Schneider, Deliargyris) CytoSorbents Corporation, Princeton, NJ, United States (Schneider, Deliargyris) Department of Medicine, Cardiovascular Research Institute, University of Vermont, Burlington, VT, United States (Storey) Cardiovascular Research Unit, University of Sheffield, Sheffield, United Kingdom Publisher Lippincott Williams and Wilkins Abstract Abstract: - Excessive surgical bleeding is a potential risk in patients taking ticagrelor who must undergo urgent cardiothoracic (CT) surgery before adequate washout of the drug can occur. The DrugSorb-Antithrombotic removal (ATR) device is a polymer sorbent-filled hemoadsorption cartridge that can remove unbound (active) fractions of ticagrelor and ticagrelor active metabolite (TAM) from blood. STAR-T was a randomized double-blind sham-controlled clinical trial investigating whether the intraoperative use of the device could reduce perioperative bleeding complications in patients undergoing CT surgery within 2 days of ticagrelor discontinuation. Blood samples were collected during the study for total drug level measurements because the ability to measure unbound ticagrelor and TAM (0.2% of total levels) requires an ultra-high sensitivity assay, which is not commercially available. A published and validated pharmacokinetic (PK) model was used to explore the effect of the device on unbound ticagrelor/TAM using the total drug concentrations from the study. The model performed well for simulations of total ticagrelor and TAM, which indicated that the unbound concentrations were also appropriate. The model demonstrated that DrugSorb-ATR significantly reduced unbound ticagrelor and TAM concentrations. Linear and logistic regression analyses of summed ticagrelor and TAM concentrations showed that the DrugSorb-ATR device reduced the probability of clinically relevant bleeding in STAR-T because of the reduction in unbound ticagrelor and TAM. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <45> Accession Number 650896538 Title Hemofilters versus hemodialyzers: impacts on cytokine removal during cardiopulmonary bypass in pediatric cardiac surgery: a randomized controlled trial. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 13 Apr 2026. Author Abdelazim A.M.; Alaaeldin B.; Amer A.M.; Rizk A.; Mahmoud D.; Elsobky Y.; Tawfik H.; Fadaly A.S.; Elshazly M. Institution (Abdelazim) Cardiothoracic surgery Department, Alnas Hospital, Egypt (Alaaeldin, Fadaly, Elshazly) Cardiothoracic surgery Department, Alnas Hospital, Egypt (Amer) Department of Anesthesia, Intensive Care & Pain Management, Ain Shams University, Cairo, Egypt (Amer) Anesthesia Department, Alnas hospital, Egypt (Rizk) Critical Care Department, Cairo University, Cairo, Egypt (Rizk) Alnas Academy Medical Program Director, Alnas hospital, Former Laboratory and Blood Bank Director, Egypt (Mahmoud) Medical Laboratory Specialist, Alnas hospital, Laboratory and Blood Bank Department, Egypt (Elsobky) Alnas Clinical Research Center (CRC), Alnas Hospital, Egypt (Tawfik) Biostatistician, Alnas Clinical Research Center (CRC), Alnas hospital, Egypt (Fadaly) Cardiothoracic Surgery Department, Faculty of Human medicine, Zagazig University, Zagazig, Egypt (Elshazly) Cardiothoracic Surgery Department, Cairo University Hospitals, Cairo, Egypt Abstract BACKGROUND: Congenital heart disease (CHD) remains a leading cause of pediatric morbidity and mortality worldwide. Cardiopulmonary bypass (CPB) is crucial for surgical repair but is associated with systemic inflammation and/or end-organ dysfunction. Ultrafiltration (UF) techniques, particularly zero-balance ultrafiltration (Z-BUF), have been developed to mitigate these effects by removing cytokines. Conventional hemofilters are widely used, but in low- and middle-income countries, high-flux hemodialyzers are increasingly substituted, although evidence for their equivalence in pediatric CPB remains scarce. METHOD(S): In this prospective, single-blinded, randomized controlled noninferiority trial, a total of 60 pediatric patients (aged 1-15 years) who underwent elective CPB for congenital heart surgery were enrolled. Thirty patients were assigned to the Medica hemofilter group, and thirty to the Fresenius Helixone hemodialyzer group. Interleukin-6 (IL-6) was designated as the primary endpoint, whereas interleukin-1beta (IL-1beta), hematocrit, lactate levels, mechanical ventilation (MV) duration, length of stay in the intensive care unit (ICU), and overall hospital stay served as secondary endpoints. Cytokine levels were measured at baseline (T1), before Z-BUF (T2), and immediately after Z-BUF (T3). Prespecified noninferiority margins were applied, and generalized estimating equations (GEEs) were used to assess temporal trends. RESULT(S): Baseline characteristics and procedural complexity were comparable between cohorts. Following Z-BUF, changes in IL-1beta (median difference - 0.223 pg/mL) and IL-6 (0.642 pg/mL) met the predefined noninferiority criteria (p < 0.001 for both). GEE analysis revealed no significant interaction between filter type and cytokine trends. The median hematocrit, lactate levels, MV duration, length of stay in the ICU, and overall hospital stay were also similar between the study arms. Mortality was identical (3.3%) in both arms. Importantly, no cases of acute kidney injury or acute neurological events were observed in either group. CONCLUSION(S): Compared with conventional hemofilters, high-flux hemodialyzers are noninferior in controlling intraoperative cytokines during Z-BUF in pediatric CPB and demonstrate comparable clinical safety outcomes. Hemodialyzers appear to be an effective and practical alternative in resource-limited settings. Validation in larger multicenter trials with extended postoperative sampling is warranted. TRIAL REGISTRATION AND DATE: ClinicalTrials.gov (NCT06792565) on 22 March 2024. Copyright © 2026. The Author(s). <46> Accession Number 2043072194 Title A Bayesian Meta-Analysis of Renin-Angiotensin System Inhibitors Following TAVR. Source Catheterization and Cardiovascular Interventions. 107(5) (pp 1554-1561), 2026. Date of Publication: 01 Apr 2026. Author Oliveira V.M.R.; Barbosa L.M.; Sousa P.A.D.; Lima A.P.D.; Akabane M.A.C.; Borges A.; Bertoli E.D.; Bulhoes E.; Farias C.A.; Mazetto R.; Tartuce Filho P.R.F.; Alcantara R.W.A.; Bignoto T.; Pileggi B.; Moreira H.G.; Tartuce L.P. Institution (Oliveira, Borges, Moreira) Federal University of Goias, Goiania, Brazil (Oliveira, Tartuce Filho, Tartuce) Instituto de Cardiologia e Radiologia Intervencionista de Rio Verde, Rio Verde, Brazil (Barbosa) Federal University of Minas Gerais, Belo Horizonte, Brazil (Barbosa, Bignoto, Pileggi) Instituto do Coracao-InCor-Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Sousa) Federal University of Uberlandia, Uberlandia, Brazil (Lima) University of Rio Verde, Rio Verde, Brazil (Akabane) Federal University of Juiz de Fora, Juiz de Fora, Brazil (Bertoli) Hospital e Maternidade Marieta Konder Bornhausen, Itajai, Brazil (Bulhoes) Universidade da Amazonia Reunida, Redencao, Brazil (Farias) Universidade Nove de Julho, Sao Paulo, Brazil (Mazetto) State University of Amazon, Manaus, Brazil (Alcantara) Clinica Aurus, Oliveira, Brazil (Alcantara) Interventional Cardiology Unit, Hospital Sao Judas Tadeu, Oliveira, Brazil Publisher John Wiley and Sons Inc Abstract Background: Aortic stenosis leads to left ventricular remodeling, hypertrophy, and fibrosis, increasing the risk of heart failure. Renin-angiotensin system (RAS) inhibitors may mitigate these adverse effects and improve clinical outcomes. Despite advancements in transcatheter aortic valve replacement (TAVR), substantial mortality, heart failure readmissions, and other complications persist. Aim(s): This study aimed to evaluate the impact of RAS inhibitor therapy following TAVR on clinical outcomes. Method(s): We conducted a systematic review and Bayesian meta-analysis following the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search of PubMed, Embase, and Cochrane was performed to identify studies comparing RAS inhibitor (RASi) use versus non-use in patients undergoing TAVR for aortic stenosis. Odds ratios (OR) and 95% credible intervals (CrI) were estimated using a Bayesian random-effects model. Between-study heterogeneity was quantified using the posterior distribution of the heterogeneity parameter (tau). Posterior probabilities (PP) of treatment benefit were calculated, with clinically meaningful effects defined as P (OR < 0.8). All analyses were performed using R version 4.5.0. Result(s): A total of 12 studies comprising 35,988 patients were included, of whom 17,026 (47.3%) received RASi therapy. The mean age ranged from 78.9 to 84.4 years. Post-TAVR RASi use was associated with a 79.4% probability of a clinically relevant reduction in all-cause mortality and a 99.5% probability of a clinically relevant reduction in cardiovascular mortality. There was a 54% probability of a clinically relevant reduction in heart failure hospitalization and a negligible (2.26%) probability of a reduction in the odds of myocardial infarction in the RASi group. Conclusion(s): RASi therapy following TAVR is associated with reduced odds of mortality and heart failure readmission. Copyright © 2026 Wiley Periodicals LLC. <47> Accession Number 2044334018 Title Beyond Opioid Comparison: Interpreting Oliceridine in Contemporary Thoracic Recovery Pathways [Letter]. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 610584. Date of Publication: 2026. Author Lu C.-W.; Chang K.-C. Institution (Lu, Chang) Department of Anesthesiology, Far Eastern Memorial Hospital, 21, Section 2Nan-Ya South Road, Banqiao Dist, New Taipei, Taiwan (Republic of China) (Lu) Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan (Republic of China) Publisher Dove Medical Press Ltd <48> Accession Number 2037899168 Title Levosimendan vs. Intra-Aortic Balloon Pump in Coronary Artery Bypass Grafting: A Meta-Analysis. Source Brazilian Journal of Cardiovascular Surgery. 41(3) (no pagination), 2026. Article Number: e20250057. Date of Publication: 2026. Author Wang Y.; Qu J.; Sheng D.; Sun X.; Zhong L.; Wu Y.; Liang H. Institution (Wang, Sheng, Zhong, Wu, Liang) Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Hunan, Changsha, China (Qu) School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Hunan, Changsha, China (Sun) Cardiology Department, Changsha Hospital of Traditional Chinese Medicine, Hunan, Changsha, China Publisher Sociedade Brasileira de Cirurgia Cardiovascular Abstract Objective: To compare the clinical efficacy and safety of intra-aortic balloon pump (IABP) and levosimendan in coronary artery bypass grafting (CABG). Method(s): A systematic search of PubMed, Embase, Cochrane Library, and Google Scholar was conducted through July 2024. Outcomes analyzed included atrial fibrillation, postoperative mediastinitis, the requirement for inotropic support, in-hospital mortality, postoperative intensive care unit (ICU) stay, postoperative length of stay, ventilation time, and mean arterial pressure (MAP) levels. Result(s): The analysis included nine studies with 681 patients. Levosimendan presented advantage over IABP in CABG patients in terms of postoperative ICU stay, postoperative length of stay, and reduction in MAP levels, with effect sizes: mean difference (MD) =-0.83, 95% confidence interval (CI)-0.97 to-0.68, P < 0.00001, MD =-1.14, 95% CI:-1.33 to-0.95, P < 0.00001, and MD =-4.55, 95% CI:-6.14 to-2.96, P < 0.00001, respectively. Levosimendan had an advantage on subgroup analyses in terms of postoperative ICU stay and postoperative length of stay, with effect sizes: MD =-0.83, 95% CI:-0.93 to-0.72, P < 0.00001 and MD =-1.14, 95% CI:-1.28 to-1.01, P < 0.00001, respectively. However, the incidence of postoperative mediastinitis was higher in the levosimendan group (relative risk = 1.45, 95% CI: 0.88 to 2.38), though not statistically significant. Conclusion(s): Levosimendan may improve recovery and hemodynamic outcomes in high-risk CABG patients compared to IABP but may be associated with a higher, though non-significant, risk of mediastinitis. Further high-quality studies are warranted. Copyright © 2026, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved. <49> Accession Number 2044946820 Title Economic impact of disposable versus reusable instruments in minimally invasive surgery: a systematic review. Source Surgical Endoscopy. (no pagination), 2026. Date of Publication: 2026. Author Greve P.J.W.; Rahimi M.; Daams F.; Greve J.W.M.; Bonjer J.H.; Horeman T.; Schijven M.P. Institution (Greve, Rahimi, Daams, Bonjer, Schijven) Dept. of Surgery, Amsterdam UMC Location, De Boelelaan 1117, Amsterdam, Netherlands (Greve, Schijven) Amsterdam Gastroenterology and Metabolism, Amsterdam, Netherlands (Greve, Schijven) Amsterdam Public Health, Digital Health, Amsterdam, Netherlands (Greve, Rahimi, Horeman) Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands (Greve) Maastricht NUTRIM - Institute of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands (Rahimi, Daams, Bonjer) Cancer Center Amsterdam, Amsterdam, Netherlands (Greve, Rahimi, Daams, Bonjer) Science Hub for ASC Research and Education (SHARE), Amsterdam Skills Centre for Health Sciences (ASC), Amsterdam, Netherlands Publisher Springer Abstract Objective: To systematically evaluate the economic impact of disposable versus reusable instruments in minimally invasive surgery (MIS), and to summarize the limited available evidence on environmental impact. Background(s): The increasing use of disposable instruments in MIS has raised concerns regarding healthcare costs and environmental sustainability. While reusable instruments may reduce per-procedure costs and waste, their economic and environmental performance is influenced by procedure type, workflow, and reprocessing requirements. Evidence integrating these factors across surgical specialties remains limited. Method(s): A systematic review was conducted in accordance with PRISMA guidelines. Studies published since 2014 comparing disposable and reusable instruments in MIS were identified using predefined PICOS criteria. Data extraction focused on cost components, including instrument costs, sterilization, operating room time, and total procedural costs. Environmental outcomes were recorded when available. Result(s): Nine studies encompassing 4,724 procedures across multiple surgical specialties met inclusion criteria. In general surgery, reusable instruments were consistently associated with lower per-procedure costs, with reported savings ranging from $16 to $388. In selected subspecialties, including gynecology, thoracic surgery, and spinal surgery, disposable instruments were associated with reduced operative time, indirectly lowering total costs in specific settings. Only one included study directly assessed environmental impact, providing limited, low-level evidence that reusable instruments may confer environmental benefit primarily when used repeatedly. Conclusion(s): Reusable instruments appear to be associated with lower per-procedure costs in general surgery, while disposable instruments may offer context-specific economic advantages in selected subspecialties. Conclusions regarding environmental impact are limited by the scarcity of primary data. Future studies incorporating standardized cost definitions and robust environmental assessments, including life-cycle analyses, are needed to support evidence-based and sustainable instrument selection in MIS. Copyright © The Author(s) 2026. <50> Accession Number 650975205 Title Recurrent ischemic stroke in atrial fibrillation patients despite NOAC therapy: Recent advances and their therapeutic implications. Source Kardiologia polska. (no pagination), 2026. Date of Publication: 22 Apr 2026. Author Paciaroni M.; Maruccia A.; Pugliatti M. Institution (Paciaroni, Maruccia, Pugliatti) Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy Abstract Non-vitamin K oral anticoagulants (NOACs) are currently the preferred anticoagulant therapy for patients with non-valvular atrial fibrillation. Nevertheless, for patients receiving oral anticoagulants, clinical trials have reported a residual annual risk of recurrent ischemic events ranging from 0.7% to 2.3%, in both primary and secondary prevention settings. Furthermore, in the non-randomized RENO-EXTEND study, patients who had an ischemic stroke while on NOAC therapy, also had a recorded combined rate of thromboembolic and bleeding events of 16.7%, corresponding to an annual incidence of 13.4%. For those patients who experience an ischemic stroke while receiving NOAC therapy, reliable evidence on how to proceed with management is limited. This patient setting need to take into consideration the following strategies: 1) Exclude poor adherence to treatment; 2) Assess potential drug-drug interactions; 3) Ensure the prescription of the most appropriate NOAC dose; 4) Confirm the underlying mechanism of the recurrent ischemic event; 5) Continue the same NOAC after a cardioembolic event occurring during NOAC therapy, when appropriate; 6) Consider switching to a different NOAC so to improve adherence; 7) Evaluate, on a case-by-case basis and for the shortest feasible duration, the possible addition of an antiplatelet agent to NOAC therapy; 8) Consider left atrial appendage occlusion combined with indefinite NOAC therapy in selected patients with recurrent events despite anticoagulation; 9) Increment stricter risk factor controls. Moreover, results from randomized controlled trials investigating for more effective management strategies are needed to better treat patients in this setting. <51> Accession Number 2044686314 Title Discrepancy Between Invasive and Echocardiographic Transvalvular Gradients After TAVI Procedure: A Review of the Literature. Source Journal of Clinical Medicine. 15(7) (no pagination), 2026. Article Number: 2740. Date of Publication: 01 Apr 2026. Author Afendoulis D.; Vlachakis P.K.; Tsiamis N.; Tsakirian F.; Tountas C.; Theofilis P.; Synetos A.; Tsalamandris S.; Toulgaridis F.; Drakopoulou M.; Aggeli K.; Tsioufis K.; Toutouzas K. Institution (Afendoulis, Vlachakis, Tsiamis, Tsakirian, Theofilis, Tsalamandris, Drakopoulou, Aggeli, Tsioufis, Toutouzas) Unit of Structural and Valvular Heart Diseases, First Department of Cardiology, National and Kapodestrian University of Athens, General Hospital of Athens "Hippokration", Athens, Greece (Tsiamis, Tountas, Toulgaridis) Catheterization Laboratory, General Hospital of Athens "Sismanogleio", Athens, Greece (Synetos) School of Medicine, European University of Cyprus, Nicosia, Cyprus Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Transcatheter aortic valve implantation (TAVI) has become an established treatment for patients with severe aortic stenosis. The accurate post-procedural assessment of transvalvular gradients is essential for evaluating procedural success and long-term prognosis. However, significant discrepancies have been reported between gradients measured invasively and those derived by Doppler echocardiography. This systematic review aims to summarize the current evidence comparing invasive and echocardiographic gradient measurements after TAVI. Method(s): A comprehensive literature search was conducted of the PubMed database from inception to 8 November 2025 using the keywords: "TAVI/TAVR," "invasive versus echocardiographic gradient," and related terms. Studies were included if they compared invasive and Doppler-derived aortic valve gradients following TAVI. Out of 44 identified articles, 12 studies met the inclusion criteria and were analyzed. Result(s): Across all the included studies, the echocardiography-derived mean gradients were consistently 4-7 mmHg higher than those obtained invasively, reflecting physiologic rather than procedural discordance. The difference was more pronounced in balloon-expandable and small-diameter valves and in patients with high-flow states. Invasive gradients were independently associated with mortality and major adverse cardiovascular events (MACEs) in multiple studies. An invasive mean gradient <= 10 mmHg immediately post-TAVI was repeatedly identified as the threshold for optimal procedural success and improved long-term outcomes. Conclusion(s): Doppler echocardiography systematically overestimates transvalvular gradients after TAVI. While both modalities remain valuable, an invasive hemodynamic assessment provides the most reliable evaluation of immediate procedural success and long-term prognosis. Echocardiographic gradients should be interpreted relative to the baseline invasive measurement to avoid overdiagnosis of prosthetic dysfunction and ensure appropriate clinical management. Copyright © 2026 by the authors. <52> [Use Link to view the full text] Accession Number 2044877673 Title Impaired endotoxin inactivation, rather than gut translocation, is associated with organ injury in cardiac surgery with cardiopulmonary bypass: An ancilliary analysis of a randomised control trial. Source European Journal of Anaesthesiology. Publish Ahead of Print (no pagination), 2026. Date of Publication: 14 Jan 2026. Author Nguyen M.; Alvarez M.; Evezard C.; Ibrahima A.; Huette P.; Mahjoub Y.; Pais-De-Barros J.-P.; Bouhemad B.; Masson D.; Gautier T.; Guinot P.-G.; Abou-Arab O. Institution (Nguyen, Alvarez, Evezard, Ibrahima, Huette, Mahjoub, Pais-De-Barros, Bouhemad, Masson, Gautier, Guinot, Abou-Arab) From the Department of Anesthesiology and Intensive Care, Dijon Universite Hospital (MN, CE, BB, PGG), the Universite Bourgogne Europe, Dijon, France (MN, BB, DM, PPG), the Centre for Translational and Molecular Medicine (CTM), INSERM UMR1231, Lipness Team, Dijon (MN, MA, JPPde B, BB, DM, TG, PGG), the Department of Anesthesiology and Intensive Care, Amiens Universite Hospital (AI, PH, YM, OAA), the Department of Anesthesiology and Intensive Care, Pauchet sante, Clinique Victor Pauchet, the DiviOmics Facility, UMS 58 BioSanD, Universite de Bourgogne (JPPdeB), the Laboratory of Clinical Chemistry, Dijon Universite Hospital, Dijon, France Publisher Lippincott Williams and Wilkins Abstract BACKGROUNDS - In patients with cardiac surgery under cardiopulmonary bypass (CPB), postoperative inflammation is a driver of adverse outcomes. Endotoxaemia is one of the factors thought to trigger this inflammatory response. The mechanism behind high endotoxin activity (increased translocation vs. reduced inactivation capacity) has never been elucidated and may imply different therapeutic candidates. OBJECTIVES - We aimed to evaluate, in patients with cardiac surgery with prolonged CPB, mechanisms and consequences of endotoxaemia and the efficacy of haemo-adsorption to reduce the endotoxin burden. DESIGN - Ancillary analysis of a randomised controlled trial. Patients scheduled for cardiac surgery with prolonged CPB were assigned to receive either intra-operative haemo-adsorption or standard of care. Endotoxin mass and activity were measured before surgery, at the end of CPB, 6, 24 and 48h after the end of surgery. SETTING - Operating room, Amiens University Hospital. PATIENTS - Adults scheduled for cardiac surgery under CPB with an expected CPB time more than 90min. INTERVENTION - Patients were randomised to receive either haemo-adsorption or standard care during CPB. MAIN OUTCOME MEASURES - Endotoxin activity. RESULTS - Two hundred and ninety-five samples from 66 patients were analysed. Following CPB, we observed a reduction in endotoxin mass accompanied by a relative increase in endotoxin activity. High postoperative endotoxin activity was associated with intra-operative dobutamine requirement, increased postoperative inflammatory biomarkers and organ injury. Endotoxin plasma concentration and activity were not lower in patients treated with haemo-adsoprtion. CONCLUSION - The capacity of individuals to inactivate endotoxin rather than raw endotoxin mass (i.e. Quantity) seemed to be a determinant of endotoxin noxious effect in cardiac surgery and CBP. Haemo-adsorption was not associated with a reduction of endotoxin plasma mass or activity in patients with cardiac surgery under CPB. TRIAL REGISTRATION - ClinicalTrials.gov, NCT04201119NCT04201119 Copyright © 2026 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited. <53> Accession Number 650974439 Title The Link Between Atrial Fibrosis and Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review. Source Trends in cardiovascular medicine. (no pagination), 2026. Date of Publication: 19 Apr 2026. Author Nawaz A.; Sohpal A.; Mitra R.; Abu-Omar Y.; Elsebaie A.; El-Diasty M. Institution (Nawaz, Sohpal) School of Medicine, Case Western Reserve University, Cleveland, OH, United States (Mitra) Case School of Engineering, Case Western Reserve University, Cleveland, OH, United States (Abu-Omar) Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (Elsebaie) Department of Medicine, Queen's University, Kingston, ON, Canada (El-Diasty) Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada. Electronic address: med7@queensu.ca Abstract Postoperative atrial fibrillation (POAF) is a common complication that can affect up to 20-44% of patients undergoing cardiac surgery. Evidence suggests that atrial fibrosis is a key factor in the development of POAF due to the disruption of the myocardial electric properties. This systematic review examines the correlation between pre-existing atrial fibrosis and the development of POAF after cardiac surgery. A systematic literature search was conducted in MEDLINE, Embase, and Google Scholar (2000 to March 2025) to identify studies that conducted comparative analysis of atrial fibrosis levels between those who did and did not develop POAF, using histological assessment methods. Extracted data, included study characteristics, histopathological staining methods and analysis findings, fibrosis quantification methods, and overall POAF incidence. Thirteen studies met the inclusion criteria, resulting in a total of 1,222 patients, primarily undergoing coronary artery bypass surgery. The incidence of POAF ranged from 14%-42.4 % (median 31.6%). In more than half of the studies (7/13), patients who developed POAF demonstrated statistically significant higher degrees of atrial fibrosis compared to those that remained in sinus rhythm postoperatively (four exhibited p<0.001). Of the eight studies that conducted multivariate analyses, three identified atrial fibrosis as an independent POAF predictor. High heterogeneity precluded pooling of results into a meta-analysis. The current evidence examining the link between pre-existing atrial fibrosis and the development of POAF is restricted by methodological heterogeneity and inconsistent findings. Further efforts to standardize fibrosis quantification methods and POAF definitions are warranted before histopathological assessments can reliably inform POAF risk before cardiac surgery. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. <54> [Use Link to view the full text] Accession Number 2044541399 Title Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis and Prior Mediastinal Radiation: A Meta-Analysis of Short-Term and 1-Year Outcomes. Source Cardiology in Review. (no pagination), 2026. Date of Publication: 2026. Author Elbenawi H.; Mostafa N.; Abdelgalil M.S.; Dahik B.; Mohamed Hamed B.; Botros M.M.; Eisa M.; Zreigh S.; Kalaiger A.M.; Almaadawy O.; Youssef M.; Zaaya M.; Stephens R.; Ghanim M.; Lin C.-J.; Elgendy I.Y.; Goldsweig A.M. Institution (Elbenawi) From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Mostafa, Abdelgalil) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Dahik, Zreigh) Faculty of Medicine, Ankara Yilidirim Beyazit University, Ankara, Turkey (Mohamed Hamed) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Botros) Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States (Eisa, Ghanim) Rochester General Hospital, Rochester, NY, United States (Kalaiger) Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, United States (Almaadawy, Lin) Department of Cardiovascular Medicine, St. Louis University, St. Louis, MO, United States (Youssef) Division of Internal Medicine, Arkansas College of Osteopathic Medicine, Greenville, TX, United States (Zaaya) Cardiovascular Medicine Department, Maimonides Medical Center, Brooklyn, NY, United States (Stephens) Department of General Internal Medicine, Mayo Clinic, Rochester, MN, United States (Ghanim) Department of Cardiovascular Medicine, Morris Hospital & Health Care Centers, Morris, IL, United States (Elgendy) Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, MA, United States Publisher Lippincott Williams and Wilkins Abstract Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34-0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15-0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59-0.95), bleeding (RR: 0.37, 95% CI: 0.33-0.42), and shorter length of hospital stay (MD: -4.30; 95% CI: -5.45 to -3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50-2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <55> Accession Number 2045234975 Title Transcatheter edge-to-edge mitral valve repair versus medical therapy for secondary mitral regurgitation: a meta-analysis of randomized controlled trials. Source Monaldi Archives for Chest Disease. 96(1) (no pagination), 2026. Article Number: 3264. Date of Publication: 2026. Author Mata E.; Garcia B.L.; Tinoco M.; Castro M.; Pinheiro L.; Portugues J.; Ferreira F.; Ribeiro S.; Melica B.; Lourenco A. Institution (Mata, Garcia, Tinoco, Castro, Pinheiro, Portugues, Ferreira, Ribeiro, Lourenco) Department of Cardiology, Local Health Unit of Alto Ave, Guimaraes, Portugal (Melica) Department of Cardiology, Local Health Unit of Gaia and Espinho, Vila Nova de Gaia, Portugal Publisher Page Press Publications Abstract Secondary mitral regurgitation (SMR) is associated with increased hospitalizations and mortality. Clinical trials comparing mitral valve transcatheter edge-to-edge repair (M-TEER) with guideline-directed medical therapy (GDMT) show conflicting results, but the RESHAPE-HF2 trial offers new insights. This study aims to assess the M-TEER effect in addition to GDMT in reducing all-cause mortality, cardiovascular death, and heart failure hospitalizations (HHF) in patients with SMR when compared to GDMT alone. On September 2, 2024, PubMed, Cochrane CENTRAL, Scopus, and Web of Science were searched for randomized controlled trials comparing M-TEER in addition to GDMT with GDMT in SMR patients with heart failure. A study-level random-effects meta-analysis was conducted using trial-reported point estimates. Seven records from three trials (COAPT, MITRA-FR, RESHAPE-HF2) involving 1426 participants were included. At 24 months, M-TEER (using MitraClip) significantly reduced the first HHF [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.45-0.96] and all HHF (HR 0.63, 95% CI 0.49-0.81). However, no significant reduction was observed in all-cause mortality (HR 0.76, 95% CI 0.57-1.01) or cardiovascular death (HR 0.77, 95% CI 0.56-1.06). The intervention group had more patients in the New York Heart Association class I/II at 12 and 24 months, but no significant improvement in 6-minute walk test performance at 12 months. High trial heterogeneity requires careful interpretation of pooled estimates. Differences in medical therapy and patient characteristics likely affected outcomes across trials. While M-TEER demonstrates benefits in reducing HHF, its effectiveness in reducing mortality remains inconclusive. The degree of left ventricular enlargement may have influenced outcomes, underscoring the importance of careful patient selection. © Copyright: the Author(s), 2025. <56> Accession Number 2045101042 Title The prognostic utility of the pulmonary artery pulsatility and aortic pulsatility index in patients with heart failure: A systematic review. Source JRSM Cardiovascular Disease. 15 (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Albdour Z.; Qadri M.; AlAbed Z.A.; Jarrar Z.M.; Bayadreh A.F.; Abu-Shattal O.M.; Albdour K. Institution (Albdour, Qadri, AlAbed, Jarrar, Bayadreh, Abu-Shattal, Albdour) Faculty of Medicine, University of Jordan, Amman, Jordan Publisher SAGE Publications Ltd Abstract Heart failure (HF) continues to pose a major burden worldwide, and risk stratification is important to guide management. Hemodynamic indices such as the pulmonary artery pulsatility index (PAPI) and aortic pulsatility index (API) have gained attention as potential prognostic tools, but their role is still not well established. We conducted a systematic review to assess the prognostic role of PAPI and API in HF patients. We systematically searched PubMed, Web of Science, Scopus, and Cochrane Library for studies assessing PAPI and API in adults (>=18 years) with HF. We included cohort studies and randomized trials reporting outcomes such as mortality, hospitalization, left ventricular assist device implantation, or heart transplantation. Of 601 studies identified, 12 met the inclusion criteria, comprising 3681 patients. Across different HF populations, lower PAPI values were consistently associated with worse outcomes, with reported cutoffs ranging from <=1.9 in cardiogenic shock to around <=2.8-2.95 in broader HF populations, and up to <=3.65 in advanced HF. Aortic pulsatility index showed a similar pattern, but with more consistent performance: values <1.45 were linked to mortality or rapid progression to advanced therapies, while values >2.9 were associated with better event-free survival. In studies that evaluated both indices, API generally showed stronger prognostic value. Overall, PAPI and API provide clinically useful prognostic information, particularly in advanced HF patients undergoing invasive hemodynamic assessment, though further large-scale prospective studies are needed to better define their role. Copyright © The Author(s) 2026 <57> Accession Number 650983790 Title THE INFLUENCE OF PATIENT-CENTERED NURSING MANAGEMENT MODEL ON THE PSYCHOLOGICAL STATE OF INPATIENTS IN THORACIC AND CARDIOVASCULAR SURGERY. Source Schizophrenia Bulletin. Conference: MHBM 2025. Kuala Lumpur Malaysia. 51(Supplement 4) (pp S350), 2025. Date of Publication: 01 Dec 2025. Author Chen L.; Yang J. Institution (Chen) Thoracic and Cardiovascular Surgery, Feicheng People's Hospital, Shandong, Taian, China (Yang) ENT Department, Feicheng People's Hospital, Shandong, Taian, China Publisher Oxford University Press Abstract Objective: To explore the impact of a patient-centered nursing management model on the psychological state of inpatients in the thoracic and cardiovascular surgery. Method(s): Seventy patients who underwent thoracic and cardiovascular surgeries in our hospital from December 2023 to June 2025 were selected. They were randomly and double-blindly divided into the observation group and the control group, with 35 cases in each group. Both groups of patients were given conventional drug treatment. The control group received routine care, while the observation group received patient-centered nursing management model on the basis of the control group. The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) were used to compare the psychological states (anxiety and depression) of the two groups before and after the nursing intervention. The nursing satisfaction levels were also compared between the two groups. Result(s): The comparison of HAMA and HAMD scores between the two groups before nursing showed no statistically significant difference (p>.05). The HAMA and HAMD scores of the two groups after nursing were lower than before nursing, and the HAMA and HAMD scores of the observation group after nursing were lower than those of the control group (p<.05). The satisfaction score of the observation group patients with nursing services was significantly higher than that of the control group (p<.05). Conclusion(s): patient-centered psychological care can alleviate the adverse psychological state of hospitalized patients in thoracic and cardiovascular surgery, ultimately improving their quality of life. <58> Accession Number 2045090687 Title Evaluation of Analgesic Effectiveness of Fentanyl Versus Fentanyl-Dexmedetomidine Combination in Pediatric Cardiac Surgery: A Prospective Comparative Study. Source International Journal of Pharmaceutical Quality Assurance. 16(12) (pp 184-188), 2025. Date of Publication: 2025. Author Bhore K.; Dasghara A.; Purkayastha P.; Dutta Gupta S.; Majumder S.; Banerjee S. Institution (Bhore) Critical Care Technology, Nil Ratan Sarkar Medical College and Hospital, West Bengal, Kolkata, India (Dasghara, Purkayastha) Department of Cardiac Anaesthesiology, Nil Ratan Sarkar Medical College and Hospital, West Bengal, Kolkata, India (Dutta Gupta, Majumder, Banerjee) Department of cardiac Anaesthesia, Nil Ratan Sarkar Medical College and Hospital, West Bengal, Kolkata, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Effective postoperative pain control is essential in pediatric cardiac surgery to prevent physiological and psychological complications. This prospective comparative study evaluated whether adding dexmedetomidine to fentanyl improves postoperative analgesia in children undergoing corrective congenital heart surgery. Fifty patients aged 3-12 years were randomized into two groups: Group A received fentanyl infusion (0.5 mug/kg/hr), while Group B received fentanyl (0.5 mug/kg/hr) plus dexmedetomidine (0.5 mug/kg/hr). Pain scores using the Wong-Baker Faces Scale, sedation scores, and rescue analgesic requirements were recorded at extubation and up to 24 hours post-extubation. Group B demonstrated significantly lower pain scores at extubation and at 3, 6, and 12 hours, improved sedation quality, and reduced rescue analgesic use without hemodynamic instability. The findings support dexmedetomidine as an effective adjuvant to fentanyl, enhancing analgesia and sedation while reducing opioid requirements in pediatric cardiac surgery. Copyright © 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. <59> Accession Number 2045193623 Title Association of duration of amino acids infusion and renal protection: a secondary analysis of the PROTECTION trial. Source British Journal of Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Landoni G.; Oriani A.; Ti L.K.; Losiggio R.; Bradic N.; Pruna A.; Burrell A.; Pieri M.; Hodgson C.L.; D'Amico F.; Ranucci M.; Oliva F.M.; Comis M.; Calabro M.G.; Viscido C.; Ajello S.; Ferrod F.; Fresilli S.; Guarracino F.; Damiani D.; Pisano A.; Bonizzoni M.A.; Silvetti S.; Pontillo D.; Neri G.; Scquizzato T.; Bosco V.; Marmiere M.; Carmosino M.; Labanca R.; Federici F.; Giardina G.; Baiardo Redaelli M.; Belletti A.; Costamagna A.; Fominskiy E.; Arangino C.; Scandroglio A.M.; Monti G.; Cortegiani A.; Paternoster G.; Bove T.; Bellomo R.; Zangrillo A.; Monaco F. Institution (Landoni, Oriani, Losiggio, Pruna, Pieri, D'Amico, Oliva, Calabro, Ajello, Fresilli, Damiani, Bonizzoni, Pontillo, Scquizzato, Marmiere, Labanca, Giardina, Belletti, Fominskiy, Scandroglio, Monti, Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (Landoni, Pieri, Monti, Zangrillo) School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (Ti) Department of Anaesthesia, National University Hospital, Singapore (Bradic) Clinic for Anaesthesiology, Resuscitation and Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia (Bradic) Department of Nursing, University North, Varazdin, Croatia (Burrell, Hodgson, Bellomo) Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Burrell) Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Australia (Hodgson) Intensive Care Unit and Physiotherapy Department, The Alfred Hospital, Melbourne, Australia (Hodgson, Bellomo) Department of Critical Care, University of Melbourne, Melbourne, Australia (Ranucci) Department of Cardiovascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy (Comis, Viscido, Ferrod) S.C. Anestesia e Rianimazione Cardiovascolare, A.O. Ordine Mauriziano Umberto I di Torino, Turin, Italy (Guarracino) Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy (Pisano) Cardiac Anesthesia and Intensive Care Unit, AORN 'Dei Colli', Monaldi Hospital, Naples, Italy (Silvetti) Department of Cardiac Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genoa, Italy (Neri, Bosco) Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (Carmosino, Paternoster) Department of Health Sciences, School of Medicine, University of Basilicata, Potenza, Italy (Federici) Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy (Baiardo Redaelli) Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy (Baiardo Redaelli) General and Neurosurgical Intensive Care Units, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy (Costamagna) Department of Anaesthesia, Intensive Care and Emergency, 'Citta della Salute e della Scienza' University Hospital, Turin, Italy (Arangino) Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy (Cortegiani) Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy (Cortegiani) General Intensive Care Unit, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy (Paternoster) Department of Health Sciences, School of Medicine, University of Basilicata, Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy (Bove) Department of Basic Biotechnological Sciences, Intensive Care Peri-Operative Clinics, Universita Cattolica del Sacro Cuore, Rome, Italy (Bove) Department of Emergency, Anaesthesiology and Reanimetion Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (Monaco) Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy (Monaco) Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola, Bologna, Italy Publisher Elsevier Ltd Abstract Background: Intravenous amino acids (AA) reduce acute kidney injury (AKI) in adult patients undergoing cardiac surgery. Because the optimal duration of AA infusion is unknown, we investigated the effect of AA infusion duration on AKI and survival. Method(s): In a secondary post hoc analysis of the PROTECTION randomised double-blind placebo-controlled trial, we divided patients into brief (<=48 h) or prolonged (>48 h but <=72 h) AA infusion. The primary objective was to assess whether the direction of the effects on AKI and ICU mortality was consistent across subgroups. Result(s): A total of 3481/3511 patients had available data. Brief and prolonged AA infusion had similar magnitude and direction of effect on AKI (interaction P=0.89), with a risk reduction of 3.8% (25% to 21%) and 5.7% (44% to 38%), respectively. Brief AA infusion showed a reduction in the use of renal replacement therapy, whereas prolonged infusion showed no effect. The effects of AA on intensive care unit mortality were discordant (a reduction from 1.9% to 1.0% in the brief infusion group, and an increase from 2.5% to 3.5% in the prolonged infusion group; interaction P=0.04). Conclusion(s): The effect of AA on AKI was consistent across subgroups, whereas they had opposing effects on survival in patients receiving brief or prolonged study drug infusion and in favour of the brief infusion group. Although these results are hypothesis generating, centres that are following European guidelines and PROTECTION trial results and are implementing AA in clinical practice should consider AA infusion lasting <=48 h. Clinical trial registration: NCT03709264. Copyright © 2026 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <60> Accession Number 2038028035 Title No antithrombotic therapy versus single antiplatelet therapy after percutaneous left atrial appendage closure in non-valvular atrial fibrillation: rationale and design of the multicentre, randomised, non-inferiority NAPT-LAAC trial. Source EuroIntervention. 22(8) (pp e455-e462), 2026. Date of Publication: 2026. Author Otsuka T.; Yamamoto M.; Asami M.; Naganuma T.; Ohno Y.; Tani T.; Nakazawa G.; Izumo M.; Saji M.; Hachinohe D.; Ueno H.; Sugiura A.; Shimura T.; Okazaki S.; Morikawa T.; Izumi Y.; Nakashima M.; Kubo S.; Shirai S.; Watanabe Y.; Hayashida K. Institution (Otsuka) Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (Otsuka) Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (Yamamoto) Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (Asami) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan (Ohno) Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan (Tani) Department of Cardiology, Sapporo East Tokushukai Hospital, Sapporo, Japan (Nakazawa) Division of Cardiology, Department of Medicine, Kindai University, Faculty of Medicine, Osaka, Japan (Izumo) Department of Cardiology, St. Marianna University, School of Medicine, Kawasaki, Japan (Saji) Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan (Hachinohe) Department of Cardiology, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan (Ueno) Department of Cardiology, Toyama University Hospital, Toyama, Japan (Sugiura) Department of Cardiology, Nagoya Heart Center, Nagoya, Japan (Shimura) Department of Cardiology, Gifu Heart Center, Gifu, Japan (Okazaki) Department of Cardiology, Juntendo University Hospital, Tokyo, Japan (Morikawa) Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan (Izumi) Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Nakashima) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan (Kubo) Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan (Shirai) Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Watanabe) Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Hayashida) Department of Cardiology, Keio University School of Medicine, Tokyo, Japan Publisher Europa Group Abstract The current standard regimen for antithrombotic therapy after percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) recommends long-term use of antiplatelet agents. However, this recommendation is not supported by sufficient clinical evidence. Since LAAC is a treatment option for managing patients at high risk of bleeding, it is necessary to clarify whether long-term antiplatelet therapy is truly required after LAAC. The Non-Antithrombotic Versus. Single antiPlatelet Therapy Following Left Atrial Appendage Closure (NAPT-LAAC) trial, a prospective, randomised, controlled, open-label, blinded-endpoint multicentre study, will be conducted in Japan. It was designed to evaluate whether non-antithrombotic therapy is non-inferior to antiplatelet monotherapy after 45 days of oral anticoagulant (OAC) monotherapy following LAAC, with respect to the incidence of thrombotic and bleeding composite events in patients with NVAF and high bleeding risk. Patients with NVAF with a CHA<inf>2</inf> DS<inf>2</inf>-VA score >=2 and who successfully undergo LAAC are eligible for inclusion. A total of 500 patients undergoing LAAC will be randomised (1:1) to aspirin monotherapy versus non-antithrombotic therapy for the 45 days following OAC monotherapy. The primary outcome is a composite of all-cause mortality, myocardial infarction, stroke, systemic embolism, major bleeding, and clinically relevant non-fatal bleeding during a maximum of 4 years of follow-up. Major bleeding or clinically relevant non-fatal bleeding is defined as Type 2, 3, or 5 bleeding, according to the Bleeding Academic Research Consortium definition. The NAPT-LAAC trial will determine the probable non-inferiority of long-term non-antithrombotic therapy to aspirin monotherapy in patients with NVAF who undergo LAAC. (ClinicalTrials.gov: NCT07125417; jRCTs031250110). Copyright © 2026, The Authors. <61> Accession Number 650972831 Title Cardiovascular Outcomes in Patients With Deferred and Performed Coronary Revascularization Based on Intracoronary Physiology: A Systematic Review and Meta-Analysis. Source Journal of the American Heart Association. (pp e042044), 2026. Date of Publication: 22 Apr 2026. Author Lombardi M.; Travieso A.; Cerrato E.; Mohammad M.A.; Gotberg M.; Davies J.; Escaned J. Institution (Lombardi, Travieso, Escaned) Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC) and Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV) Complutense University of Madrid Madrid Spain, Spain (Lombardi) Department of Internal Medicine University of Genova Genoa Italy, Italy (Cerrato) Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Rivoli Infermi Hospital, Orbassano, Italy (Mohammad, Gotberg) Cardiology Unit, Department of Clinical Sciences Lund Lund University Lund Sweden, Sweden (Mohammad, Gotberg) Department of Cardiology Skane University Hospital Lund Sweden, Sweden (Davies) National Heart and Lung Institute Imperial College London London United Kingdom, United Kingdom Abstract BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology. METHOD(S): Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization. RESULT(S): A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean+/-SD follow-up of 2.6+/-1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance. CONCLUSION(S): Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization. <62> Accession Number 2045150584 Title P202. Transcatheter Aortic Valve Replacement with Supra-Annular Versus Intra-Annular Self-Expanding Valves in Small Aortic Annulus: A Meta-Analysis. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S318), 2026. Date of Publication: 01 May 2026. Author Sa M.P.; Neves G.; Dexheimer L.; Consoli L.; Abraham D.; Camarotti T.; Napoli F.; Polanco A.; Brozzi N.; Navia J. Institution (Sa, Napoli, Polanco, Brozzi, Navia) Cleveland Clinic Florida, Weston, FL, United States (Neves) Uepa, Belem, PA, United States (Dexheimer) USP, Sao Paulo, Brazil (Consoli) UFBA, El Salvador (Abraham) UFAM, Manaus, Brazil (Camarotti) UPE, Recife, Brazil Publisher Elsevier Inc. Abstract Objective: Transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEVs) may have different outcomes with supra-annular valves (SAVs) or intra-annular valves (IAVs) in patients with small aortic annuli (SAA), but this topic remains underexplored. We aimed to evaluate outcomes between different SEVs, namely SAVs (CoreValve/Evolut R/PRO/PRO+/FX) VERSUS IAVs (Portico/Navitor). Method(s): We performed a systematic review and meta-analysis of studies comparing TAVR with SEV-SAV versus SEV-IAV in patients with SAA. Pubmed/MEDLINE, EMBASE, Web of Science and Cochrane databases (inception to September 2025) were searched. Separate meta-analyses were conducted with random-effects models to assess patient-relevant outcomes and echocardiographic results; reconstructed time-to-event data from published Kaplan-Meier curves were pooled to calculate survival in the follow-up. Result(s): Five observational studies met our eligibility criteria, including a total of 3303 patients (SAV: 2295; IAV: 1008). After TAVR, we did not find statistically significant differences for the following outcomes: 30-day mortality, mortality in the follow-up, stroke, device success, technical success, acute kidney injury, coronary occlusion, major bleeding and paravalvular leak; however, we found lower rates of permanent pacemaker implantation in the SAV group (RR 0.754; 95%CI 0.603-0.942; P=0.013). Despite the slightly larger indexed effective orifice area with SAVs (mean difference +0.066 cm2/m2; 95%CI 0.015-0.118; P=0.012) and slightly lower mean gradients (-0,909mmHg; 95%CI -1.766 - -0.051; P=0.038), we did not find statistically significant differences between the groups in terms of residual mean gradients >=20 mmHg (RR 1.470; 95%CI 0.624-3.459; P=0.378); however, SAV showed a lower risk of prosthesis-patient mismatch (RR 0.640; 95%CI 0.420-0.980; P=0.042). We observed a statistically significance in survival at 5 years in favor of the SAV group (HR 0.770; 95%CI 0.600-0.980; P=0.034) Conclusion(s): IAVs and SAVs may have a different performance in terms of hemodynamic structural and nonstructural dysfunction. Randomized data are needed to validate these findings and guide informed device selection. [Formula presented] STRUCTURAL HEART: Aortic Valve / TAVR. Copyright © 2026 <63> Accession Number 2045150749 Title P66. Is Ultra-Fast-Track Superior to Fast-Track Extubation in Adult Cardiac Surgery? A Comprehensive Meta-Analysis with Subgroup and Meta-Regression Analyses. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S229-S230), 2026. Date of Publication: 01 May 2026. Author Santos K.; Patel N.; Belen Kim Kim J.Y.; Umibe T.; Abo T.; Sakai W.; Plonek T. Institution (Santos, Plonek) Medisch Spectrum Twente, Enschede, Netherlands (Patel) New Vision University, Tbilisi, Georgia (Belen Kim Kim) Universidad Nacional De Asuncion, Asuncion, Paraguay (Umibe, Abo, Sakai) National Center For Global Health And Medicine, Tokyo, Japan Publisher Elsevier Inc. Abstract Objective: Ultra-fast-track extubation (UFTE), defined as extubation in the operating room or within one hour postoperatively, is increasingly adopted in cardiac surgery. However, its benefits compared to fast-track extubation (FTE), defined as extubation within six hours in the ICU, remain unclear. Method(s): We systematically searched multiple databases for studies comparing UFTE and FTE, applying strict timing definitions for both groups. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were performed by procedure type (e.g. coronary artery bypass grafting [CABG], minimally invasive cardiac surgery [MICS]) and study design. Meta-regression assessed the influence of age, left ventricular ejection fraction (LVEF), and proportions of male and diabetic patients on the primary outcomes: reintubation and 30-day mortality. Result(s): Twenty studies involving nearly 800,000 patients were included. UFTE was associated with lower 30-day mortality [OR 0.54; 95% CI 0.35-0.83; p = 0.005], shorter ICU [MD -12.27 hours] and hospital stays [MD -1.19 days], and reduced stroke rates [OR 0.85] and 30-day readmission [OR 0.64], but a higher incidence of VTE/PE [OR 2.55]. Other outcomes including reintubation, reoperation for bleeding, AKI, pneumonia, and atrial fibrillation were similar between groups. In the MICS subgroup, UFTE was associated with a significantly reduced reintubation rate [OR 0.26; I2 = 0%], while in the CABG subgroup, only hospital stay was shorter. In propensity-matched cohorts, mortality and reintubation were comparable, though ICU and hospital stays remained shorter with UFTE. Meta-regression identified male sex and LVEF as significant moderators of mortality benefit, while no covariates influenced reintubation rates. Conclusion(s): UFTE is associated with lower mortality, shorter ICU and hospital stays, and reduced stroke and readmission rates, supporting its selective implementation within enhanced recovery after surgery (ERAS) pathways in adult cardiac surgery. However, despite extensive subgroup, sensitivity, and meta-regression analyses, residual confounding cannot be ruled out due to the predominance of observational data. High-quality randomised controlled trials and standardised UFTE protocols are essential to confirm these findings and inform guideline-based adoption. [Formula presented] PERIOPERATIVE CARE: ERAS Cardiac. Copyright © 2026 <64> Accession Number 2045088413 Title Accuracy of ChatGPT and DeepSeek in answering clinical questions from the 2025 Society for Cardiovascular Angiography & Interventions/Heart Rhythm Society left atrial appendage occlusion guidelines. Source Journal of International Medical Research. 54(4) (no pagination), 2026. Date of Publication: 01 Apr 2026. Author Jin Y.; Feng C.; Zhao J.; Lin W.; Li B. Institution (Jin, Feng, Zhao, Lin) Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, China (Li) Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, China Publisher SAGE Publications Ltd Abstract Objective: To evaluate the accuracy of ChatGPT and DeepSeek in answering guideline-based clinical questions in cardiology. Method(s): In August 2025, responses generated from four large language models to eight clinical questions based on the 2025 Society for Cardiovascular Angiography & Interventions/Heart Rhythm Society guidelines were evaluated. Three cardiologists independently rated accuracy using a six-point Likert scale: (a) completely incorrect; (b) more incorrect than correct; (c) nearly equally correct and incorrect; (d) more correct than incorrect; (e) nearly all correct; and (f) completely correct. Reproducibility (Fleiss' kappa coefficient, five repeated queries) and inter-rater reliability (intraclass correlation coefficient) were assessed. Result(s): The median (interquartile range) accuracy scores were 5.5 (5, 6) for ChatGPT-5, 6 (5, 6) for ChatGPT-4o, and 5 (4, 6) for both DeepSeek-R1 and DeepSeek-V3, with a significant overall difference (p < 0.001). Pairwise comparisons showed significantly higher accuracy for ChatGPT models than for DeepSeek models (all p < 0.001), whereas no significant differences were observed between ChatGPT-5 and ChatGPT-4o (p = 0.518) or between DeepSeek-R1 and DeepSeek-V3 (p = 0.812). Reproducibility (Fleiss' kappa coefficient) was excellent for ChatGPT-5 (0.803) and good for ChatGPT-4o (0.574), DeepSeek-R1 (0.577), and DeepSeek-V3 (0.618). Overall inter-rater reliability was moderate (intraclass correlation coefficient = 0.463). Conclusion(s): ChatGPT and DeepSeek demonstrated high accuracy and reproducibility but moderate inter-rater reliability, necessitating further validation for educational use. Copyright © The Author(s) 2026. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). <65> Accession Number 2044936741 Title Continuous Erector Spinae Plane Block versus Thoracic Epidural Analgesia After Thoracotomy: A Randomized Controlled Assessor-Blinded Non-Inferiority Trial. Source Journal of Pain Research. 19 (no pagination), 2026. Article Number: 585519. Date of Publication: 2026. Author Cho S.; Lee H.-J.; Yoon S.-H.; Park S.-Y.; Park S.; Lee H.J.; Park I.K.; Kang C.H.; Na K.J.; Yoon S.; Kim Y.T.; Bahk J.-H. Institution (Cho, Lee, Yoon, Park, Yoon, Bahk) Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea (Lee, Yoon, Yoon, Bahk) Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea (Park, Lee, Park, Kang, Na, Kim) Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea (Park, Lee, Park, Kang, Na, Kim) Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea (Na, Kim) Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea Publisher Dove Medical Press Ltd Abstract Purpose: Thoracic epidural analgesia (TEA) remains the current gold standard for postoperative pain control after thoracotomy, but is associated with significant complications and contraindications. This study evaluated whether continuous erector spinae plane block (ESPB) provides non-inferior analgesia to TEA. Patients and Methods: Adult patients scheduled for elective thoracotomy were randomized 1:1 to receive continuous TEA or ESPB. Outcome assessors were blinded to group allocation. In the TEA group, an epidural catheter was inserted at T6-7 under fluoroscopic guidance with tip confirmation at T5. In the ESPB group, a catheter was placed under ultrasound guidance at the T5 transverse process. Both groups received 0.2% ropivacaine boluses before incision, followed by patient-controlled analgesia for three days. The primary endpoint was resting numeric rating scale pain score on postoperative day 1 with a 2-point non-inferiority margin. Secondary endpoints included pain scores on days 2-3, opioid consumption, QoR-15K scores, and chronic pain assessments at 3 and 6 months. Result(s): Fifty-three patients were enrolled; 44 were included in the modified intention-to-treat analysis (ESPB n=23; TEA n=21). Mean resting NRS scores on postoperative day 1 were 4.22+/-1.93 (ESPB) versus 4.81+/-1.78 (TEA). The between-group difference was -0.59 (95% CI, -1.72-0.54; P=0.296), meeting the predefined non-inferiority margin. Secondary outcomes, including pain scores, opioid consumption, Quality of Recovery-15 scores, and chronic pain assessments at 3 and 6 months, were comparable between groups. No major complications occurred. Conclusion(s): Continuous ESPB demonstrated analgesic efficacy comparable to TEA for postoperative pain control after thoracotomy. Combined with its superior safety profile and technical simplicity, ESPB may serve as an effective alternative to TEA in thoracic surgery. Copyright © 2026 Cho et al. <66> Accession Number 2044999306 Title Perinatal Management and Appropriate Time of Delivery in Monochorionic Monoamniotic Twins When One Twin has Transposition of the Great Arteries. A Case Report and Systematic Review of the Literature. Source Pediatric Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Montoya J.; Tapasco L.; Mulinari L.; Ruano R.; Alkon J. Institution (Montoya, Tapasco, Alkon) Department of Pediatrics, Division of Pediatric Cardiology, Miller School of Medicine, University of Miami, Miami, United States (Mulinari) Department of Surgery, Division of Pediatric Cardiac Surgery, Miller School of Medicine, University of Miami, Miami, United States (Ruano) Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Miller School of Medicine, University of Miami, Miami, United States Publisher Springer Abstract Monochorionic monoamniotic (MCMA) twin pregnancies are typically delivered at 32-34 weeks of gestation to reduce the risk of intrauterine demise, but this practice may compromise outcomes for a growth-restricted or very-low-birth-weight twin requiring complex cardiac surgery. We conducted a literature review in Cochrane Central Register of Controlled Trials, EMBASE and PubMed from inception to October 26, 2025. We included reports of MCMA twin pregnancies with one fetus with TGA describing perinatal outcomes, cord complications, and cardiac surgery in very-low-birth-weight neonates. Of 388 records identified, 302 abstracts were screened, 54 full texts reviewed, and 8 studies were included. Only five published cases of MCMA with one twin affected by transposition of the great arteries were identified: two in conjoined twins, one with postmortem diagnosis after extreme prematurity, and two operated cases, of whom just one survived. We describe to our knowledge the third non-conjoined MCMA twin pregnancy with TGA and only the second postoperative survivor, delivered at 34 weeks. Systematic reviews have suggested that, in otherwise stable MCMA pregnancies with TGA, prolonging gestation to at least 33 weeks is considered safe, and based on our experience we suggest that prolonging pregnancy to 34 weeks may still be beneficial, but multicenter data is needed to reach this conclusion. Copyright © The Author(s) 2026. <67> Accession Number 2045149920 Title P185. Tubeless Technique in Uniportal VATS Wedge Resection for Enhanced Recovery After Surgery (ERAS): A Prospective Study. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S307-S308), 2026. Date of Publication: 01 May 2026. Author Li D.; Zhu H.; Zhang L. Institution (Li, Zhu, Zhang) Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, Nanjing, China Publisher Elsevier Inc. Abstract Objective: To investigate the effect of applying the tubeless technique (no urinary catheter, no postoperative chest tube) in uniportal video-assisted thoracoscopic surgery (VATS) for wedge resection of pulmonary nodules on improving postoperative Enhanced Recovery After Surgery (ERAS). Method(s): A total of 60 patients scheduled for wedge resection of early-stage pulmonary nodules in the Department of Thoracic Surgery, Nanjing Drum Tower Hospital Jiangbei Branch between January 2025 and March 2025 were selected as subjects. Patients were randomly assigned to either the tubeless group (n=30) or the control group (n=30). The tubeless group underwent surgery without a urinary catheter and without indwelling chest tube postoperatively. The control group received conventional management with a 16F chest tube and indwelling urinary catheter. Postoperative clinical data were compared, including pain VAS scores, NRS scores, limb mobility on the operative side (assessed via Fugl-Meyer score), postoperative pain satisfaction, and the incidence of postoperative adverse events. Result(s): All 60 enrolled patients successfully completed the surgery. The operative time in the tubeless group (42 +/- 15.01 min) showed no statistically significant difference compared to the control group (46.21 +/- 15.21 min) (P > 0.05). However, significant differences (P < 0.05) favoring the tubeless group were observed in: VAS score (2.23 +/- 2.11 vs. 4.45 +/- 2.50), NRS score (2.3 +/- 2.22 vs. 4.48 +/- 2.56), limb mobility score (63.87 +/- 3.51 vs. 56.86 +/- 3.85), intraoperative blood loss (7.67 +/- 12.58 mL vs. 20.17 +/- 17.85 mL), hospital stay length (2.33 +/- 0.66 days vs. 4.48 +/- 0.68 days), hospitalization costs (23874.45 +/- 3500.57 CNY vs. 29767.32 +/- 5346.06 CNY), and postoperative pain satisfaction (98.33 +/- 3.03 vs. 90.52 +/- 3.09). One-month CT follow-up revealed good recovery in both groups without significant statistical difference. Regarding adverse events, one patient in the tubeless group required tube placement due to postoperative air leak. Neither group experienced significant complications such as major pneumothorax or pulmonary infection. Conclusion(s): The application of the tubeless technique in uniportal VATS wedge resection for pulmonary nodules significantly improved postoperative pain levels, limb mobility on the operative side, intraoperative blood loss, hospitalization costs, length of stay, and patient satisfaction. The lack of significant difference in operative time is likely attrib. PERIOPERATIVE CARE: ERAS Thoracic. Copyright © 2026 <68> Accession Number 2045150377 Title 33. Normothermic cardiopulmonary bypass and postoperative bleeding in adults undergoing coronary artery bypass grafting: a multi-center randomized clinical trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S23), 2026. Date of Publication: 01 May 2026. Author Wang J.; Wang S.; Song Y.; Jiang F.; zhao H.; Zhou C.; Tian R.; Liu C.; Wang T.; Zhang H.; Yan S.; Ji B. Institution (Wang, Wang, Zhang, Yan, Ji) Fuwai Hospital of Chinese Academy of Medical Sciences, Beijing, China (Wang) TEDA International Cardiovascular Hospital, Tianjin, China (Song) Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming, Yunnan, China (Jiang) Fuwai Hospital Chinese Academy of Medical Sciences, Guangdong, Shenzhen, China (zhao) First Affiliated Hospital of Zhejiang University, Zhejiang, Hangzhou, China (Zhou) Guangdong Academy of Medical Sciences, Guangdong, Guangzhou, China (Tian) The Affiliated Hospital of Zunyi Medical University, Guizhou, Zunyi, China (Liu) Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Jiangsu, Nanjing, China Publisher Elsevier Inc. Abstract Objective: Temperature management during cardiopulmonary bypass (CPB) may affect hemostasis, organ function, and perioperative outcomes, yet the optimal intraoperative strategy remains uncertain. This study aims to evaluate the safety and efficacy of normothermic CPB in patients undergoing isolated Coronary artery bypass grafting (CABG), with a focus on postoperative bleeding and transfusion requirements. METHODS This multicenter, randomized, single-blind trial enrolled adult patients undergoing isolated CABG with CPB between September 21, 2023, and January 20, 2025, with the last follow-up on January 26, 2025, at 8 tertiary cardiac surgery centers in China. Patients were randomized to normothermic CPB (target oxygenator outlet temperature 35-36degreeC) or mild hypothermic CPB (target 32-33degreeC).The primary outcome was the occurrence of moderate-to-severe perioperative bleeding, defined by Universal Definition of Perioperative Bleeding (UDPB) class 2-4. This included any of the following: delayed sternal closure; chest tube output greater than 800 mL within 12 hours postoperatively; transfusion of two or more units of red blood cells or fresh frozen plasma within 24 hours; any transfusion of platelets, cryoprecipitate, prothrombin complex concentrate, or use of recombinant activated factor VII within 24 hours; or surgical re-exploration for bleeding. UDPB is graded as follows: Class 0, insignificant; Class 1, mild; Class 2, moderate; Class 3, severe; and Class 4, massive. RESULTS Of 330 enrolled patients (median age, 61 years (IQR [Interquartile Range] 55-67), 83.9% male), 166 were allocate to the mild hypothermic CPB group and 164 to the normothermic CPB group. The primary endpoint occurred in 21 of 166 patients (12.7%) in the mild hypothermic group and 19 of 164 patients (11.7%) in the normothermic group (Difference: 0.4%, 95% CI [Confidence interval]: -6.6% to 7.4%; OR [odds ratio]: 0.963, 95% CI: 0.493-1.880; p = .912). The distribution of UDPB levels did not differ significantly (p = .830): 0 in 131 (78.9%) vs 133 (81.1%), grade 1 in 15 (9.0%) vs 12 (7.3%), grade 2 in 15 (9.0%) vs 14 (8.5%), grade 3 in 5 (3.0%) vs 4 (2.4%), and grade 4 in 0 vs 1 (0.6%) for the mild hypothermic and normothermic groups, respectively. CONCLUSIONS Among adults undergoing isolated on-pump CABG, normothermic CPB, guided by membrane oxygenator outlet temperature, compared with hypothermic CPB, did not decrease the incidence of postoperative bleeding. [Formula presented] ADULT CARDIAC: Coronary Artery Disease Copyright © 2026 <69> Accession Number 650974373 Title Invasive vs Conservative Strategy for Frail Older Patients With Myocardial Infarction: A Secondary Analysis of the SENIOR-RITA Randomized Clinical Trial. Source JAMA network open. 9(4) (pp e267316), 2026. Date of Publication: 01 Apr 2026. Author Rubino F.; Mossop H.; Ripley D.P.; Carter J.; Twomey D.; Cooke J.; Austin D.; Veerasamy M.; Kelly D.; Felmeden D.; Anand A.; Newby D.E.; Storey R.F.; Fox K.A.A.; Pocock S.J.; Kunadian V. Institution (Rubino, Kunadian) Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (Mossop, Austin) Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (Ripley) Cardiology Department, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (Carter) North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom (Twomey) County Durham and Darlington NHS Trust, Darlington, United Kingdom (Cooke) Chesterfield Royal Hospital, Chesterfield, United Kingdom (Austin) Academic Cardiovascular Unit, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom (Veerasamy) Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom (Kelly) Royal Derby Hospital, Derby, United Kingdom (Felmeden) Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom (Anand, Newby) Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (Storey) NIHR Sheffield Biomedical Research Centre, Sheffield University, Sheffield, United Kingdom (Fox) University of Edinburgh, Edinburgh, United Kingdom (Pocock) London School of Hygiene and Tropical Medicine, London, United Kingdom (Kunadian) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom Abstract Importance: Frail older patients with non-ST-elevation myocardial infarction (NSTEMI) experience an increased risk of major adverse cardiovascular events. The beneficial role of an invasive strategy over a conservative strategy among frail patients with NSTEMI is unclear. Objective(s): To compare the clinical outcomes of an invasive strategy with those of a conservative strategy among older patients with NSTEMI stratified by frailty status. Design, Setting, and Participant(s): In this prespecified exploratory subgroup analysis from the SENIOR-RITA randomized clinical trial, patients were screened across 48 National Health Service trusts in England and Scotland from November 1, 2016, through March 31, 2023. The SENIOR-RITA trial included patients with NSTEMI aged 75 years or older, randomized to an invasive strategy with coronary angiography, revascularization if needed, and optimal medical therapy vs a conservative strategy with optimal medical therapy only. In this analysis, frailty status was defined using the Fried frailty criteria (frail, >=3 criteria present). Statistical analysis was performed from March through November 2025. Intervention(s): Invasive vs conservative strategy. Main Outcomes and Measures: The primary composite outcome was the time to cardiovascular death or nonfatal myocardial infarction. All participants were analyzed according to the intention-to-treat principle. Result(s): Fried frailty criteria were available for 1446 of the 1518 randomized patients (95.3%), of whom 469 (32.4%; median age, 83 years [IQR, 80-86 years]; 240 women [51.2%]) met criteria for frailty. The primary outcome among frail patients occurred among 87 of 231 patients (37.7%) in the invasive group and 70 of 238 patients (29.4%) in the conservative group (hazard ratio [HR], 1.21; 95% CI, 0.88-1.67) over a median follow-up of 4.1 years (IQR, 2.8-4.6 years). When frailty was analyzed as a continuous variable, there was a significant interaction with treatment such that patients at the highest levels of frailty had a potential signal for harm with routine invasive strategy. There were no significant treatment differences across frailty categories for cardiovascular death (HR, 1.44; 95% CI, 0.97-2.10) or nonfatal myocardial infarction (HR, 1.00; 95% CI, 0.61-1.63). Conclusions and Relevance: In this subgroup analysis of a randomized clinical trial, an invasive strategy did not reduce the risk of a composite outcome of cardiovascular death or nonfatal myocardial infarction compared with a conservative strategy, with a potential signal for increased risk of harm among those at the highest levels of frailty. These findings underscore the need for individualized, frailty-informed treatment strategies. Trial Registration: isrctn.org Identifier: ISRCTN11343602. <70> Accession Number 2044962067 Title Effect of Continuous Theta-Burst Stimulation on Postoperative Delirium in Older Patients Who Undergo Cardiac Surgery. Source Neuromodulation. (no pagination), 2026. Date of Publication: 2026. Author Zhang J.; Zhu Y.; Yin Y.; Xiao C.; Zhang Y.; Sun J.; Qi Y.; Wang L. Institution (Zhang, Zhu, Yin, Zhang, Qi, Wang) Department of Anesthesiology, Xuzhou Central Hospital, Southeast University, Jiangsu, Xuzhou, China (Zhang, Zhu, Yin, Zhang, Qi, Wang) Department of Anesthesiology, Xuzhou Central Hospital, Jiangsu, Xuzhou, China (Xiao) Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, China (Sun) Department of Anesthesiology, Zhongda Hospital, Southeast University, Jiangsu, Nanjing, China Publisher International Neuromodulation Society Abstract Objectives Postoperative delirium (POD) is a common complication after cardiac surgery in older patients, associated with higher mortality and prolonged stays. Continuous theta-burst stimulation (cTBS), a noninvasive neuromodulation technique, has been shown to modulate cortical excitability, offering potential as a treatment for cognitive dysfunction after surgery. The posterior cingulate cortex (PCC) is strongly involved in resource allocation, episodic memory, and executive function. This study aims to investigate the efficacy of cTBS on PCC in reducing POD in older patients having cardiac surgery. Materials and Methods A single-center, randomized, double-blind, placebo-controlled trial was conducted. Older patients receiving cardiac surgery were randomly assigned to either active or sham cTBS groups. cTBS was applied to PCC for five days before and after surgery. The primary outcome was POD incidence during the first five postoperative days. Intention-to-treat analysis was performed in February 2026. Results A total of 78 patients were recruited and randomly assigned to the active cTBS group (39 patients) or the sham cTBS group (39 patients). The active cTBS group showed a significantly lower incidence of POD than did the sham cTBS group (23.1% vs 48.7%). Moreover, the active cTBS group exhibited considerably lower levels of anxiety and pain, and reduced analgesic consumption. However, although the levels of tumor necrosis factor-alpha and interleukin-6 in the active cTBS group showed a downward trend, the changes did not reach statistical significance. Conclusion PCC-targeted cTBS effectively reduces POD in older patients who undergo cardiac surgery, alleviating anxiety, pain, and sleep disturbances. These findings suggest cTBS as a promising nonpharmacologic treatment for POD. Clinical Trial Registration The Clinicaltrials.gov registration number for the study is NCT0557 5583. Copyright © 2026. Published by Elsevier Inc. <71> Accession Number 2045150099 Title P67. PancreAgent: A Reinforcement Learning-Driven Closed-Loop Insulin Control System for Perioperative Glucose Management. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S230-S231), 2026. Date of Publication: 01 May 2026. Author Manerikar A.; Hodges K.; Al Qamari A.; Arora R.; Kline A.; Johnston D. Institution (Manerikar, Hodges, Al Qamari, Kline, Johnston) Northwestern University Feinberg School Of Medicine, Chicago, IL, United States (Arora) Cleveland University Hospitals, Cleveland, OH, United States Publisher Elsevier Inc. Abstract Objective: Perioperative dysglycemia, defined as blood glucose 180 mg/dL, is associated with increased perioperative morbidity and mortality in cardiac surgery. The purpose of this study is to compare the in silico (computer-simulated) safety and efficacy of a novel reinforcement-learning based artificial intelligence formulation for insulin dosing against established rules-based methods. Method(s): A reinforcement-learning (RL) agent for closed-loop insulin dosing, coined PancreAgent, was developed and benchmarked against a standard rule-based bolus calculator (heuristic policy) within the FDA-approved UVA/Padova Type 1 Diabetes Simulator. A randomized, within-subject crossover design was used: 300 virtual patients each underwent two 14-day simulation periods under varied meal and disturbance scenarios: one controlled by the RL agent and one by the heuristic policy. The environment consisted of the time moving average derivative of blood glucose level, carbohydrate intake, current insulin dose and time. Outcomes were quantified by time-in-range (TIR), time-below-range, time-above-range, mean blood glucose, and hypoglycemic episodes. Paired t-tests and Wilcoxon signed-rank tests were applied with Bonferroni correction. Effect sizes and 95% confidence intervals were reported. Result(s): In silico results in 300 virtual patients over 14 days show PancreAgent achieved a mean TIR (70-180 mg/dL) of 71.8 +/- 9.6% vs 65.4 +/- 11.8% for the rule-based calculator (mean difference +6.4%, 95% CI 5.0-7.8, p<0.001, Cohen's d=0.59). Time-below-range (<70 mg/dL) was similar between controllers, while time-above-range (>180 mg/dL) was reduced using RL (23.3 +/- 9.8% vs. 29.4 +/- 11.5%; 95% CI -7.4 to -4.8, p<0.001). The RL policy also lowered mean blood glucose from 154 +/- 14 mg/dL to 147 +/- 12 mg/dL (95% CI -8.7 to -5.3, p<0.001), and reduced glucose variability (coefficient of variation) from 22.8 +/- 5.2% to 20.1 +/- 4.3% (95% CI -3.4 to -2.0, p<0.001). The average number of hypoglycemic episodes per patient decreased modestly (1.5 +/- 0.8 heuristic vs. 1.3 +/- 0.7 with RL; 95% CI -0.4 to 0.0, p=0.03). Conclusion(s): A novel RL agent achieved a statistically significant increase in TIR and reduction in hypoglycemic exposure compared to rule-based methods during in silico testing, suggesting its potential to improve the safety and effectiveness of perioperative glucose management. In vivo studies are needed to assess this technology in cardiac surgery patients. [Formula presented] PERIOPERATIVE CARE: Innovations: New devices or novel approaches, preclinical or clinical. Copyright © 2026 <72> Accession Number 2045150242 Title P201. Safety and effectiveness of transcatheter tricuspid valve repair vs replacement: A systematic review and meta-analysis. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S318), 2026. Date of Publication: 01 May 2026. Author Chang J.; Wei P.; Ma J.; Fang F.; Pan X. Institution (Chang, Wei, Fang, Pan) Fuwai Hospital, Beijing, China (Ma) Guangdong Province People's Hospital, Beijing, China Publisher Elsevier Inc. Abstract Background: Transcatheter tricuspid valve therapies, including replacement (TTVR) and repair (TTVr), have emerged as less invasive alternatives to surgery for patients with moderate-to-severe tricuspid regurgitation (TR). However, direct comparative evidence on their relative safety and efficacy remains limited. Method(s): A network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted through systematic searches of PubMed, Cochrane CENTRAL, and Web of Science. Bayesian random-effects models were used to perform indirect comparisons between TTVR and TTVr. Outcomes included 30-day all-cause mortality, residual TR, pacemaker implantation, cardiogenic shock, and respiratory complications. Result(s): Five eligible studies encompassing 3,911 patients with moderate-to-severe TR were included. TTVr was consistently associated with the lowest 30-day all-cause mortality, with significant reductions compared with both TTVR (OR=0.43, 95% CI: 0.23-0.79, P=0.02) and TS (OR=0.21, 95% CI: 0.04-0.95, P=0.03). SUCRA ranking confirmed TTVr as the most favorable for survival. For residual TR, no significant differences were observed, although TTVR ranked highest for regurgitation reduction. Regarding device-related complications, TTVR carried the greatest probability of pacemaker implantation, whereas TTVr ranked most favorably for cardiogenic shock and respiratory complications. TS consistently showed the least favorable outcomes, reflecting the higher perioperative risk of surgical intervention. Collectively, these results underscore distinct procedural trade-offs between repair- and replacement-based strategies. Conclusion(s): TTVr provides superior short-term survival and a favorable safety profile compared with TTVR and conventional surgery, supporting its role as the preferred minimally invasive strategy in moderate-to-severe TR patients. STRUCTURAL HEART: Mitral and Tricuspid. Copyright © 2026 <73> Accession Number 2045135062 Title Outcomes of off-pump versus on-pump coronary artery bypass grafting in diabetic patients: A propensity-adjusted systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. (no pagination), 2026. Date of Publication: 2026. Author Murad Z.A.; Lahcen A.A.; Alkhawam M.; Al-awadh M.F.; Ali M.; Saeed S.A.S.; Elghazaly S.M. Institution (Murad) Faculty of Medicine and Health Science, University of Aden, Aden, Yemen (Lahcen) Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco (Alkhawam) University of Alabama at Birmingham, Birmingham, AL, United States (Al-awadh) University of Bahri, Alkadroo, Sudan (Ali, Elghazaly) Faculty of Medicine, Assiut University, Assiut, Egypt (Saeed) Ibn Sina University, Khartoum, Sudan Publisher SAGE Publications Inc. Abstract Objective: Diabetes is a major risk factor for coronary artery disease. We compared outcomes of off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass grafting in diabetic patients using propensity-adjusted observational studies. Method(s): We searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing OPCAB and ONCAB in diabetic patients using propensity-score matching or covariate adjustment. Eligible studies reported short-term or long-term clinical outcomes. Primary endpoints were early (in-hospital or 30-day) mortality and long-term survival. Secondary outcomes included stroke, myocardial infarction, reoperation for bleeding, atrial fibrillation, renal replacement therapy, low cardiac output syndrome, and completeness of revascularization. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Result(s): Nine studies (observation periods 1996-2021), including >10,000 diabetic patients, met criteria. There was no significant difference in early mortality between OPCAB and ONCAB (OR 0.71, 95% CI 0.44-1.14; P = .15). Long-term mortality was significantly higher with OPCAB (HR 1.16, 95% CI 1.01-1.33; P = .04), while mid-term survival showed no difference. OPCAB was associated with lower risks of stroke (OR 0.47, 95% CI 0.24-0.94; P = .03) and reoperation for bleeding (OR 0.60, 95% CI 0.41-0.88; P = .009), but higher risks of incomplete revascularization (OR 2.07, 95% CI 1.60-2.68; P < .00001) and atrial fibrillation (OR 1.70, 95% CI 1.16-2.47; P = .006). Conclusion(s): In diabetic patients undergoing CABG, OPCAB lowers stroke and bleeding risk but increases incomplete revascularization and is associated with significantly higher long-term mortality. Choice of technique should be individualized with emphasis on complete revascularization. Copyright © The Author(s) 2026 <74> Accession Number 2045119095 Title Real-World Outcomes of Transcatheter Tricuspid Valve Replacement: Analysis From the STS/ACC TVT Registry. Source JAMA. (no pagination), 2026. Date of Publication: 2026. Author Makkar R.R.; Gupta A.; O'neill B.P.; Lalani C.; Sharma R.P.; Yadav P.; Frisoli T.M.; Thourani V.; Makar M.; Eleid M.F.; Lee J.; Babaliaros V.C.; Haeffele C.; Bajwa T.K.; Flueckiger P.; Cubeddu R.J.; Davidson L.J.; Padang R.; Spinetto P.V.; Allaqaband S.; Narang A.; Williams M.; Gleason P.; Tang G.H.L.; Khera S.; Vavalle J.P.; Byku I.; Depta J.P.; Garcia S.; Kapadia S.; Zajarias A.; Chanin J.M.; Kodali S.K.; Herrmann H.C.; Morse M.A.; Petrossian G.; Sivak J.A.; Hahn R.T.; Song Y.; Leon M.B.; Yeh R.W.; Davidson C.J. Institution (Makkar, Gupta, Makar) Cedars-Sinai Medical Center, Los Angeles, CA, United States (O'neill, Frisoli, Lee, Spinetto) Henry Ford Heart & Vascular Institute, Henry Ford Hospital, Detroit, MI, United States (Lalani, Song, Yeh) Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Sharma, Haeffele) Division of Cardiovascular Medicine, Stanford University, Stanford Health Care, Stanford, CA, United States (Yadav, Thourani, Flueckiger) Piedmont Heart Institute, Piedmont Atlanta Hospital, Atlanta, GA, United States (Eleid, Padang) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Babaliaros, Gleason, Byku) Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, United States (Bajwa, Allaqaband) Aurora St Luke's Medical Center, Milwaukee, WI, United States (Cubeddu) Naples Comprehensive Health Heart Institute, Naples, FL, United States (Davidson, Narang, Davidson) Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States (Davidson) Edwards Lifesciences, Irvine, CA, United States (Williams) New York University Langone Medical Center, New York, United States (Tang, Khera) Mount Sinai Health System, New York, NY, United States (Vavalle, Sivak) Division of Cardiology, University of North Carolina, Chapel Hill, United States (Depta) Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, United States (Garcia) The Christ Hospital, Cincinnati, OH, United States (Kapadia) Department of Cardiovascular Medicine and Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States (Zajarias) Cardiovascular Division, Washington University School of Medicine, St Louis, MO, United States (Chanin) Intermountain Health Heart & Vascular Institute, Denver, CO, United States (Kodali, Hahn, Leon) Columbia University Irving Medical Center and Cardiovascular Research Foundation, New York, NY, United States (Herrmann) Hospital of the University of Pennsylvania, Philadelphia, United States (Morse) Ascension Saint Thomas Hospital, Nashville, TN, United States (Petrossian) St Francis Hospital & Heart Center, Roslyn, NY, United States Publisher American Medical Association Abstract Importance: Transcatheter tricuspid valve replacement (TTVR) demonstrated superior outcomes over medical therapy in patients with severe tricuspid regurgitation (TR) in the Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device II (TRISCEND II) randomized clinical trial, and received regulatory approval in the US in 2024. Contemporary real-world data on its effectiveness and safety remain limited. Objective(s): To evaluate 30-day clinical, echocardiographic, and health status outcomes of TTVR in real-world use. Design, Setting, and Population: Retrospective cohort study of all consecutive patients who underwent TTVR in the US from February 2024 through March 2025 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Patients had symptomatic, severe TR despite optimal medical therapy and TTVR was deemed appropriate by a heart team. Statistical analysis was conducted from September 2025 to February 2026. Exposure: Device-enabled TTVR. Main Outcomes and Measures: Thirty-day event rates (all-cause death, stroke, bleeding, new cardiac implantable electronic device [CIED] implantation, heart failure hospitalizations), TR reduction, and changes in health status (New York Heart Association [NYHA] functional class and Kansas City Cardiomyopathy Questionnaire Overall Summary [KCCQ-OS] score) are reported. Subgroup analyses examined the impact of baseline CIED status on outcomes. Result(s): Among 1034 attempted procedures at 82 centers (mean [SD] age, 77.1 [10.6] years; 69.1% female; 73.2% NYHA functional class III/IV), a valve was successfully implanted in 1017 patients (98.4%). Mild or less TR was achieved in 98.4% of patients post procedure and in 97.7% at 30 days. At 30 days, all-cause mortality was 3.1%; stroke, 0.2%; bleeding, 7.9%; new CIED, 15.9% in CIED-naive patients; and heart failure hospitalization, 3.1%. There were significant improvements in NYHA functional class (class I/II, 82.7%; P <.001) and mean KCCQ-OS score (22.4 points; P <.001) from baseline to 30 days. There were no significant differences in 30-day mortality (P =.47), heart failure hospitalization (P >.99), and functional outcomes (P =.55) when patients were stratified by baseline CIED status. Conclusions and Relevance: Early US real-world experience with TTVR confirms safety and effectiveness in patients with severe TR. Thirty-day outcomes are consistent with the TRISCEND II pivotal trial, demonstrating acceptable safety, near-complete TR elimination, and significant health status improvements in an older, comorbid population. Rates of new CIED implantation and bleeding were lower than randomized clinical trial experience. Copyright © 2026 American Medical Association. All rights reserved. <75> [Use Link to view the full text] Accession Number 650971059 Title Impact of Virtual Reality on Transcatheter Aortic Valve Implantation: A Prospective Randomized Controlled Trial. Source Circulation. Cardiovascular imaging. (pp e018922), 2026. Date of Publication: 22 Apr 2026. Author Kanschik D.; Steinhoff D.; Klein K.; Lichtenberg A.; Ballazs C.; Stadnik D.; Scherner M.; Antoch G.; Kelm M.; Zeus T.; Jung C. Institution (Kanschik, Steinhoff, Klein, Kelm, Zeus, Jung) Department of Cardiology, Pulmonology, Vascular Medicine, Medical Faculty (D.K., D. Steinhoff, K.K., University Hospital and Heinrich-Heine University, Germany (Lichtenberg, Ballazs, Stadnik, Scherner) Department of Cardiac Surgery, Medical Faculty (A.L., C.B., D. Stadnik, University Hospital and Heinrich-Heine University, Germany (Lichtenberg, Kelm, Zeus, Jung) Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty, Heinrich-Heine University, Germany (A.L., Germany (Antoch) Department of Diagnostic and Interventional Radiology, Medical Faculty (G.A.), University Hospital and Heinrich-Heine University, Germany Abstract BACKGROUND: Accurate preprocedural planning is crucial for a successful transcatheter aortic valve implantation to ensure patient safety and valve longevity. Through 3-dimensional visualization, virtual reality (VR) offers the potential to enhance this process. The study investigated whether the inclusion of VR in preprocedural planning can improve the procedural preparation, impact intraprocedural parameters, and improve short-term patient outcomes. METHOD(S): This randomized, prospective, controlled study included 140 patients who underwent transcatheter aortic valve implantation at the University Hospital Duesseldorf between April and August 2024. In the control group, preprocedural planning was based on multislice computed tomography data using 3mensio software, while in the intervention group, it was supplemented with VR software. In addition, interventionalists assessed both tools via a structured questionnaire. RESULT(S): The evaluation did not reveal any relevant differences in patient characteristics. VR was superior to 3mensio software with respect to the 3-dimensional understanding (P<0.001). Similarly, depth perception, visualization of atherosclerotic plaques, and iliofemoral tortuosity were better in the VR group. Both methods were found to be useful and helpful in preparing for the procedure. There were no significant differences in procedural data between the 2 groups. However, the VR group had a lower rate of bleeding at the access site (P<0.05). There was no significant difference in the length of hospital stay or postprocedural transthoracic echocardiography data evaluations. CONCLUSION(S): The data show that virtual reality visualization can optimize preparation for the procedure by improving the 3-dimensional understanding of the aortic valve and adjacent structures. The detailed visualization of the access routes can lead to a reduction in periprocedural complications. <76> Accession Number 2045150490 Title P199. Outcomes, Survival, Mortality, and Major Adverse Events in Aortic Valve Replacement Surgeries in Africa: A Systematic Review and Meta-analysis. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S315-S317), 2026. Date of Publication: 01 May 2026. Author Effiom V.; Femi-Lawal V.; Oak A.; Oyesola O.; Ahmed F.; Fodop S.; Anayo M.; Anyinkeng A.; Ibekwe J.; Olalekan K.; Girma S.; Daniel B.; Kilic A. Institution (Effiom) University Of Calabar, Cross River State, Nigeria (Femi-Lawal, Oyesola, Anayo, Ibekwe, Olalekan) University Of Ibadan, Ibadan, Nigeria (Oak) Johns Hopkins School Of Medicine, Baltimore, MD, United States (Ahmed) University Of Nairobi, Nairobi, Kenya (Fodop) Catholic University Of Cameroon, Bamenda, Cameroon (Anyinkeng) University Of Buea, Buea, Cameroon (Girma) Addis Ababa University, Addis Ababa, Ethiopia (Daniel) University Of Health And Allied Sciences, Ho, Ghana (Kilic) Johns Hopkins University, Baltimore, MD, United States Publisher Elsevier Inc. Abstract Objectives: Aortic valve replacement (AVR) is the definitive treatment for severe aortic valve disease. However, comprehensive outcome data from the African continent remain scarce. This systematic review and meta-analysis aimed to assess survival rates, mortality, and major adverse events following AVR across Africa. Method(s): This study adhered to PRISMA guidelines for systematic review and meta-analysis. We searched PubMed, Embase, and Web of Science for studies reporting AVR outcomes in African populations. Data extraction was conducted. Outcomes analysed included survival, mortality, echocardiographic improvements, and valve- or procedure-related complications. Result(s): Of 571 studies, 21 studies involving 1303 patients across six countries were included; 15 studies were from Egypt. The mean age was 60.4 years, with 43.3% female participants. Aortic stenosis (70.4%) and Aortic regurgitation (64.0%) were the predominant diagnoses. Surgical approaches comprised conventional AVR (45.1%), minimally invasive AVR (27.8%), and transcatheter implantation (27.1%). Technical success rate was high (97.5%-100%). Echocardiography demonstrated significant reduction in mean pressure gradient (SMD -3.64, 95% CI -5.05 to -2.23), whilst changes in ejection fraction and valve area were not statistically significant. Complications included arrhythmias (15.2%), post-operative bleeding (13.1%), paravalvular leak (5.7%), pacemaker requirement (6.1%), stroke (4.4%), and myocardial infarction (3.0%). Reoperation rate was 4.4%. Thirty-day mortality was 5.0% (95% CI 3.1-8.1%), with one-year and five-year survival of 93.2% and 91.0%, respectively. Conclusion(s): AVR outcomes in Africa show favourable success rate and survival comparable to global standards, despite resource constraints. While technical proficiency in established centres is evident, notable complications including arrhythmias and post-operative bleeding underscore the need for enhanced perioperative protocols. The marked geographical concentration of data, particularly Egypt, reveals critical disparities in cardiac surgical infrastructure across the continent. Addressing these inequities requires coordinated investment in training programmes, sustainable financing mechanisms, and establishment of regional centres of excellence through strategic partnerships between governments, international organisations, and healthcare stakeholders. [Formula presented] STRUCTURAL HEART: Aortic Valve / TAVR. Copyright © 2026 <77> Accession Number 2044829360 Title Intercostal nerve cryoablation for postoperative analgesia in open thoracic surgical procedures: a GRADE-assessed systematic review and meta-analysis. Source Cardiothoracic Surgeon. 34(1) (no pagination), 2026. Article Number: 16. Date of Publication: 01 Dec 2026. Author Hamza M.; Shah S.Z.; Saqib H.W.; Altaf H.; Khalid A.A.; Shahid S.R.; Singh A.; Khurshid M.M.; Chaudhry I.U.H. Institution (Hamza, Chaudhry) Muzaffarabad General Hospital, AJK, Muzaffarabad, Pakistan (Shah) Frontier Medical and Dental College, Abbottabad, Pakistan (Saqib) Islamic International Medical College, Rawalpindi, Pakistan (Altaf) Combined Military Hospital CMH, AJK, Muzaffarabad, Pakistan (Khalid) Peshawar Medical College, Peshawar, Pakistan (Shahid) Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan (Singh) Southampton General Hospital, University Hospital Southampton United Kingdom, Southampton, United Kingdom (Khurshid) Anglia Ruskin University Chelmsford, Chelmsford, United Kingdom Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: Major open thoracic surgery is associated with severe postoperative pain and substantial opioid requirements, contributing to pulmonary complications and delayed recovery. Thoracic epidural analgesia (TEA) remains the standard regional technique but is frequently contraindicated or associated with complications in high-risk cardiothoracic patients. Intraoperative intercostal nerve cryoablation (CRYO) has emerged as a potential opioid-sparing alternative; however, its effectiveness across diverse thoracic surgical indications remains uncertain. Method(s): A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane Library were searched from inception to January 5, 2026 for randomized and observational studies evaluating intraoperative CRYO in adult patients undergoing major open thoracic surgery. Comparators included standard multimodal analgesia and TEA. Random-effects models were applied, and certainty of evidence was assessed using GRADE. Result(s): Eight studies comprising nine independent cohorts (n = 825) were included. CRYO significantly reduced cumulative inpatient opioid consumption compared with control strategies (SMD - 0.86; 95% CI - 1.57 to - 0.15) and improved early postoperative pain scores (MD - 0.74; 95% CI - 1.45 to - 0.03). Pulmonary function recovery was significantly enhanced (SMD 0.61; 95% CI 0.20 to 1.01), with consistent effects across surgical indications. Conclusion(s): Intraoperative intercostal nerve cryoablation is associated with no significant increase in reported complications and is an effective opioid-sparing adjunct that improves early pain control and pulmonary recovery following major open thoracic surgery. Its clinical benefits are procedure-dependent, with greatest impact observed outside the lung transplantation population. CRYO represents a viable alternative to neuraxial analgesia, particularly in patients at elevated risk for epidural-related complications. Copyright © The Author(s) 2026. <78> Accession Number 2045150105 Title P189. Early Aortic Valve Replacement in Asymptomatic Severe Aortic Stenosis: A Meta-Analysis of Time-to-Event Data of Randomized Controlled Trials. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S309-S310), 2026. Date of Publication: 01 May 2026. Author Sa M.P.; Consoli L.; Neves G.; Camarotti T.; Napoli F.; Polanco A.; Brozzi N.; Navia J. Institution (Sa, Napoli, Polanco, Brozzi, Navia) Cleveland Clinic Florida, Weston, FL, United States (Consoli) UFBA, Salvador, BA, Brazil (Neves) UEPA, Belem, PA, United States (Camarotti) UPE, PE, Recife, Brazil Publisher Elsevier Inc. Abstract Objective: Aortic valve replacement (AVR) for symptomatic patients with severe aortic stenosis (AS) has been recommended by current guidelines, but intervention in asymptomatic patients remains a matter of debate (class IIa). Recent randomized controlled trials (RCTs) have afforded new insights into this topic. Method(s): We performed a systematic review and meta-analysis of RCTs comparing AVR with watchful waiting in patients with asymptomatic. Pubmed/MEDLINE, EMBASE, Web of Science and Cochrane databases (inception to September 2025) were searched. Separate meta-analyses were conducted with reconstructed time-to-event data from published Kaplan-Meier curves to assess patient-relevant outcomes. Result(s): Four RCTs met our eligibility criteria, including 1427 patients (719 randomized to early AVR, and 708 randomized to watchful waiting). The early AVR group demonstrated a significant reduction in all-cause mortality (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.54-0.98, P=0.037), cardiovascular mortality (HR 0.54, 95%CI 0.35-0.86, P=0.009), unplanned CV or HF-related rehospitalization (HR 0.41, 95% CI 0.32-0.51, P<0.001) and heart failure hospitalization (HR 0.42, 95% CI 0.33-0.53, P<0.001). The cumulative conversion rates to AVR in the watchful-waiting group were 42.8 % at 1 year, 82.3 % at 3 years, and 94.9 % at 5 years, with a median time to conversion of 13.4 months. Conclusion(s): Our findings suggest that early AVR is associated with reduction of mortality and hospitalization in patients with asymptomatic AS and current guidelines should be revised (early AVR should be considered a class I indication for this group of patients). [Formula presented] STRUCTURAL HEART: Aortic Valve / TAVR. Copyright © 2026 <79> Accession Number 2045150067 Title 119. Randomized Trial of Tricuspid Flexible Band Versus Rigid Ring in Patients with Moderate and Above Tricuspid Regurgitation: Results of the JPH2019 Trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S77-S78), 2026. Date of Publication: 01 May 2026. Author Xu X.; Gu J.; Liu H.; Shao Y. Institution (Xu, Gu, Liu, Shao) The First Affiliated Hospital of Nanjing Medical University, Jiangsu, Nanjing, China Publisher Elsevier Inc. Abstract Objective: To compare the efficacy and long-term outcomes of flexible band versus rigid ring annuloplasty for the correction of moderate and above tricuspid regurgitation (TR). Method(s): From January 2021 to June 2024, a prospective, randomized controlled clinical trial (NCT04093297) was conducted to allocate adult patients with moderate and above TR to receive either a flexible band or a rigid ring. The primary outcome was recurrent TR (>= moderate) during follow-up. Secondary outcomes included mortality, pacemaker implantation, and other adverse events. Result(s): A total of 400 patients were randomized, with 200 in each group. After eligibility review, 321 patients were included in the final analysis (155 flexible band, 166 rigid ring). The ring size in the flexible band group was significantly larger than that in the rigid ring group [29 (28~30) vs 27 (27~29), p<0.001]. There was no statistical difference in other baseline data between the two groups. At discharge, flexible band annuloplasty showed a significantly higher risk of recurrent TR [10.1% (15/148) vs 3.8% (6/159), relative risk (RR): 2.686, 95% confidence interval (CI): 1.070~6.739, p=0.027]. Multivariate analysis indicated preoperative moderate to severe and above TR was the only independent risk factor (odds ratio: 4.304, 95%CI: 1.107~16.743, p=0.035). At a median follow-up of 2.8 years, there was no statistical difference in recurrent TR between the groups [16.8% (26/155) vs 12.0% (20/166), hazard ratio (HR): 1.438, 95% CI: 0.803~2.576, p=0.222]; Sensitivity analysis, which excluded patients with recurrent TR at discharge, showed no statistical difference in the primary outcome [7.9% (11/140) vs 8.8% (14/160), HR: 0.892, 95% CI: 0.405~1.966, p=0.778]. Kaplan-Meier survival analysis showed the mortality of the two groups was comparable [7.1% (11/155) vs 6.0% (10/166), HR:1.162, 95%CI: 0.493~2.735, p=0.732] during follow-up. There was also no statistical difference between the groups in pacemaker implantation and other adverse events. Conclusion(s): Patients in the flexible band group exhibited a markedly higher incidence of recurrent TR at discharge. However, multivariate analysis indicated that ring type was not an independent risk factor. During follow-up, both ring annuloplasty methods provided acceptable results in correcting TR, with comparable rates of adverse events. ADULT CARDIAC: Mitral and Tricuspid Valve Copyright © 2026 <80> Accession Number 2044912205 Title Clinical Applications of Artificial Intelligence in Structural Heart Disease. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(4) (no pagination), 2026. Article Number: 104396. Date of Publication: 01 Apr 2026. Author Allaham H.; Chahal D.; Srivastava M.; Aalaei-Andabili S.H.; Gupta A. Institution (Allaham, Chahal, Srivastava, Aalaei-Andabili, Gupta) Division of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore, MD, United States Publisher Elsevier B.V. Abstract Transcatheter cardiac interventions have advanced substantially over the past decade, providing less invasive therapeutic options for an expanding spectrum of structural heart disease. As procedural complexity increases, artificial intelligence (AI) has emerged as a complementary tool to support clinical decision making. Early studies demonstrated that AI can automate imaging analysis, quantify cardiac anatomy, and assess hemodynamics with greater accuracy, efficiency, and reproducibility than conventional methods. This comprehensive review summarizes current clinical applications of AI in structural heart disease, focusing on its role in diagnosis, assessment of disease progression, risk stratification, procedural planning, and prediction of clinical outcomes. Copyright © 2026 The Author(s). <81> Accession Number 2045150493 Title 125. Posterior Left Pericardiotomy for the Prevention of New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: A Pilot Randomized Controlled Trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S83-S84), 2026. Date of Publication: 01 May 2026. Author Osmanaj F.; Yang X. Institution (Osmanaj, Yang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China Publisher Elsevier Inc. Abstract Objective: New-onset postoperative atrial fibrillation (POAF) is a common and costly complication after off-pump coronary artery bypass grafting (OPCABG). While posterior left pericardiotomy (PLP) is effective in reducing POAF in on-pump surgery, its efficacy and safety in OPCABG remain unproven. The absence of cardiopulmonary bypass may alter pericardial fluid dynamics and inflammation, potentially influencing POAF pathogenesis. This pilot randomized controlled trial (RCT) aimed to evaluate PLP specifically in the OPCABG population. Method(s): A single-center RCT was conducted. Seventy-seven patients scheduled for elective, isolated OPCABG without atrial fibrillation history were enrolled. Patients were randomized to either the PLP group (n=33), receiving a 4-5 cm incision in the posterior pericardium, or the control group (n=44), receiving standard care. The primary endpoint was the incidence of POAF (episode >=30 seconds) within the first 7 postoperative days. Secondary endpoints included postoperative pericardial effusion, major adverse cardiac and cerebrovascular events (MACCE), and hospital length of stay (LOS). Result(s): The cohort's median age was 63.0 years, with 27% females. Baseline characteristics were balanced. Protocol adherence was complete. The primary endpoint of POAF occurred in 12.5% (4/33) of the PLP group, compared to 27.3% (12/44) in the control group (adjusted odds ratio 0.45; 95% CI 0.30-0.65; p < 0.05), representing a 55.4% relative risk reduction. PLP completely prevented significant postoperative pericardial effusion (0% vs. 20.5% in controls; p=0.005). The procedure added a median of 8 minutes to operative time. Consequently, the median hospital LOS was significantly shorter in the PLP group (5 days vs. 6 days; p=0.04). MACCE rates were low and comparable (3.0% vs. 2.3%). No PLP-specific complications were observed. Conclusion(s): This first pilot RCT demonstrates that posterior pericardiotomy is a safe, feasible, and effective intervention for preventing POAF in patients undergoing OPCABG. It significantly reduced AF incidence, virtually eliminated pericardial effusion, and shortened hospital stay, with minimal added operative time and no related complications. These compelling results justify a larger, definitive trial to confirm efficacy and support its potential integration as a standard adjunct in OPCABG. ADULT CARDIAC: Innovations: New devices or novel approaches, preclinical or clinical Copyright © 2026 <82> Accession Number 2045150795 Title P88. Valve-in-Valve Transcatheter Mitral Valve Replacement versus Redo Surgical Mitral Valve Replacement: A Meta-Analysis. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S243-S244), 2026. Date of Publication: 01 May 2026. Author Sa M.P.; Neves G.; Consoli L.; Iqbal A.; Dexheimer L.; Abraham D.; Camarotti T.; Napoli F.; Polanco A.; Brozzi N.; Navia J. Institution (Sa, Napoli, Polanco, Brozzi, Navia) Cleveland Clinic Florida, Weston, FL, United States (Neves) Universidade Do Estado Do Para, PA, Belem, Brazil (Consoli) UFBA, Salvador, BA, Brazil (Iqbal) University Of Pakistan, Pakistan (Dexheimer) USP, SP, Sao Paulo, Brazil (Abraham) UFAM, AM, Manaus, Brazil (Camarotti) UPE, PE, Recife, Brazil Publisher Elsevier Inc. Abstract Objective: Bioprosthetic mitral valve degeneration is traditionally treated with redo surgical mitral valve replacement (redo-SMVR), but valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) procedure offers a less invasive alternative. Our study aims to compare the outcomes of ViV-TMVR and redo-SMVR. Method(s): We performed a systematic review and meta-analysis of studies comparing ViV-TMVR and redo-SMVR. Pubmed/MEDLINE, EMBASE, Web of Science and Cochrane databases (inception to September 2025) were searched. Separate meta-analyses were conducted with random-effects models to assess patient-relevant outcomes; Kaplan-Meier-derived time-to-event data were pooled to assess late outcomes. Result(s): Thirteen observational studies met our eligibility criteria, including a total of 15941 patients (ViV-TMVR: 5465; Redo-SMVR: 10476). In comparison with redo-SMVR, ViV-TMVR was associated with lower risk of in-hospital mortality (RR 0.72; 95%CI 0.57-0.90; P=0.004), stroke (RR 0.49; 95%CI 0.29-0.83; P=0.008), bleeding (RR 0.43; 95%CI 0.20-0.94; P=0.035), acute kidney injury (RR 0.57; 95%CI 0.42-0.77; P<0.001), permanent pacemaker implantation (RR 0.30; 95%CI 0.19-0.49; P<0.001) and shorter hospital length of stay (mean difference -5.09 days; 95%CI -6.56 - -3.63; P<0.001). We did not find statistically significant differences for the following outcomes: 30-day mortality, vascular complications, atrial fibrillation, left ventricle outflow tract obstruction and mean gradients. Nine studies included longer follow-up with Kaplan-Meier curves and we did not find a statistically significant difference between the groups in terms of 5-year survival (HR 0.92; 95%CI 0.81-1.05; P=0.256); however, the proportional hazards assumption for this endpoint was tested and, since this assumption was not met, a landmark survival analysis was carried out to assess time-dependent treatment effect. The landmark analysis revealed that ViV-TMVR was associated with lower risk of death in the initial 6 months (HR 0.69; 95%CI 0.58-0.83; P<0.001), but a higher risk beyond 6 months (HR 1.47; 95% CI 1.20-1.79; P<0.001). Conclusion(s): In patients amenable to ViV-TMVR, this procedure shows a lower initial risk of death and complications, but higher mortality after 6 months in comparison with redo-SMVR. These findings highlight the importance of striking a balance between surgical risk and estimated life expectancy when selecting interventions.. [Formula presented] STRUCTURAL HEART: Redo-THV (surgery, valve-in-valve, valve-in-ring). Copyright © 2026 <83> Accession Number 2045150916 Title 7. RIMA-SVG versus Ao-SVG in coronary artery bypass grafting: perioperative results of an ongoing prospective randomized single-center, non-inferiority trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S4-S5), 2026. Date of Publication: 01 May 2026. Author Liu K.; Wei R.; He T. Institution (Liu, Wei, He) Second Hospital of Jilin University, Jilin, China Publisher Elsevier Inc. Abstract Objective To evaluate perioperative outcomes from an ongoing randomized trial comparing right internal mammary artery-saphenous vein grafts (RIMA-SVG) with aorta-saphenous vein grafts (Ao-SVG) in patients undergoing off-pump coronary artery bypass grafting (CABG). Methods This study enrolled patients undergoing off-pump coronary artery bypass grafting (CABG). Participants were randomized 1:1 to receive either RIMA-SVG or Ao-SVG. The left internal mammary artery was grafted to the left anterior descending artery in all patients. Saphenous veins were sequentially anastomosed to the right coronary, circumflex, and diagonal arteries. In the RIMA-SVG group, the proximal anastomosis was end-to-side to the RIMA(Figure 1A), whereas in the Ao-SVG group, it was to the ascending aorta. Off-pump CABG was the standard approach, with cardiopulmonary bypass (CPB) used only for intraoperative instability. The primary endpoint was 1-year graft patency assessed by coronary CT angiography. This interim analysis presents perioperative findings, including graft patency, perioperative complications, all-cause mortality, neurological events, and deep sternal wound infection. Results A total of 293 patients were included (RIMA-SVG, n=147; Ao-SVG, n=146)(Figure 1B). Baseline and intraoperative characteristics were comparable. Mean heparinization time was 109.1 +/- 39.7 min in RIMA-SVG and 101.3 +/- 46.5 min in Ao-SVG (p > 0.05). Mean saphenous vein diameter was 3.75 +/- 0.80 mm in RIMA-SVG vs. 4.06 +/- 0.92 mm in Ao-SVG (p > 0.05). Mean total graft flow was significantly lower in RIMA-SVG than Ao-SVG (64.6 +/- 26.8 vs. 78.1 +/- 25.0 mL/min; p < 0.001), though individual coronary flows were similar. CPB was required in 3.3% and 4.7% of patients (p > 0.05). At discharge, graft occlusion occurred in 1.57% of RIMA-SVG and 1.77% of Ao-SVG cases (p = 0.698), meeting the non-inferiority margin. The incidence of perioperative myocardial infarction (2.7% vs. 2.7%), deep sternal wound infection (4.0% vs. 2.7%), and mortality (0% vs. 0.13%) was similar, while postoperative stroke was significantly lower in the RIMA-SVG group (1.3% vs. 6.8%; p = 0.035). Conclusions Early outcomes indicate that the RIMA-SVG strategy achieves perioperative safety and graft performance equivalent to the conventional Ao-SVG technique, with a lower incidence of postoperative stroke. These findings support the feasibility and safety of RIMA-SVG in off-pump CABG. Long-term follow-up for 1-year graft patency is ongoing. [Formula presented] ADULT CARDIAC: Coronary Artery Disease Copyright © 2026 <84> Accession Number 2045150769 Title P87. The First Global Umbrella Review and Meta-Regression of Long-Term Outcomes in Low-Risk Patients Undergoing Transcatheter Versus Surgical Aortic Valve Replacement: Analysis of 526,189 Patients. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S243), 2026. Date of Publication: 01 May 2026. Author Cubas Llalle W.S.; Bagur R.; Dayan V.; Chu M.W.A. Institution (Cubas Llalle, Chu) Western University, London, Canada (Bagur) London Health Sciences Centre, London, Canada (Dayan) Instituto Nacional De Cirugia Cardiaca, Montevideo, Uruguay Publisher Elsevier Inc. Abstract Objective: This study aims to evaluate Transcatheter Aortic Valve Replacement (TAVR) long-term performance in low-risk patients, using data from over 500,000 cases through a global umbrella review and meta-regression to compare outcomes versus Surgical Aortic Valve Replacement (SAVR). Method(s): This first global umbrella review and meta-regression evaluated long-term (>1 year) outcomes of TAVR versus SAVR in 526,189 low-risk patients (2015-2025). Meta-analyses reporting primary (mortality, valve deterioration, stroke, bleeding, pacemaker) and secondary outcomes were systematically identified from PubMed, Embase, Scopus, and Cochrane. AMSTAR-2 assessed quality. Data on study characteristics, effect estimates, and heterogeneity were extracted. Meta-regression examined mortality modifiers. Analyses used R with random/fixed-effects models, I2 statistics, and global review mapping. Result(s): 59 meta-analyses were analyzed (Mean 2.8 years, 1-9 years). The majority was published and was predominantly conducted in the United States (47%), with a mix of industry-funded (15%) and unfunded research (71%). The pooled data demonstrated comparable all-cause mortality between TAVR and SAVR (OR 0.91; RR 0.93, HR 1.07, p<0.001). TAVR presented a Cardiovascular mortality (RR 0.92, 95% CI 0.61-1.38, p=0.037), 60% lower odds of major bleeding (p=0.0008), and halved risk of acute kidney injury (p=0.0001). However, these benefits were offset by the increased risk of permanent pacemaker implantation (OR 2.478, 95% CI 2.29-3.03, p=0.005), and significant valve-related complications, including 2.79-fold higher odds of valve deterioration (p=0.005) and a 3.67-fold increased risk of moderate-severe paravalvular leak (p=0.0001). Regression analysis demonstrated significant positive slopes for all effect measures (p < 0.05), indicating that the relative benefit of TAVR decreases over time, whereas SAVR outcomes improve progressively over a 3-year follow-up (R2 = 43%, p = 0.00297). Meta-regression shows industry-funded studies report lower mortality (p=0.02), reflecting advanced valves or potential research bias. Conclusion(s): This global synthesis shows TAVR's early benefits in low-risk patients diminish after three years due to valve complications, with long-term durability and outcomes favoring SAVR, emphasizing careful patient selection and follow-up. [Formula presented] STRUCTURAL HEART: Aortic Valve / TAVR. Copyright © 2026 <85> Accession Number 2045150131 Title 126. Impact of Endoscopic vs Open Vein Harvest on 2-Year Saphenous Vein Graft Patency: Prespecified Analysis of the NEWTON-CABG CardioLink-5 Randomized Trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S84), 2026. Date of Publication: 01 May 2026. Author Verma S.; Mazer D.; Leiter L.; Teoh H.; Mancini G.B.J.; Quan A.; Elituv R.; Verma M.; Misner E.; Szarek M.; Saha T.; Yanagawa B.; Juni P.; Koren M.; Nicholls S.; Bhatt D. Institution (Verma, Mazer, Leiter, Yanagawa) University Of Toronto, Toronto, ON, Canada (Teoh, Quan, Elituv, Misner) St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada (Mancini) University Of British Columbia, Vancouver, British Columbia, Canada (Verma) Royal College Of Surgeons In Ireland, Dublin, Ireland (Szarek) CPC Clinical Research, Aurora, CO, United States (Saha) Queen's University, Kingston, ON, Canada (Juni) Oxford University, Oxford, United Kingdom (Koren) Encore Research Group, Jacksonville, FL, United States (Nicholls) Monash University, Melbourne, Australia (Bhatt) Mount Sinai Fuster Heart Hospital, New York, NY, United States Publisher Elsevier Inc. Abstract Objective: Conduit harvest technique may influence saphenous vein graft (SVG) quality, patency, and long-term outcomes. Endoscopic vein harvest (EVH) has been suggested to cause greater vascular trauma than open vein harvest (OVH), potentially compromising graft patency. Whether EVH adversely affects SVG patency remains uncertain. We compared 2-year coronary CT angiography (CCTA) SVG disease rates between EVH and OVH in this prespecified analysis of the NEWTON-CABG CardioLink-5 trial. Method(s): NEWTON-CABG CardioLink-5 was a global, multicentre, double-blind, randomized trial evaluating evolocumab vs. placebo on SVG disease after CABG. Adults with >=2 SVGs were enrolled in Canada, Australia, Hungary, and the U.S. Participants were randomized 3-21 days post-operatively and treated for 24 months with 140 mg evolocumab or placebo every 2 weeks. The primary endpoint was the 24-month vein graft disease rate (>=50% stenosis or occlusion). Secondary endpoints included >=1 occluded graft and total occlusion rate. Since the primary efficacy endpoint was not different between the two treatment groups, the data were pooled for purposes of the current analyses. Result(s): Overall, 782 participants were randomized, 389 to evolocumab and 393 to placebo. Among the 551 participants with primary outcome data, EVH was used in 375 (68%) and OVH in 176 (32%). Baseline characteristics were similar between groups: median age 66 years, 15% female, ~50% with diabetes, baseline LDL-C 1.82 mmol/L (~70 mg/dL), 40% with prior MI, most operations were elective and on cardiopulmonary bypass, and all patients on statins and ASA, one-third on DAPT. Across the 1,324 SVGs analyzed, 2-year graft-level SVG disease occurred in 19.4% (95% CI 15.6-23.8) of OVH vs. 21.5% (18.5-24.9) of EVH grafts (adjusted OR 0.88, 95% CI 0.64-1.21; p = 0.42). SVG total occlusion rates were 14.3% vs 17.0% (OR 0.85, 95% CI 0.60-1.20; p = 0.36). At the patient level, >=1 totally occluded SVG occurred in 30.1% vs 28.5% (OR 1.08, 95% CI 0.73-1.60; p = 0.70). No significant differences were observed across endpoints. Conclusion(s): SVG disease rates were similar between the EVH and OVH groups. EVH was not associated with higher 2-year graft disease or occlusion, supporting its routine use when performed by experienced operators. Despite modern surgical and medical therapy, overall SVG disease rates remain high, underscoring the need for continued conduit-quality and secondary-prevention strategies ADULT CARDIAC: Coronary Artery Disease Copyright © 2026 <86> Accession Number 2045150790 Title P174. Defining Optimal Therapeutic Fluid Window Using the Cardiac Diuretic Responsiveness Index to Reduce AKI After Cardiac Surgery. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S300), 2026. Date of Publication: 01 May 2026. Author Guinn M.; Miles T.; Engelman D.; Moon M.; Coselli J.; Rosengart T.; Li M.; Chatterjee S.; Ghanta R. Institution (Guinn, Miles, Moon, Coselli, Rosengart, Chatterjee, Ghanta) Baylor College Of Medicine, Houston, TX, United States (Engelman) University Of Massachusetts Medical School - Baystate, Longmeadow, MA, United States (Li) Rice University, Houston, TX, United States Publisher Elsevier Inc. Abstract Objective: Oliguria is common after cardiac surgery, yet conventional clinical thresholds lack physiologic specificity and often prompt conflicting management decisions. We hypothesized that quantifying renal responsiveness to diuretics may improve postoperative goal directed fluid therapy. This study evaluated whether the Cardiac Diuretic Responsiveness Index (CDRI; cc/kg/hr/mg furosemide equivalents)-a dose-adjusted measure of early diuretic response-could identify patients in whom targeted post-diuretic fluid administration reduces acute kidney injury (AKI), thereby defining an individualized therapeutic fluid window. Method(s): Time-series data for hemodynamics, fluid balance, medications, and laboratory results were analyzed from 1,795 adult cardiac surgery patients (2017-2022) who received postoperative diuretics and were linked to our institutional STS database. Patients with creatinine > 4 mg/dL, preoperative dialysis, or no postoperative diuretic exposure were excluded. The CDRI was defined as the urine output in the first hour following initial diuretic administration. Cardiac surgery-associated-AKI was defined by KDIGO serum creatinine criteria. Inverse probability of treatment weighing (IPTW) was applied to estimate adjusted odds ratios of AKI in patients within 5 hours post-diuretic, stratified by CDRI thresholds. Result(s): Among oliguric patients with low CDRI values, AKI risk followed a U-shaped pattern across fluid volumes (Figure). Odds ratios were normalized to each group's nadir at 1300 mL, emphasizing relative increases in AKI risk with under- or over-resuscitation. Moderate post-diuretic fluid administration (1,000-1,450 mL) corresponded to the lowest adjusted odds of AKI (OR ~1), whereas fluid restriction and excess were associated with increased risk (OR ~1.5-2). Treatment analysis revealed renal vulnerability and fluid benefit were strongly modulated by diuretic responsiveness, defining a quantifiable therapeutic fluid window that lowered AKI risk. Conclusion(s): In patients with poor diuretic responsiveness, moderate fluid administration following diuresis may paradoxically mitigate AKI risk. The CDRI offers a physiologic, dose-adjusted framework for tailoring goal directed postoperative fluid therapy beyond conventional urine output thresholds. These findings define a response-dependent, precision-guided strategy for fluid management after cardiac surgery, linking individualized renal responsiveness to AKI prevention. [Formula presented] PERIOPERATIVE CARE: Critical Care (Cardiogenic Shock (non-MCS), All Post-operative Care). Copyright © 2026 <87> Accession Number 2045150750 Title 75. Efficacy of In-line Intravenous Filtration in Reducing Systemic Inflammatory Response Syndrome After Adult Cardiac Surgery: A Randomized Controlled Trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S49), 2026. Date of Publication: 01 May 2026. Author Kantathut N.; Chanvaranyu P.; Khajarern S.; Leelayana P.; Cherntanomwong P. Institution (Kantathut, Chanvaranyu, Khajarern, Leelayana, Cherntanomwong) Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Publisher Elsevier Inc. Abstract Objective: Particulate emboli introduced perioperatively during cardiac surgery through intravenous infusions of drugs, fluids, and nutrients may exacerbate systemic inflammation and contribute to systemic inflammatory response syndrome (SIRS), organ dysfunction, and adverse outcomes. In-line intravenous filtration effectively removes microparticles, air, and microorganisms from infusion solutions, and pediatric studies have shown that it reduces SIRS and major complications. This study aimed to evaluate the efficacy of in-line intravenous filtration in reducing the incidence of SIRS, organ dysfunction, and postoperative complications in adults undergoing cardiac surgery. Method(s): We conducted a single-center, prospective, triple-blind, randomized controlled trial (NCT03784521). Adults undergoing elective coronary artery bypass grafting and/or valve surgery were randomized 1:1 to receive in-line intravenous filtration for all perioperative infusions or standard intravenous therapy without filtration. The primary endpoint was the incidence of SIRS within 96 hours postoperatively. Secondary endpoints included organ dysfunction defined by Sepsis-3, Sequential Organ Failure Assessment (SOFA) scores, and major complications. Result(s): A total of 474 patients were analyzed (231 filter group, 243 control group). Baseline characteristics were comparable between groups. The incidence of SIRS did not differ significantly between the filter and control groups (77.5% vs. 83.5%, p = 0.096). Both SIRS and SOFA scores decreased over time in both groups, with no significant differences at any time point. Rates of organ dysfunction were similar (15.6% vs. 16.9%, p = 0.704). Major complications and mortality also showed no difference. Mixed-effects regression confirmed a time-dependent decline in SIRS (-0.55 per 24 hours; 95% CI -0.69 to -0.40; p < 0.001), but filtration had no independent effect (-0.01; 95% CI -0.18 to 0.16; p = 0.900). Younger age and diabetes mellitus were independently associated with a higher risk of SIRS. Conclusion(s): In-line intravenous filtration during adult cardiac surgery did not reduce SIRS, organ dysfunction, or complications compared with standard care, in contrast to the benefits previously demonstrated in pediatric populations. [Formula presented] PERIOPERATIVE CARE: Critical Care (Cardiogenic Shock (non-MCS), All Post-operative Care) Copyright © 2026 <88> Accession Number 2045150816 Title P176. Effectiveness of Regional Analgesic Techniques in Cardiac Surgery: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S301), 2026. Date of Publication: 01 May 2026. Author Al Matairi A.; Hammadeh B.; Abuhashem O.; Aldeeb O.; Zamel M.; Al Najjar B.; Abdeljalil R. Institution (Al Matairi, Hammadeh, Aldeeb, Al Najjar, Abdeljalil) Reading Hospital, Amman, Jordan (Abuhashem) Jordan University Of Science And Technology, Irbid, Jordan (Zamel) University Of Jordan, Amman, Jordan Publisher Elsevier Inc. Abstract Objective: This study aimed to compare the effectiveness of various regional analgesic techniques in reducing postoperative pain and opioid consumption following cardiac surgery and to determine the relative performance of these techniques across different postoperative phases. Method(s): A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA-NMA guidelines. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed up to August 2025. Eligible studies included adults undergoing cardiac surgery via median sternotomy or minimally invasive approaches. Interventions included regional blocks (ESPB, PIFB, TTPB, SAPB, thoracic epidural, paravertebral, or local infiltration) versus patient-controlled intravenous opioid analgesia (PCIA) or placebo. Primary outcomes were postoperative pain (VAS) and opioid consumption; secondary outcomes included rescue analgesia, chronic pain, and ICU/hospital stay. Comparative efficacy was assessed using a Bayesian network model, and SUCRA values ranked interventions. Result(s): A total of 55 randomized controlled trials, including 4,872 patients undergoing cardiac surgery, were included in the analysis. In the early postoperative phase (1-4 hours), ultrasound-guided transversus thoracis plane block (UG-TTMPB) ranked highest for analgesic efficacy (SUCRA = 0.000-0.172), followed by erector spinae plane block (ESPB). In the intermediate phase (6-12 hours), UG-ESPB was most effective at 6 and 8 hours (SUCRA 0.081 and 0.024), while TTPB led at 12 hours (SUCRA 0.119). During the late phase (16-48 hours), PIFB and SAPB provided superior prolonged analgesia, with interpectoral block (IPB) ranking first at 24 and 48 hours. The control (PCIA) group consistently ranked lowest across all time points. For renal outcomes, TTPB and TTMPB were associated with the greatest urine output (SUCRA 0.734 and 0.628, respectively), suggesting improved hemodynamic stability. Conclusion(s): Regional analgesic techniques-particularly ultrasound-guided TTMPB, ESPB, PIFB, and SAPB-offer superior and sustained analgesia compared with opioid-based regimens after cardiac surgery. Their use may enhance postoperative recovery and maintain renal function without increasing complications. Supporting Document: [Formula presented] [Formula presented]. PERIOPERATIVE CARE: Critical Care (Cardiogenic Shock (non-MCS), All Post-operative Care). Copyright © 2026 <89> Accession Number 2044785736 Title Comparative Analysis of Early Stroke Risk in Transcatheter Versus Surgical Aortic Valve Replacement in Elderly Patients. Source Journal of Interventional Cardiology. 2026(1) (no pagination), 2026. Article Number: 5850249. Date of Publication: 2026. Author Al Hooti J.; Mohammed M.; Gupta R.; MacKenzie A. Institution (Al Hooti, Mohammed) School of Medicine, University College Dublin, Dublin, Ireland (Gupta) School of Medicine, University of Edinburgh, Edinburgh, United Kingdom (MacKenzie) School of Medicine, University of Limerick, Limerick, Ireland Publisher John Wiley and Sons Inc Abstract Background and Aims: Transcatheter aortic valve replacement (TAVR) is an innovative treatment option for patients with severe symptomatic aortic stenosis. However, an analysis of cerebrovascular risk post-TAVR compared to surgical aortic valve replacement (SAVR) in elderly patients has not been established. Method(s): We performed a systematic review and meta-analysis of randomised controlled trials and observational studies by conducting a comprehensive literature search in multiple digital databases to compare the 30-day and 1-year cerebrovascular risk in elderly patients undergoing TAVR or SAVR. Result(s): Our search yielded 12 studies with a total of 12,457 patients, with 7247 and 5210 in the TAVR and SAVR groups, respectively. A statistically significant reduction in cerebrovascular risk was observed at the 30-day follow-up for patients undergoing TAVR compared to SAVR (OR 0.74; 95% CI 0.55-0.99; p = 0.02, N = 12,231). Likewise, at the 1-year follow-up, TAVR demonstrated a statistically significant reduction in cerebrovascular risk compared to SAVR (OR 0.77; 95% CI 0.62-0.96; p = 0.02, N = 12,457). Meta-regression analysis revealed that prior myocardial infarction, prior percutaneous coronary intervention and a pre-existing pacemaker were associated with attenuation of the stroke risk advantage of TAVR at 30 days post-op. Similarly, prior myocardial infarction and pre-existing pacemakers were identified as risk factors at 1 year. Conclusion(s): This review and meta-analysis highlight the significant difference in the risk of cerebrovascular events between TAVR and SAVR. However, pre-existing conditions modify these differences, underscoring the necessity of patient selection and risk stratification to optimise clinical outcomes. Copyright © 2026 Jubran Al Hooti et al. Journal of Interventional Cardiology published by John Wiley & Sons Ltd. <90> Accession Number 2045126179 Title Drug-Coated Balloons Versus Drug-Eluting Stents for Side Branch Lesions in Coronary Bifurcations: An Updated Comparative Meta-Analysis. Source American Journal of Cardiology. 268 (pp 142-151), 2026. Date of Publication: 01 Jun 2026. Author Quevedo-Candela F.; Cieza T.; Ruhl A.; Nolte C.; Bertrand O.F. Institution (Quevedo-Candela, Cieza, Ruhl, Bertrand) Interventional Cardiology - Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec City, Canada (Nolte) Interventional Cardiology - Instituto Nacional Cardiovascular (INCOR), Lima, Peru Publisher Elsevier Inc. Abstract The management of side branch (SB) lesions in true coronary bifurcations remains controversial, particularly regarding long-term risks associated with metallic implants. Drug-coated balloons (DCB) have emerged as an alternative to drug-eluting stents (DES), offering a scaffold-free approach that may simplify percutaneous coronary intervention (PCI) and reduce adverse events. We performed a systematic review and meta-analysis of randomized and observational studies directly comparing placlitaxel DCB and limus-eluting DES for SB treatment. The primary endpoint was major adverse cardiac events (MACE) including cardiovascular death, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR); secondary endpoints included target lesion revascularization, binary restenosis, myocardial infarction, and all-cause or cardiovascular mortality. Risk of bias was assessed using RoB 2 and Newcastle-Ottawa tools. Five studies (n = 898) were included. In pooled random-effects analyses, DCB use was associated with a significant reduction in MACE (odds ratio 0.48, 95% confidence interval 0.27 to 0.81; p = 0.008) and target lesion revascularization (odds ratio 0.35, 95% confidence interval 0.19 to 0.68; p = 0.001). Late lumen loss was significantly lower with DCB across studies. In conclusion, placlitaxel DCBs therefore appeared to be an effective alternative to DES for SB lesions in true bifurcations. Larger randomized trials are still required to confirm these findings and clarify their role in bifurcation (side branch) PCI. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <91> Accession Number 2038005086 Title Prognostic value of myocardial work indices measured on echocardiography in patients with aortic stenosis undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Source Pakistan Journal of Medical Sciences. 42(4) (pp 1042-1050), 2026. Date of Publication: 01 Apr 2026. Author Zhou J.; Liu R.; Chen F.; Chen Y.; Xiao Q.; Yu Y. Institution (Zhou, Liu, Chen, Chen, Xiao, Yu) Department of Ultrasound, The First Hospital of Jiaxing, Zhejiang Province, Jiaxing, China Publisher Professional Medical Publications Abstract Background & Objective: Myocardial work (MW) indices offer an afterload-adjusted assessment of left ventricular (LV) function and may improve risk stratification in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This systematic review and meta-analysis aimed to evaluate the prognostic significance of MW indices, global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), in patients with severe AS undergoing TAVR. Methodology: PubMed, Embase, Web of Science, and Scopus were searched from inception to 26 November 2025 for studies assessing prognostic value of MW indices in TAVR-treated AS patients. Data were synthesised qualitatively, and a random-effects meta-analysis was performed when at least three studies reported comparable effect estimates. Result(s): Five cohort studies met the inclusion criteria. Across studies, GWI consistently demonstrated strong prognostic performance. Lower post-TAVR GWI predicted mortality in multiple cohorts, with thresholds ranging from 1,095 to 1,234 mmHg% and area-under-the-curve values up to 0.71. Pooled analysis confirmed that higher GWI was associated with reduced mortality (HR: 0.94 95% CI: 0.90, 0.98 I2=68% p=0.004). GCW showed modest prognostic value, whereas GWW was not independently predictive. GWE was a significant predictor in select studies, but mostly in univariate models. Conclusion(s): Limited evidence shows that MW indices, especially GWI, may provide meaningful prognostic information in AS patients undergoing TAVR. Further studies are needed to improve the evidence. Copyright © 2026, Professional Medical Publications. All rights reserved. <92> Accession Number 650961261 Title Outcomes of off-pump versus on-pump coronary artery bypass grafting in diabetic patients: A propensity-adjusted systematic review and meta-analysis. Source Asian cardiovascular & thoracic annals. (pp 2184923261437937), 2026. Date of Publication: 20 Apr 2026. Author Murad Z.A.; Lahcen A.A.; Alkhawam M.; Al-Awadh M.F.; Ali M.; Saeed S.A.S.; Elghazaly S.M. Institution (Murad) University of Aden Faculty of Medicine and Health Science, Aden, Yemen (Lahcen) Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco (Alkhawam) University of Alabama at Birmingham, Birmingham, AL, United States (Al-Awadh) University of Bahri, Sudan (Ali, Elghazaly) Faculty of Medicine, Assiut University, Egypt (Saeed) Ibn Sina University, Khartoum, Sudan Abstract ObjectiveDiabetes is a major risk factor for coronary artery disease. We compared outcomes of off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass grafting in diabetic patients using propensity-adjusted observational studies.MethodsWe searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing OPCAB and ONCAB in diabetic patients using propensity-score matching or covariate adjustment. Eligible studies reported short-term or long-term clinical outcomes. Primary endpoints were early (in-hospital or 30-day) mortality and long-term survival. Secondary outcomes included stroke, myocardial infarction, reoperation for bleeding, atrial fibrillation, renal replacement therapy, low cardiac output syndrome, and completeness of revascularization. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models.ResultsNine studies (observation periods 1996-2021), including >10,000 diabetic patients, met criteria. There was no significant difference in early mortality between OPCAB and ONCAB (OR 0.71, 95% CI 0.44-1.14; P = .15). Long-term mortality was significantly higher with OPCAB (HR 1.16, 95% CI 1.01-1.33; P = .04), while mid-term survival showed no difference. OPCAB was associated with lower risks of stroke (OR 0.47, 95% CI 0.24-0.94; P = .03) and reoperation for bleeding (OR 0.60, 95% CI 0.41-0.88; P = .009), but higher risks of incomplete revascularization (OR 2.07, 95% CI 1.60-2.68; P < .00001) and atrial fibrillation (OR 1.70, 95% CI 1.16-2.47; P = .006).ConclusionsIn diabetic patients undergoing CABG, OPCAB lowers stroke and bleeding risk but increases incomplete revascularization and is associated with significantly higher long-term mortality. Choice of technique should be individualized with emphasis on complete revascularization. <93> Accession Number 2045138279 Title Anticoagulation Monitoring Strategies During Cardiopulmonary Bypass in Patients With Antiphospholipid Syndrome: A Systematic Review. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Yoshida S.; Ishida O.; Tsutsumi K. Institution (Yoshida, Ishida, Tsutsumi) Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan Publisher W.B. Saunders Abstract Objectives: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder that complicates anticoagulation during cardiovascular surgery requiring cardiopulmonary bypass (CPB). This systematic review aimed to characterize the anticoagulation monitoring strategies reported during CPB in patients with APS and to identify recurring limitations and clinical patterns rather than to assess comparative efficacy between management approaches. Design(s): Systematic review of published clinical studies. Setting(s): Hospital-based cardiovascular surgery and perioperative care settings, including single- and multi-institutional reports. Participant(s): Patients with a confirmed diagnosis of APS who underwent cardiac or cardiovascular surgery using CPB with heparin anticoagulation. Intervention(s): Intraoperative anticoagulation strategies during CPB, including activated clotting time (ACT)-based monitoring and adjunctive strategies such as heparin concentration monitoring (Hepcon), anti-factor Xa assays, and viscoelastic testing. Measurements and Main Results: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant search of PubMed, Scopus, and the Cochrane Library identified 66 studies, of which 17 met the inclusion criteria. ACT monitoring was reported in 25 patients, Hepcon-guided heparin concentration monitoring in 25, and heparin-ACT titration in 1; most studies used multimodal monitoring approaches. Among 62 patients, 15 perioperative complications were reported, predominantly from a single cohort study that contributed the majority of quantitative outcome data. The aggregated data illustrated the heterogeneous use of monitoring strategies and recurrent concerns regarding the reliability of ACT alone. Conclusion(s): Anticoagulation monitoring during CPB in patients with APS remains heterogeneous and insufficiently standardized. The available evidence does not permit conclusions regarding comparative efficacy among monitoring strategies. Instead, this review highlights recurrent limitations of ACT-based monitoring and the heterogeneous use of adjunctive modalities in reported cases, providing a conceptual framework to inform future prospective investigations. Copyright © 2026 The Author(s) <94> Accession Number 2044848096 Title Preoperative Educational Video Viewing is Associated with a Reduced Incidence of Subconjunctival Hemorrhage Following Intravitreal Anti-VEGF Injection. Source Patient Preference and Adherence. 20 (no pagination), 2026. Article Number: 583463. Date of Publication: 2026. Author Cai H.; Xu J.; He J.; Sui A.; Zhang P.; Tang Y.; Ding J.; Hua P.; Zheng W.; Su M.; Ye P.; Fang X.; Zheng F. Institution (Cai, Xu, He, Sui, Zhang, Tang, Ding, Hua, Zheng, Su, Ye, Fang, Zheng) Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou, China (Cai, Zhang, Tang, Ding, Hua) Nursing Unit, Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China Publisher Dove Medical Press Ltd Abstract Objective: To assess whether preoperative viewing of an educational procedural video reduces the incidence and severity of subconjunctival hemorrhage (SCH) following intravitreal anti-VEGF injections (IVI), and improves patient experience. Method(s): In this surgeon-blind randomized controlled trial conducted at a single tertiary care center (NCT07002372), treatment-naive patients scheduled for their first IVI were prospectively enrolled and randomized to either an intervention group (video viewing) or a control group (no video viewing). All participants completed the State-Trait Anxiety Inventory-State (STAI-S) before and after the injection. SCH incidence and area were assessed via standardized post-injection photographs analyzed using ImageJ software. Additional outcomes included patient-reported pain scores, heart rate, procedure time, and surgeon-rated cooperation. Result(s): A total of 108 patients were enrolled, of whom 103 completed the study, which was fewer than the initially planned sample size. Baseline demographics were similar between groups. SCH occurred in 21/51 (41.2%) patients in the intervention group versus 36/52 (69.2%) in the control group (P = 0.004), though SCH area did not differ significantly. Logistic regression analysis revealed that the use of anticoagulant medication was positively associated with the occurrence of SCH (OR = 3.252; 95% CI, 1.166-9.071; P = 0.024), whereas watching an educational video prior to IVI was associated with a lower risk of SCH (OR = 0.275; 95% CI, 0.115-0.656; P = 0.004). Anxiety scores decreased post-procedure in both groups. In the intervention group, anxiety decreased modestly after video viewing (28.54 +/- 10.40 to 27.00 +/- 8.78, P = 0.052). Patients rated the video as helpful for understanding (8.75/10), calming nerves (8.44/10), and improving cooperation (8.55/10). No significant differences were observed in pain scores, heart rate, procedure time, or surgeon-rated cooperation. Conclusion(s): Preoperative procedural video viewing reduces the incidence of SCH and improves patients' understanding of IVI. Given its simplicity and ease of implementation, this approach may serve as a practical adjunct to enhance patient experience in clinical practice. Copyright © 2026 Cai et al. <95> Accession Number 650959748 Title Effect of preoperative respiratory prehabilitation on cardiopulmonary function in patients undergoing lung resection for non-small cell lung cancer: a randomized controlled trial. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 20 Apr 2026. Author Huang F.; Kong P.; Liu J.; Wang C.; Xia P.; Pan L.; Jin Y.; Hu H.; Zhang X. Institution (Huang, Wang, Pan, Jin, Hu, Zhang) Department of Nursing, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China (Kong, Xia) Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China (Liu) Department of Nursing, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China Abstract BACKGROUND: Preoperative respiratory prehabilitation has attracted increasing attention as a perioperative strategy in thoracic surgery, but evidence regarding its short-term effects on early postoperative functional recovery remains limited. This randomized controlled trial investigated the effect of a 7-day preoperative respiratory prehabilitation program on postoperative pulmonary function, cardiopulmonary exercise capacity, and postoperative complications in patients undergoing curative-intent lung resection for non-small cell lung cancer (NSCLC). METHOD(S): This single-center exploratory randomized controlled trial enrolled 120 patients with suspected NSCLC who were scheduled to undergo curative-intent anatomical lobectomy or wedge resection between January 2025 and November 2025. Patients were randomly assigned in a 1:1 ratio to routine perioperative care alone (control group, n = 60) or routine perioperative care plus a 7-day preoperative respiratory prehabilitation program (intervention group, n = 60). The primary endpoint was pulmonary function on postoperative day 7, assessed by forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Secondary endpoints included within-group preoperative pulmonary function change in the intervention group, cardiopulmonary exercise capacity on postoperative day 7, and postoperative complications. RESULT(S): Baseline characteristics were generally comparable between the two groups. In the intervention group, FEV1, FVC, and PEF were all significantly higher 1 day before surgery than before training (all P < 0.001). At admission, no significant between-group differences were observed in pulmonary function. On postoperative day 7, the intervention group had significantly higher FEV1 (1.86 +/- 0.64 vs. 1.55 +/- 0.48 L, P = 0.003), FVC (2.30 +/- 0.58 vs. 1.78 +/- 0.42 L, P < 0.001), and PEF (4.50 +/- 0.67 vs. 3.85 +/- 0.64 L/s, P < 0.001) than the control group. Cardiopulmonary exercise variables were also higher in the intervention group, including VO2max, VO2/kg, anaerobic threshold, and O2 pulse (all P < 0.001). The postoperative complication rate was numerically lower in the intervention group than in the control group (6.67% vs. 18.33%), although this difference should be interpreted cautiously (P = 0.053). CONCLUSION(S): In this single-center exploratory randomized trial, short-term preoperative respiratory prehabilitation was associated with better pulmonary function and cardiopulmonary exercise capacity on postoperative day 7 in patients undergoing curative-intent lung resection for NSCLC. These findings suggest that short-term respiratory prehabilitation may be a feasible perioperative strategy to support early postoperative functional recovery. TRIAL REGISTRATION: Medical Research Registration and Record Information System of the National Healthcare Security Information Platform, MR-33-25-019022. Copyright © 2026. The Author(s). <96> Accession Number 2045095914 Title Goal-directed perfusion during cardiopulmonary bypass: Physiological rationale, clinical evidence, and critical appraisal. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Mukaida H.; Minami Y. Institution (Mukaida) Graduate School of Medical Science, Juntendo University, Urayasu, Japan (Mukaida, Minami) Department of Clinical Engineering, Juntendo University Hospital, Tokyo, Japan Publisher SAGE Publications Ltd Abstract Objectives: Cardiopulmonary bypass (CPB) is essential to cardiac surgery but is associated with organ injury from non-physiological perfusion. Goal-directed perfusion (GDP) has emerged as a physiology-based strategy to optimize intraoperative perfusion by targeting specific hemodynamic and metabolic parameters, particularly oxygen delivery (DO<inf>2</inf>). This review critically appraises the evidence supporting GDP during CPB, emphasizing comparative strategies, clinical outcomes, and limitations. Method(s): A narrative review of the literature was conducted, incorporating evidence from randomized controlled trials, observational studies, meta-analyses, and international guidelines addressing perfusion strategies during CPB. This review included studies evaluating DO<inf>2</inf>-guided, pressure-guided, and oxygen-metabolic-indicator-guided approaches, focusing on target definitions, outcome measures, and patient populations. Result(s): Randomized and observational studies have consistently demonstrated that maintaining adequate DO<inf>2</inf> levels during CPB is associated with a reduced incidence of cardiac surgery-associated acute kidney injury (CSA-AKI), leading to the guideline endorsement of DO<inf>2</inf>-guided perfusion. In contrast, evidence on neurological outcomes, length of stay, and mortality remains limited and inconsistent. Pressure-guided and venous-oxygen-saturation- or oxygen-metabolic-indicator-guided strategies provide complementary physiologic information but have not independently demonstrated superiority in randomized trials. Substantial heterogeneity has been reported in perfusion targets, outcome definitions, patient risk profiles, and potential trade-offs, including increased transfusion exposure and implementation complexity. Conclusion(s): Current evidence supports DO<inf>2</inf>-guided perfusion as an effective strategy to reduce CSA-AKI during CPB, although its impact on broader clinical outcomes remains uncertain. Future studies should focus on individualized perfusion targets that account for patient-specific risk, metabolic demand, temperature, and autoregulatory capacity, rather than universal thresholds. Copyright © The Author(s) 2026 <97> Accession Number 2044945185 Title Impact of SGLT2 Inhibitors on Clinical Outcomes in Patients with Diabetes Mellitus Following Heart Transplantation: A Meta-analysis. Source Diabetes Therapy. (no pagination), 2026. Date of Publication: 2026. Author Wang H.; Xie X.; Gong G.; Huang L.; Tang Z. Institution (Wang) Department of Cardiology, The Peoples Hospital of Guangxi Zhuang Autonomous Region, Guangxi, Nanning, China (Xie) Macau University of Science and Technology, Macao (Gong) Department of Cardiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, China (Huang) Wuming Hospital of Guangxi Medical University, Guangxi, Nanning, China (Tang) Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China Publisher Adis Abstract Introduction: In this new era, heart transplantation (HT) is rapidly gaining popularity worldwide. Patients with end-stage heart disease are often candidates for HT. However, studies have shown that more than 30% of patients who undergo HT have pre-existing diabetes mellitus (DM), which is associated with a higher risk of graft failure and death. In this analysis, we aimed to assess the impact of sodium-glucose co-transporter 2 (SGLT2) inhibitors on clinical outcomes in patients with DM following HT. Method(s): Online databases were searched for relevant publications. The statistical analysis was performed using the RevMan software version 5.4. The clinical outcomes included rejection post-HT, mortality, sepsis, weight reduction, change in body mass index (BMI), change in serum creatinine level, glomerular filtration rate (eGFR), and improvement in glycated hemoglobin (HbA1c). For dichotomous data, risk ratios (RR) with 95% confidence intervals (CI) were used to summarize the analysis. However, for continuous data, weight mean difference (WMD) with 95% CI was used. Result(s): Eight studies with a total number of 2755 participants were included in this analysis. Our current results showed that rejection risk post HT was significantly lower in the SGLT2 inhibitor group (RR: 0.85, 95% CI: 0.78-0.93; P = 0.0001). The mortality risk was not significantly different (RR: 0.64, 95% CI: 0.32-1.29; P = 0.21). Similarly, sepsis following HT was similar in both groups (RR: 1.62, 95% CI: 0.13-20.11; P = 0.71). No significant differences were observed in weight reduction, BMI, change in serum creatinine level, change in eGFR, or improvement in HbA1c following HT. Conclusion(s): In participants with DM following HT, SGLT2 inhibitors significantly reduced rejection post transplantation. However, its impact on other important clinical outcomes, including mortality, should be further assessed with more data in future studies. Copyright © The Author(s) 2026. <98> Accession Number 2044937197 Title Predicting Factors Affecting Postoperative Length of Stay in Patients Undergoing Coronary Artery Bypass Graft Surgery Using Machine Learning Methods: A Systematic Review. Source Health Science Reports. 9(4) (no pagination), 2026. Article Number: e72391. Date of Publication: 01 Apr 2026. Author Jafarkhani A.; Imani B.; Saeedi S.; Shams A. Institution (Jafarkhani, Imani) Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of (Saeedi) Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of (Shams) Department of Cardiology, Clinical Research Development Unit of Farshchian Hospital, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background and Aim: Nowadays, coronary artery bypass graft (CABG) surgery has become a common method for treating coronary artery diseases. This surgery requires a long post-operative length of stay (PLOS) in the hospital. The purpose of this study was to systematically review the factors affecting PLOS in patients undergoing CABG surgery using machine learning methods. Method(s): A comprehensive search was conducted on PubMed, Scopus, IEEE Xplore, and Web of Science, from inception until September 25, 2023. This review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All studies that investigated the factors affecting PLOS using machine learning methods in patients undergoing CABG surgery were included in the study. Result(s): In total, 9715 articles were identified after the removal of the duplicates. After the systematic screening, 20 studies met the inclusion criteria. The result showed there are 56 effective factors in predicting PLOS in patients undergoing CABG surgery. Of which 15 factors: age, gender, left ventricular ejection fraction, infection, Perceived Control (PC) levels, BMI, angina class, diabetes, Logistic Euro-score, smoking, fluid balance, inotropes, low cardiac output, atrial fibrillation, and history of cerebrovascular accident are mentioned in more than one article as an affecting factors. Conclusion(s): This systematic review highlights the multifactorial nature of PLOS, showing that patients' postoperative length of stay is influenced by factors across pre-, intra-, and postoperative care. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <99> Accession Number 650956766 Title The Society of Thoracic Surgeons 2026 Clinical Practice Guidelines for the Prevention and Treatment of New-Onset Postoperative Atrial Fibrillation after Cardiac Surgery. Source The Annals of thoracic surgery. (no pagination), 2026. Date of Publication: 18 Apr 2026. Author Chatterjee S.; Grant M.C.; Hui D.S.; Schwann T.A.; Alexander J.H.; Gaudino M.F.L.; Mack C.A.; Malaisrie S.C.; Merritt H.; Sood P.; Wyler von Ballmoos M.; Schena S. Institution (Chatterjee) Department of Surgery, Baylor College of Medicine; and The Texas Heart Institute at Baylor College of Medicine, Houston, Texas (Grant) Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, Liberia (Hui) Department of Cardiothoracic Surgery, Joe and Teresa R. Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States (Schwann) Division of Cardiac Surgery, Department of Surgery, Royal Oak, Corewell Health East, MI, United States (Alexander) Division of Cardiology, Duke Clinical Research Institute, Duke Health, Durham, NC, United States (Gaudino, Mack) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY, United States (Malaisrie) Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, United States (Merritt) Nebraska Methodist Hospital, Cardiothoracic Surgery, Omaha, NE, United States (Sood) Society of Thoracic Surgeons, Chicago, IL, United States (Wyler von Ballmoos) Department of Cardiovascular and Thoracic Surgery, Texas Health Fort Worth, Fort Worth, TX, United States (Schena) Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States Abstract BACKGROUND: Postoperative atrial fibrillation (POAF) is the most frequent complication after cardiac surgery and is associated with greater morbidity, mortality, length of stay, and cost. Multiple pharmacologic and procedural strategies exist for POAF prevention and treatment, yet practice variation persists. The Society of Thoracic Surgeons (STS) Workforce on Evidence-Based Surgery convened a multidisciplinary writing group to synthesize contemporary evidence and develop guideline recommendations for preventing and treating new-onset POAF after cardiac surgery. METHOD(S): In 2025, the group used the Population, Intervention, Comparison, Outcome framework to formulate clinical questions spanning preoperative, intraoperative, and postoperative domains. Following standardized STS methodology, evidence from randomized controlled trials and observational studies was reviewed, and recommendations were graded by Class of Recommendation and Level of Evidence. RESULT(S): Fifteen recommendations were developed: 8 addressing preventive strategies, 3 intraoperative techniques, and 4 postoperative treatments. Two Class I recommendations addressed perioperative oral amiodarone and rhythm cardioversion for hemodynamically unstable POAF. Two Class IIa recommendations supported posterior pericardiotomy and perioperative beta-blockers. Eight Class IIb recommendations reflected areas of uncertainty and limited data. Three Class III recommendations addressed therapies without demonstrated benefit. CONCLUSION(S): Levels of evidence vary across interventions, and high-quality data remain limited for POAF after cardiac surgery. Pharmacologic studies often lack granularity in dose and timing, and intraoperative maneuvers continue to evolve. Individualized risk assessment remains essential given therapy-related side effects. The 2026 STS guidelines provide the most comprehensive recommendations focused on postoperative atrial fibrillation after cardiac surgery, offering a framework to standardize care and highlight future investigational priorities. Copyright © 2026. Published by Elsevier Inc. <100> Accession Number 2038004969 Title Clinical effects of the Collaborative Care Model on pulmonary function and quality of life in postoperative patients with lung cancer. Source Pakistan Journal of Medical Sciences. 42(4) (pp 808-813), 2026. Date of Publication: 11 Apr 2026. Author Liu P.; Liu C.; Liu W.; Qi X.; Shi C.; Cao H. Institution (Liu, Liu, Liu, Qi, Shi, Cao) Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China Publisher Professional Medical Publications Abstract Objective: To evaluate the clinical efficacy of the Collaborative Care Model (CoCM) in improving pulmonary function and quality of life in patients following lung cancer surgery. Methodology: This was a retrospective study. Eighty patients who underwent radical lung cancer resection at Affiliated Hospital of Hebei University's Department of Thoracic Surgery between January 2022 to June 2025 were enrolled and randomly assigned to the observation group(n= 40, received CoCM in addition to the standard postoperative care based on the control group) and the control group(n= 40, received standard postoperative care) according to their choice of postoperative nursing approach. Pulmonary function parameters, arterial blood gas(ABG) parameters, activities of daily living(ADL) were compared between the two groups. Result(s): At seven days, one month, and three months post-intervention, pulmonary function parameters showed progressive improvement in both groups. The observation group demonstrated significantly greater improvements at each time point compared with the control group(P< 0.05, respectively). ABG parameters also improved over time in both groups, with the observation group exhibiting superior outcomes at all assessed intervals(P< 0.05, respectively). Both groups showed marked enhancement in ADL scores, with significantly greater improvements in the observation group(P< 0.05); Quality of life scores also increased significantly in both groups after one and three months, with the observation group achieving significantly more pronounced improvements than the control group(P< 0.05). Conclusion(s): The implementation of CoCM for patients recovering from lung cancer surgery can significantly enhance pulmonary function and ABG while also improving ADL and quality of life. Copyright © 2026, Professional Medical Publications. All rights reserved. <101> Accession Number 2045067669 Title Efficacy and Safety of preoperative Controlling Heart Rate in Patients with Acute Type A Aortic Dissection (ESCORT): protocol for a randomised controlled trial. Source BMJ Open. 16(4) (no pagination), 2026. Date of Publication: 01 Apr 2026. Author Liu G.; Wang D.; Yang Y.; Zhang T.; Xie B.; Hu J.; Wei X.; Chen J.; Yuan S.; Yu C. Institution (Liu, Yuan) Anaesthesiology Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China (Wang, Yu) Vascular Surgery Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China (Yang) Emergency Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China (Zhang) Arrhythmia Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China (Xie) Department of Cardiovascular Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China (Hu) Department of Cardiac and Great Vascular Surgery, West China Hospital of Sichuan University, Sichuan, Chengdu, China (Wei, Chen) Department of Cardiac Surgery, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Hubei, Wuhan, China Publisher BMJ Publishing Group Abstract Introduction: Aortic dissection (AD) is a life-threatening cardiovascular emergency with a high mortality rate, and acute Stanford Type A AD is the most dangerous form, often requiring surgical intervention. Factors contributing to the progression of AD include increased heart rate, blood pressure and the rate of ventricular contraction (dP/dt). While heart rate control is a cornerstone of preoperative management for AD per existing guidelines, the recommended target (eg, <=60 bpm in American Heart Association 2010) is consensus-driven (Level C) and thus not grounded in high-level evidence. The ESCORT (Efficacy and Safety of preoperative Controlling heart Rate in patients with acute Type A aortic dissection) trial is designed to address this critical gap by providing high-level evidence from a randomised controlled trial to define the optimal preoperative heart rate target. Methods and analysis: The study is a multicentre, single-blind, RCT involving adult patients diagnosed with acute (Stanford Type A) AD, scheduled for aortic arch prosthetic vascular replacement and elephant trunk stent implantation surgery. 680 patients will be randomised into two groups: low heart rate target group (55-65 beats per minute) and standard heart rate target group (75-85 beats per minute). The intervention involves protocol-directed medication to achieve the target heart rates, with esmolol as the primary recommended agent. The primary outcome measure is the rate of major adverse cardiovascular event within 30 days after surgery, and secondary outcomes include various clinical, economic and biochemical measures. Discussion(s): The ESCORT study is the large-scale RCT to investigate the optimal preoperative heart rate control in patients with acute type A AD. The results of this study have the potential to fill the evidence gap in current clinical guidelines and provide evidence-based support for clinical management. The findings may influence the standard of care by either endorsing lower heart rate targets or providing alternative guidance for managing heart rate in this high-risk patient population. The study's results will be disseminated through publications and presentations at both national and international conferences, ensuring that the results are accessible to the medical community and relevant patient organisations. Ethics and dissemination: This study, including the study protocol (version 1.3, 3 December 2022), was approved by the Ethics Committee of Fuwai Hospital, CAMS and PUMC (approval number: 2022-1886). Additional approvals were obtained from the ethics committees of participating subcentres (approval numbers are listed in the main text). The findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. Trial registration number: ChiCTR2300067811. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/. <102> Accession Number 650948425 Title Direct Oral Anticoagulants Versus Dual Antiplatelet Therapy Following Left Atrial Appendage Closure in Atrial Fibrillation. Source Heart rhythm. (no pagination), 2026. Date of Publication: 17 Apr 2026. Author Kaisaier W.; Xu Z.; Ye M.; Wu Z.; Dong Y.; He J.; Liu C.; Chen Y.; Lip G.Y.H.; Zhu W. Institution (Kaisaier, Ye, Wu, Dong, He, Liu, Zhu) Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Xu) Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Chen) Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (Lip) Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland Abstract BACKGROUND: Percutaneous left atrial appendage closure (LAAC) is an established alternative to oral anticoagulants for preventing thromboembolic events for selected atrial fibrillation (AF) patients. However, optimal post-procedural antithrombotic therapy remains uncertain, particularly regarding the use of direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT). OBJECTIVE(S): This meta-analysis aimed to compare the efficacy and safety outcomes of DOACs versus DAPT in the early post-implant period following LAAC in AF patients. METHOD(S): We systematically searched PubMed and Embase until November 2025 to identify randomized controlled trials (RCTs) that compared DOACs with DAPT after LAAC. Efficacy outcomes included device-related thrombosis, stroke, and all-cause mortality, whereas safety outcomes encompassed major and minor bleeding. Pooled effect estimates were calculated as odds ratios (ORs) with 95% confidence intervals (CIs). Where appropriate, fixed- or random-effects models were applied according to between-study heterogeneity. RESULT(S): Three RCTs (ADRIFT, ADALA, ANDES) involving 704 patients (mean age 75.8-78.4 years; 65% males) were included, with 368 assigned to DOAC and 336 to DAPT. Baseline thromboembolic and bleeding risk were high (mean CHA2DS2-VASc 4.0-4.7; mean HAS-BLED 3.5-3.8). Clinical outcomes were evaluated at 2-3 months. Compared with DAPT, DOACs were associated with significantly lower risks of device-related thrombosis (OR=0.16; 95% CI: 0.05-0.57), major bleeding (OR = 0.46; 95% CI: 0.26-0.81) and minor bleeding (OR=0.59; 95% CI: 0.38-0.92). No significant differences were observed in stroke (OR=0.46; 95% CI: 0.07-3.13) and all-cause mortality (OR=0.60; 95% CI: 0.23-1.54). CONCLUSION(S): In randomized trials of AF patients undergoing LAAC, short-term DOAC-based regimens were associated with lower rates of device-related thrombosis and fewer bleeding events than DAPT, without differences in stroke or mortality. These findings support DOACs as a favorable short-term antithrombotic option after LAAC in selected patients. Copyright © 2026. Published by Elsevier Inc. <103> Accession Number 2045066466 Title Assessment of the Bangla Heart Manual in patients with coronary heart disease and their caregivers in Bangladesh: a feasibility study. Source BMJ Open. 16(3) (no pagination), 2026. Date of Publication: 30 Mar 2026. Author Uddin J.; Faruque M.; Mashreky S.R.; Siddiqueea Y.; Chowdhury M.A.; Karim R.; Khaled M.F.I.; Taylor L.; Dalal H.M.; Taylor R. Institution (Uddin) MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, College of Medical Veterinary and Life Sciences, Glasgow, United Kingdom (Uddin) Department of Cardiac Surgery, Physiotherapy Unit, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh (Faruque, Siddiqueea) Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh (Mashreky) Department of Public Health, North South University, Dhaka, Bangladesh (Chowdhury, Khaled) University Cardiac Centre, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh (Karim) Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh (Taylor) The Heart Manual Department, NHS Lothian, Edinburgh, United Kingdom (Dalal) Research, Development and Innovation, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom (Dalal) Primary Care, University of Exeter Medical School, Truro, United Kingdom (Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom Publisher BMJ Publishing Group Abstract Objectives: To assess the feasibility and acceptability of the home-based Bangla Heart Manual of Cardiac Rehabilitation (CR) programme for people with coronary heart disease (CHD) following revascularisation living in Bangladesh. Design and settings: Tertiary level cardiac hospital in Dhaka city; a single-centre feasibility pilot study, with a mixed-methods single arm pre-post design. Participant(s): The study involved 33 patients with CHD admitted for revascularisation (coronary artery bypass graft or percutaneous coronary intervention) between June and July 2024, selected from 72 screened. Two physiotherapists and one nurse conducted the research, focusing on patients deemed suitable for CR. Intervention(s): Selected patients received the Bangla Heart Manual intervention that consisted of a 6-week programme of home-based CR including exercise training, self-care, relaxation, risk factor management and psychological support facilitated by a healthcare professional. Primary and secondary outcomes: The primary outcomes focused on feasibility, assessing patient recruitment, retention and adherence to the intervention using quantitative and qualitative methods, including interviews with patients, caregivers and healthcare professionals. Secondary outcomes measured patient-reported metrics like health-related quality of life (HeartQoL, EQ-5D-5L), psychological well-being, exercise capacity (Hospital Anxiety and Depression Scale), and serious adverse events (hospitalisation and mortality) before and after the Bangla Heart Manual intervention. Result(s): The 33 patients recruited included 29 (88%) males with a mean age of 55 years. The following feasibility outcomes were achieved: 46% (33 patients from 72 screened) recruited, 91% (30/33) retention (complete outcome data at follow-up) and 75% intervention adherence (>=6 sessions attended of 8 sessions). Improvements following CR participation were seen in patient-reported outcomes and exercise capacity. Two deaths and one rehospitalisation occurred during the study. Conclusion(s): This study showed that the Bangla Heart Manual home-based CR programme was acceptable and feasible for people with CHD in Bangladesh and healthcare professional staff to deliver. Our results also support the feasibility of recruitment and data collection processes for a future multicentre randomised trial to formally test the clinical and cost effectiveness of the adapted Bangla Heart Manual. Trial registration number: ISRCTN1545620. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. <104> Accession Number 650949436 Title Neosinus and Valve Thrombosis After Transcatheter Aortic Valve Replacement. Source Journal of the American Heart Association. (pp e048121), 2026. Date of Publication: 20 Apr 2026. Author Chen N.; Mao Y.; Zhang H.-P. Institution (Chen, Zhang) Department of Cardiology, Beijing Hospital, National Center of Gerontology Institute of Geriatric Medicine, Chinese Academy of Medical Sciences Beijing China, China (Mao) Institute of Science and Technology for Brain-Inspired Intelligence Fudan University Shanghai China, China (Mao) Department of Cardiovascular Surgery Xijing Hospital Xi'an Shaanxi China, China Abstract Transcatheter aortic valve replacement is regarded as an effective intervention for patients with aortic stenosis and has now been extended to low-risk populations. Leaflet thrombosis is a distinct and concerning form of transcatheter aortic valve dysfunction following transcatheter aortic valve replacement. Emerging studies have consistently shown that the formation of the neosinus after transcatheter aortic valve replacement and the resulting local hemodynamic changes are closely related to the occurrence of leaflet thrombosis. However, there is currently a lack of systematic integration of this evidence. This review aims to systematically summarize 4 key aspects of neosinus thrombosis after transcatheter aortic valve replacement: the incidence of thrombosis, the anatomical and pathological remodeling of the neosinus, the mechanisms of neosinus thrombosis, and the hemodynamic determinants within the neosinus. Local hemodynamics is the dominant and modifiable factor affecting thrombosis. Future research may integrate patient-specific modeling with long-term clinical outcomes to optimize the design and surgical strategies of transcatheter heart valves. <105> Accession Number 2045098614 Title The PRINCE trial of remote ischaemic preconditioning in noncardiac surgery to reduce myocardial injury: sign o' the times. Source British Journal of Anaesthesia. 136(2) (pp 475-480), 2026. Date of Publication: 01 Feb 2026. Author Ackland G.L.; Pinto B.B. Institution (Ackland) Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (Pinto) Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland Publisher Elsevier Ltd Abstract The remote ischemic PReconditioning In Non-Cardiac surgEry (PRINCE) trial was a multinational, double-blind trial in which 1213 patients undergoing noncardiac surgical procedures were randomly assigned to receive remote ischaemic preconditioning (RIPC) or sham-RIPC after general anaesthesia and before surgery to reduce myocardial injury. Postoperative myocardial injury, defined alone by postoperative high-sensitivity troponin above the highest 99th percentile of reference values, occurred in 215/566 patients (38.0%) in the RIPC group and in 223/596 patients (37.4%) in the sham-RIPC group. The PRINCE trial adds to an apparently contradictory literature on the role of RIPC in perioperative medicine. We discuss both trial-specific and mechanistic reasons to explain these discrepancies, and we contend that a role for RIPC in minimising organ injury as a result of noncardiac surgery remains possible. Copyright © 2025 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <106> Accession Number 650944500 Title Impact of Optimal Medical Therapy, Insulin Sensitization, and Revascularization Strategies on Soluble Urokinase Plasminogen Activator Receptor and Its Association with Cardiovascular Outcomes-A BARI-2D Ancillary Study. Source Diabetes. Conference: 83rd Scientific Sessions of the American Diabetes Association, ADA 2023. San Diego, CA United States. 72(Supplement 1) (no pagination), 2023. Date of Publication: 01 Jun 2023. Author Amadi K.-M.; Huang Y.; Ismail A.; Hayek S.; Vasbinder A.; Pratley R.E.; Banerjee M.; Busui R.; Catalan T.C.; Erne G.; Presswalla F.; Bitterman B.; Nelapudi M.; Pizzo I.S.; Tripathi M.; Tekumulla A.; Meyette N.; Blakely P.; Sulaiman N.; Bardwell A.; Chen J.; Tilley C.R. Publisher American Diabetes Association Inc. Abstract Get Permissions Chronic inflammation is a hallmark of type 2 diabetes (T2D) and a driver of its complications. Soluble urokinase plasminogen activator receptor (suPAR) is an immune-derived signaling glycoprotein involved in the pathogenesis of diabetes-related outcomes, notably atherosclerosis and nephropathy. We aimed to determine if optimal medical therapy, insulin sensitization, and revascularization strategy impact suPAR levels and modulate its association with outcomes. We leveraged the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI-2D) trial, a study of patients with T2D and coronary artery disease (CAD) who underwent either revascularization or optimized medical therapy, and were randomized to either insulinsensitization or insulin-provision therapy. We measured plasma suPAR levels in 2316 patients at baseline and 1-year followup and examined the association between suPAR and major adverse cardiovascular events (MACE). The median suPAR level at baseline was 3.02 ng/ml (IQR 2.32-3.95) and 3.15 ng/ml (2.4-4.2) at 1-year. SuPAR levels were notably higher in patients who underwent CABG (2.94 vs 2.70, p<0.001), but were unchanged post-PCI, insulin sensitization or insulin provisioning at 1 year. In multivariable analyses, baseline and 1-years suPAR levels were predictive of MACE, without difference in the strengths of the association between the two time points (HR of 2.18 (95%CI[1.57-3.03]) at baseline and 2.13 (95%CI[1.45-3.13]) at follow-up for the 3rd tertile compared to the first. Our findings suggest that inflammation as measured by suPAR is not reduced by revascularization or T2D treatment strategy, and likely accounts for the residual CV risk in patients with T2D. The advent of anti-suPAR therapies may offer new promise for patients with T2D and co-morbid CAD. <107> Accession Number 650948149 Title Impact of Cancer on Early Outcomes After Coronary Artery Bypass Grafting According to Cancer Stage - A Systematic Review and Meta-Analysis. Source The American journal of cardiology. (no pagination), 2026. Date of Publication: 17 Apr 2026. Author Corvisier M.F.; Ziotti S.D.V.; Rodrigues L.S.; Santos L.E.B.; Rios E.P.A.; Senfft I.C.N.; Rabelo A.A.; Correia M.G.; Oliveira G. Institution (Corvisier, Correia) Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil (Ziotti) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil (Rodrigues, Rios) Universidade de Vassouras, Vassouras, Brazil (Santos) Hospital Vila Nova Star, Sao Paulo, Brazil (Senfft) Hospital Universitario Gaffree e Guinle, Rio de Janeiro, Brazil (Rabelo) Faculdade de Medicina de Bauru - USP, Bauru, Brazil (Oliveira) Tampa General Hospital, FL - USA, Tampa, Romania Abstract Advances in cancer therapy have markedly expanded the population of survivors at risk for cardiovascular disease; however, evidence regarding the safety and outcomes of coronary artery bypass grafting (CABG) in patients with malignancy remains scarce. This study aimed to investigate the prognostic impact of cancer on early postoperative outcomes after CABG, including mortality, bleeding, infection, stroke, and acute kidney injury (AKI). We conducted a systematic review and meta-analysis according to the PRISMA and Cochrane guidelines. PubMed, Embase, and Cochrane Library were searched through August 2025 for studies comparing CABG outcomes in patients with and without cancer. Random-effects models generated pooled odds ratios (OR) and 95% confidence intervals (CI). Five studies were included, comprising 99,866 patients (30,818 with cancer). Early mortality was higher in cancer patients (OR 1.88; 95% CI [1.004-3.520]; p=0.049) as well as bleeding (OR 1.47; 95% CI [1.018-2.138]; p=0.044). Infection (OR 1.66; 95% CI [0.142-19.477]; p=0.467), stroke (OR 0.85; 95% CI [0.463-1.563]; p=0.370), and AKI (OR 1.08; 95% CI [0.755-1.545]; p=0.545) did not significantly differ between groups. Sensitivity analysis excluding the only study restricted to non-metastatic solid tumors reduced heterogeneity (I2 from 87.6% to 0%) and strengthened the mortality association (OR 2.65; 95% CI [1.94-3.61]; p=0.002). In conclusion, cancer was associated with increased early mortality and bleeding after CABG, whereas infection, stroke, and AKI rates were not, and CABG prognosis may depend on cancer activity and stage, underscoring the need for individualized risk assessment and prospective validation. Copyright © 2026. Published by Elsevier Inc. <108> Accession Number 650943761 Title Dapagliflozin for Inpatient Hyperglycemia in Cardiac Surgery Patients with Type 2 Diabetes-Randomized Controlled Trial. Source Diabetes. Conference: 83rd Scientific Sessions of the American Diabetes Association, ADA 2023. San Diego, CA United States. 72(Supplement 1) (no pagination), 2023. Date of Publication: 01 Jun 2023. Author Kuchay M.S.; Khatana P.; Mishra M.; Parvathi S.; Kaur P.; Wasir J.S.; Kaur H.; Singh A.; Jain R.; Kohli C.; Bakshi G.; Radhika V.; Saheer S.; Singh M.K.; Mishra S. Publisher American Diabetes Association Inc. Abstract Get Permissions Sodium/glucose cotransporter-2 (SGLT2) inhibitors have not been assessed extensively for the treatment of hyperglycemia in noncritically ill, hospitalized patients with type 2 diabetes (T2D). In this investigator-initiated, treat-to-target, randomized trial, 250 cardiac surgery patients with T2D were randomly assigned (1:1) to receive dapagliflozin 10 mg daily plus basal-bolus insulin (DAPA group) or basal-bolus insulin alone (INSULIN group) in the early postoperative period. The primary outcome was mean differences between groups in their daily blood glucose (BG) concentrations. The major safety outcomes were the occurrence of severe ketonemia/diabetic ketoacidosis (DKA) and hypoglycemia. All analyses were performed according to the intention-to-treat principle. There were no differences in mean daily BG concentrations (149 vs. 150 mg/dL), mean percentage of readings within the target BG of 70-180 mg/dL (82.7% vs. 82.5%), daily total insulin dose (mean, 39 vs. 40 units/day), number of daily insulin injections (median, 3.9 vs. 4), length of stay (median, 10 vs. 10 days), or hospital complications (21.6% vs. 24.8%) between the DAPA and INSULIN groups. Mean plasma ketone levels were significantly higher in the DAPA group than in the INSULIN group at day 3 (0.71 vs. 0.30 mmol/L) and day 5 (0.42 vs. 0.19 mmol/L) of randomization. Six patients in the DAPA group developed severe ketonemia, but none developed DKA. There were no differences in the proportion of patients with BG <70 mg/dL (9.6% vs. 7.2%) between the treatment groups. Numerically fewer patients in the DAPA group developed acute kidney injury (7.2%) than in the insulin group (12.8%). These findings indicate that dapagliflozin complementary to basal-bolus insulin does not improve glycemia further over and above the basal-bolus in hospitalized cardiac surgery patients with T2D. However, dapagliflozin is safe and does not increase the incidence of DKA or other complications during the hospital stay. <109> Accession Number 650945646 Title Diabetes after Cardiac Transplant with Low-Dose Everolimus and Tacrolimus. Source Diabetes. Conference: 83rd Scientific Sessions of the American Diabetes Association, ADA 2023. San Diego, CA United States. 72(Supplement 1) (no pagination), 2023. Date of Publication: 01 Jun 2023. Author Raven L.M.; Muir C.A.; Pouliopoulos J.; Macdonald P.S.; Jabbour A.; Greenfield J. Publisher American Diabetes Association Inc. Abstract Background: Although modern immunosuppressants improve survival post-transplant, they are associated with long-term metabolic complications, such as post-transplant diabetes mellitus (PTDM). Calcineurin inhibitor-sparing regimens using everolimus attenuate some complications such as left ventricular hypertrophy. However, the metabolic effects of everolimus following transplant are less clear. Aim(s): To compare incidence of diabetes in heart transplant recipients exposed to low-dose everolimus and tacrolimus versus standard-dose tacrolimus. Method(s): Post-hoc analysis in participants of a randomised open-label clinical trial of low-dose everolimus and tacrolimus versus standard-dose tacrolimus in heart transplant recipients. Result(s): There were 39 participants in the trial, mean follow up was 6.4 +/- 1.5 years. There was a high rate of pre-existing diabetes (26%) and newly-diagnosed PTDM (36%) during follow-up (Figure 1). Half the patients who developed PTDM in the everolimus-tacrolimus group (n=4/8) ceased diabetes medications during follow-up, which was not observed in patients on standard tacrolimus (n=0/6). Conclusion(s): This study suggests that treatment with everolimus may improve PTDM outcomes relative to treatment with standard doses of calcineurin inhibitor. These findings should be further studied in prospective randomised trials. <110> Accession Number 650938808 Title Anticoagulation Monitoring Strategies During Cardiopulmonary Bypass in Patients With Antiphospholipid Syndrome: A Systematic Review. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 17 Mar 2026. Author Yoshida S.; Ishida O.; Tsutsumi K. Institution (Yoshida, Ishida, Tsutsumi) Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan Abstract OBJECTIVES: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder that complicates anticoagulation during cardiovascular surgery requiring cardiopulmonary bypass (CPB). This systematic review aimed to characterize the anticoagulation monitoring strategies reported during CPB in patients with APS and to identify recurring limitations and clinical patterns rather than to assess comparative efficacy between management approaches. DESIGN: Systematic review of published clinical studies. SETTING: Hospital-based cardiovascular surgery and perioperative care settings, including single- and multi-institutional reports. PARTICIPANTS: Patients with a confirmed diagnosis of APS who underwent cardiac or cardiovascular surgery using CPB with heparin anticoagulation. INTERVENTIONS: Intraoperative anticoagulation strategies during CPB, including activated clotting time (ACT)-based monitoring and adjunctive strategies such as heparin concentration monitoring (Hepcon), anti-factor Xa assays, and viscoelastic testing. MEASUREMENTS AND MAIN RESULTS: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant search of PubMed, Scopus, and the Cochrane Library identified 66 studies, of which 17 met the inclusion criteria. ACT monitoring was reported in 25 patients, Hepcon-guided heparin concentration monitoring in 25, and heparin-ACT titration in 1; most studies used multimodal monitoring approaches. Among 62 patients, 15 perioperative complications were reported, predominantly from a single cohort study that contributed the majority of quantitative outcome data. The aggregated data illustrated the heterogeneous use of monitoring strategies and recurrent concerns regarding the reliability of ACT alone. CONCLUSION(S): Anticoagulation monitoring during CPB in patients with APS remains heterogeneous and insufficiently standardized. The available evidence does not permit conclusions regarding comparative efficacy among monitoring strategies. Instead, this review highlights recurrent limitations of ACT-based monitoring and the heterogeneous use of adjunctive modalities in reported cases, providing a conceptual framework to inform future prospective investigations. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. <111> Accession Number 650938036 Title Impact of Prosthesis-Patient Mismatch After Surgical Mitral Valve Replacement: Systematic Review and Meta-Analysis. Source The American journal of cardiology. (no pagination), 2026. Date of Publication: 16 Apr 2026. Author Jacquemyn X.; Rohit G.; Sa M.P.; Serna-Gallegos D.; Hasan I.; Ogami T.; Bonatti J.; Sultan I. Institution (Jacquemyn) UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium (Rohit) Division of Cardiology, Cedar-Sinai Medical Center, Los Angeles, CA, United States (Sa) Cleveland Clinic Florida, Weston, FL, United States (Serna-Gallegos, Hasan, Ogami, Bonatti, Sultan) UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Abstract The long-term clinical impact of mitral prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) remains incompletely defined. We aimed to systematically assess the prevalence of mitral PPM and its association with long-term mortality, cardiac death, and heart failure-related hospitalizations. We conducted a systematic review and meta-analysis of observational studies reporting Kaplan-Meier time-to-event data in patients with and without mitral PPM. Sixteen studies including 10,872 patients were analyzed. The pooled prevalence of any mitral PPM was 43% (95% CI, 29-59%), with significant heterogeneity (I2 = 100%). All-cause mortality was higher with PPM (HR, 1.32; 95% CI, 1.20-1.45; P<0.001; RMST difference, -3.35 years; 95% CI, -3.98 to -2.71; P<0.001), as was cardiac mortality (HR, 1.96; 95% CI, 1.54-2.51; P<0.001) and risk of heart failure hospitalization (HR, 2.82; 95% CI, 1.86-4.29; P<0.001). Risk-adjusted analyses confirmed these associations for all-cause and cardiac mortality. Severity-stratified analyses demonstrated a gradient effect: moderate PPM showed a trend toward higher mortality (HR, 1.12; 95% CI, 0.98-1.27; P=0.08), whereas severe PPM significantly increased mortality risk (HR, 1.36; 95% CI, 1.15-1.60; P<0.001). Sensitivity analyses according to PPM quantification method (in vivo vs. Doppler) and leave-one-out testing confirmed the robustness of the results. In conclusion, mitral PPM is common and independently associated with increased long-term all-cause mortality, cardiac death, and heart failure hospitalizations after MVR, with a dose-response relationship according to PPM severity. These findings highlight the importance of preventive strategies to avoid PPM when planning mitral valve replacement. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. <112> Accession Number 2044821607 Title Uni-leaflet mitral valve in adults: a systematic review of case reports and case series. Source Future Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Mookadam M.; Mookadam S.A.; Morris M.; Pradhan S.; Mookadam F. Institution (Mookadam, Pradhan) Department of Family Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States (Mookadam) Neuroscience, Arizona State University, Tempe, AZ, United States (Morris) Cardiac Radiology, Banner University Medical Center Phoenix, Phoenix, AZ, United States (Mookadam) Banner MD Anderson Cancer Center-Phoenix, University of Arizona and Cardio-Oncology Services, Phoenix, AZ, United States Publisher Taylor and Francis Ltd. Abstract Introduction: Uni-leaflet mitral valve (ULMV) is a rare congenital anomaly historically considered incompatible with long-term survival, yet increasing reports describe diagnosis in adulthood. We conducted a systematic review to characterize clinical presentation, anatomy, imaging findings, management, and outcomes in adults with ULMV. Method(s): Following PRISMA guidelines, major databases were searched from 1960 through January 2024. Eligible studies reported adult patients with confirmed ULMV. Data were extracted on demographics, valve morphology, symptoms, associated anomalies, imaging modalities, interventions, and outcomes. Result(s): Thirty-six publications comprising 40 adult patients met inclusion criteria. Mean age at diagnosis was 50.5 years, with female predominance. Posterior leaflet hypoplasia or agenesis accounted for 97.5% of cases. Most patients were symptomatic, commonly with dyspnea or heart failure, and over half had moderate or greater mitral regurgitation. Atrial fibrillation, atrial septal defects, and aortic valve abnormalities were frequent comorbidities. Transthoracic echocardiography was used universally, with transesophageal and three-dimensional imaging providing incremental anatomical detail. Approximately one-third underwent mitral valve repair or replacement, with generally favorable outcomes. Conclusion(s): Adult ULMV demonstrates marked clinical and anatomical heterogeneity and may represent a developmental spectrum rather than a single entity. Standardized definitions and prospective registries are needed to improve risk stratification and guide management. Protocol Registration: http://www.crd.york.ac.uk/prospero identifier is CRD420251083213. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <113> Accession Number 650937832 Title Prevalence and influencing factors of postoperative delirium in children undergoing low-risk surgeries: A meta-analysis. Source Journal of pediatric nursing. 89 (pp 38-49), 2026. Date of Publication: 17 Apr 2026. Author Liu S.-L.; Bai X.; Xu T.; Lin S.-Y.; Zhou X.-Y.; Xu H.-Y.; Jiang Y.-L. Institution (Liu, Bai, Xu, Lin, Zhou, Xu) College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China (Jiang) Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China Abstract BACKGROUND: Postoperative delirium (POD) is a serious complication in pediatric surgery that may induce prolonged hospital stays, while increasing risks of cognitive impairment and mortality. Its incidence after low-risk surgery remains incompletely characterized, despite extensive study in critically ill children, especially those following cardiac surgery. This meta-analysis systematically evaluated POD prevalence and its influencing factors in children undergoing low-risk surgeries to inform clinical prevention and management strategy development. METHOD(S): This meta-analysis was conducted by retrieving studies in PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CNKI, SinoMed, Wanfang, and VIP Database from their inception to 21 March 2025. Data processing was performed using RevMan 5.4 and Stata 15.0, with subgroup analyses, meta-regression, and sensitivity analyses. RESULT(S): This study screened 31 studies involving 13,718 pediatric patients. The overall pooled POD prevalence was 23.4% (95% CI: 0.185-0.286, P < 0.001). Furthermore, significant risk factors included age < 5 years (OR = 2.75, 95% CI: 1.85-4.08, P < 0.001), preoperative anxiety (OR = 1.16, 95% CI: 1.02-1.32, P = 0.03), postoperative pain (OR = 5.52, 95% CI: 3.15-9.67, P < 0.001), otolaryngologic surgery (OR = 2.61, 95% CI: 1.47-4.63, P < 0.001), and midazolam use (OR = 2.33, 95% CI: 1.48-3.67, P < 0.001). CONCLUSION(S): POD is particularly prevalent in children following low-risk pediatric surgery. IMPLICATIONS FOR PRACTICE: Priority should be given to early identification and suitable intervention targeting modifiable risk factors (preoperative anxiety, postoperative pain, and midazolam use), particularly in young children (<5 years) and those undergoing otolaryngologic surgeries. Copyright © 2026 Elsevier Inc. All rights reserved. <114> Accession Number 2044821601 Title Effect of EEG-guided opioid-free anesthesia on perioperative blood glucose variation in patients undergoing video-assisted thoracic surgery: a secondary analysis of a randomized controlled study. Source Perioperative Medicine. 15(1) (no pagination), 2026. Article Number: 36. Date of Publication: 01 Dec 2026. Author Yan X.; Liang C.; Guo M.; Jiang J.; Ji Y.; Wu A.-S.; Wei C.-W. Institution (Yan, Guo, Jiang, Wu, Wei) Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China (Liang) Department of Medical Statistics, Medieco Group Co., Ltd, Beijing, China (Ji) Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China Publisher BioMed Central Ltd Abstract Objectives: To evaluate the impact of electroencephalogram-guided opioid-free anesthesia (OFA) on perioperative blood glucose variability in patients undergoing video-assisted thoracic surgery. Method(s): This article is a secondary analysis of a randomized controlled trial. Eligible patients were randomly allocated to either the OFA group or the opioid-based anesthesia (OBA) group. Patients in the OFA group did not receive any opioids during surgery, whereas those in the OBA group received sufentanil and remifentanil intraoperatively. The primary end point was the coefficient of variation for glucose (GLU<inf>cv</inf>), calculated based on predefined time points during the perioperative period. The secondary end points were the mean of glucose (GLU<inf>mean</inf>), the standard deviation of glucose (GLU<inf>SD</inf>), mean amplitude of glycemic excursions (MAGE), and largest amplitude of glycemic excursion (LAGE). Result(s): A total of 126 patients were included in the final analysis: the OFA group (n = 64) and the OBA group (n = 62). Blood pressure, heart rate, sedation index, and analgesia index during surgery were comparable between the two groups, and there was no significant difference in pain in the early postoperative period. The primary end point, GLU<inf>CV</inf>, was significantly higher in OFA group than in OBA group (22.7 +/- 9.1 vs 14.1 +/- 6.0, P < 0.001). In addition, the OFA group had higher GLU<inf>mean</inf> (5.68 +/- 0.87 vs 5.31 +/- 0.87 mmol/L, P = 0.003), GLU<inf>SD</inf> (1.3 +/- 0.59 vs 0.76 +/- 0.40 mmol/L, P < 0.001), MAGE (1.75 +/- 0.86 vs 0.95 +/- 0.54 mmol/L, P < 0.001), and LAGE (2.97 +/- 1.35 vs 1.72 +/- 0.96 mmol/L, P < 0.001). Conclusion(s): The OFA regimen provides sedation and analgesia comparable to OBA in video-assisted thoracic surgery, but is associated with greater perioperative blood glucose variation. Trial registration: Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022. Date of enrolment of the first research participant: 10 Jun, 2022. Copyright © The Author(s) 2026. <115> [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. (no pagination), 2026. Date of Publication: 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, No. 167 Beilishi Road, Xicheng District, Beijing, China Publisher Lippincott Williams and Wilkins Abstract Objective: - Cardiac surgery frequently induces moderate to severe postoperative pain, which 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. <116> Accession Number 2044560119 Title Effects of preconditioning with one-lung ventilation on perioperative oxygenation and oxidative stress in thoracoscopic surgery: a prospective single-center randomized controlled clinical trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 215. Date of Publication: 01 Dec 2026. Author Lin J.; Du X.; Zhang W.; Wu C.; Zhao D.; Fang J. Institution (Lin) Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China (Du, Fang) Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Zhang) Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China (Wu) Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China (Zhao) Department of Anesthesiology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China Publisher BioMed Central Ltd Abstract Background: Hypoxemia is a common and clinically significant problem during one-lung ventilation (OLV). Prophylactic ventilation strategies to prevent OLV-associated hypoxemia and lung injury remain insufficiently defined. Method(s): Patients scheduled for elective video-assisted thoracoscopic lung lobectomy or segmentectomy were enrolled and randomly assigned into a preconditioning group or a control group. After anesthesia induction, a visual double-lumen endotracheal tube was inserted. The preconditioning group underwent three cycles of OLV preconditioning protocol before surgery: 2 min OLV -> 2 min two-lung ventilation (TLV) -> 4 min OLV -> 4 min TLV -> 6 min OLV -> 6 min TLV. The control group received conventional OLV only. Ventilation parameters: the tidal volume was set at 6 mL/kg during OLV and 8 mL/kg during TLV. Respiratory rate was adjusted to maintain an end-tidal carbon dioxide partial pressure of 35-45 mmHg. The primary outcome was the oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen, PaO<inf>2</inf>/FiO<inf>2</inf>). Secondary outcomes included perioperative oxidative stress markers and the incidence of postoperative pulmonary complications (PPCs) within 7 days after surgery. Result(s): Seventy-four patients were included in the final analysis. The oxygenation index decreased in both groups after initiation of OLV, reaching its lowest value at 30 min. At this time point, the preconditioning group showed a significantly higher oxygenation index than the control group (209 +/- 64 vs. 145 +/- 43 mmHg, P < 0.001). No significant differences were observed between the two groups in perioperative superoxide dismutase (SOD) levels [168 +/- 16 vs. 160 +/- 21 U/mL, P = 0.302] or in the incidence of PPCs (10/38 vs. 16/36, P = 0.105). Conclusion(s): OLV preconditioning improved intraoperative oxygenation during thoracic surgery, but did not significantly affect perioperative oxidative stress or the incidence of PPCs. Trial registration: The study was retrospectively registered in the Chinese Clinical Trial Registry on April 8, 2021, (http://www.chictr.org.cn, ChiCTR2100045203). Copyright © The Author(s) 2026. <117> Accession Number 650926517 Title Myocardial Fibrosis and Early Intervention in Asymptomatic Patients With Severe Aortic Stenosis: Insights From the EVOLVED Randomized Clinical Trial. Source JAMA cardiology. (no pagination), 2026. Date of Publication: 15 Apr 2026. Author Craig N.J.; Loganath K.; Everett R.J.; Bing R.; Ramtoola T.; Tsampasian V.; Molek P.; Botezatu S.; Aslam S.; MacGillivray T.; Tuck C.E.; Rayson P.; Calvert P.A.; Berry C.; Chin C.W.L.; Hillis G.S.; Fairbairn T.; Greenwood J.P.; Steeds R.; Leslie S.J.; Lang C.C.; Bucciarelli-Ducci C.; Joshi N.V.; Kunadian V.; Prendergast B.; Mills N.L.; Vassiliou V.S.; Dungu J.N.; Hothi S.S.; Boon N.; Prasad S.K.; Keenan N.G.; Dawson D.; Motwani M.; Miller C.A.; Rajani R.; Ripley D.P.; Treibel T.A.; McCann G.P.; Singh A.; Newby D.E.; Dweck M.R. Institution (Craig, Loganath, Ramtoola, Tuck, Mills, Newby, Dweck) British Heart Foundation Centre of Research Excellence, University of Edinburgh, Edinburgh, United Kingdom (Craig, Everett, Bing, Ramtoola, Mills, Newby, Dweck) Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Tsampasian, Vassiliou) Norwich Medical School, University of East Anglia, United Kingdom (Tsampasian, Vassiliou) Department of Cardiology, Norfolk and Norwich University Hospital, United Kingdom (Molek) Department of Coronary Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland (Botezatu) University of Medicine and Pharmacy Carol Davila, Cardiology Department, Bucharest, Romania (Aslam, McCann, Singh) Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom (MacGillivray) University of Edinburgh, Edinburgh, United Kingdom (Rayson) Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (Calvert) Royal Papworth Hospital NHS Foundation Trust, University of Cambridge, Cambridge, United Kingdom (Berry) School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom (Chin) Department of Cardiology, National Heart Centre Singapore, Singapore (Chin) Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia (Hillis) Medical School, University of Western Australia, Perth, WA, Australia (Hillis, Greenwood) Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (Fairbairn) Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (Greenwood) Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom (Steeds) Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, United Kingdom (Leslie) Cardiac Unit, Raigmore Hospital, Inverness, United Kingdom (Lang) Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom (Lang) National University of Malaysia, Malaysia (Bucciarelli-Ducci, Joshi) Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, United Kingdom (Bucciarelli-Ducci, Prasad) Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Foundation Trust, London, United Kingdom (Kunadian) Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle, United Kingdom (Kunadian) University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (Prendergast) Cleveland Clinic London and St Thomas' Hospital, London, United Kingdom (Mills) Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (Dungu) Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, United Kingdom (Dungu) Anglia Ruskin University, Chelmsford, Essex, United Kingdom (Hothi) Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom (Hothi) Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (Boon) Retired, Hertfordshire, United Kingdom (Keenan) Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, United Kingdom (Keenan) Imperial College, London, United Kingdom (Dawson) Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, Aberdeen, United Kingdom (Motwani) Department of Cardiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom (Miller) Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom (Rajani) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Ripley) Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (Treibel) Institute of Cardiovascular Sciences, University College London, and St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom Abstract Importance: Myocardial fibrosis burden has been associated with adverse clinical outcomes in symptomatic patients with aortic stenosis. Objective(s): To determine whether midwall myocardial fibrosis burden is associated with adverse clinical outcomes in asymptomatic patients and whether those with more fibrosis derive greater benefit from early intervention. Design, Setting, and Participant(s): This post hoc analysis of a randomized clinical trial was conducted between August 2017 and October 2022. The trial took place at 24 cardiac centers across the United Kingdom and Australia. Participants included asymptomatic patients with severe aortic stenosis and midwall fibrosis on cardiac magnetic resonance. These data were analyzed from October 2024 through June 2025. Intervention(s): Early intervention with transcatheter or surgical aortic valve replacement. Main Outcomes and Measures: Primary outcome was all-cause death or unplanned aortic stenosis-related hospitalization. Secondary outcomes included the individual components of the primary outcome. Result(s): In 224 trial participants (mean [SD] age, 73 [9] years; 63 women and 161 men, and mean [SD] aortic valve peak velocity 4.3 [0.5] m per second) with a median follow-up of 42 months, fibrosis burden (per 1% increase) was associated with an increase in the primary end point (hazard ratio [HR], 1.23; 95% CI, 1.08-1.37) and its component of unplanned aortic stenosis-related hospitalizations (HR, 1.22; 95% CI, 1.03-1.40) but not all-cause death (HR, 1.17; 95% CI, 0.98-1.35). There were no interactions between randomization arm and the midwall fibrosis burden for the primary (P for interaction = .39) or secondary end points. In patients with high fibrosis burden above the median, the primary end point occurred in 12 of 59 (20%) of those randomized to early intervention and 17 of 53 (32%) of those randomized to guideline-directed conservative management (HR, 0.62; 95% CI, 0.29-1.28). For the individual components, all-cause death occurred in 9 (15%) and 10 (19%) patients, respectively (HR, 0.84; 95% CI, 0.33-2.07), and unplanned aortic stenosis-related hospitalization in 4 (7%) and 13 (25%) patients respectively (HR, 0.27; 95% CI, 0.08-0.77). In patients with low fibrosis burden below the median, there were no differences in the primary outcome (HR, 1.05; 95% CI, 0.39-2.86) or its components between intervention groups. Conclusions and Relevance: In this study, in asymptomatic patients with severe aortic stenosis, higher midwall fibrosis burden was associated with adverse outcomes. There was no demonstrable heterogeneity by the degree of midwall fibrosis for the treatment effects of early surgical or transcatheter aortic valve replacement compared to clinical surveillance. Trial Registration: ClinicalTrials.gov Identifier: NCT03094143.

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