EPICORE Embase Updates

Total documents retrieved: 140 Results Generated From: Embase <1980 to 2026 Week 32> Embase Weekly Updates (updates since 2026-07-31) - (140 records) <1> Accession Number 2047832730 Title Efficacy and Safety of Venous Closure Devices for Femoral Venous Access in Interventional Cardiology: A Systematic Review and Meta-Analysis. Source Journal of Personalized Medicine. 16(7) (no pagination), 2026. Article Number: 340. Date of Publication: 01 Jul 2026. Author Parato A.G.; La Fazia V.M.; Marino M.; Marchetta M.; Colarocchio L.; Albano G.; Pocelli F.; Chiarazzo E.; Di Francesco A.; Gerardi L.; Xu W.M.; Marongiu V.; Stifano G.; Natale A. Institution (Parato, Marchetta, Colarocchio, Albano, Pocelli, Chiarazzo, Di Francesco, Gerardi, Xu, Marongiu, Stifano, Natale) Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy (La Fazia, Marino, Natale) Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, United States (La Fazia) Department of Experimental Medicine, University of Tor Vergata, 00133, Rome, Italy (Natale) Interventional Electrophysiology, Scripps Clinic, San Diego, CA, United States (Natale) School of Medicine, Case Western Reserve University, Cleveland, OH, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Venous closure devices (VCDs) are being increasingly used after femoral venous access to facilitate recovery, but their comparative efficacy and safety versus manual compression or figure-of-eight suture remain uncertain. Because femoral venous access management is influenced by patient-related and procedural factors, VCDs may contribute to a more personalized postprocedural recovery strategy. Objective(s): Evaluation of the impact of VCDs on procedural recovery and vascular complications in patients undergoing cardiac procedures via femoral venous access. Method(s): We systematically searched PubMed, Embase, and CENTRAL through to April 2025 for randomized controlled trials (RCTs) comparing VCDs with manual compression and/or figure-of-eight suture. Primary efficacy outcomes were time to hemostasis (TTH), time to ambulation (TTA), time to discharge (TTD), and time to discharge eligibility (TTDe). Safety outcomes were major and minor vascular complications. Risk of bias was assessed with RoB 2, and certainty of evidence assessed with GRADE. Random-effects models were used to pool standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Result(s): Seven RCTs (n = 948) were included. VCDs use significantly reduced TTH (SMD: -1.00; 95% CI: -1.57 to -0.42) and TTA (SMD: -1.50; 95% CI: -2.42 to -0.58). TTD showed a non-significant trend favoring VCDs (SMD: -0.99; 95% CI: -2.13 to 0.15), while TTDe was consistently shorter with VCDs across three trials. Major vascular complications were rare and similar between groups (RR: 0.41; 95% CI: 0.09-1.89). Minor vascular complications were significantly reduced with VCDs (RR: 0.42; 95% CI: 0.22-0.79). Conclusion(s): In patients requiring femoral venous access for interventional cardiology procedures, VCDs improve time to hemostasis and ambulation and reduce minor vascular complications without increasing major events. These findings support VCDs as an effective and safe strategy for venous closure. Copyright © 2026 by the authors. <2> Accession Number 2047850913 Title Acute kidney injury after heart transplantation: A systematic review and meta-analysis. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101045. Date of Publication: 01 Dec 2026. Author Murad C.M.; Freitas A.P.S.; Cavalcanti H.T.G.; Zeferino S.P.; Marcondes-Braga F.G.; Galas F.R.B.G.; Bacal F. Institution (Murad, Zeferino, Marcondes-Braga, Galas, Bacal) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Sao Paulo, Brazil (Murad, Bacal) Hospital Israelita Albert Einstein, SP, Sao Paulo, Brazil (Freitas, Cavalcanti) Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), SP, Sao Paulo, Brazil Publisher Elsevier Inc. Abstract Background: Acute kidney injury (AKI) after heart transplantation (HT) remains incompletely understood. This systematic review and meta-analysis aimed to estimate the pooled incidence of AKI and AKI requiring renal replacement therapy (RRT) after HT, assess associated mortality risks and identify characteristics associated with AKI requiring RRT. Method(s): A systematic literature search identified original studies reporting the incidence of AKI after HT using standardized definitions or reporting AKI requiring RRT. Meta-analyses were conducted using random-effects models. Result(s): Forty-eight studies covering 14,389 patients were included. The pooled incidence of AKI was 57.05% (95% CI: 49.51-64.28), and AKI requiring RRT occurred in 16.99% (95% CI: 13.58-21.04). Among patients with AKI, 30-day and one-year mortality were of 12.96% (95% CI: 9.80-16.94) and 18.51% (95% CI: 14.56-23.23) respectively. AKI was associated with an approximately threefold increase in 30-day (OR: 2.92; 95% CI: 2.02-4.22) and one-year mortality (OR: 3.07; 95% CI: 1.76-5.34). In patients requiring RRT, 30-day and one-year mortality were 26.47% (95% CI: 18.46-36.41) and 35.13% (95% CI: 28.78-42.06), respectively. AKI requiring RRT was associated with and increased 30-day mortality of more than twelvefold (OR: 12.11; 95% CI: 6.05-24.24) and one-year mortality of more than fivefold (OR: 5.40; 95% CI: 3.88-7.51) Characteristics associated with AKI requiring RRT included higher body mass index, elevated baseline creatinine, chronic kidney disease, perioperative extracorporeal membrane oxygenation support, and longer cardiopulmonary bypass time. Conclusion(s): AKI is highly prevalent after HT and is strongly associated with increased early and late mortality, particularly in patients requiring RRT. Copyright © 2026 Elsevier Inc. <3> Accession Number 2047861690 Title Left Atrial Appendage Closure vs Anticoagulation for Stroke Prevention in Atrial Fibrillation: Meta-Analysis of Randomized Trials. Source JACC: Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Turagam M.K.; Halperin J.L.; Granger C.B.; Bhatt D.L.; Velagapudi P.; Dukkipati S.R.; Gurol M.E.; Sartori S.; Nair D.G.; Neuzil P.; Doshi S.K.; Leon M.B.; Fuster V.; Reddy V.Y. Institution (Turagam, Dukkipati, Reddy) Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, United States (Halperin, Bhatt, Sartori, Fuster) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Granger) Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States (Velagapudi) Division of Cardiology, Barnes-Jewish Christian Cardiology, St. Louis, MO, United States (Gurol) Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Nair) St. Bernards Medical Center & Arrhythmia Research Group, Jonesboro, AR, United States (Neuzil) Charles University and Faculty Hospitals Motol and Homolka, Prague, Czechia (Doshi) Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States (Leon) Department of Cardiology, Columbia University Irving Medical Center, New York, NY, United States (Leon) Cardiovascular Research Foundation, New York, NY, United States Publisher Elsevier Inc. Abstract Background: Oral anticoagulation (OAC) and left atrial appendage closure (LAAC) are stroke prevention strategies for patients with atrial fibrillation. Objective(s): To compare stroke and bleeding outcomes from a meta-analysis of randomized controlled trials comparing LAAC to OAC. Method(s): The primary outcome was stroke or systemic embolism (stroke/SE). Secondary outcomes included ischemic stroke, hemorrhagic stroke, major bleeding (MB), clinically significant bleeding (MB + clinically relevant nonmajor bleeding), non-procedure related clinically-significant bleeding, and cardiovascular or all-cause mortality. Result(s): Seven randomized controlled trials met inclusion criteria (n = 7,353 patients; CHA<inf>2</inf>DS<inf>2</inf>-VASc score: 3.9; mean follow-up: 37.6 months), including 294 stroke/SE events. LAAC was similar to OAC for preventing stroke/SE (risk ratio [RR]: 1.10, 95% CI: 0.82-1.48). Clinically significant bleeding (RR: 0.60, 95% CI: 0.36-0.98) and non-procedure-related clinically significant bleeding (RR: 0.50, 95% CI: 0.39-0.64) were less frequent after LAAC. No statistically significant differences were observed for ischemic stroke, hemorrhagic stroke, MB, cardiovascular mortality, or all-cause mortality. The annualized incidence rate difference of stroke with LAAC did not increase with higher CHA<inf>2</inf>DS<inf>2</inf>-VASc scores and did not exceed 0.37%/year in any nonwarfarin-OAC comparative trial. In postablation patients, LAAC showed similar stroke/SE rates (RR: 0.92, 95% CI: 0.53-1.60; P-interaction = 0.76) and less nonprocedural clinically significant bleeding (RR: 0.51, 95% CI: 0.42-0.62; P-interaction = 0.56). Conclusion(s): LAAC prevents stroke/SE at rates not significantly different from OAC while reducing clinically significant bleeding, with possibly a more favorable benefit in postablation patients. In the full cohort, the numerically higher ischemic stroke rate was not statistically significant, and small in absolute terms. These findings support LAAC based on individualized, patient-centered decision-making, balancing stroke and bleeding risks. Copyright © 2026 The Authors <4> Accession Number 2047874714 Title Coronary plaque burden and computed tomography-derived fractional flow reserve are predictors of 5-year mortality in peripheral artery disease patients with no known coronary artery disease. Source Journal of Vascular Surgery Cases, Innovations and Techniques. 12(5) (no pagination), 2026. Article Number: 102361. Date of Publication: 01 Oct 2026. Author Krievins D.; Jegere S.; Arko F.; Lacis A.; Zellans E.; Latkovskis G.; Kumsars I.; Putrins D.; Vetra J.; Supols E.; Zvaigzne L.; Tzivian L.; Lacis L.; Erglis A.; Zarins C.K. Institution (Krievins, Jegere, Lacis, Zellans, Latkovskis, Kumsars, Putrins, Vetra, Supols, Zvaigzne, Erglis) Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia (Krievins, Jegere, Zellans, Latkovskis, Kumsars, Supols, Tzivian, Erglis) Faculty of Medicine and Life Sciences, University of Latvia, Riga, Latvia (Arko) Sanger Heart and Vascular Institute, Charlotte, NC, United States (Lacis, Vetra, Lacis) Faculty of Medicine, Riga Stradins University, Riga, Latvia (Zarins) Stanford University Medical Center, Stanford, CA, United States Publisher Society for Vascular Surgery Abstract Objective: Patients with peripheral artery disease (PAD) have poor long-term survival due to coexisting coronary artery disease (CAD), which is often asymptomatic and undiagnosed. Coronary computed tomography angiography (CTA)-derived quantitative plaque analysis (CT-QPA) and fractional flow reserve (FFR<inf>CT</inf>) are established predictors of cardiovascular death in patients with symptomatic CAD. However, their prognostic value in patients with PAD with no symptoms of CAD undergoing peripheral vascular surgery is unknown. This study assessed the value of CT-QPA and FFR<inf>CT</inf> in predicting 5-year mortality in patients with vascular surgery with no known CAD. Method(s): Patients with PAD with no evidence of CAD who were cleared for elective peripheral vascular surgery were enrolled in a prospective study of preoperative CTA and FFR<inf>CT</inf> to evaluate cardiac risk. Lesion-specific coronary ischemia was defined as FFR<inf>CT</inf> <= 0.80, with severe ischemia defined as FFR<inf>CT</inf> < 0.75. CT-QPA analysis provided quantitative data on total plaque volume (TPV) and plaque characteristics. Vascular surgery was performed on all patients with no perioperative mortality. Postoperatively, all patients received guideline-directed medical therapy with no elective coronary revascularization. The primary endpoint was all-cause death at 5 years, assessed by Cox regression analysis. Result(s): Among 124 patients with PAD with no cardiac history or symptoms (mean age, 67 +/- 8 years; 76% men), coronary plaque burden was high (median [TPV] 550 mm3 [IQR, 299-1156]), and 53% had asymptomatic (silent) coronary ischemia (FFR<inf>CT</inf> <= 0.80). During a 5-year follow-up, 32 patients (26%) died. Nonsurvivors had nearly twofold higher TPV compared with survivors (975 vs 458 mm3; P < .001), with significant increases in calcified (P < .001), noncalcified (P < .001), and low-attenuation plaque (P = .038). Five-year mortality in patients with TPV > 750 mm3 was 46% compared to 4% in those with TPV < 250 mm3 (log-rank P < .001). Both TPV >= 550 mm3 (hazard ratio, 3.6; 95% confidence interval, 1.6-7.9; P = .002) and FFR<inf>CT</inf> <= 0.80 (hazard ratio, 2.1; 95% confidence interval, 1.0-4.5; P = .045) were predictors of increased mortality risk. Five-year mortality in patients with both high plaque and coronary ischemia was 42% compared with only 10% in patients with low plaque and no ischemia (log-rank P = .006). Conclusion(s): In patients with PAD with no known CAD undergoing elective vascular surgery, coronary plaque burden and silent coronary ischemia detected by CT-QPA and FFR<inf>CT</inf> were predictors of a 5-year mortality. Coronary CTA with quantitative plaque and FFR analysis should be considered for comprehensive cardiac risk stratification in patients with vascular surgery, regardless of cardiac symptoms. Copyright © 2026 The Author(s) <5> Accession Number 2047759709 Title Left Atrial Appendage Occlusion Versus Medical Therapy in Atrial Fibrillation: A Systematic Review and Meta-Analysis. Source Journal of Clinical Medicine. 15(14) (no pagination), 2026. Article Number: 5529. Date of Publication: 01 Jul 2026. Author Khan M.A.; Muhammad A.; Nawaz S.; Ali M.K.B.; Shahzaib M.; Sameen A.; Anwar M.; Agrawal A.; Bhatia H.; Khan S.Z.; Sharma S. Institution (Khan, Nawaz, Anwar, Agrawal) Department of Internal Medicine, Guthrie Clinic Robert Packer Hospital, Sayre, PA, United States (Muhammad, Ali, Shahzaib, Sameen, Bhatia) Department of Medicine, King Edward Medical University, Lahore, Pakistan (Khan) Department of Cardiology, Guthrie Clinic Robert Packer Hospital, Sayre, PA, United States (Sharma) Department of Cardiology, University of Cincinnati, Cincinnati, OH, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Percutaneous left atrial appendage occlusion (LAAO) is an established nonpharmacologic strategy for stroke prevention in atrial fibrillation (AF). Its comparative effectiveness and safety relative to contemporary medical therapy, including direct oral anticoagulants (DOACs), remain uncertain following recent large randomized controlled trials (RCTs). Method(s): We performed a systematic review and meta-analysis of RCTs comparing catheter-based LAAO with medical therapy in AF patients. PubMed, CENTRAL, and ScienceDirect were searched from inception through May 2026. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models. The primary outcome was the composite primary endpoint. Secondary outcomes included all-cause death, cardiovascular death, all stroke/TIA, ischemic stroke/TIA, systemic embolism, major bleeding, and nonprocedural major bleeding. Risk of bias was assessed using ROB 2. Result(s): Six RCTs were included, contributing 7073 participants (3729 LAAO; 3344 medical therapy). LAAO was not associated with significant differences in the composite endpoint (RR 1.02; 95% CI 0.85-1.23), all-cause death (RR 1.02; 95% CI 0.79-1.31), cardiovascular death (RR 0.93; 95% CI 0.67-1.29), all stroke/TIA (RR 1.06; 95% CI 0.81-1.38), ischemic stroke/TIA (RR 1.24; 95% CI 0.88-1.76), systemic embolism (RR 0.76; 95% CI 0.12-4.77), or total major bleeding (RR 0.93; 95% CI 0.77-1.13). LAAO significantly reduced nonprocedural bleeding (RR 0.54; 95% CI 0.46-0.63; p < 0.0001; I2 = 0.0%). Heterogeneity was low to moderate across outcomes. Conclusion(s): No significant differences were observed between LAAO and medical therapy for the composite endpoint, mortality, or thromboembolic outcomes; however, confidence intervals for ischemic stroke/TIA and systemic embolism remained wide and cannot exclude a clinically meaningful excess of thromboembolic events after LAAO. LAAO was associated with a substantial and consistent reduction in nonprocedural bleeding. These findings suggest LAAO may be considered an individualized alternative to oral anticoagulation for selected patients with high bleeding risk or anticoagulation intolerance, weighing upfront procedural risk against this bleeding benefit, while uncertainty for rare thromboembolic outcomes remains to be resolved. Copyright © 2026 by the authors. <6> Accession Number 2047932083 Title Study design of the EDGEFIRM trial: transcatheter edge-to-edge repair versus guideline-directed medical therapy in atrial functional mitral regurgitation and HFpEF. Source ESC Heart Failure. 13(4) (no pagination), 2026. Article Number: xvag203. Date of Publication: 01 Aug 2026. Author Ozturk C.; Bohm L.; Altintac E.; Vogelhuber J.; Weber M.; Zimmer S.; Nickenig G. Institution (Ozturk, Bohm, Altintac, Vogelhuber, Weber, Zimmer, Nickenig) Department of Cardiology, Heart Centre, University Hospital Bonn, Bonn, Germany Publisher Oxford University Press Abstract Introduction: Over the past decade, mitral valve transcatheter edge-to-edge repair (M-TEER) has become an established interventional treatment option for functional mitral regurgitation. One subtype that has recently gained increasing scientific attention is atrial functional mitral regurgitation (aFMR) occurring in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Randomized trials to date have largely excluded patients with HFpEF, leading to limited data in this cohort. Study design: The randomized evaluation of transcatheter edge-to-edge repair in patients with atrial functional mitral regurgitation and HF with preserved ejection fraction compared with GDMT (EDGEFIRM) is a prospective, open-label, randomized, multicentre trial evaluating the additive effect of M-TEER in patients with aFMR and HFpEF compared to guideline-directed medical therapy (GDMT) only. Eligible patients must be symptomatic under stable GDMT with significant aFMR (>grade II or grade II with hemodynamic relevance) and HFpEF and considered high risk for surgical therapy by Heart Team evaluation. Randomization will be conducted in a 2:1 manner M-TEER + GDMT vs GDMT only. The primary combined endpoint consists of cardiovascular mortality, HF hospitalization/worsening HF, improvement <10 points in KCCQ-Score after 1 year. Secondary endpoints include reduction of mitral regurgitation, device safety, functional capacity as well as the individual components of the combined endpoint. Discussion(s): The EDGEFIRM trial aims to evaluate the additive effect of M-TEER compared with GDMT only in patients with symptomatic aFMR and HFpEF. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. <7> Accession Number 2047903009 Title ICE-guided left atrial appendage closure: Reassuring real-world outcomes in an era of conflicting randomized evidence. Source International Journal of Cardiology. 462 (no pagination), 2026. Article Number: 134690. Date of Publication: 01 Nov 2026. Author Ebrahimi S. Institution (Ebrahimi) Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States Publisher Elsevier Ireland Ltd <8> Accession Number 2038269612 Title The effect of diabetes mellitus on aortic valve stenosis and its treatment outcome: A meta-analysis review. Source ARYA Atherosclerosis. 22(2) (pp 55-56), 2026. Date of Publication: 01 Mar 2026. Author Hosseini A.; Maghami-Mehr A.; Khesali H. Institution (Hosseini, Khesali) Department of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of (Maghami-Mehr) Department of Statistics, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of Publisher Isfahan University of Medical Sciences(IUMS) Abstract BACKGROUND: Given the importance of diabetes mellitus (DM) and its role in the development of aortic valve stenosis (AVS), as well as its association with adverse outcomes after aortic valve replacement (AVR), the present meta analysis aimed to provide a comprehensive review of previous studies in this field. METHOD(S): To achieve this objective, a thorough literature search was conducted in PUBMED/MEDLINE, ScienceDirect, CINAHL, EMBASE/SCOPUS, PsycINFO, ClinicalKey, the Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest, Web of Science, and Persian databases such as SID and Magiran. The number of patients, gender ratio, mean age, prevalence of T2DM, AVS, and treatment outcomes after TAVI, TAVR, and SAVR (stroke, early and late mortality) were recorded. RESULT(S): This meta-analysis comprised 22 studies involving a total of 760,287 patients with AVS. The pooled prevalence of DM was approximately 31% (95% CI: 26-36%). DM was associated with a significantly higher risk of early mortality, including both in-hospital mortality (OR: 2.399) and 30-day mortality (OR: 1.45), compared with non-DM patients (p<0.05). However, the increase in late mortality (one year or longer) among DM patients was not statistically significant. Additionally, DM patients showed a significantly elevated risk of stroke compared with non-DM patients (OR: 1.15; 95% CI: 1.03-1.28; p=0.009). CONCLUSION(S): Overall, DM appears to play a significant role in the development of AVS and is associated with adverse outcomes including mortality and stroke after AVR. Copyright © 2026, Isfahan University of Medical Sciences(IUMS). All rights reserved. <9> Accession Number 2047722043 Title Long-term valve durability and clinical outcomes after transcatheter versus surgical aortic valve replacement in low-risk patients: a systematic review and meta-analysis of randomized trials. Source Journal of Thrombosis and Thrombolysis. (no pagination), 2026. Date of Publication: 2026. Author Ramamoorthy L.; Otmani F.; Gupta A.; George L.R.; Khanuja P.K.; Galadima H.S.; Lee D.S.; Skef S.; Al Khatib B.; B M.R.; Vapheas E.; Khawar M.; Khawar M.M.H. Institution (Ramamoorthy) University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States (Otmani) First Community Health and Care, Surrey, Redhill, United Kingdom (Gupta) Department of Medicine, DMC Sinai Grace Hospital, Detroit, United States (George) Azeezia Institute of Medical Sciences and Research Institute, Kollam, India (Khanuja) Univeristy of North Carolina at Chapel Hill, Chapel Hill, NC, United States (Galadima) School of Medicine, New Vision University, Tbilisi, Georgia (Lee) Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain (Skef) Alfaisal University, Riyadh, Saudi Arabia (Al Khatib) Central Michigan University, Saginaw, United States (B) JSS Medical College, Mysore, India (Vapheas) St. Georges University School of Medicine, St. Georges, Grenada (Khawar) King Edward Medical University, Lahore, Pakistan (Khawar) Services Institute of Medical Sciences, Lahore, Pakistan Publisher Springer Abstract Transcatheter aortic valve replacement (TAVR) has extended its use to low-surgical-risk populations, yet long-term comparative data against surgical aortic valve replacement (SAVR) are still limited, particularly concerning durability and the need for reintervention. We conducted a search of PubMed/MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov through March 2026 for randomized trials comparing TAVR with SAVR in patients with low surgical risk and severe aortic stenosis, specifically those with at least three years of follow-up. Outcomes were pooled as risk ratios (RR) using Mantel-Haenszel random-effects models, and durability and mortality outcomes were analyzed as time-to-event hazard ratios (HR) to accommodate different follow-up durations. Prespecified subgroup analyses by valve platform were performed. Four trials involving 3,014 patients (follow-up ranging from 3 to 10 years) were included. Cardiovascular mortality (HR 1.11, 95% CI 0.86-1.42; P = 0.43) and all-cause stroke (HR 1.09, 95% CI 0.73-1.64; P = 0.67) did not differ significantly between TAVR and SAVR. Aortic valve reintervention was higher with TAVR in risk-ratio analysis (RR 1.58, 95% CI 1.16-2.16) but did not reach statistical significance in the prespecified time-to-event analysis (HR 1.29, 95% CI 0.81-2.05). The excess reintervention risk was confined to the self-expanding valve platform. Permanent pacemaker implantation was significantly more frequent after TAVR (RR 2.08, 95% CI 1.48-2.93; P < 0.0001), with a significant interaction by valve platform (self-expanding RR 2.57 vs balloon-expandable RR 1.40; P = 0.02 for interaction). Bioprosthetic valve failure showed a nonsignificant trend favoring TAVR (HR 0.80, 95% CI 0.54-1.17). The only available 10-year randomized data (NOTION trial) showed significantly less severe structural valve deterioration with TAVR than with SAVR. The results suggest that TAVR and SAVR are equivalent in terms of cardiovascular mortality and stroke outcomes. However, pacemaker implantation rates were higher with TAVR and were strongly dependent on the valve platform used. The observed excess in reinterventions was confined to self-expanding valves and did not show robust support in the time-to-event analysis. The unique 10-year data from the self-expanding platform indicate less severe structural valve deterioration compared to SAVR, suggesting that durability should not be generalized across different device families. These findings advocate for individualized, platform-aware decision-making in clinical practice. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <10> Accession Number 2047448958 Title Drug-coated balloons vs. drug-eluting stents for coronary artery disease: an updated systematic review and meta-analysis of randomized controlled trials with lesion-specific insights. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1843262. Date of Publication: 18 May 2026. Author Wang Y.; Shi Y.; Wang Q.; Yang S.; Chen X. Institution (Wang, Shi, Wang, Yang, Chen) Cardiovascular Disease Center, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Hubei, Enshi, China Publisher Frontiers Media SA Abstract Objective - To compare the efficacy and safety of drug-coated balloons (DCB) vs. drug-eluting stents (DES) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention, with a focus on lesion-specific and presentation-specific outcomes. Methods - We systematically searched PubMed, Embase, CENTRAL, and Web of Science for randomized controlled trials (RCTs) comparing DCB with DES from inception to March 2026. Outcomes included major adverse cardiac events (MACEs), target lesion revascularization (TLR), device-oriented composite endpoint (DoCE), patient-oriented composite endpoint (PoCE), cardiac death, myocardial infarction (MI), all-cause death, thrombosis (definite/probable), and angiographic endpoints. Pooled odds ratios (ORs) or mean differences (MDs) were calculated using random-effects models. Subgroup analyses were performed by lesion type [de novo vs. in-stent restenosis (ISR)], vessel size, clinical presentation (STEMI vs. NSTEMI vs. unstable angina), and DCB type (paclitaxel vs. sirolimus). Results - Twenty-three RCTs comprising 8, 123 patients were included. DCB was associated with significantly higher risks of TLR (OR 2.22, 95% CI 1.49-3.33), DoCE (OR 1.86, 95% CI 1.49-2.31), PoCE (OR 1.43, 95% CI 1.20-1.72), and cardiac death (OR 1.53, 95% CI 1.11-2.10) compared with DES. No significant differences were observed for MACEs, MI, all-cause death, or thrombosis. In the critical subgroup analysis, for ISR, DES was superior to DCB (OR for TLR with DCB vs. DES: 3.54, 95% CI 2.05-6.09), whereas for de novo lesions, DCB was associated with a higher risk of TLR compared to DES (OR 1.76, 95% CI 1.03-3.02). In small vessel disease, TLR did not differ significantly between the two strategies (OR 1.17, 95% CI 0.64-2.14). The increased risk of cardiac death with DCB was observed only in trials using paclitaxel-coated balloons (OR 1.63, 95% CI 1.17-2.28), while no signal was seen with sirolimus-coated balloons (OR 0.96, 95% CI 0.19-4.81). However, this finding is exploratory, derived from post-hoc subgroup analyses with limited events and shorter follow-up in sirolimus studies, and should be interpreted with caution. Exploratory analysis by clinical presentation showed no significant interaction between treatment effect and STEMI, NSTEMI, or unstable angina (P-interaction = 0.34 for MACEs). Conclusions - The comparative effectiveness of DCB vs. DES is lesion-specific. For ISR, DES remains the superior treatment. DCB represents a viable alternative to DES in de novo small vessel disease. However, in de novo lesions of non-small vessels, DES remains superior. The increased cardiac death signal appears to be driven by paclitaxel-coated balloons and warrants further investigation. Clinical presentation (STEMI/NSTEMI/unstable angina) did not modify the relative treatment effect, but these analyses were exploratory and limited by sample size. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261355942, PROSPERO CRD420261355942. Copyright © 2026 Wang, Shi, Wang, Yang and Chen. <11> Accession Number 2047821452 Title Perioperative Immunonutrition in Patients Undergoing Lung Cancer Surgery: Current Evidence and Future Perspectives. Source Nutrients. 18(14) (no pagination), 2026. Article Number: 2381. Date of Publication: 01 Jul 2026. Author Werblinska A.; Skrzypczak P.J.; Roszak M.; Bryl M.; Piwkowski C.; Gabryel P. Institution (Werblinska, Skrzypczak, Piwkowski, Gabryel) Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, Poznan, Poland (Werblinska) Doctoral School, Poznan University of Medical Sciences, Bukowska 70, Poznan, Poland (Werblinska, Skrzypczak, Bryl, Piwkowski, Gabryel) Greater Poznan Center of Pulmonology and Thoracic Surgery, Szamarzewskiego 62 Street, Poznan, Poland (Roszak) Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, and surgical resection is the primary curative treatment for patients with early-stage non-small cell lung cancer (NSCLC). Patients undergoing lung cancer surgery are frequently affected by malnutrition, systemic inflammation, sarcopenia, and cancer-related cachexia, which may adversely affect postoperative recovery and clinical outcomes. Perioperative immunonutrition has been proposed as a strategy to support immune and metabolic responses associated with surgical stress. This narrative review summarizes current evidence regarding the role of perioperative immunonutrition in patients undergoing lung cancer surgery. Method(s): This narrative review summarizes current evidence regarding perioperative immunonutrition in patients undergoing lung cancer surgery. Relevant studies evaluating perioperative immunonutrition, including formulations enriched with arginine, omega-3 fatty acids, glutamine, and nucleotides, were analyzed. Particular attention was given to clinical studies in thoracic surgical oncology, perioperative outcomes, inflammatory response, and current nutritional guideline recommendations. Result(s): Available evidence suggests that perioperative immunonutrition may improve nutritional and immunological status in patients undergoing lung cancer surgery. Clinical studies have reported reductions in postoperative complications, shorter chest drainage duration, improved nutritional indices, and decreased inflammatory markers in patients receiving immunonutritional support. Experimental and translational studies also indicate potential beneficial effects on immune cell function and inflammatory regulation. However, current thoracic-specific evidence remains limited because of small study populations, heterogeneity of nutritional protocols, and variability in study design. Conclusion(s): Perioperative immunonutrition appears to be a promising adjunct to comprehensive perioperative care in patients undergoing lung cancer surgery. Although preliminary evidence suggests potential benefits in postoperative recovery and nutritional optimization, its implementation should be individualized according to the patient's nutritional status, disease stage, and overall treatment strategy. As immunonutrition modulates metabolic and immune pathways that may also influence tumor biology, nutritional interventions should be evidence-based, carefully monitored, and integrated within multidisciplinary perioperative care to maximize clinical benefits while minimizing potential unintended effects. Further large, well-designed randomized clinical trials are needed to establish standardized protocols and clarify the role of immunonutrition in thoracic surgical oncology. Copyright © 2026 by the authors. <12> Accession Number 2047865156 Title Changes in Free and Total Remimazolam Concentrations During Cardiopulmonary Bypass: A Randomized Dose-Comparison Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Ohno S.; Yoshikawa Y.; Kurihara D.; Sato Y.; Kunigo T.; Takahashi K.; Sato T.; Hirahata T.; Maeda M.; Negishi K.; Ikeshima Y.; Ishida M.; Shimizu H.; Hayashi M.; Takasaki Y.; Chaki T.; Aoyama T.; Toda T.; Yamakage M. Institution (Ohno, Yoshikawa, Sato, Kunigo, Takahashi, Sato, Hirahata, Maeda, Negishi, Ikeshima, Chaki, Yamakage) Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Sapporo, Japan (Kurihara, Ishida, Shimizu, Hayashi, Takasaki, Aoyama, Toda) Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Hokkaido, Sapporo, Japan Publisher W.B. Saunders Abstract Objectives: Remimazolam is increasingly used in cardiac surgery for hemodynamic stability; however, during cardiopulmonary bypass (CPB), hemodilution and hypoalbuminemia may increase its pharmacologically active free fraction, raising concern about unrecognized overexposure under constant infusion. Yet, the temporal profile of free remimazolam during CPB has not been fully elucidated. We investigated whether a pragmatic dose adjustment could maintain free remimazolam concentrations within a stable range. Design(s): Randomized, controlled, parallel-group trial. Setting(s): A university hospital. Participant(s): Thirty-six adults undergoing cardiac surgery with CPB. Intervention(s): Patients were assigned to a normal-dose group (1 mg/kg/h) or a low-dose group in which the infusion rate of remimazolam was reduced to 70% at CPB initiation (0.7 mg/kg/h). Measurements and Main Results: The primary outcome was free remimazolam concentration. Secondary outcomes included total remimazolam concentration, protein binding, and associations between bispectral index values and drug concentrations. Baseline-adjusted analysis of free remimazolam concentrations showed a significant time-by-group interaction (p<inf>interaction</inf> = 0.001), increasing over time in the normal-dose group but remaining stable in the low-dose group. The largest adjusted between-group difference was observed 30 minutes after CPB termination (mean difference [95% CI], 89 [58-120] ng/mL; p < 0.001). No linear association was observed between bispectral index values and free or total remimazolam concentrations. Conclusion(s): During CPB, free remimazolam concentrations increased over time under constant infusion without corresponding changes in bispectral index values, whereas reducing the infusion rate to 70% at CPB initiation maintained free remimazolam concentrations within a stable range. Copyright © 2026 Elsevier Inc. <13> Accession Number 2040599962 Title Revascularisation strategies for non-acute myocardial ischaemic syndromes. Source Heart. 112(10) (pp 530-538), 2026. Date of Publication: 01 May 2026. Author Kawczynski M.J.; Barili F.; Brophy J.M.; De Caterina R.; Biondi Zoccai G.; Boden W.E.; Albuquerque A.; Almeida R.; Anselmi A.; Beurtheret S.; Boden W.; Borger M.; Brophy J.; Buttiglione G.; Dayan V.; Caterina R.D.; Cuesta M.D.L.; Firstenberg M.; Garcia-Villareal O.; Gomes W.; Heuts S.; Kaul S.; Kawczynski M.; Mandrola J.; Cuartas M.M.; Misfield M.; Musumeci F.; Parolari A.; Quintana E.; Redberg R.; Riad R.; Stuart J.R.-R.; Ronco D.; Uva M.S.; Tomasi J.; Verhoye J.-P.; Zenati M.; Dib N. Institution (Kawczynski, Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands (Kawczynski, Heuts) Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands (Barili, Parolari) Universita Degli Studi Di Milano, Milan, Italy (Barili) IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy (Barili) Harvard T.H. Chan School of Public Health, Boston, MA, United States (Brophy) McGill University, Montreal, QC, Canada (De Caterina) Cardiology Division, Pisa University Hospital, Pisa, Italy (Biondi Zoccai) Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (Biondi Zoccai) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Anselmi) Department of Thoracic and Cardiovascular Surgery, University Hospital Centre Rennes, Rennes, France (Boden) VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States Publisher BMJ Publishing Group Abstract Background: Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes. Method(s): A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores. Result(s): 10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68-1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79-1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71-1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models. Conclusion(s): This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains. PROSPERO registration number: CRD42024541215. Copyright © Author(s) (or their employer(s)) 2026. No commercial re-use. See rights and permissions. Published by BMJ Group. <14> Accession Number 2047832729 Title Minimally Invasive Surgery for Mitral Valve Endocarditis: A Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data. Source Journal of Personalized Medicine. 16(7) (no pagination), 2026. Article Number: 350. Date of Publication: 01 Jul 2026. Author Karagkounis T.; Alifragki A.; Zoupas I.; Sarantou S.; Schizas N.; Mylonas K.S.; Iliopoulos D.C. Institution (Karagkounis, Schizas, Iliopoulos) 4th Department of Cardiac Surgery, Hygeia Hospital, Athens, Greece (Alifragki) Medical School, University of Crete, 70013, Heraklion, Greece (Zoupas, Iliopoulos) Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States (Sarantou) Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States (Mylonas) Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States (Iliopoulos) Laboratory of Experimental Surgery and Surgical Research 'N.S. Christeas', National and Kapodistrian University of Athens, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Minimally invasive (MIS) mitral valve surgery has been proven to be a safe and effective alternative to median sternotomy (ST), with advantages in postoperative recovery and morbidity. However, its role in the setting of infective endocarditis (IE) remains uncertain. This meta-analysis aims to evaluate the outcomes of MIS in mitral valve surgery for infective endocarditis. Method(s): A PRISMA-compliant search for studies including patients undergoing MIS for mitral valve IE was performed through 14 January 2026, in PubMed, Scopus and Cochrane. Time-to-event data were reconstructed from published Kaplan-Meier curves. A secondary comparative analysis focusing on MIS versus ST techniques was conducted. Result(s): Fourteen retrospective studies comprising 949 patients were analyzed. In the MIS cohort, early mortality was 4.2% (95%CI: 1.8%, 7.4%). Overall survival was 86.7% at 1 year, 75.2% at 5 years and 56.2% at 10 years. Freedom from IE-related reoperation remained high at 97.5%, 95.9%, and 90.7% at 1, 5, and 10 years, respectively. Mitral valve repair was performed in 52.5% of patients. In secondary comparative analyses, overall survival at 4-year follow-up was not different between MIS and ST [HR: 0.82 (95%CI: 0.43, 1.57), p = 0.55]. MIS was associated with a significantly shorter intensive care unit (ICU) stay [MD: -1.52 days (95%CI: -2.08, -0.97), p < 0.01]. Conclusion(s): MIS for mitral valve IE is associated with favorable early and long-term outcomes, comparable survival with sternotomy, and reduced ICU stay. These findings suggest that MIS may be considered as a feasible and potentially effective alternative for the management of mitral valve IE in carefully selected patients. Further prospective comparative studies are warranted. Copyright © 2026 by the authors. <15> Accession Number 2047603922 Title Incidence and Predictors of Postoperative Atrial Fibrillation Following Cardiac Surgery: A Systematic Review. Source Annals of Cardiac Anaesthesia. 29(3) (pp 314-324), 2026. Date of Publication: 01 Jul 2026. Author Prasetyadhi J.; Adil A.; Hisbullah; Arif S.K. Institution (Prasetyadhi) Department of Anesthesiology, Intensive Care, and Pain Management, Kolaka Timur Regional Public Hospital, Kolaka Timur, South Sulawesi, Indonesia (Adil, Hisbullah, Arif) Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Wahidin Sudirohusodo Hospital, South Sulawesi, Makassar, Indonesia Publisher Wolters Kluwer Medknow Publications Abstract Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with an incidence ranging from 10% to 65%, and is associated with increased risks of stroke, prolonged hospitalization, and mortality. This systematic review aimed to evaluate the incidence and identify predictors of POAF in adults undergoing cardiac procedures. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Europe PMC, and SAGE databases for English-language studies published between January 2020 and June 2025. Eligible studies included observational and experimental designs involving adults (>18 years) undergoing cardiac surgery. Two reviewers independently screened titles/abstracts, assessed full texts, extracted data, and evaluated quality using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools. From 6598 initial records, 52 studies (32 prospective cohorts, 17 retrospective cohorts, and 3 cross-sectional) were included, encompassing diverse geographies, and surgical types (e.g., coronary artery bypass grafting, valve surgery). POAF incidence varied from 7.9% to 60.9%, highest in combined procedures (40%-50%), and valve surgery (30%-40%). Consistent predictors included advanced age (odds ratio 1.05-1.10/year), left atrial enlargement, valve surgery, comorbidities (hypertension, diabetes, renal dysfunction), prolonged cardiopulmonary bypass, inflammation (e.g. C-reactive protein, neutrophil-to-lymphocyte ratio), and oxidative stress markers (e.g. NOX2). Novel biomarkers like MR-proANP and gene panels showed potential. POAF remains multifactorial and burdensome; standardized monitoring and integrated risk models could enhance prediction and prevention, warranting further validation in multicenter trials. Copyright © 2026 Annals of Cardiac Anaesthesia. <16> Accession Number 2047908317 Title Emergency Department Imaging of Pediatric Patients with Blunt Thoracic Trauma: A Systematic Review, Meta-Analysis, and Practice Management Guideline. Source JACEP Open. 7(5) (no pagination), 2026. Article Number: 100474. Date of Publication: 01 Oct 2026. Author Lam S.H.F.; Claudius I.; Valente J.H.; Yorkgitis B.K.; Dietrich A.M.; Wang R.J.; Kvasnovsky C.; Gaspard C.S.; Thomas A.K.; Koberlein G.; Mitchell I.C. Institution (Lam) Children's Hospital Colorado, Aurora, CO, United States (Lam) Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States (Claudius) Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States (Valente) Departments of Emergency Medicine and Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States (Valente) Rhode Island Hospital, Providence, RI, United States (Valente) Hasbro Children's Hospital, Providence, RI, United States (Yorkgitis) Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States (Dietrich) Department of Emergency Medicine, Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC, United States (Wang) Department of Dermatology, The University of Texas Health Science Center Houston, Houston, TX, United States (Kvasnovsky) Department of Surgery, University of Chicago, Chicago, IL, United States (Gaspard) Health Science Center Libraries, The University of Texas, San Antonio, TX, United States (Thomas) Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States (Koberlein) Department of Radiology, Nemours Children's Health, Central Florida, Orlando, FL, United States (Mitchell) Division of Pediatric Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States Publisher Elsevier Inc. Abstract Pediatric blunt torso trauma is a common reason for emergency department visits. Computed tomography (CT) is a highly sensitive tool for diagnosis of thoracic cavity injuries. However, the prevalence of thoracic injuries requiring intervention is lower in children compared with adults, and ionizing radiation from CT is associated with higher potential harms in this population. The role of screening chest x-ray and point-of-care ultrasound in identifying thoracic injuries requiring operative and procedural intervention has not been systematically reviewed previously. Four relevant questions related to imaging after blunt thoracic trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). A systematic review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development and Evaluation methodology. The multispecialty working group reached consensus on the final evidence-based recommendation. A total of 10,447 articles were screened, and data from 3 studies were included in the final meta-analysis. All the studies were retrospective in design, and the quality of the available evidence was determined to be very low. Based on the limited data, we were only able to make a recommendation on one of the 4 drafted PICO questions. In pediatric (<18 years) patients with blunt trauma presenting to the emergency department who have no or minor traumatic findings on initial screening chest imaging, we conditionally recommend that chest CT not be routinely used to identify thoracic injuries requiring procedural or operative intervention, or to identify thoracic injuries leading to mortality. Copyright © 2026 The Author(s) <17> Accession Number 2047784468 Title Acute normovolaemic haemodilution after cardiac surgery: failed diffusion or clinical re-invention? Comment on Br J Anaesth 2026; 136: 836a"46. Source British Journal of Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Tanaka K.; Alhamami R.; Butt A.L.; Stewart K.E. Institution (Tanaka, Butt, Stewart) Department of Anaesthesiology, University of Oklahoma Health, Oklahoma City, OK, United States (Alhamami) College of Medicine, University of Oklahoma Health, Oklahoma City, OK, United States (Stewart) Department of Surgery, University of Oklahoma Health, Oklahoma City, OK, United States Publisher Elsevier Ltd <18> Accession Number 2038389269 Title Remifentanil versus Fentanyl impact on Ejection Fraction and Troponin in Off-Pump Cardiac Surgery. Source Baghdad Journal of Biochemistry and Applied Biological Sciences. 7(2) (pp 169-176), 2026. Date of Publication: 01 Apr 2026. Author Ibrahim Z.Y.; Mohammad H.N.; Mustafa M.H. Institution (Ibrahim, Mohammad, Mustafa) Department of Anesthesia Sciences, College of Health Sciences, University of Duhok, Duhok, Iraq Publisher Al-Nahrain University College of Medicine Abstract Background: Remifentanil is structurally synthesized from fentanyl. It offers markedly superior analgesic effects compared to fentanyl and reaches peak efficacy within minutes after parenteral dosing (1). This study compared the effects of fentanyl and remifentanil on ejection fraction (EF) and troponin I measurement during elective off-pump coronary artery bypass graft (OPCABG) surgery. Method(s): Seventy-two patients, aged 35-75 years, were included. Parameters recorded include arterial oxygen saturation (SaO<inf>2</inf>), heart rate (HR), invasive blood pressure (IBP), and EF. Baseline IBP was recorded before any surgical or anesthetic interventions. In addition, a baseline blood sample was collected for troponin I measurement. Before anesthesia induction, all patients received 100% oxygen for at least 3 minutes, followed by intravenous midazolam 0.06 mg/kg, propofol 1.3 mg/kg, rocuronium 1.2 mg/kg, and sevoflurane 0.5 MAC. Patients were then randomly assigned to one of the two groups (randomization was done using patient numbering: odd-numbered patients were assigned to Group R (remifentanil group), and evennumbered patients to Group F (fentanyl group); Group R received 0.5 mug/kg remifentanil over 1 minute for induction and 0.1-1 mug/kg/hour for maintenance. Meanwhile, Group F received 5 mug/kg fentanyl over 1 minute for induction and 0.1-1 mug/kg/hour for maintenance. Data were analyzed using SPSS version 23 (IBM Corp., USA). Normality was assessed with the Kolmogorov-Smirnov and Shapiro-Wilk tests. Normally distributed data were expressed as mean +/- SD and nonnormally distributed data as median (IQR). EF and serum troponin were analyzed using the Friedman and Wilcoxon signed-rank tests, respectively, and group comparisons were performed using the Mann-Whitney U test. A p-value < 0.05 was considered statistically significant. Result(s): Group R showed a median preoperative EF of 55% (IQR 0.110, MR 29.23), while Group F had 58% (IQR 0.113, MR 1.77). The overall median preoperative EF was 56% (IQR 0.100), with no significant difference between groups (p=0.567). Intraoperatively, Group R demonstrated a higher median EF of 60% (IQR 0.12, MR 37.33) compared with 52% (IQR 0.10, MR 23.67) in Group F. The overall intraoperative EF was 52% (IQR 0.10), with a statistically significant difference (p=0.002). The p-value of 0.001 indicates a highly statistically significant difference in serum troponin I levels from preoperative to 24 hours post intensive care unit (ICU) admission for both R and F groups. The p-value of 0.024 indicates a highly statistically significant difference in serum troponin I levels between Group R and Group F, with Group R having a higher median 24 hours post ICU admission troponin. Conclusion(s): Both opioids provided safe and effective anesthesia for OPCABG. However, remifentanil was associated with superior intraoperative EF, suggesting greater compatibility with fast-track anesthesia and enhanced postoperative recovery, on the other side, remifentanil demonstrated higher serum troponin levels compared with fentanyl. Copyright © 2026 the Authors. <19> Accession Number 2047663832 Title Endocarditis following the Ross procedure: the advantage of a living valve. Source Global Cardiology Science and Practice. 2025(HVBTE) (no pagination), 2025. Date of Publication: 01 Jan 2025. Author Coppola G.; Melina G.; De Robertis F.; Notenboom M.; Salmasi M.Y.B.; De Siena P.; Elshalkamy M.; Mokhtassi S.S.; Holy A.A.; Petrou M.; Gaer J.; El-Hamamsy I.; Takkenberg J.J.M.; Yacoub M. Institution (Coppola, De Robertis, Mokhtassi, Petrou, Gaer) Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Melina) Department of Cardiac Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy (Notenboom) Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands (Salmasi, De Siena, Elshalkamy) Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Salmasi) Department of Surgery, Imperial College London, London, United Kingdom (Holy) Magdi Yacoub Institute, Heart Science Centre, Harefield Hospital, London, United Kingdom (El-Hamamsy, Takkenberg) Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States (Yacoub) National Heart and Lung Institute, Imperial College London, London, United Kingdom (Yacoub) Cardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt Publisher HBKU Press Abstract Background: Large observational studies have shown a rapid increase in the incidence of prosthetic valve endocarditis(PVE), due to the increasing number of patients receiving heart valve substitutes.Recently, a renewed interest has gathered around the Ross procedure(pulmonary autograft) for the treatment of aortic valve disease (AVD) in adults.Being the only available living aortic valve substitute,the pulmonary autograft is thought to be more resistant to PVE.Aim of this study was to investigate the incidence of infective endocarditis (IE) following the Ross operation. Material(s) and Method(s): We performed a post hoc analysis of a randomized clinical trial comparing AVD surgical patients undergoing homograft root replacement or the Ross procedure.In this study, the principal focus was to analyse long-term IE incidence after the Ross procedure. Result(s): From September 1,1994 to May 31,2001,a total of 108 patients (16 female, median age 38 years) received a pulmonary autograft. Aortic stenosis was present in 30 (28%),regurgitation in 49(45%) and mixed disease in 29 (27%) cases.Nine patients(8%) had active endocarditis and 45(42%) were redo operations.There was only one perioperative death(0.9%).During a median follow-up of 24.1 years (IQR, 22.6-26.1 years),there was 1 case of autograft endocarditis (0.04% per year) which was treated conservatively, and 9 cases of homograft endocarditis (0.36% per year). Conclusion(s): Infective endocarditis following the Ross procedure is rarely observed in the pulmonary autograft.The incidence of homograft endocarditis is consistent with the data in the literature.These data further support the importance of a living valve substitute and encourage the development of bioengineered valves. Copyright (c) 2025 Giuditta Coppola, Giovanni Melina, Fabio De Robertis, Maximiliaan Notenboom, Mohammad Yousuf Bilal Salmasi, Paolo De Siena, Mohamed Elshalkamy, Shiva Seyed Mokhtassi, Albaraa Al Holy, Mario Petrou, Julien Gaer, Ismail El-Hamamsy, Joanna J.M. Takkenberg, Magdi Yacoub This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. <20> Accession Number 2047452448 Title Association of achieved LDL-C levels with global coagulability and clinical outcomes in patients with acute coronary syndrome receiving PCSK9 inhibitors: a prospective cohort study. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1804585. Date of Publication: 10 Jun 2026. Author Fu T.; Yao S.; Zhang S.; Linghu H. Institution (Fu, Zhang, Linghu) Department of Emergency, The First People's Hospital of Zunyi City (The Third Affiliated Hospital of Zunyi Medical University), Guizhou Province, Zunyi City, China (Yao) Department of Cardiology, The First People's Hospital of Zunyi City (The Third Affiliated Hospital of Zunyi Medical University), Guizhou Province, Zunyi City, China Publisher Frontiers Media SA Abstract Background - The safety of achieving ultra-low low-density lipoprotein cholesterol (LDL-C) levels in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT), particularly regarding global coagulability, specific platelet reactivity, and bleeding risk, requires further validation. Methods - In this prospective, open-label, single-center cohort study, 120 post-PCI ACS patients treated with PCSK9 inhibitors and DAPT were enrolled. After a 2-week run-in, patients were stratified by their achieved LDL-C levels into a Low LDL-C group (<=0.78 mmol/L) and a Non-Low LDL-C group (>0.78 mmol/L). Global coagulability and specific platelet reactivity were serially assessed via thromboelastography and rapid platelet function assays over 12 months. The primary safety endpoint was clinically relevant bleeding [Bleeding Academic Research Consortium (BARC) types 2, 3, or 5]. Results - The incidence of clinically relevant bleeding was comparable between the Low LDL-C (6.7%) and Non-Low LDL-C (5.0%) groups (risk difference 1.7%, 95% CI: -5.8% to 9.2%). Due to the sparse number of overall bleeding events (n = 7), the pre-specified non-inferiority analysis was severely underpowered; therefore, these safety findings are reported descriptively. Exploratory time-to-event analysis showed no significant difference in overall bleeding risk (log-rank P = 0.72). Global coagulability and specific platelet reactivity parameters remained stable throughout follow-up, with no significant intergroup differences (all P > 0.05). Major adverse cardiovascular events (MACE) occurred in 6.7% of the Low LDL-C group and 13.3% of the Non-Low LDL-C group (HR 0.48, 95% CI: 0.15-1.55; log-rank P = 0.22). Conclusion - In ACS patients receiving PCSK9 inhibitors and DAPT, achieving an LDL-C level <=0.78 mmol/L was associated with neither an increased bleeding risk nor significant alterations in global coagulability and specific platelet reactivity. These exploratory observational findings descriptively support the clinical safety of profound lipid-lowering in this high-risk population. Copyright © 2026 Fu, Yao, Zhang and Linghu. <21> Accession Number 2047603892 Title Relationship Between Entropy-Guided Sevoflurane Administration and End Oxygenator Sevoflurane Concentration in Adult Patients Undergoing Cardiopulmonary Bypass Surgery. Source Annals of Cardiac Anaesthesia. 29(3) (pp 378-385), 2026. Date of Publication: 01 Jul 2026. Author Kumar V.; Kumar A.; Gourav K.P.; Devarakonda B. Institution (Kumar, Kumar) Department of Anaesthesia and Critical Care, Armed Forces Medical College, Maharashtra, Pune, India (Gourav) Department of Anaesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Devarakonda) Department of Anaesthesia and Critical Care, Army R and R Hospital, New Delhi, India Publisher Wolters Kluwer Medknow Publications Abstract Background: Cardiopulmonary bypass (CPB) during cardiac surgery poses physiological challenges such as altered drug pharmacokinetics. Sevoflurane, a commonly used volatile agent, provides favorable myocardial protection; however, precise dosing during CPB remains difficult. Entropy monitoring, which assesses cerebral and electromyographic activity, offers real-time guidance on anesthetic depth. This study aimed to investigate entropy-guided sevoflurane administration relation with end-oxygenator sevoflurane concentrations, in patients undergoing elective on-pump cardiac surgery. Material(s) and Method(s): A prospective, randomized controlled trial was conducted in a single tertiary care center affiliated with a teaching hospital, enrolling 74 adult patients scheduled for elective on-pump cardiac surgeries. Participants were randomized into two groups: fixed sevoflurane concentration (1.5% v/v) and entropy-guided sevoflurane titration. Depth of anesthesia was monitored with state entropy (SE) and response entropy (RE), end-oxygenator sevoflurane concentrations, and clinical parameters. Result(s): Compared to the fixed-dose group, the entropy-guided group exhibited lower SE and RE values intraoperatively, indicating tighter control of anesthetic depth. Higher sevoflurane dial settings were used initially in the entropy group, resulting in higher end-oxygenator concentrations. Although mean arterial pressure and arterial blood gas parameters remained within acceptable ranges in both groups, VIS was higher in the entropy-guided group, suggesting an increased requirement for vasoactive and inotropic support. There was no statistically significant variation in postoperative mechanical ventilation duration or intensive care unit stay between the two groups. Conclusion(s): Overall, entropy monitoring facilitated a precise titration of sevoflurane without adversely affecting immediate postoperative outcomes. Copyright © 2026 Annals of Cardiac Anaesthesia. <22> Accession Number 2047384835 Title Residual Angina Following Complete Revascularization in the ISCHEMIA Trial: Frequency, Clinical Characteristics, Health Status, and Cardiovascular Outcomes. Source Journal of the American Heart Association. 15(10) (no pagination), 2026. Article Number: e047355. Date of Publication: 2026. Author Singh A.; Brown D.L.; Jones P.G.; Fu Z.; Reynolds H.R.; Boden W.E.; O'Brien S.M.; Mavromatis K.; Poh K.K.; Ali Z.; Stone G.W.; Bangalore S.; Spertus J.A.; Maron D.J.; Hochman J.S. Institution (Singh, Brown) Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States (Jones, Fu, Spertus) University of Missouri, Kansas City's Healthcare Institute for Innovations in Quality, Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Reynolds, Bangalore, Hochman) Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology,, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States (Boden) VA New England Healthcare System, Boston, MA, United States (O'Brien) Duke Clinical Research Institute, Durham, NC, United States (Mavromatis) Atlanta VA Healthcare System, Atlanta, GA, United States (Mavromatis) Emory University School of Medicine, Atlanta, GA, United States (Poh) National University Heart Center Singapore, the Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Ali) Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, NY, United States (Ali) Cardiovascular Research Foundation, New York, NY, United States (Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United States (Maron) Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States Publisher American Heart Association Inc. Abstract BACKGROUND: The frequency of residual angina and its impact on health status and death following anatomic complete revascularization in symptomatic patients with chronic coronary disease are unknown. METHOD(S): Data were analyzed from ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial participants randomized to invasive management with baseline angina (Seattle Angina Questionnaire Angina Frequency score <100), no prior coronary artery bypass graft surgery, and anatomic complete revascularization within 90days of randomization. The primary outcome was frequency of residual angina after revascularization, defined as a Seattle Angina Questionnaire Angina Frequency score <100 within 6months of randomization. Secondary outcomes included 6-month health status and medication use and 5-year all-cause and cardiovascular death. RESULT(S): Among 2588 participants randomized to invasive management, 1442 (56%) had baseline angina and no prior coronary artery bypass graft surgery; 1034 underwent revascularization within 90days, and 436 achieved anatomic complete revascularization. Of these, 184 (42.2%) had residual angina within 6 months. Baseline characteristics were similar between those with and without residual angina. Percutaneous coronary intervention was more common than coronary artery bypass graft surgery in those with residual angina (88% versus 80%, P=0.03). At 6 months, residual angina participants reported lower quality of life (Seattle Angina Questionnaire Quality of Life: 70+/-20 versus 83+/-20, P<0.001), greater physical limitation (Seattle Angina Questionnaire Physical Limitation: 84+/-20 versus 95+/-11, P<0.001), more dyspnea (Rose Dyspnea Scale score: 1+/-1.3 versus 0.4+/-0.8, P<0.001), and more antianginal medication use (P=0.006). Five-year all-cause and cardiovascular death did not differ significantly between groups. CONCLUSION(S): Residual angina is common (>40%) following anatomic complete revascularization for chronic coronary disease and is associated with reduced quality of life and greater antianginal medication use but no increase in death. REGISTRATION: Unique Identifier: NCT01471522. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. <23> Accession Number 2047324223 Title From Failure to Promise: Obicetrapib and the Renaissance of Cholesteryl Ester Transfer Protein Inhibition in Atherosclerotic Cardiovascular Disease. Source Journal of the American Heart Association. 15(9) (pp 1-17), 2026. Article Number: e047676. Date of Publication: 2026. Author Prajapathi S.; Mahajan K.; Mohta A.; Pradhan A. Institution (Prajapathi) Department of Cardiology, All India Institute of Medical Sciences, Madhya Pradesh, Bhopal, India (Mahajan) Himachal Heart Institute, Himachal Pradesh, Mandi, India (Mohta) Department of Community Medicine, People's College of Medical Sciences & Research Centre, People's University, Madhya Pradesh, Bhopal, India (Pradhan) Department of Cardiology, King George's Medical University, Uttar Pradesh, Lucknow, India Publisher American Heart Association Inc. Abstract Atherosclerotic cardiovascular diseases are a leading global cause of death, driven significantly by elevated low-density lipoprotein cholesterol levels. Despite the emergence of effective lipid-lowering therapies such as statins and other agents, a significant proportion of high-risk patients fail to reach the recommended low-density lipoprotein cholesterol targets. This highlights a critical unmet need for additional lipid-lowering therapies that are not only efficacious and orally administered, but also demonstrate durable safety and cardiovascular benefits. CETP (cholesteryl ester transfer protein) inhibition alters lipid metabolism by preventing the transfer of cholesteryl esters from high-density lipoprotein to apolipoprotein B-containing lipoproteins, thereby reducing atherogenic cholesterol burden. CETP inhibitors have had a challenging development history due to off-target effects observed in early compounds like torcetrapib. However, obicetrapib is a highly selective and hydrophilic CETP inhibitor that heralds a promising new generation of drugs with robust lipid-lowering capabilities and a favorable safety profile. This review presents a comprehensive overview of obicetrapib's mechanism of action, its pharmacokinetic and pharmacodynamic profiles, and a detailed critical assessment of its clinical development through various pivotal trials including TULIP (TA-8995: Its Use in Patients With Mild Dyslipidemia), ROSE (Trial Evaluating Obicetrapib in Combination With Ezetimibe), ROSE2 (Phase 2b ROSE Trial Evaluating Obicetrapib in Combination With Ezetimibe), BROADWAY (Randomized Study to Evaluate the Effect of Obicetrapib on Top of Maximum Tolerated Lipid-Modifying Therapies), BROOKLYN (Obicetrapib on Top of Maximum Tolerated Lipid-Modifying Therapies, TANDEM (Study of Obicetrapib and Ezetimibe Fixed Dose Combination on Top of Maximum Tolerated Lipid-Modifying Therapies), and the ongoing PREVAIL (Cardiovascular Outcome Study to Evaluate the Effect of Obicetrapib in Patients With Cardiovascular Disease) cardiovascular outcomes trial. We compare the efficacy, safety, and tolerability of obicetrapib against prevailing treatment options, positioning it as a potential oral adjunct to maximally tolerated lipid-lowering regimens in the current lipid management landscape. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. <24> Accession Number 2036477663 Title Treating Older Patients in Cardiogenic Shock With a Microaxial Flow Pump: Is it DANGERous?. Source Journal of the American College of Cardiology. 85(6) (pp 595-603), 2025. Date of Publication: 18 Feb 2025. Author Klein A.; Eiskjaer H.; Schulze P.C.; Engstom T.; Moller J.E.; Jensen L.O.; Junker A.; Veien K.T.; Udesen N.L.J.; Schmidt H.; Hassager C.; Engstrom T.; Holmvang L.; Kjaergaard J.; Sorensen R.; Lonborg J.; Frydland M.; Beske R.P.; Boesgaard S.; Christensen S.; Christiansen E.H.; Terkelsen C.J.; Schafer A.; Linke A.; Woitek F.J.; Hommel J.; Mangner N.; Polzin A.; Westenfeld R.; Schulze C.; Moebius-Winkler S.; Skurk C.; Nordbeck P.; Clemmensen P.; Westermann D.; Panoulas V.; Zimmer S.; Werner N. Institution (Klein, Beske, Hassager, Engstom, Holmvang, Moller) Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (Hassager) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Jensen, Junker, Moller) Department of Cardiology, Odense University Hospital, Odense, Denmark (Jensen, Schmidt, Moller) Department of Clinical Research, University of Southern, Odense, Denmark (Eiskjaer, Terkelsen) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Mangner, Linke) Department of Internal Medicine and Cardiology, Heart Center Dresden University Hospital, Technische Universitat Dresden, Dresden, Germany (Polzin) Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Dusseldorf, Medical Faculty of the Heinrich Heine University Dusseldorf, Dusseldorf, Germany (Schulze) Department of Internal Medicine I, Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Jena, Germany (Skurk) Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany (Skurk) Deutsches Zentrum fur Herz-Kreislauf-Forschung e.V., Berlin, Germany (Nordbeck) Department of Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany (Clemmensen) Department of Cardiology, University Heart and Vascular Center (UHZ), University Clinic Hamburg-Eppendorf (UKE), Hamburg, Germany (Clemmensen) Department of Cardiology, Zealand University Hospital, Roskilde and Nykobing Falster, Denmark (Panoulas) Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (Zimmer) Department of Cardiology, University Hospital Bonn, Bonn, Germany (Schafer) Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (Werner) Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Bruder, Trier, Germany (Schmidt) Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark Publisher Elsevier Inc. Abstract Background: Whether age impacts the recently demonstrated survival benefit of microaxial flow pump (mAFP) treatment in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) is unknown. Objective(s): The purpose of this study was to assess the impact of age on mortality and complication rates in patients with STEMI-related CS randomized to standard care or mAFP on top of standard care. Method(s): This is a secondary analysis of the Danish-German Cardiogenic Shock (DanGer Shock) trial, an international, multicenter, open-label trial, in which 355 adult patients with STEMI-related CS were randomized to receive an mAFP (Impella CP) plus standard care or standard care alone. The primary outcome of 180-day all-cause mortality is analyzed according to age and intervention. Result(s): From lowest to highest age quartile, the median ages (range) were 54 years (Q1-Q3: 31-59 years), 65 years (Q1-Q3: 60-69 years), 73 years (Q1-Q3: 70-76 years), and 81 years (Q1-Q3: 77-92 years). There were no differences in blood pressure, lactate level, left ventricular ejection fraction, or shock severity at randomization across age groups. Mortality increased from lowest to highest quartile (31%, 47%, 61%, and 73%, respectively; log-rank P < 0.001), with an adjusted OR for death at 180 days of 7.85 (95% CI: 3.37-19.2; P < 0.001) in the highest quartile compared to the lowest. The predicted risk of mortality was higher in the standard-care group until approximately 77 years, after which the predicted risk became higher in the mAFP group (P = 0.20). In patients <77 years, a reduced 180-day mortality was observed in patients randomized to the mAFP (OR: 0.45; 95% CI: 0.28-0.73; P = 0.001), opposed to patients aged >=77 years (OR: 1.52; 95% CI: 0.57-4.08; P = 0.40), P for interaction = 0.028. Complications were more frequent in the mAFP group, but there were no apparent differences in incidence of complications across all ages. Conclusion(s): This exploratory secondary analysis of the DanGer Shock trial demonstrates that older patients with STEMI-related CS experience high mortality and may not attain the same benefit from routine treatment with an mAFP as younger patients. Incorporating age as a factor in patient selection may enhance the overall benefit of this therapy. (Danish Cardiogenic Shock Trial [DanShock]; NCT01633502) Copyright © 2025 American College of Cardiology Foundation <25> Accession Number 2047693966 Title Intracardiac Echocardiography-Guided Left Atrial Appendage Occlusion: A Comprehensive Narrative Review. Source PACE - Pacing and Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Gahona C.T.; Vempati R.; Ha Q.D.; Mohammed F.; Shah V.; Alla S.S.M.; Manickavelan H.V.; Bhatt P.; Sanusi M.; Umashankar D.; Jiwani S.; Ghannam M.; Reddy Y.M. Institution (Gahona, Mohammed) Cardiology Department, Trinity Health Oakland Hospital, Pontiac, MI, United States (Vempati, Ha, Alla, Manickavelan, Bhatt, Sanusi, Umashankar) Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI, United States (Shah) Internal Medicine, Smt. N.H.L. Municipal Medical College, Ahmedabad, India (Jiwani, Ghannam) Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, United States (Reddy) Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States Publisher John Wiley and Sons Inc Abstract Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography for imaging guidance during left atrial appendage occlusion (LAAO) in patients with atrial fibrillation with intolerance to long-term oral anticoagulation. This narrative review synthesizes contemporary evidence on ICE-guided LAAO. Across observational studies, ICE provides real-time high-resolution imaging enabling accurate trans-septal puncture, device sizing, and deployment under conscious sedation. Procedural success, peri-device leak, and device-related thrombus rates appear comparable between ICE- and TEE-guided LAAO, while ICE may also shorten fluoroscopy time and avoid general anesthesia. Challenges with ICE include operator learning curve, need for additional venous access and intracardiac catheter manipulation, that may add to risks like pericardial effusions, vascular complications and higher costs. Emerging 3D/4D ICE and artificial-intelligence-integrated computed tomographic planning may improve efficiency and allow for combined ablation and LAAO procedures. Further randomized controlled trials and cost-effectiveness studies are needed to define the role of ICE-first approach. Copyright © 2026 Wiley Periodicals LLC. <26> Accession Number 2047861217 Title Safety and Efficacy of Transcatheter Aortic Valve Implantation at Centres With Versus Without On-Site Cardiac Surgery: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. (no pagination), 2026. Date of Publication: 2026. Author Elettreby A.M.; El-Sayed O.S.; Al-Hawari N.E.M.; Alqeeq B.F.; Gadelmawla A.F.; Abo Elnaga A.A.; Abushanap M.M.; Alkasasbeh J.A.; Jreisat L.; Alkhawaldeh I.M.; Bisht O. Institution (Elettreby, Abo Elnaga) Faculty of Medicine, Mansoura University, Mansoura, Egypt (El-Sayed) Faculty of Medicine, Zagazig University, Sharqia, Zagazig, Egypt (Al-Hawari) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Alqeeq) Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine (Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt (Abushanap, Jreisat) The Hashemite University, Zarqaa, Jordan (Alkasasbeh, Alkhawaldeh) Faculty of Medicine, Mutah University, Al-Karak, Jordan (Bisht) Evanglisches Herzzentrum Coswig, Coswig, Germany Publisher Elsevier Ltd Abstract Background: Aortic stenosis (AS) is the most common heart valve disorder causing significant complications. While transcatheter aortic valve implantation (TAVI) offers a less invasive alternative to surgery, debate remains about whether it should require on-site cardiac surgery backup. This systematic review and meta-analysis evaluate existing literature comparing outcomes of TAVI performed at centres with versus without on-site cardiac surgery, aiming to guide optimal patient management and institutional decision-making. Method(s): A comprehensive literature search was conducted in multiple databases up to May 2025 to retrieve relevant studies. Random-effects meta-analyses pooled risk ratios (RR) or mean differences. Because definitions of surgical backup varied across studies, backup organisation was extracted for each study. Risk of bias was assessed with the Newcastle-Ottawa Scale and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Result(s): Six observational cohort studies (n=6,109 patients) were included. No statistically significant differences were observed for in-hospital mortality (four studies; n=3,463; RR= 0.94), 30-day mortality (five studies; n=4,880; RR= 0.87), or emergent conversion to open-heart surgery (four studies; n=4,136; RR= 0.78). Most secondary outcomes were likewise not statistically different, but several had substantial heterogeneity or unstable leave-one-out results. In one matched registry study from the included studies, in-hospital mortality among patients requiring emergent cardiac surgery after intraprocedural complications was high in both settings (50% vs 62.5%). Conclusion(s): This observational meta-analysis did not detect statistically significant differences in short-term mortality, emergent conversion, or major complications between centres with and without on-site cardiac surgery. However, the absence of statistically significant differences does not establish safety equivalence. Certainty of evidence was low to very low, and findings should be interpreted cautiously in light of residual confounding, publication bias, and variation in backup models. Accordingly, future high-quality studies are needed to validate these findings. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) <27> Accession Number 2047674015 Title Parasternal Intercostal Plane Blocks for Enhanced Recovery After Cardiac Surgery: A Systematic Review of Technical Refinements and Evidentiary Support. Source Journal of Pain Research. 19 (no pagination), 2026. Article Number: 600493. Date of Publication: 2026. Author He Y.-N.; Lin P.-R.; Wang S. Institution (He, Lin, Wang) Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (He) Department of Anesthesiology, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Sichuan, Nanchong, China (Wang) Department of Anesthesiology, Linzhi People's Hospital, Tibet, Linzhi, China Publisher Dove Medical Press Ltd Abstract Background: Parasternal intercostal plane (PIP) blocks provide opioid-sparing analgesia within cardiac Enhanced Recovery After Surgery (ERAS) pathways, but non-standardized nomenclature and ambiguous anatomical targets limit their adoption. Method(s): A systematic search of PubMed, Cochrane, and Embase databases was conducted. Inclusion criteria encompassed randomized controlled trials and observational studies reporting on PIP blocks in adult cardiac surgery to synthesize evidence on their efficacy, technical refinements, and safety. Result(s): This review integrated 20 clinical studies (2019-2025). Adopting the El-Boghdadly terminology resolves descriptive inconsistencies by distinguishing superficial (SPIP) and deep (DPIP) techniques. SPIP targets the pectoralis major-intercostal interface (T2-T6), while DPIP accesses the intercostal-transversus thoracis plane (T1-T6). PIP blocks reduced 12-hour postoperative pain (average 1.21-point reduction) and opioid use (average 30.34 milligram morphine equivalents (MME) reduction), though analgesic benefits diminished after 24 hours. SPIP provides a safer profile with minimal internal mammary artery (IMA) injury risk but limited cephalad spread. DPIP achieves broader dermatomal coverage but positions the needle 3-5 mm from the IMA; thus, it should be applied with caution or replaced by SPIP in post-CABG patients. Recovery outcomes demonstrated earlier extubation and shorter intensive care unit stays. However, bupivacaine concentrations approached neurotoxic thresholds >=2.0 mug/mL in 7.1% of DPIP cases. Conclusion(s): PIP blocks provide effective opioid-sparing analgesia, requiring meticulous anatomical execution. SPIP is favored for safety, whereas DPIP demands real-time ultrasound guidance and caution in patients with IMA grafts. Future research should optimize dermatomal coverage, refine individualized dosing, and evaluate long-term outcomes. Copyright © 2026 He et al. <28> Accession Number 2047687886 Title Measuring patient disability in the peri-operative period using the WHODAS 2.0 questionnaire: a systematic review. Source Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Boerlage R.M.; van Dartel D.; Vernooij J.E.M.; Koning N.J.; Posthuma L.M.; Kalkman C.J.; Doggen C.J.M.; Preckel B. Institution (Boerlage, Vernooij, Koning) Department of Anaesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, Netherlands (Boerlage, Doggen) Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands (Boerlage, Doggen) Clinical Research Center, Rijnstate Hospital, Arnhem, Netherlands (Boerlage, Preckel) Department of Anaesthesiology, Amsterdam UMC location AMC, Amsterdam, Netherlands (van Dartel) Department of Intensive Care, Gelre ziekenhuizen, Apeldoorn, Netherlands (Posthuma) Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, Netherlands (Kalkman) Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, Netherlands (Preckel) Amsterdam Public Health, Quality of Care Research Institute, Amsterdam, Netherlands (Preckel) Amsterdam Cardiovascular Science Research Institute, Amsterdam, Netherlands Publisher John Wiley and Sons Inc Abstract Introduction: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is recommended by peri-operative core outcome sets as a measure of disability. Despite its growing use, the effect of different surgical procedures on disability measured by WHODAS 2.0 remains poorly understood and heterogeneous reporting across studies limits direct comparison. Method(s): We conducted a systematic review to assess the effect of different surgical procedures on disability measured by WHODAS 2.0, and the reporting of disability endpoints in peri-operative medicine. The primary outcome was the difference in WHODAS 2.0 summary score before and after surgery. Disability scores were calculated as a metric between 0% (no disability) and 100% (complete disability). Result(s): Thirty-nine studies were included. Pre-operative disability ranged from 2% to 61%. In 21 studies, disability increased by 1% to 17% within 3 months of surgery, with little change between 6 and 12 months (0% to -2%). Studies of orthopaedic surgery generally reported high pre-operative disability (> 35%) but also reductions in disability (10-37% reduction) within 3 months of surgery. In contrast, studies evaluating cancer surgery (n = 12) generally reported lower pre-operative disability (< 20%) but small increases (1-8%) within 3 months of surgery. Cardiovascular surgical studies displayed pre-operative disability between 4% and 17% with a difference in disability of -8% to +3% 3 months after surgery. Three different thresholds to define disability and 13 different WHODAS 2.0 endpoints were used, measured at eight different time-points after surgery. Discussion(s): The effect of surgical procedures on postoperative disability as measured by WHODAS 2.0 is influenced by the type of surgery. Orthopaedic surgery may decrease disability, whereas cancer surgery may be associated with persistent increases. Standardised reporting of disability endpoints is needed to enhance the quality and comparability of future studies using WHODAS 2.0. Copyright © 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. <29> Accession Number 2046236731 Title Driving pressure-guided ventilation during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1837064. Date of Publication: 2026. Author Yin X.; Du S. Institution (Yin) Department of Anesthesiology, Aerospace Center Hospital, Beijing, China (Du) Department of VIP Dental Service, Peking University Stomatological Hospital, Beijing, China Publisher Frontiers Media SA Abstract Background - Driving pressure-guided ventilation has been proposed as a physiologically rational lung-protective strategy during one-lung ventilation for thoracic surgery. However, no previous systematic review has specifically focused on trials in which driving pressure was the explicit primary ventilatory target during one-lung ventilation. We aimed to assess the effects of driving pressure-guided ventilation on postoperative pulmonary complications (PPCs) and related perioperative outcomes in adults undergoing thoracic surgery. Methods - We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus, and trial registries from inception to 19 March 2026. We included randomized controlled trials comparing explicit driving pressure-guided ventilation with conventional non-driving-pressure-guided ventilation during one-lung ventilation in adults undergoing thoracic surgery. Observational studies were summarised narratively. Random-effects meta-analyses were performed using restricted maximum likelihood estimation with Hartung-Knapp adjustment. Certainty of evidence was assessed using GRADE. The review was registered in PROSPERO (CRD420261329253). Results - Four randomized controlled trials (654 patients) were included in the primary analysis. The pooled effect on PPCs was not statistically significant in the primary random-effects analysis (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.26-1.35; p=0.14; I2=49.7%). Exploratory supportive analyses-including a fixed-effect model (RR 0.61; p=0.007), the pooled absolute risk difference (-7.6%; p=0.027), and a broadened sensitivity analysis of six trials incorporating individualised PEEP strategies (RR 0.70; p=0.12)-were directionally concordant but should not be interpreted as independent confirmation of effect, given the imprecision of the primary estimate and variation in baseline PPC risk. Four observational studies provided mixed supplementary evidence. The overall certainty of evidence was low according to GRADE, owing to inconsistency and imprecision. Conclusion - The primary randomized evidence did not demonstrate a statistically significant reduction in postoperative pulmonary complications, and the overall certainty of evidence was low. The available data are therefore hypothesis-generating. Larger, multicentre, and geographically diverse randomized trials with harmonised outcome definitions are needed to clarify whether driving pressure-guided ventilation improves postoperative outcomes and should be adopted more broadly in thoracic anaesthesia. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329253, Unique Identifier: CRD420261329253. Copyright © 2026 Yin and Du. <30> Accession Number 2047603947 Title Efficacy of Preincisional Ultrasound Guided Pecto-intercostal Fascial Plane Block with Ropivacaine and Fentanyl in Patients Undergoing Open Heart Surgery by Median Sternotomy - A Prospective Single Blinded Randomized Controlled Study. Source Annals of Cardiac Anaesthesia. 29(3) (pp 335-344), 2026. Date of Publication: 01 Jul 2026. Author Malik I.; Ahlawat G.; Budhwar D.; Singh S.; Dalai M.; Kumar V.; Gupta D.; Malhotra N. Institution (Malik, Ahlawat, Budhwar, Dalai, Malhotra) Department of Cardiac Anaesthesia, Pt BD Sharma PGIMS, Haryana, Rohtak, India (Singh) Department of Cardiothoracic Surgery, Pt BD Sharma PGIMS, Haryana, Rohtak, India (Kumar) Department of Anaesthesiology and Critical Care, Pt BD Sharma PGIMS, Haryana, Rohtak, India (Gupta) Department of Cardiac Anaesthesia, Medanta - The Medicity, Haryana, Gurgaon, India Publisher Wolters Kluwer Medknow Publications Abstract Aim: To evaluate the role of ultrasound (USG) guided Superficial Parasternal intercostal plane block (SPIP)/Pecto-Intercostal Fascial Plane Block (PIFB) on post sternotomy pain and postoperative outcomes in patients undergoing cardiac surgery. Method(s): This prospective single-blinded, randomized controlled study was conducted in 75 adult patients of age 18-75 years of ASA II-III undergoing cardiac surgery by median sternotomy. Patients were randomized into three groups with 25 patients in each group. Group I patients did not receive any block. Group II patients received USG guided PIFB with 0.4% ropivacaine+ 25 mug fentanyl on each side. Group III patients received USG guided PIFB with 0.4% ropivacaine+ 50 mug fentanyl. Numeric rating scale (NRS) for pain, Time to extubation, hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure) and SpO<inf>2</inf> at various time points (T0: at extubation, T1: 2 h, T2: 4 h, T3: 8 h, T4: 16 h, T5: 24 h, T6: 48 h post extubation), cumulative fentanyl consumption and rescue analgesia, post operative nausea vomiting (PONV), time to drain removal, catheter removal, ambulation, length of intensive care unit (ICU), and hospital stay were noted. Result(s): Group II and III patients as compared to group I showed lower NRS values, shorter time to extubation, drain and catheter removal, early ambulation, stable hemodynamics, less fentanyl consumption and rescue analgesia requirement, less incidence of PONV, early ICU and hospital discharge. Group II and III had comparable results with no significant difference. Conclusion(s): USG guided SPIP/PIFB provides improved postoperative pain control, reduces the need for perioperative opioids, faster extubation, early ICU and hospital discharge. Copyright © 2026 Annals of Cardiac Anaesthesia. <31> Accession Number 2047719220 Title The Potential Role of MicroRNAs as Cardioprotective Agents During Cardioplegia: A Preliminary Qualitative Systematic Review. Source Health Science Reports. 9(8) (no pagination), 2026. Article Number: e72841. Date of Publication: 01 Aug 2026. Author Baniani M.; Dabbagh A.; Shokri P.; Madadi F. Institution (Baniani, Dabbagh, Shokri, Madadi) Shahid Beheshti University of Medical Sciences School of Medicine, Tehran, Iran, Islamic Republic of (Baniani, Dabbagh, Shokri, Madadi) Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background and Aims: Recent advancements in gene expression studies have shed light on the role of non-coding RNAs in negatively regulating mRNA and inhibiting mRNA translation. Given the significant impact of miRNAs on cardiovascular function, our review aims to comprehensively explore their contribution to mitigating heart injury and their protective effects during cardioplegic-induced cardiac arrest. Method(s): A systematic search conducted in December 2023 across PubMed, Web of Science, Scopus, and Google Scholar yielded valuable insights. Result(s): Our findings indicate that cardioplegia leads to the upregulation of several miRNAs, including miR-208b, miR-499-5p, miR-10b, miR-96, miR-339-5p, and miR-483-3p, alongside the downregulation of miR-139-5p, and miR-194-5p. Many of these miRNAs are implicated in cardiac pathophysiology, particularly in myocardial injury following cardioplegia in on-pump cardiac surgery. Conclusion(s): While current applications of discovered miRNAs primarily focus on early diagnosis and prognosis of cardiac conditions, their therapeutic potential holds promise for revolutionizing the management of various heart diseases in the future. By elucidating the intricate roles of miRNAs in cardiac health and disease, this review underscores the importance of harnessing their therapeutic potential for improved patient outcomes. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <32> Accession Number 2046536844 Title Effect of HA380 hemoperfusion on cardiac valve surgery and systemic inflammation at high altitude. Source Current Problems in Surgery. 81 (no pagination), 2026. Article Number: 102073. Date of Publication: 01 Aug 2026. Author Zhang W.; Yuan L.; Zeng F.; Xiao Y.; Li X.; Wei L. Institution (Li, Zhang, Yuan, Zeng, Xiao, Li) Department of Anesthesiology, People's Hospital of Qinghai Province, Qinghai Province, Xining City, China (Wei) Department of Anesthesiology, Qinghai Provincial Hospital of Traditional Chinese Medicine, Qinghai Province, Xining City, China Publisher Elsevier Inc. <33> Accession Number 2047704694 Title Intraoperative hemoadsorption and cardiac surgery-associated acute kidney injury: an updated systematic review and meta-analysis with trial sequential analysis. Source Critical Care. 30(1) (no pagination), 2026. Article Number: 385. Date of Publication: 01 Dec 2026. Author Liu M.; Lin D.; Zhou R. Institution (Liu, Lin, Zhou) Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, Chengdu, China Publisher BioMed Central Ltd Abstract Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) following cardiopulmonary bypass (CPB) remains a high-risk complication with limited effective management. Hemoadsorption is increasingly used as an adjunctive therapy due to its potent cytokines clearance in experimental settings, yet its clinical efficacy is debated. This study aimed to evaluate the effect of hemoadsorption versus standard care on CSA-AKI and other major outcomes in adult cardiac surgery patients. Method(s): An updated systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to 8 February 2025. Eligible RCTs enrolled adult patients undergoing cardiac surgery and compared intraoperative hemoadsorption with standard care, with reported outcomes including CSA-AKI and other major endpoints. Pooled estimates were synthesized using inverse-variance random-effects models, with heterogeneity quantified by I2 statistics. Subgroup, sensitivity and trial sequential analyses (TSA) were further performed. Result(s): Fifteen RCTs were included, of which nine reported CSA-AKI (947 patients). Hemoadsorption was not associated with a statistically significant reduction in CSA-AKI (RR 0.80, 95% CI 0.63-1.03, P = 0.08, I2 = 40%, GRADE: very low). The finding was sensitive to model choice and the inclusion of two studies (Diab 2022 and Abou-Arab 2025). Subgroup analyses revealed no significant interaction by device type. TSA indicated that the required information size was not reached. No significant differences were observed for CSA-AKI Stage 1 (RR 0.72, 95% CI 0.49-1.05, P = 0.09, I2 = 16%), Stage 2 (RR 0.66, 95% CI 0.30-1.43, P = 0.29, I2 = 11%), Stage 3 (RR 0.43, 95% CI 0.17-1.05, P = 0.06, I2 = 0%), or renal replacement therapy (RR 0.52, 95% CI 0.22-1.25, P = 0.15, I2 = 0%). Mortality and other clinical endpoints were comparable between groups. Among exploratory outcomes, only an overall reduction in IL-8 was noted (MD -18.23, 95% CI -31.90 to -4.56, P = 0.009, I2 = 40%). Conclusion(s): Intraoperative hemoadsorption did not significantly reduce CSA-AKI or improve clinical outcomes in adult cardiac surgery. Although trends favored severe AKI, very low certainty evidence and insufficient information preclude definitive conclusions, warranting further large-scale RCTs. Registration: PROSPERO identifier CRD420250651941. Copyright © The Author(s) 2026. <34> Accession Number 2047804936 Title Right ventricular to pulmonary artery coupling and clinical outcomes after interatrial shunting in heart failure: exploratory analysis of the PRELIEVE study. Source ESC Heart Failure. 13(4) (no pagination), 2026. Article Number: xvag180. Date of Publication: 01 Aug 2026. Author Bakhshaliyev N.; Fiori E.; Paitazoglou C.; Bergmann M.; Pfister R.; Mahfoud F.; Kilic T.; Ozdemir R.; Anker S.; Bartunek J. Institution (Bakhshaliyev) Department of Cardiology, Ege Hospital, 38, Academician Hasan Aliyev St, Azerbaigian, Baku, Azerbaijan (Fiori, Bartunek) Cardiovascular Center Aalst, AZORG-Clinic, Moorselbaan 164, Aalst, Belgium (Fiori) Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Via di Grottarossa, 1035, Rome, Italy (Paitazoglou, Bergmann) Interventional Cardiology, Cardiologicum Hamburg, Hamburg, Germany (Pfister) Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (Mahfoud) Clinic for Cardiology, University Heart Center, Universitatsspital CH, Petersgraben 4, Basel, Switzerland (Mahfoud) Cardiovascular Research Institute Basel (CRIB), University Heart Center, Spitalstrasse 2, Basel, Switzerland (Kilic) Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey (Ozdemir) Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey (Anker) Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany Publisher Oxford University Press Abstract Introduction: Heterogeneous outcomes were reported in studies targeting left atrial (LA) pressure reduction by interatrial shunting in heart failure (HF). Right ventricular (RV) performance and pulmonary arterial (PA) afterload are essential in assuring the efficient blood flow shunting through the pulmonary circulation. We investigated whether baseline RV-PA coupling, expressed as the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio, is associated with outcomes after atrial flow regulator (AFR) implantation in the PRELIEVE study. Method(s): In this post hoc analysis of the multicentre, single-arm PRELIEVE study (NCT03030274), 106 patients with symptomatic HF (62 with reduced and 44 with preserved ejection fraction) underwent AFR implantation and were followed for 12 months. TAPSE/PASP was measured by echocardiography at baseline and 3 months. The primary composite endpoint was cardiovascular (CV) death or HF hospitalization (HFH). Result(s): During follow-up, 19 patients (18%) experienced the composite endpoint. At baseline, these patients had higher NT-proBNP [1261 (567, 1790) vs. 317 (114, 1200) pg/mL; P = .009] and lower TAPSE/PASP [0.43 (0.33-0.53) vs 0.53 (0.43-0.76), P = .04]. In Kaplan-Meier analysis, lowest TAPSE/PASP ratio tended to show the worst outcome (P = .07). Using recurrent-event Poisson regression, lower baseline TAPSE/PASP was associated with a higher cumulative incidence of HFHs [incidence rate ratio 2.4 (95% CI 1.0-5.6) for lowest vs middle tertile, P = .039]. Conclusion(s): In patients with HF undergoing interatrial shunting, impaired baseline RV-PA coupling assessed by a low TAPSE/PASP ratio was associated with higher rates of CV death or recurrent HF hospitalizations. The potential value of baseline RV-PA uncoupling in identifying responders to LA shunt therapies requires prospective evaluation in adequately powered prospective studies. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. <35> [Use Link to view the full text] Accession Number 2045940319 Title Colchicine for Major Adverse Cardiovascular Events: An Updated ChatGPT-Assisted Systematic Review and Meta-Analysis. Source Journal of Cardiovascular Pharmacology. (no pagination), 2025. Date of Publication: 25 Nov 2025. Author Teperikidis L.; Boulmpou A.; Chownk M.; Jagdale R.; Booz G.W.; Biondi-Zoccai G.; Bhatt D.L. Institution (Teperikidis, Chownk, Jagdale) Synthesa, Inc., 19 West 24th St., New York, NY, United States (Teperikidis) Clinical Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece (Teperikidis, Boulmpou) Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (Booz) Department of Pharmacology & Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS (Biondi-Zoccai) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (Biondi-Zoccai) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher Lippincott Williams and Wilkins Abstract Colchicine has been studied as an anti-inflammatory treatment for cardiovascular prevention, but findings from randomized trials have been inconsistent. This meta-analysis evaluated the efficacy and safety of colchicine in reducing major adverse cardiovascular events (MACE) and its individual components, using ChatGPT as an assistant throughout the process. Randomized trials of colchicine for cardiovascular prevention were systematically identified, and data extraction, risk of bias assessment, and meta-analyses were performed with ChatGPT under human supervision. The primary outcome was MACE, while secondary outcomes included myocardial infarction (MI), stroke, revascularization, cardiovascular mortality, and all-cause mortality. Eleven trials involving 30, 888 patients were included. Colchicine significantly reduced MACE (risk ratio 0.75, 95% CI 0.63-0.88), though no significant effects were observed for MI, stroke, cardiovascular mortality, or all-cause mortality. In addition to its clinical findings, this study illustrates the potential of ChatGPT to assist in systematic reviews and meta-analyses by automating screening, data extraction, bias assessment, and statistical code generation. This integration reduced researcher time by over 70% while maintaining accuracy through human validation. Overall, colchicine appears to lower the risk of MACE but the results of the CLEAR trial have lowered certainty, while the findings highlight the feasibility and efficiency gains of using large language models in evidence synthesis workflows. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <36> Accession Number 650329218 Title The Effect of a Virtual Reality Distraction Intervention on Pain in Patients Following a Percutaneous Coronary Intervention: A Randomized Clinical Trial. Source Pain management nursing : official journal of the American Society of Pain Management Nurses. 27(4) (pp e632-e638), 2026. Date of Publication: 01 Aug 2026. Author Shutnan A.H.I.; Athbi H.A.; Dokoohaki R.; Torabizadeh C.; Rahimi S. Institution (Shutnan) Kerbala Health Department, Al-Imam Al-Hassan Al-Mujtaba Teaching Hospital, Iraq (Athbi) Department of Adult Nursing, College of Nursing, University of Kerbala, Iraq (Dokoohaki, Rahimi) Community-Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Torabizadeh) Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of Abstract BACKGROUND: Post-procedural pain following percutaneous coronary intervention (PCI) remains a significant clinical challenge, affecting 5% of patients and potentially impairing recovery and quality of life. While pharmacological interventions are commonly used, their side effects highlight the need for non-invasive alternatives. Recent studies demonstrate VR's efficacy in acute pain settings, yet its application in post-PCI pain management remains underexplored. OBJECTIVE(S): This study evaluated the efficacy of VR on pain management in patients undergoing PCI. As a secondary objective, we assessed patient acceptability and satisfaction with the VR intervention using a 5-item Likert questionnaire (range 1 = very dissatisfied to 5 = very satisfied). METHOD(S): A randomized clinical trial was conducted at two tertiary-care centers in Karbala, Iraq: the Karbala Center for Cardiac Diseases and Surgery and Al-Imam Al-Hassan Al-Mujtaba Teaching Hospital, from September 2024 to January 2025. Participants (N = 144) were equally allocated to control (routine care) and intervention (VR-based distraction via 3D nature videos with relaxing music) groups. Pain levels were assessed using the Visual Analogue Scale (VAS). The collected data were analyzed in SPSS v. 27, and the level of significance was set at p < 0.05. This study adheres to the CONSORT (Consolidated Standards of Reporting Trials) guidelines for reporting randomized controlled trials. RESULT(S): Most participants were male (56.9% in the intervention group). Mean ages were 57.38 +/- 6.514 (intervention) and 60.53 +/- 7.530 (control) years. A statistically significant reduction in pain scores (p < 0.01) was observed in the VR group, whereas the control group showed no significant changes (p > 0.05). CONCLUSION(S): VR-based distraction significantly reduces post-PCI pain. The intervention demonstrated high acceptability and safety with no adverse effects. VR is recommended as a proactive, non-pharmacological strategy for pain management following PCI. Copyright © 2026. Published by Elsevier Inc. <37> Accession Number 2047718160 Title Mortality and adverse events of extracorporeal haemoadsorption therapy in cardiac surgery: a systematic review and meta-analysis of randomised controlled trials. Source British Journal of Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Pittaway H.C.A.; Kelly J.M.; Price M.J.; Parekh D.; Howells P.A. Institution (Pittaway, Parekh, Howells) Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom (Pittaway, Kelly, Parekh, Howells) University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (Pittaway, Parekh) National Institute of Health Research, Birmingham Biomedical Resource Centre, Birmingham, United Kingdom (Price) Canadian University of Dubai, Dubai, United Arab Emirates (Price) Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom Publisher Elsevier Ltd Abstract Background: Extracorporeal haemoadsorption (HA) therapy has been studied in RCTs for use during cardiopulmonary bypass (CPB). CPB is known to activate a systemic inflammatory response. Haemoadsorption has the potential to mitigate this through the removal of pro-inflammatory mediators. We aimed to examine available RCT data reporting on clinically important outcomes in a systematic review and meta-analysis. Method(s): We performed a systematic review and meta-analysis involving adult patients undergoing cardiac surgery with the use of CPB. The intervention was HA inserted into the CPB circuit, and the comparator was conventional CPB without HA. The primary outcome was mortality, and secondary outcomes included adverse events, requirements for organ support, and length of stay in ICU and hospitals. Result(s): We included 12 RCTs with 713 participants. Only one study had low risk of bias, limiting the strength of findings. Meta-analysis showed no statistically significant benefit of HA during CPB on mortality (odds in the intervention vs control group (odds ratio, 95% confidence interval [CI]=1.08, 0.59-2.01, P=0.75), hospital length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=0.21, -1.89-2.30, P=0.82) and intensive care length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=-0.36, -1.31-0.60, P=0.42) when compared with standard CPB. However, confidence intervals included the possibility of clinically important benefit or harm. There was also no significant difference in adverse events or requirements for ventilation, cardiovascular support or renal replacement therapy. Conclusion(s): This meta-analysis did not show evidence of clinical benefit for routine use of HA during CPB for cardiac surgery, although clinically relevant benefit or harm cannot be excluded on the currently available evidence. Appropriately powered and clinically focused RCTs targeting cases at the highest risk of cytokine burden are required. Copyright © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <38> Accession Number 2047778587 Title Comparative evaluation of left atrial appendage occlusion and oral anticoagulation: a Bayesian meta-analysis of randomized controlled trials. Source Europace. 28(7) (no pagination), 2026. Article Number: euag163. Date of Publication: 01 Jul 2026. Author Athmakuri K.S.; Nandyal S.R.; Pamreddy H.R.; Vinjamuri S.; Lingamsetty S.S.P.; Mahajan A.V.; Hussain M.; Chaliki H.P.; Srivathsan K. Institution (Athmakuri, Mahajan, Hussain, Chaliki, Srivathsan) Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 East Mayo Blvd., Phoenix, AZ, United States (Nandyal) Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, United States (Pamreddy) Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, United States (Vinjamuri) Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, United States (Lingamsetty) Division of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States Publisher Oxford University Press Abstract Aims: Randomized trials comparing percutaneous left atrial appendage occlusion (LAAO) with oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation have yielded conflicting results across device generations and anticoagulant eras. This Bayesian meta-analysis of randomized trials aimed to compare LAAO vs. OAC for stroke or systemic embolism (SSE) and non-procedural clinically relevant bleeding (CRB). Methods and Results: We conducted a systematic search across five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL) to identify randomized trials of LAAO vs. OAC. Primary outcomes of stroke or systemic embolism, non-procedural CRB and clinical benefit composite were estimated using a Bayesian hierarchical random effects model and findings confirmed across robust sensitivity and subgroup analyses. Posterior probabilities for superiority, non-inferiority and equivalence were estimated using clinically meaningful margins. Six randomized trials including 7004 participants in the intention-to-treat groups, were analysed. LAAO was not associated with lower SSE vs. OAC (pooled RR, 1.11; 95% CrI, 0.80-1.49), with a 74.6% posterior probability of favouring OAC. The posterior probability of crossing non-inferiority was P(HR < 1.4) of 89%. In contrast, LAAO reduced non-procedural CRB (pooled RR, 0.59; 95% CrI, 0.45-0.78). The net clinical benefit composite, pooling contemporary trials, demonstrated a pooled RR of 0.90 (95% CrI 0.51-1.50), with P(RR < 1) of 76%, with substantial heterogeneity for this outcome. Conclusion(s): This Bayesian meta-analysis found no clear evidence supporting clinically meaningful non-inferiority of LAAO over OAC for stroke prevention. Despite reduced non-procedural bleeding, LAAO did not demonstrate a similar reduction in major bleeding. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <39> Accession Number 651054904 Title Efficacy of intranasal insulin in preventing postoperative delirium and its impact on insulin resistance in elderly non-cardiac surgical patients: a systematic review and meta-analysis. Source Minerva anestesiologica. 92(7-8) (pp 739-749), 2026. Date of Publication: 01 Jul 2026. Author Qin J.; Zhou W.; Chen S.; Cheng M.; Shen X.; Ma J. Institution (Qin, Zhou, Chen, Cheng, Shen) Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China (Ma) Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China Abstract BACKGROUND: Postoperative delirium (POD) is a common and serious complication in elderly patients and has been established to be associated with insulin resistance (IR), a key marker of dysregulated glucose metabolism. Therefore, this study aims to systematically evaluate the efficacy of intranasal insulin in preventing POD in elderly non-cardiac surgery patients and to further investigate whether its mechanism of action is related to the improvement of IR. METHOD(S): A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journals Database and Chinese Biomedical Literature Database from inception to October 19, 2025, to identify randomized controlled trials that compared elderly patients who were administered intranasal insulin during the perioperative period with those who were not. The primary outcomes of this study were the incidence of POD and the efficacy of different insulin dosing regimens. The secondary outcome was the change in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values before and after surgery. Data from eligible trials were pooled to calculate the combined risk ratio (RR) or standardized mean difference (SMD). RESULT(S): Analysis of seven trials involving 778 elderly patients showed that, compared to placebo, intranasal insulin significantly reduced POD incidence on day one (RR: 0.33; 95%CI: 0.22 to 0.47; P<0.001) and its cumulative incidence over three days (RR: 0.31; 95%CI: 0.22 to 0.44; P<0.001) and five days (RR: 0.32; 95%CI 0.18 to 0.56; P<0.001). In contrast, the change in HOMA-IR across the surgery period did not differ significantly between the two groups (SMD: -0.27; 95%CI: -0.77 to 0.23; P=0.290). CONCLUSION(S): Intranasal insulin is effective in reducing the incidence of POD. This benefit is likely mediated through central nervous system glucose metabolism, rather than by reversing peripheral IR, a premise that requires validation in future trials. <40> Accession Number 2047806028 Title A Comparison of Percutaneous Mitral Valve Repair and Surgical Mitral Valve Intervention: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. (no pagination), 2026. Date of Publication: 2026. Author Nazir B.; Mukherjee P.; Balaji A.; Makam R.; Haqzad Y.; Javangula K. Institution (Balaji, Nazir, Mukherjee, Balaji) Department of Medical Education, University of Hull, Hull, United Kingdom (Makam) Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, United Kingdom (Haqzad, Javangula) Department of Cardiothoracic Surgery, Leeds General Infirmary, Leeds, United Kingdom Publisher Elsevier Ltd Abstract Background & Aim: Transcatheter edge-to-edge repair (TEER) has expanded options for high-risk patients with severe mitral regurgitation (MR), however its longer-term performance relative to surgical mitral valve repair (SMVR) remains uncertain. This systematic review and meta-analysis compares the clinical outcomes of TEER versus SMVR in adults with MR. Method(s): We performed a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and random-effects meta-analysis of randomised and comparative observational studies including adults with primary or secondary MR treated with TEER (MitraClip therapy) or SMVR. Primary outcomes were mortality, reintervention and recurrent >=3+ MR; secondary outcomes included stroke, acute kidney injury (AKI) and permanent pacemaker implantation. Subgroup analyses explored modification by MR aetiology, study design and surgical strategy. Result(s): Twenty-one studies (70,641 patients; 24,820 TEER, 45,821 SMVR) met the inclusion criteria. TEER recipients were older, more comorbid and had higher baseline risk. In-hospital and 30-day mortality were similar between strategies. At 1 year, mortality was significantly higher after TEER (risk ratio [RR] 1.58, 95% confidence interval [CI] 1.10-2.28). Within 1 year, reintervention was almost three-fold more frequent after TEER (RR 2.98, 95% CI 2.14-4.14), and recurrent >=3+ MR was substantially higher both at approximately 1 year (RR 4.80, 95% CI 1.97-11.72) and 3 years (RR 6.51, 95% CI 2.60-16.29). TEER was associated with a lower 1-year stroke risk, while pooled AKI and pacemaker outcomes did not differ significantly. Conclusion(s): TEER is a short-term alternative for high-risk patients but demonstrates higher long-term recurrence and reintervention. SMVR remains superior for durability and survival. Further studies are needed to evaluate TEER in high-risk surgical cohorts. Copyright © 2026 The Author(s) <41> Accession Number 2047681388 Title A critical appraisal of "A novel survival prediction model after isolated surgical aortic valve replacement in the transcatheter aortic valve replacement era". Source General Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Akhtar I.; Javaid M.H. Institution (Akhtar) Ayub Medical College, Abbottabad, Pakistan (Javaid) Shifa College of Medicine, Islamabad, Pakistan Publisher Springer Abstract Maeda et al. recently proposed a model to predict long-term survival after isolated surgical aortic valve replacement (SAVR) in the transcatheter aortic valve replacement (TAVR) era. While the model shows encouraging discrimination and calibration, several methodological and clinical limitations may restrict its broader applicability. The authors selected the final six-variable model primarily on the basis of maximal five-year C-statistic, without formal sample size justification or contemporary shrinkage-based criteria. Validation was restricted to internal resampling within the same registry, limiting evidence for transportability. Important prognostic domains, notably frailty and key anatomical and comorbidity variables, were not incorporated, and performance was not directly compared with established risk scores. Reporting only partially aligns with modern prediction model guidelines and omits decision curve analysis, leaving clinical utility uncertain. Overall, the model represents a valuable step but requires methodological refinement and external validation before guiding lifetime management between SAVR and TAVR. EBM Rating: Level V evidence. The article represents expert opinion derived from the author's clinical experience and interpretation of existing literature, without original experimental, randomized, controlled, cohort, or comparative analytic data. Copyright © The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery 2026. <42> Accession Number 2047763847 Title Long-term durability of self-expandable transcatheter heart valves in bicuspid versus tricuspid aortic valve stenosis: a matched-cohort analysis. Source Journal of Cardiovascular Medicine. 27(7) (pp 587-596), 2026. Date of Publication: 01 Jul 2026. Author Massussi M.; Cristiano N.; Chizzola G.; Fiorina C.; Costa G.; Angelillis M.; Bellini B.; Bruschi G.; Merlanti B.; Gorla R.; Barletta M.; Fineschi M.; Chin D.; Pancaldi E.; Pezzola E.; Archetti P.; Branca L.; Regazzoli D.; Montorfano M.; De Carlo M.; Adamo M. Institution (Massussi, Chizzola, Fiorina, Pancaldi, Pezzola, Archetti, Branca, Adamo) Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Italy (Cristiano, Adamo) Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (Costa, Angelillis, De Carlo) Cardiac Catheterization Laboratory, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (Bellini) Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Italy (Bruschi, Merlanti) ASST Grande Ospedale Metropolitano Niguarda, Heart Transplant & Cardiac Surgery Unit, 'De Gasperis' Cardio-Thoracic and Vascular Department, Italy (Gorla) Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, United States (Barletta) Interventional Cardiology UOSA, Azienda Ospedaliera Universitaria Senese, Siena, United States (Fineschi) Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy (Chin, Regazzoli) Humanitas Research Hospital IRCCS, Rozzano, Italy (Montorfano) School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (Montorfano) Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy Publisher Lippincott Williams and Wilkins Abstract Background - A bicuspid aortic valve (BAV) presents unique challenges for transcatheter aortic valve implantation (TAVI), and evidence on long-term bioprosthetic durability in an BAV compared to a tricuspid aortic valve (TAV) remains limited. We aimed to compare the 5-year durability and hemodynamic performance of self-expandable TAVI in patients with BAV versus TAV stenosis, using propensity score-matched data from a large, real-world, multicentre registry. Methods - This retrospective, multicentre analysis included patients treated with self-expandable TAVI (2009-2020) from the Medtronic One Hospital ClinicalService registry. Patients with at least one echocardiographic follow-up were matched 1 : 1 (n = 106 BAV; n = 106 TAV) based on key clinical and procedural characteristics. Primary endpoints were structural valve deterioration (SVD) and bioprosthetic valve failure (BVF), defined by VARC-3 criteria, analysed as cumulative incidence functions accounting for competing risk of death. All-cause mortality was analysed using Kaplan-Meier estimates. Results - At 5 years, the cumulative incidence of SVD was 1.07% [95% confidence interval (CI): 0.09-5.26] in BAV and 1.79% (95% CI: 0.14-8.50) in TAV (P = 0.829). BVF occurred in 2.38% (95% CI: 0.44-7.62) of BAV and 2.8% (95% CI: 0.47-9.19) of TAV patients (P = 0.782). Hemodynamic performance remained stable over time, with no statistically significant differences between the mean gradients at 5 years (7.8 +/- 2.8 mmHg BAV versus 9.5 +/- 11.7 mmHg TAV, P = 0.304). All-cause mortality at 5 years was 41.7% (BAV) versus 51.5% (TAV, P = 0.09). Conclusion - In this propensity-matched, real-world multicentre cohort, BAV and TAV patients treated with self-expandable TAVI showed no statistically significant differences in 5-year durability and hemodynamic performance. These findings are hypothesis-generating and suggest TAVI may be a reasonable option for selected BAV patients, pending further validation from randomized controlled trials. Copyright © 2026 Italian Federation of Cardiology - I.F.C. All rights reserved. <43> Accession Number 650795406 Title Effects of Preprocedural Acupressure on Pain, Anxiety, and Vital Signs in Patients Undergoing Transradial Coronary Angiography: A Randomized Controlled Trial. Source Pain management nursing : official journal of the American Society of Pain Management Nurses. 27(4) (pp e784-e793), 2026. Date of Publication: 01 Aug 2026. Author Ozen S.; Aydin D.; Sinmaz T. Institution (Ozen) Angiography Unit, Kocaeli City Hospital, Kocaeli, Turkey (Aydin, Sinmaz) Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balikesir, Turkey Abstract AIM: To evaluate the effects of pre-procedural acupressure on pain, anxiety, and vital signs among patients undergoing transradial coronary angiography. DESIGN: A single-blind, three-arm randomized controlled trial was conducted. METHOD(S): Ninety-three eligible participants were randomly allocated to acupressure, sham, or control groups. The acupressure intervention was applied for 20 minutes to the HT7, LI4, and PC6 acupoints prior to the procedure. Pain, anxiety, and vital signs were assessed at five time points: twice before transradial coronary angiography and at 0, 2, and 4 hours postprocedure. RESULT(S): Pain, anxiety, and systolic blood pressure were significantly lower in the acupressure group than in the sham and control groups. No significant differences were observed in diastolic blood pressure, heart rate, respiratory rate, or oxygen saturation. CONCLUSION(S): Preprocedural acupressure effectively reduces pain and anxiety and contributes to hemodynamic stability in patients undergoing transradial coronary angiography. CLINICAL IMPLICATIONS: Acupressure may be considered a simple and low-cost complementary nursing intervention that could support symptom management in patients undergoing cardiovascular procedures. Copyright © 2026 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. <44> Accession Number 2047865380 Title A systematic review and meta-analysis comparing the clinical outcomes of the Watchman FLX versus Watchman 2.5 device for transcatheter left atrial appendage occlusion in patients with atrial fibrillation. Source Critical Pathways in Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Khan M.A.; Muhammad A.; Shahbaz H.; Khan A.; Jawaid K.A.; Riaz T.; Attaullah K.; Noor A.; Zahid S.; Warya M.A.; khan U.; Ali M.; Taher Al-Zamili S.M.; Aslam B.; Umar A.; Abdullah A.; Bacha Z. Institution (Khan) Allama Iqbal medical college, Lahore, Pakistan (Muhammad) Nowshera Medical College, Nowshera, Pakistan (Shahbaz) Ayub medical college, Abbottabad, Pakistan (Khan, Riaz, Noor, Ali, Umar, Abdullah, Bacha) Khyber Medical College, Peshawar, Pakistan (Jawaid) Sharif Medical City Hospital, Lahore, Pakistan (Attaullah, Zahid) Khyber Girls Medical College, Peshawar, Pakistan (Warya) Islam Medical College Sialkot, Pakistan (khan) Saidu Teaching Hospital, Swat, Pakistan (Taher Al-Zamili) College of Medicine, Al-Ayen University, Thi-Qar, Iraq (Aslam) University of Lahore Hospital, Pakistan Publisher Lippincott Williams and Wilkins Abstract Background: - Transcatheter left atrial appendage occlusion (LAAO) prevents cardioembolic stroke in patients with non-valvular atrial fibrillation who cannot tolerate long term anticoagulation. Whether the second-generation Watchman FLX confers superior clinical outcomes over the first-generation Watchman 2.5 remains incompletely characterized. Method(s): - We performed a PRISMA 2020-compliant systematic review and meta-analysis of studies comparing Watchman FLX with Watchman 2.5. Three electronic databases were searched through April 2026. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were derived using DerSimonian-Laird random-effects models. Nine prespecified outcomes were analyzed: procedural success, device-related embolism, device-related thrombosis (DRT), major bleeding, pericardial effusion, all-cause mortality, any stroke, ischemic stroke, and length of hospital stay (LOHS). Result(s): - Seven observational cohort studies enrolling 131, 728 patients (Watchman FLX: n = 54, 023; Watchman 2.5: n = 77, 705) were included. All studies received Newcastle-Ottawa Scale scores of 8-9 (high quality). The Watchman FLX demonstrated significantly higher procedural success (RR 1.02 [1.02-1.02]; p < 0.00001) and significant reductions in pericardial effusion (RR 0.33 [0.27-0.41]; p < 0.00001), device-related embolism (RR 0.38 [0.23-0.60]; p < 0.0001), all-cause stroke (RR 0.75 [0.65-0.86]; p < 0.0001), ischemic stroke (RR 0.81 [0.69-0.96]; p = 0.01), major bleeding (RR 0.65 [0.53-0.81]; p < 0.0001), and all-cause mortality (RR 0.54 [0.37-0.78]; p = 0.001). DRT showed a directional but non-significant trend toward reduction (RR 0.33 [0.09-1.20]; p = 0.09). LOHS was not reliably estimable (I2 = 87%). Conclusion(s): - The Watchman FLX is associated with significantly superior safety and efficacy outcomes relative to the Watchman 2.5 across the principal clinical domains of transcatheter LAAO. These findings are observational and hypothesis-generating rather than definitive evidence of device superiority; all comparisons reflect temporal and contextual differences inherent to sequential device eras and should be interpreted with caution. These results support the design of prospective, contemporaneously enrolled comparative studies and may inform future guideline deliberations. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <45> Accession Number 2045658306 Title Pharmacists' contribution to improving vaccination uptake among children: A systematic review. Source Research in Social and Administrative Pharmacy. 22(10) (pp 908-920), 2026. Date of Publication: 01 Oct 2026. Author Amare S.N.; Leung M.; Yee K.C.; Naunton M.; Bushell M. Institution (Amare, Yee, Naunton, Bushell) Discipline of Pharmacy, University of Canberra, Canberra, Australia (Leung) Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia (Amare) Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia Publisher Elsevier Inc. Abstract Background Pharmacists are increasingly involved in vaccine delivery, yet evidence specific to pediatric populations remains limited. Most existing studies focus on adults, leaving uncertainty about pharmacists' impact on children's vaccination uptake. Therefore, this review aimed to evaluate the impact of pharmacist interventions on vaccination uptake among children. Methods A systematic search of four major databases was conducted through July 2025. Quantitative comparative studies assessing pharmacists' contributions to improving vaccination uptake among children were included. Qualitative studies, case reports, and studies lacking child-specific data were excluded. Study selection, data extraction, and quality assessments were performed independently by two reviewers. Results Of 8368 records identified, six studies met the inclusion criteria. The evidence showed that pharmacist interventions resulted in increased vaccination uptake. These interventions included screening, recommendation, education, and direct immunization. All included studies were conducted in the United States and primarily employed pre-post designs. A meta-analysis was not conducted due to heterogeneity in populations, interventions, and outcome measures. Conclusion Pharmacists' involvement in vaccination services shows a positive association with children's vaccination uptake. However, the certainty of this evidence remains limited by non-randomized study designs and potential bias. As all studies were conducted in the United States, the findings may not apply globally. Further high-quality, controlled studies across diverse international health systems are needed to better characterize the association and inform policy development. Copyright © 2026 The Authors. <46> Accession Number 2047691194 Title Optimizing TAVI strategy: balancing predilatation benefits and direct implantation efficiency. Source Future Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Abdalwahab A.; Ibrahem A.; Farag M. Institution (Abdalwahab, Farag) Cardiothoracic Department, Freeman Hospital, Newcastle Upon Tyne, United Kingdom (Abdalwahab) Cardiovascular Department, Faculty of Medicine, Tanta University, Tanta, Egypt (Ibrahem, Farag) School of Health, Medicine and Life Sciences, University of Hertfordshire, Hertfordshire, United Kingdom Publisher Taylor and Francis Ltd. Abstract Balloon aortic valvuloplasty (BAV) has historically been considered an integral step during transcatheter aortic valve implantation (TAVI), facilitating valve crossing and expansion, particularly in early-generation devices. However, advances in valve technology, delivery systems, and imaging have prompted a shift toward direct TAVI without routine predilatation. Contemporary evidence from randomized trials, large registries, and meta-analyses demonstrates that direct TAVI is feasible and safe in anatomically favorable cases, with comparable device success and early clinical outcomes to BAV-assisted implantation. Nonetheless, predilatation remains valuable in selected patients with complex anatomy, including severe leaflet calcification, high transvalvular gradients, bicuspid morphology, horizontal aorta, or challenging valve crossing. Predilatation may further improve procedural control, optimize valve expansion, and reduce residual paravalvular leakage, particularly with self-expandable valves and platforms with lower intrinsic opening force. Conversely, routine BAV may increase procedural complexity, radiation and contrast exposure, and embolic risk. Overall, current evidence supports a selective, anatomy-driven approach to predilatation, balancing procedural efficiency with optimal valve deployment and safety. This review critically examines the evolving role of BAV in contemporary TAVI practice. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <47> Accession Number 2047778575 Title Long-term efficacy and safety of left atrial appendage closure vs. oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials. Source Europace. 28(7) (no pagination), 2026. Article Number: euag159. Date of Publication: 01 Jul 2026. Author Karakasis P.; Tzeis S.; Samaras A.; Vlachos K.; Pamporis K.; Theofilis P.; Tzikas A.; Antoniadis A.P.; Jais P.; Fragakis N. Institution (Karakasis, Samaras, Tzikas, Antoniadis, Fragakis) Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece (Tzeis) Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, Greece (Vlachos, Jais) Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Universite and Universite de Bordeaux, INSERM U1045, Pessac, France (Vlachos, Jais) Cardiac Arrhythmia Department, INSERM U1045, CHU de Bordeaux, Pessac, France (Vlachos) Electrophysiology Department, Hygeia Hospital, Athens, Greece (Pamporis, Theofilis) First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece Publisher Oxford University Press Abstract Aims: Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), but its long-term comparative efficacy remains uncertain. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LAAC with OAC in AF. Methods and Results: MEDLINE, Embase, Scopus, and the Cochrane Database of Systematic Reviews were searched through 8 April 2026. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Certainty of evidence (CoE) was assessed using GRADE. Six RCTs involving 7004 participants were included (3681 assigned to LAAC and 3323 to OAC). Compared with OAC, LAAC resulted in a significantly higher risk of ischaemic stroke or systemic embolism (134 vs. 80 events; RR 1.41, 95% CI 1.07-1.86; moderate CoE). No significant differences were observed for any stroke or systemic embolism (RR 1.10, 95% CI 0.87-1.39; moderate CoE), all-cause mortality (RR 0.92, 95% CI 0.77-1.10; high CoE), cardiovascular mortality (RR 0.90, 95% CI 0.67-1.21; moderate CoE), non-cardiovascular mortality (RR 0.92, 95% CI 0.75-1.12; moderate CoE), major bleeding (RR 0.91, 95% CI 0.77-1.08; high CoE), or haemorrhagic stroke (RR 0.58, 95% CI 0.28-1.17; moderate CoE). LAAC reduced the risk of nonprocedural clinically relevant bleeding compared with OAC (RR 0.50, 95% CI 0.43-0.59; high CoE). Conclusion(s): In patients with AF, LAAC results in a higher risk of ischaemic stroke or systemic embolism than an OAC-based strategy. Compared with OAC, LAAC has no effect on major bleeding or mortality and does not reduce haemorrhagic stroke. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <48> Accession Number 2047597683 Title Global research trends in robotic applications in cardiovascular medicine: a bibliometric analysis. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 664. Date of Publication: 01 Dec 2026. Author Oguz O.; Erdol M.A.; Yayla C.; Ertem A.G. Institution (Oguz) Department of Cardiology, Sakarya Yenikent State Hospital, Sakarya, Turkey (Erdol, Yayla, Ertem) Department of Cardiology, Ankara Bilkent City Hospital, Ankara, Turkey Publisher Springer Nature Abstract This study aimed to analyze global research trends in robotic applications in cardiovascular medicine. Robotic technologies have been increasingly integrated into cardiovascular medicine, providing enhanced precision, improved visualization, and reduced operator-related risks. Despite growing interest in this field, comprehensive evaluations of global research trends remain limited. In this bibliometric study, publications indexed in the Web of Science Core Collection between 2019 and 2025 were systematically analyzed, and 261 original articles meeting predefined criteria were included. Bibliometric analyses were carried out using VOSviewer and Biblioshiny to evaluate publication trends, citation dynamics, leading sources, and collaboration patterns. Scientific output showed a steady upward trajectory over time, with a more pronounced increase after 2021 and reaching its peak in 2025. The highest average citation rate was observed in 2024. Journal of Robotic Surgery and Journal of Cardiac Surgery were identified as the most productive journals. The United States was the leading contributor in terms of both publication volume and citation impact and also played a central role in international collaborations. Keyword analysis showed that research activity was primarily focused on robotic surgery, minimally invasive surgery, coronary artery bypass grafting, and percutaneous coronary intervention. Overall, robotic applications in cardiovascular medicine represent a rapidly expanding research area characterized by increasing scientific output and growing international collaboration. The concentration of publications in specific journals and the prominence of leading countries suggest a developing and increasingly structured research landscape. Copyright © The Author(s) 2026. <49> Accession Number 2047612662 Title Effect of Transcranial Alternating Current Stimulation on Prevention of Postoperative Pain After Video-Assisted Thoracic Surgery: A Randomized Controlled Trial. Source Pain Research and Management. 2026(1) (no pagination), 2026. Article Number: 6121920. Date of Publication: 2026. Author Chen S.; Li Z.-H.; Du N.; Lei L.; Yang J.-J. Institution (Yang, Chen, Li, Du, Lei, Yang) Department of Anesthesiology, Pain, and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, China (Yang, Chen, Li, Du, Lei, Yang) Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, China Publisher John Wiley and Sons Ltd Abstract Introduction: Transcranial alternating current stimulation (tACS), which can noninvasively entrain oscillatory brain activity, has attracted scientific attention as a possible technique to control pain. However, there is a scarcity of studies investigating the preventive effect of tACS on postoperative pain. Method(s): This double-blind, randomized, sham-controlled trial enrolled 72 patients undergoing elective video-assisted thoracoscopic surgery (VATS). Patients were randomly allocated (1:1) to receive a single 20-min session of alpha-tACS on the primary somatosensory cortex (S1) or sham stimulation postoperatively. The primary outcomes were postoperative numerical rating scale pain scores and opioid consumption at 24 h postoperatively. Secondary outcomes included cumulative opioid consumption within 48 h and Quality of Recovery-15 (QoR-15) score. Adverse events were also assessed. Result(s): The tACS group exhibited significantly lower resting pain scores versus the sham group (beta = -0.49, 95% confidence interval [CI], -0.78 to -0.20, p = 0.001) and lower movement pain scores versus the sham group (beta = -0.45, 95% CI, -0.84 to -0.06, p = 0.025), though cumulative opioid consumption showed no difference at 24 h (median difference [MD] = 1.0 mg; 95% CI, -2.3 to 2.5; p = 0.76) and 48 h (MD = 3.3 mg; 95% CI, -0.6 to 9.1; p = 0.10) postoperatively. Additionally, the area under the curve for resting pain over 2-24 h (AUC<inf>2-24 h</inf>) and 2-48 h (AUC<inf>2-48 h</inf>), as well as the AUC<inf>2-48 h</inf> of movement pain scores, were significantly lower in the tACS group. Moreover, QoR-15 scores and adverse events were also comparable. Conclusion(s): For patients undergoing VATS, a single alpha-tACS treatment targeting the bilateral S1 regions yielded a statistically significant yet modest reduction in postoperative pain. However, no significant decrease in postoperative opioid consumption was observed, and further research is warranted. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2300078723. Copyright © 2026 Jin-Jin Yang et al. Pain Research and Management published by John Wiley & Sons Ltd. <50> Accession Number 2047580348 Title Outcomes of conservative management of CT-diagnosed hemothorax in chest trauma: A systematic review and meta-analysis. Source Injury. 57(10) (no pagination), 2026. Article Number: 113476. Date of Publication: 01 Oct 2026. Author Alomar Z.; El-Khatib A.; Khreibeh M.; Refai A.; Alomari M.; Alomar A.; El-Menyar A.; Rizoli S.; Al-Thani H.; Mahmood I. Institution (Alomar, El-Khatib, Khreibeh, Refai, Alomari, Alomar) Jordan University of Science and Technology, Jordan (El-Menyar, Rizoli, Al-Thani, Mahmood) Trauma Surgery, Hamad Medical Corporation, Qatar (Mahmood) Surgery Department, Qatar University, Doha, Qatar (El-Menyar) Clinical Medicine, Weill Cornell Medicine, Doha, Qatar Publisher Elsevier Ltd Abstract Background Hemothorax is one of the most common findings in traumatic chest injuries. Emerging evidence suggests that small-volume hemothoraces (less than 300 cc) diagnosed by CT scan can often be managed successfully with conservative (non-interventional) treatment. This choice is clinically important, as chest tube drainage may itself lead to complications. The aim was to evaluate the outcomes and complications of conservative management in patients with small-volume hemothorax. Methods This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, and the Cochrane Library for studies on CT-diagnosed traumatic hemothorax in stable patients managed conservatively. Articles meeting the inclusion criteria were reviewed. The main outcome measured was the failure rate of conservative management. Results Of 3089 articles screened, 10 studies met inclusion criteria, reporting on 3030 patients with CT-diagnosed hemothorax. Among these, 1679 patients (55.4%) were managed conservatively, achieving an 81% success rate. Most cases (94.4%) involved a hemothorax volume under 300 cc, and 409 patients had an associated occult pneumothorax. Delayed tube thoracostomy was needed in 19% (319/1679) of conservatively managed patients; only 1.8% required further surgical intervention. The primary indications for delayed tube thoracostomy were progression of hemothorax on follow-up chest x-ray (62.0%), worsening pneumothorax (16.4%), and development of respiratory distress (12.3%). All reported mortality was unrelated to thoracic injuries. Conclusion Patients with CT-diagnosed hemothorax < 300 cc (thickness <15 mm) can be managed conservatively, with 1 in 5 requiring later intervention. These results support observation in stable patients and highlight the need for careful monitoring and standardized protocols. However, these findings should be interpreted with caution, as prospective, high-quality clinical trials with standardized definitions, imaging criteria, and outcomes are needed before firm clinical recommendations can be made, to strengthen the current evidence base. Copyright © 2026 British Trauma Society. <51> Accession Number 2047678170 Title Laparoscopic Surgery in Recipients of Intra-abdominal Solid Organ Transplants: A Systematic Review. Source Gynecology and Minimally Invasive Therapy. 15(3) (pp 261-268), 2026. Date of Publication: 01 Jul 2026. Author Suarthana E.; Doan L.; Danesh N.M.; Tulandi T. Institution (Suarthana, Doan, Danesh, Tulandi) Department of Obstetrics and Gynecology, McGill University Health Center, McGill University, Montreal, QC, Canada Publisher Wolters Kluwer Medknow Publications Abstract Objectives: Laparoscopy is a minimally invasive surgical approach that can reduce morbidity compared with open surgery in appropriately selected patients. However, patients with a history of intra-abdominal solid organ transplantation may have postoperative adhesions and altered anatomy, leading to more complex and variable anatomy. It remains unclear whether prior transplantation increases the risk of complications during laparoscopy. This study aimed to evaluate the incidence of complications in patients undergoing laparoscopy following intra-abdominal solid organ transplantation. Material(s) and Method(s): A systematic search of PubMed, EMBASE, and Google Scholar was conducted through October 2023 to identify studies on laparoscopy in postintra-abdominal solid organ transplant recipients. Two independent reviewers identified 30 relevant articles, of which 19 (including case reports, case-control, and cohort studies) met the inclusion criteria. Risk of bias was assessed using the Newcastle-Ottawa scale by two independent reviewers. The study protocol was registered with PROSPERO (CRD42023477254). Result(s): Four studies included direct comparisons between transplant and nontransplant patients. The mean postoperative length of stay was 3.5 days among 1402 transplant patients, compared with 2.3 days among 2,640,340 nontransplant patients. Two studies reported a lower rate of wound infection in nontransplant patients compared with posttransplant patients (1.7% vs. 4.8%). Rates of other infections, seroma formation, ileus, and disease recurrence were comparable between groups, although each was reported by only one small study. Two of the four studies were assessed as having a low risk of bias. Conclusion(s): Direct comparisons between patients with and without a history of intra-abdominal solid organ transplantation suggest that laparoscopy is generally safe, with a modest increase in hospital stay and wound infection risk in posttransplant patients. Copyright © 2026 Gynecology and Minimally Invasive Therapy. <52> Accession Number 2046302973 Title AI-enabled digital wound monitoring after cardiac surgery: a randomised controlled feasibility, safety, and acceptability trial. Source Journal of Hospital Infection. 174 (pp 428-435), 2026. Date of Publication: 01 Aug 2026. Author Rochon M.; Tanner J.; Cariaga K.; Jurkiewicz J.; Beckhelling J.; Harris R.; Wilson K.; Dhoonmoon L.; Bolton S.; Bouttell J.; Davis D.; Shipolini A.; Magboo R.; Oezalp F.; Chester V. Institution (Rochon, Cariaga) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Tanner) University of Nottingham, Nottingham, United Kingdom (Jurkiewicz) Isla Care Ltd, London, United Kingdom (Beckhelling, Davis, Chester) Derby Clinical Trials Support Unit, Derby, United Kingdom (Harris) NIHR Research Support Service (RSS) Hub Delivered by the University of Leicester and Partners, Nottingham, United Kingdom (Wilson) Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom (Dhoonmoon) London North West University Healthcare, London, United Kingdom (Bolton, Bouttell) Centre for Healthcare Equipment and Technology Adoption (CHEATA), Nottingham, United Kingdom (Shipolini, Magboo) Barts Health NHS Trust, London, United Kingdom (Oezalp) The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom Publisher W.B. Saunders Ltd Abstract Background: Surgical site infection after cardiac surgery is a common cause of morbidity and unplanned healthcare use, with most infections developing after hospital discharge. Remote wound monitoring using smartphone technology and artificial intelligence (AI) may support earlier identification of complications. Aim(s): To evaluate the feasibility, acceptability, and safety of an AI-enabled digital wound monitoring platform plus usual care (Isla-AI) compared with usual care (UC) alone. Design, setting, and participants: This multi-centre, two-arm randomised controlled feasibility trial was conducted at two U.K. hospitals between August 2024 and January 2025. Adults undergoing cardiac surgery were randomised to receive Isla-AI or UC. The study was not powered to assess effectiveness. Result(s): 120 patients were randomised and participated (Isla-AI N = 62; UC N = 58). Feasibility targets were exceeded: 60% of eligible patients approached consented, 95% of Isla-AI participants submitted at least one image, and 92% completed the study. Ninety-eight percent of images were suitable for clinical assessment. Clinician agreement with AI priority flags was 87%. AI prioritisation performance was slightly better for patients with darker skin tones. More than half of participants required assistance to capture or submit wound images. Patient- and staff-acceptability of AI was largely favourable. Adverse and serious adverse event rates were similar across both groups. The proportion of patients accessing National Health Service (NHS) resources for wound-related problems and antibiotics was lower in the Isla-AI group. Conclusion(s): These findings support progression to a large, definitive multi-centre effectiveness trial, with further attention to equity, usability, and workflow integration. Trial registration: IRAS 338141; local project UHDB/2022/024. ISRCTN16900119. Clinicaltrials.gov: NCT06475703. Date registered: 20/06/2024. Copyright © 2026 The Author(s) <53> Accession Number 2047597300 Title Pseudo-publication bias in robotic surgery: structural mapping of narrative inertia. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 687. Date of Publication: 01 Dec 2026. Author Inga-Zapata E.; Silva H.; Perez C.; Ruiz-Ucar E.; Espinoza C.; Guarecuco J.; Lee J.T.; Oviedo R.J. Institution (Inga-Zapata, Silva, Espinoza) Surgical Research Lab, DRAA-Larkin Health System, Miami, FL, United States (Inga-Zapata, Silva, Espinoza) Unidad de Cirugia, Universidad de San Martin de Porres, Lima, Peru (Inga-Zapata, Silva, Espinoza) Peruvian Society of Robotic Surgery, Lima, Peru (Perez) Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States (Ruiz-Ucar, Oviedo) Bariatric, Metabolic & Endocrine Unit, General & Digestive Surgery Department, Fuenlabrada University Hospital, Madrid, Spain (Ruiz-Ucar, Oviedo) Rey Juan Carlos University, Madrid, Spain (Guarecuco, Lee, Oviedo) Department of General Surgery, Larkin Community Hospital, South Miami, United States (Guarecuco) Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX, United States (Lee) University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States (Oviedo) Sam Houston State University College of Osteopathic Medicine, Conroe, TX, United States Publisher Springer Nature Abstract The rapid worldwide adoption of robotic surgery often outpaces high-level comparative evidence. While evidence-based medicine relies on a hierarchical pyramid where causal inference resides at the apex, most of the scientific output is concentrated at the non-comparative base. It remains unknown whether the directional conclusions of these literature layers are symmetrically aligned. This study aimed to map the structural distribution of conclusions across the evidence hierarchy in visceral robotic surgery to evaluate potential narrative discordance. A stratified random sampling of intracavitary robotic surgery publications (thoracic, abdominal, and pelvic) was conducted from PubMed (1997-2026). Our sample size was calculated to achieve maximum representativeness (n = 800). Publications were equally partitioned into two pragmatic functional layers based on the presence of a control group: the Upper Hierarchy Zone (comparative layer, n = 400) and the Lower Hierarchy Zone (non-comparative layer, (n = 400). Directional orientations of author conclusions were operationally categorized as Favorable, Neutral, or Unfavorable. To ensure non-biased processing and scalability, semantic classification was executed via a Large Language Model (GPT-5.4), previously validated against a three-evaluator human pilot trial (absolute agreement 92%, Cohen's kappa > 0.81). Statistical analysis utilized Chi-square tests and Odds Ratio (OR) calculation with 95% Confidence Intervals (CI), with a secondary bipartite analysis (favorable vs. non-favorable). The global overview of the entire dataset (n = 800) demonstrated an illusion of literary equilibrium: 51.75% (n = 414) favorable, 45.50% (n = 364) neutral, and 2.75% (n = 22) unfavorable conclusions. However, stratification revealed a massive structural asymmetry (chi^2 = 312.9, p < 0.001). Within the upper hierarchy, conclusions were overwhelmingly non-favorable (79.50% vs. 20.50% favorable), dominated by neutral comparative outcomes (77.75%). Conversely, the lower hierarchy was heavily skewed toward favorable outcomes (83.00% favorable vs. 17.00% non-favorable). The lower zone also served as a sharper sensor of surgical failure, reporting a higher raw unfavorable rate (3.75%) than the apex (1.75%). Pragmatic bipartite analysis demonstrated that a publication at the base of the evidence pyramid has nearly 19 times higher odds of reporting a favorable conclusion compared to those at the comparative apex (OR 18.93, 95% CI: 13.84-26.87). A profound structural asymmetry exists within the robotic surgery literature. The disproportionate volume of highly favorable, lower-tier evidence numerically overwhelms comparative data, creating a phenomenon of "pseudo-publication bias." This structural distortion generates a powerful narrative inertia that drives global clinical adoption and shapes professional perception through cumulative enthusiasm rather than demonstrated methodological superiority. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <54> Accession Number 2044491099 Title Effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis: a randomized controlled trial utilizing high-frequency variability index. Source Journal of Clinical Monitoring and Computing. 40(4) (pp 845-855), 2026. Date of Publication: 01 Aug 2026. Author Kotani T.; Ida M.; Naito Y.; Tanaka N.; Kawaguchi M. Institution (Kotani, Ida, Naito, Tanaka, Kawaguchi) Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Nara, Kashihara, Japan Publisher Springer Science and Business Media B.V. Abstract In this study, we aimed to compare the effects of remimazolam and propofol on parasympathetic activity during general anesthesia induction in patients with severe aortic stenosis using heart rate variability (HRV) analysis. In this single-center randomized controlled trial, 28 patients scheduled for elective transcatheter aortic valve replacement were assigned to receive either remimazolam or propofol for anesthesia induction at a tertiary emergency medical facility. Parasympathetic activity was assessed using the high-frequency variability index (HFVI), derived from spectral analysis of HRV based on electrocardiographic R-R intervals. HFVI was recorded for 3 min before and after induction. Remimazolam or propofol was administered at 6 mg/kg/h or 2.0 microg/ml via target-controlled infusion, respectively. The primary outcome was the difference in mean HFVI values recorded between the 3-min period before and after induction. Hemodynamic parameters, including mean blood pressure, heart rate, cardiac output, stroke volume variation, pulse pressure variation, and dynamic arterial elastance, were also measured. Baseline HFVI values did not differ significantly between groups. After induction, HFVI decreased significantly more in the remimazolam group than in the propofol group (DELTAHFVI: 16 vs. 3, P = 0.010). Heart rate increased in the remimazolam group but decreased in the propofol group (P = 0.006). No significant intergroup differences were observed in other hemodynamic parameters. These findings suggest that remimazolam may be associated with distinct autonomic responses during anesthesia induction. Copyright © The Author(s) 2026. <55> Accession Number 2047626744 Title Proton pump inhibitors for prevention of upper and lower gastrointestinal bleeding in patients taking aspirin: a systematic review and meta-analysis. Source European Journal of Clinical Pharmacology. 82(8) (no pagination), 2026. Article Number: 212. Date of Publication: 01 Aug 2026. Author Jia S.; Yin Y.; Huo W.; Lu H.; Gao Y.; Qi X. Institution (Jia, Huo, Lu, Gao, Qi) Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of the Shenyang Pharmaceutical University), No. 83 Wenhua Road, Liaoning Province, Shenyang, China (Jia, Huo, Lu, Qi) Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China (Yin, Qi) General Hospital of Northern Theater Command, China Medical University, Shenyang, China Publisher Springer Science and Business Media Deutschland GmbH Abstract Objectives: Proton pump inhibitors (PPIs) are recommended for the prevention of aspirin-associated gastrointestinal mucosal injury, but emerging evidence indicates that PPIs may increase the risk of lower gastrointestinal bleeding (LGIB). This meta-analysis aimed to comprehensively evaluate the effects of PPIs on gastrointestinal bleeding (GIB). Method(s): Major electronic databases were searched to identify the studies evaluating the differences between PPIs versus placebo/blank, no-PPI, histamine-2 receptor antagonists (H<inf>2</inf>RAs), mucosal protective agents (MPAs), and potassium-competitive acid blockers (P-CABs) in preventing aspirin-associated GIB. Risk ratios (RRs) with their 95% confidence intervals (CIs) were calculated. Result(s): Sixteen randomized controlled trials (RCTs) and 14 non-RCTs were included. PPIs group had significantly lower risk of upper gastrointestinal bleeding (UGIB) than placebo/blank group (7 RCTs, RR = 0.30, 95%CI = 0.19-0.46; 2 non-RCTs, RR = 0.05, 95%CI = 0.01-0.42), no-PPI group (7 non-RCTs, RR = 0.50, 95%CI = 0.38-0.66), H<inf>2</inf>RAs group (5 RCTs, RR = 0.21, 95%CI = 0.09-0.53; 4 non-RCTs, RR = 0.12, 95%CI = 0.03-0.52), and MPAs group (4 RCTs, RR = 0.24, 95%CI = 0.10-0.58), but statistically similar (2 non-RCTs, RR = 1.18, 95%CI = 0.77-1.79) or significantly higher (1 RCT, log-rank P = 0.018 and 0.019) risk of UGIB than P-CABs group. PPIs group had significantly higher risk of lower gastrointestinal bleeding (LGIB) than no-PPI group (3 non-RCTs, RR = 2.85, 95%CI = 1.85-4.38), but statistically similar risk of LGIB to H<inf>2</inf>RAs group (2 RCTs, RR = 1.88, 95%CI = 0.30-11.82). Conclusion(s): The evidence from RCTs and non-RCTs suggests the advantages of PPIs over placebo/blank, no-PPI, H<inf>2</inf>RAs, and MPAs for the prevention of UGIB in aspirin users. The evidence regarding PPIs and LGIB in aspirin users is from non-RCTs alone, and suggests their potential harms. Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026. <56> Accession Number 2047383647 Title The Impact of Insulin Glargine on Blood Glucose Control during On-Pump Beating Coronary Artery Bypass Surgery in Diabetic Patients: A Single-Blind Randomized Controlled Trial. Source Archives of Anesthesiology and Critical Care. 12(4) (pp 362-369), 2026. Date of Publication: 01 Jul 2026. Author Ganjali R.; Kahrom M.; Bijari F.; Tabari M.; Firoozjah A.G.; Sheybani S. Institution (Ganjali) Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of (Kahrom) Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of (Bijari, Tabari, Sheybani) Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of (Firoozjah) Department of Cardiac Intensive Care, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic Republic of Publisher Tehran University of Medical Sciences Abstract Background: Diabetes mellitus in subjects of coronary artery bypass grafting (CABG) surgery is associated with increased morbidity and mortality. Therefore, in recent years, glycemic monitoring and control have been the focus of clinical research. This study aimed to determine the impact of insulin glargine on the management of blood glucose during the perioperative period of on-pump coronary artery bypass graft in diabetic patients. Method(s): In a randomized clinical trial, 80 patients with type 2 diabetes, candidates for elective CABG with a cardiopulmonary pump, were randomly separated into two groups. The intervention group received 0.2 units/kg of insulin glargine 2 hours before induction of anesthesia plus usual care. The control group received usual care. Usual care included injection of regular insulin before, during, and after surgery in accordance with a changed Van den Berghe code. Blood glucose (BG) level, ICU and hospital length of stay (LOS), creatinine, white blood cell count (WBC), and postoperative complications, including infection and dehiscence, were evaluated between two groups. Result(s): The BG of patients upon entrance (p=0.04), 16 (p=0.01), 20 (p=0.01), and 24 (p=0.01) hours after admission to the ICU was significantly lower in the intervention than in the control group. There was a significant difference in the average BG levels at different times (p<0.001), so the highest and lowest BG levels were observed 4 and 20 hours after ICU administration in the intervention group and 4 hours and immediately after ICU admission in the control group. Average creatinine (p=0.01), regular insulin used until the end of the first day after surgery (p=0.01), ICU length of stay (LOS) (p=0.009), and hospital LOS (p=0.001) were significantly lower in the intervention group than the controls. Conclusion(s): Insulin glargine plus regular insulin is able to maintain BG at a controlled level up to 24 hours after surgery. It also showed significant control over postoperative complications. This study revealed the therapeutic effectiveness of both insulin glargine and regular insulin in achieving adequate BG control for type 2 diabetes patients during the critical postoperative period of on-pump CABG. Copyright © 2026 Tehran University of Medical Sciences. <57> Accession Number 2046217569 Title Extracranial vascular association of moyamoya disease: a systematic review and machine learning analysis. Source Neurological Sciences. 47(7) (no pagination), 2026. Article Number: 560. Date of Publication: 01 Jul 2026. Author Mondal R.; Deb S.; Ray N.; Sengupta A.; Sen P.; Barma D.; Roy J.; Chowdhury A.; Benito-Leon J. Institution (Mondal, Deb, Ray, Sengupta, Sen, Roy) Department of Neurology, Manipal Group of Hospitals, Kolkata, India (Mondal, Deb, Ray, Sengupta, Sen, Roy) Centre for Neurovascular Research, Manipal Group of Hospitals, Kolkata, India (Barma) Department of Internal Medicine, IPGMER and SSKM Hospital, Kolkata, India (Chowdhury) Department of Computer Science and Engineering, Indian Institute of Technology (IIT), Dhanbad, India (Benito-Leon) Department of Neurology, 12 de Octubre University Hospital, Madrid, Spain (Benito-Leon) Group of Neurodegenerative Diseases, Hospital Universitario 12 de Octubre Research Institute, Madrid, Spain (Benito-Leon) Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain (Benito-Leon) Department of Medicine, Complutense University of Madrid, Madrid, Spain Publisher Springer-Verlag Italia s.r.l. Abstract Background: Intracranial steno-occlusive lesions are characteristic of moyamoya disease (MMD), but increasing reports of extracranial vascular involvement suggest a possible systemic arteriopathy. Method(s): We conducted a PRISMA-guided systematic review (1974-May 2025) to identify extracranial vascular involvement in classical MMD. Seventy-four studies were included. Because the search was limited to English-language publications, language bias may be present. A subset of 85 patients from 46 studies was used for exploratory multilabel machine-learning and deep-learning modeling based on clinical variables. Result(s): Seventy-four studies comprising 143 patients (59.4% female) were included; mean age was 24.9 years. Bilateral intracranial disease predominated. Among patients with isolated extracranial involvement, coronary lesions were most frequent (33.1%), followed by renal (31.5%), pulmonary (14.6%), external carotid (10.8%), vertebral (4.6%), and celiac/mesenteric (3.1%) involvement; other rare single-vessel lesions accounted for 2.3%. Multisite involvement occurred in 9.1%. Of 25 genotyped patients, 23 (92.0%) carried RNF213 variants. Mortality was highest in the pulmonary subgroup (31.6%). Logistic regression and random forest showed the best overall balance of accuracy, F1 score, and ROC area, whereas one-dimensional convolutional neural networks were the strongest deep-learning models, although deep learning overall underperformed machine learning. Feature selection identified vascular risk factors and bilateral MMD as the strongest predictors. Conclusion(s): Extracranial vascular involvement in MMD appears age- and vascular bed-specific. These findings are consistent with, but do not establish, a systemic arteriopathy framework and support further prospective validation. Copyright © Fondazione Societa Italiana di Neurologia 2026. <58> Accession Number 2047692590 Title The Pediatric Cardiac Extubation Readiness Framework: An Evidence-Derived Translational Framework for Structured Extubation Assessment Following Pediatric Cardiac Surgery. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Alkhatip A.A.A.M.M.; Mills K.E.; Akram A.; Farag E.; Hamza M.K.; Abdelkader M.; Bahr M.; ELEmady M.F.M.; Hosny H.; Sallam A.; Farag A.M.G.; Wagih M.; Naguib A. Institution (Alkhatip) Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom (Alkhatip, Farag, Abdelkader, Bahr) Department of Anesthesia, Pain Management and Surgical Intensive Care, Beni-Suef University Hospital and Faculty of Medicine, Beni Suef University, Beni Suef, Egypt (Mills) Department of Science and Technology, University of Canberra, Canberra, Australia (Akram) Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan (Hamza, ELEmady, Hosny, Wagih, Naguib) Department of Anesthesia, Kasr Al Ainy Faculty of Medicine and Cairo University Hospitals, Cairo University, Cairo, Egypt (Hosny) Department of Cardiothoracic Anaesthesia and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne Foundation Trust, Newcastle upon Tyne, United Kingdom (Sallam) Department of Anaesthesia, St. Vincent's University Hospital, Dublin, Ireland (Farag) Department of Cardiac Anaesthesia, King Abdullah Medical City, Makkah al-Mukarramah, Saudi Arabia Publisher W.B. Saunders Abstract This Special Article aimed to develop an evidence-derived translational framework for structured assessment of readiness for early extubation following pediatric cardiac surgery, informed by a previously published systematic review and meta-analysis. Framework development was based on secondary synthesis of aggregated study-level data from pediatric cardiac surgical populations across multiple institutions; no clinical intervention was performed. Extracted study-level data, subgroup findings, sensitivity analyses, and predefined clinical interpretability criteria were used. Candidate variables associated with extubation timing and postoperative outcomes were mapped into clinically coherent domains according to recurrent representation within the evidence base, biological plausibility, and applicability to routine multidisciplinary assessment. The Pediatric Cardiac Extubation Readiness Framework (PCERF) was revised into a 2-layer translational framework. Layer 1 comprises age, weight, procedural complexity, cardiopulmonary stability, and peri-extubation pathway factors. Layer 2 comprises mandatory non-scored clinical safety modifiers intended to identify physiological states that may independently preclude consideration of early extubation. The numerical score structure, weight categories, equal weighting, and readiness bands are illustrative prototype framework components rather than statistically optimized or outcome-derived thresholds. PCERF is a hypothesis-generating translational framework intended to support structured multidisciplinary assessment of extubation readiness following pediatric cardiac surgery. It is not a validated prediction model and requires prospective multicenter evaluation before clinical implementation. Copyright © 2026 Elsevier Inc. <59> Accession Number 2047691138 Title Comparison of Paravertebral Block and Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Manici M.; Sincer Y.; Yaylak D.; Sogut M.S.; Darcin K.; Kalyoncu I.; Ozer K.B.; Tanju S.; Gurkan Y. Institution (Manici, Sincer, Yaylak, Sogut, Darcin, Kalyoncu, Gurkan) Department of Anaesthesiology and Reanimation, Koc University Hospital, Istanbul, Turkey (Ozer, Tanju) Department of Thoracic Surgery, Koc University Hospital, Istanbul, Turkey Publisher W.B. Saunders Abstract Objectives: To compare the analgesic efficacy of serratus posterior superior intercostal plane block (SPSIPB) versus thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracoscopic surgery (VATS), with a focus on postoperative opioid consumption and pain scores. Design(s): A prospective, randomized, controlled, single-center clinical trial. Setting(s): A tertiary university hospital. Participant(s): Sixty adult patients aged 18 to 80 years scheduled for elective VATS. Participants were randomized in a 1:1 ratio to receive either SPSIPB (n = 30) or TPVB (n = 30). Baseline characteristics were comparable between groups. Intervention(s): Prior to induction of general anesthesia, patients received either ultrasound-guided SPSIPB or TPVB using 30 mL of 0.25% bupivacaine. Measurements and Main Results: The primary outcome was cumulative 24-hour postoperative opioid consumption, expressed as oral morphine equivalents. Secondary outcomes included numeric rating scale (NRS, 0-10) for pain scores and the incidence of opioid-related adverse effects at 1, 3, 6, 12, and 24 hours after surgery. Twenty-four-hour opioid use was not significantly different between SPSIPB and TPVB (66.8 +/- 29.4 mg v 77.2 +/- 40.0 mg; mean difference -10.4 mg; 95% CI, -36.1 to 15.3; p = 0.439). No significant differences were seen in pain scores or opioid-related side effects at any assessed time point (p > 0.05). Conclusion(s): SPSIPB and TPVB were associated with similar postoperative opioid consumption, pain scores, and the incidence of adverse effects following VATS. Given its potentially simpler application, SPSIPB may serve as an effective alternative regional analgesic technique in thoracic surgery. Copyright © 2026 Elsevier Inc. <60> Accession Number 2047692044 Title Is Faster Always Better? Ultra-Fast-Track Versus Fast-Track Extubation in Adult Cardiac Surgery: A Comprehensive Meta-analysis With Meta-regression. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Santos K.; Patel N.; Umibe T.; Abo T.; Sakai W.; Oya K.; Kim Kim J.Y.B.; Plonek T. Institution (Santos, Patel) New Vision University School of Medicine, Tbilisi, Georgia (Umibe, Abo, Sakai, Oya) National Center for Global Health and Medicine, Tokyo, Japan (Kim Kim) Faculty of Medical Sciences, Universidad Nacional de Asuncion, Asuncion, Paraguay (Plonek) Department of Cardiothoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, Netherlands Publisher W.B. Saunders Abstract Objectives: To compare the clinical outcomes of ultra-fast-track extubation (UFTE), defined as extubation in the operating room or within 1 hour postoperatively, versus fast-track extubation (FTE), defined as extubation within 6 hours in the intensive care unit [ICU]), in adult patients undergoing cardiac surgery. Design(s): Systematic review and meta-analysis. Setting(s): Studies identified from MEDLINE, Scopus, and the Cochrane Library. Participant(s): Adult patients undergoing cardiac surgery. Intervention(s): Comparison of UFTE versus FTE. Measurements and Main Results: Twenty studies including nearly 800,000 patients were analyzed. UFTE was associated with lower 30-day mortality (odds ratio [OR], 0.54), shorter ICU length of stay (LOS) (mean difference [MD], -12.27 hours), shorter hospital LOS (MD, -1.19 days), reduced stroke rate (OR, 0.85) and reduced readmission rate (OR, 0.64). Rates of reintubation, reoperation for bleeding, acute kidney injury, pneumonia, and atrial fibrillation were similar. In the minimally invasive cardiac surgery subgroup, UFTE was associated with lower reintubation risk (OR, 0.26), whereas in the coronary artery bypass grafting subgroup, only hospital LOS was reduced. In propensity-matched cohorts, mortality and reintubation were comparable, although ICU and hospital stays remained shorter with UFTE. Meta-regression identified male sex and baseline left ventricular ejection fraction as significant moderators of the mortality effect. Conclusion(s): UFTE appears safe in selected patients and is associated with improved efficiency and recovery, particularly reduced ICU and hospital LOS. However, the observed mortality benefit is not sustained after adjustment, suggesting an important role of patient selection and perioperative optimization. Prospective randomized trials are required to confirm these findings. Copyright © 2026 Elsevier Inc. <61> Accession Number 2047668214 Title Diagnosis of postoperative atrial fibrillation using smartwatch monitoring after cardiac surgery: protocol for the FAWATCH single-centre, open-label, randomised controlled trial. Source BMJ Open. 16(7) (no pagination), 2026. Article Number: e118691. Date of Publication: 01 Jul 2026. Author Beyls C.; Hermida A.; Mollet N.; Vermander M.; Noe F.; Bara H.; Josse E.; Khamari M.; Diouf M.; Abou-Arab O.; Mahjoub Y. Institution (Beyls, Mollet, Abou-Arab, Mahjoub) Anesthesiology and Critical Care Medicine, CHU Amiens-Picardie, Amiens, France (Beyls, Mollet, Mahjoub) UR UPJV 7518 SSPC, Amiens University, Amiens, France (Hermida, Vermander, Noe, Bara) CHU Amiens-Picardie, Amiens, France (Josse, Khamari) Project Management Unit, Clinical Research and Innovation Directorate, CHU Amiens-Picardie, Amiens, France (Diouf) Biostatistics Unit, Clinical Research and Innovation Directorate, CHU Amiens-Picardie, Amiens, France (Abou-Arab) MP3CV, EA7517, CURS, Amiens University, Amiens, France Publisher BMJ Publishing Group Abstract Introduction: Postoperative atrial fibrillation (POAF) remains the most frequent arrhythmic complication after cardiac surgery, with most episodes occurring after discharge from the intensive care unit (ICU) when continuous rhythm monitoring is no longer routinely available. Early detection of POAF is clinically relevant and influences long-term cardiovascular outcomes. Wearable devices combining photoplethysmography technology with single-lead ECG capability offer a potential solution for continuous rhythm monitoring in conventional surgical wards. However, their effectiveness and feasibility in the immediate postoperative in-hospital setting remain insufficiently evaluated. The FAWATCH trial aims to determine whether smartwatch-based rhythm monitoring improves POAF detection within the first 5 days after ICU discharge compared with standard. Methods and analysis: FAWATCH is a single-centre, open-label, randomised controlled trial conducted in the cardiac surgery department of Amiens-Picardie University Hospital. Adult patients undergoing cardiac surgery with cardiopulmonary bypass and transferred to the conventional surgical ward within 96 hours are eligible for inclusion. Patients are randomised in a 1:1 ratio using a centralised, computer-generated block randomisation sequence implemented through secure electronic software. Randomisation is stratified by age (>65 years), diabetes status and type of surgery (valvular, coronary or combined procedures). Participants are allocated to either standard care or smartwatch-based monitoring using a conformity European-marked single-lead ECG device (ScanWatch, Withings Move ECG, Withings, France). In the intervention group, patients wear the smartwatch continuously for 5 days and perform on-demand single-lead ECG recordings when alerted or symptomatic, with confirmation by standard 12-lead ECG. In the control group, POAF is diagnosed exclusively by a 12-lead ECG performed on clinical suspicion, as per routine practice. The primary outcome is the incidence of POAF within 5 days following ICU discharge. Secondary outcomes are the proportion of asymptomatic POAF, the association between left atrial reservoir strain and POAF occurrence, the feasibility of smartwatch monitoring, recurrence of POAF and major adverse cardiovascular events at 30 days, 3 months and 6 months. Recruitment began in January 2023, and the trial is currently ongoing, with 258 patients enrolled to date. Ethics and dissemination: Ethical approval has been obtained from the Institutional Review Board of Amiens-Picardie University Hospital (IRB-ID: 2022-A00497-36). All participants provide written informed consent in accordance with French regulations for interventional clinical research. The study's results will be disseminated through peer-reviewed publications and presentations at national and international conferences. Trial registration number: NCT05573633. 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/. <62> Accession Number 2045944133 Title Icariin-mediated structural stabilization of TNF-alpha triggers a pro-regenerative signaling switch for endothelial recovery after myocardial infarction. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1817340. Date of Publication: 2026. Author Cao C.; Liu Z.; Yang L.; Song J.; Li L.; Fu J.; Liu J. Institution (Cao, Liu, Yang, Song, Li, Fu, Liu) Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Chinese Materia Pharmacology, National Clinical Research Center of Traditional Chinese Medicine for Cardiovascular Diseases, Beijing, China (Cao, Liu) Duke-NUS Medical School, Singapore, Singapore Publisher Frontiers Media SA Abstract Background - Coronary microvascular recovery is essential for cardiac repair post-myocardial infarction (MI), but the endogenous signals driving endothelial cell (EC) cycle reentry remain elusive. While tumor necrosis factor-alpha (TNF-alpha) is typically considered a pro-inflammatory mediator, its biological effects are profoundly influenced by protein conformation. In this study, we identify a novel pro-regenerative signaling switch where structural stabilization of TNF-alpha, rather than its inhibition, dictates endothelial neogenesis. Methods - A rat model of HF was established via left anterior descending coronary artery ligation. In vitro, coronary microvascular endothelial cells (CMECs) were subjected to oxygen-glucose deprivation and reoxygenation. Bioinformatics analysis, molecular docking (MD) and molecular dynamics simulations (MDs) were employed to identify potential targets. The effects of Icariin (ICA) on EC proliferation, migration, and the TNF signaling pathway were validated using EdU assays, wound healing assays, and Western blotting. Results - Bioinformatics analysis and experimental validation identified the TNF signaling pathway as a critical regulator of EC regeneration. ICA significantly improved cardiac function and promoted CD31+/BrdU+ endothelial cell proliferation in the peri-infarction area of HF rats. MD and MDs revealed that ICA directly binds to the hydrophobic pocket of TNF-alpha, enhancing its structural stability. Mechanistically, ICA treatment upregulated the expression of cell cycle-promoting proteins by stabilizing TNF signaling, whereas TNF inhibition significantly abrogated the pro-proliferative effects of ICA. Our findings suggest that ICA may promote endothelial regeneration and alleviate HF in part by structurally stabilizing TNF-alpha and activating the downstream cell cycle cascade. Conclusion - This study provides a mechanistic basis for the ethnopharmacological use of the traditional herb Epimedium by demonstrating that its primary bioactive monomer, ICA, acts as a potential candidate for revascularization therapy. Copyright © 2026 Cao, Liu, Yang, Song, Li, Fu and Liu. <63> Accession Number 2047692640 Title Heparin Dose-Response Curve for Heparin Dose Determination During Cardiopulmonary Bypass for Pediatric Cardiac Surgery: A Prospective Randomized Controlled Study. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Gokhale P.; Hasija S.; Choudhury A.; B S.G.; Yadav M.; Chauhan S. Institution (Gokhale, Hasija, Choudhury, Chauhan) Department of Cardiac Anaesthesia and Critical Care, AIIMS, New Delhi, India (B, Yadav) Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi, India Publisher W.B. Saunders Abstract Objectives: To determine whether individualized heparin dosing guided by a heparin dose-response (HDR) curve is noninferior to conventional weight-based dosing in achieving target activated clotting time (ACT) of >=480 seconds before cardiopulmonary bypass (CPB) and to compare total heparin and protamine requirements, postoperative blood loss, and transfusion needs in children younger than 14 years undergoing cardiac surgery with cardiopulmonary bypass support. Design(s): Single-center, prospective, double-blinded, randomized controlled trial. Setting(s): Cardiothoracic operating theaters and intensive care unit of a tertiary care hospital in India. Participant(s): Pediatric (<14 years) patients undergoing elective cardiac surgery with CPB support. Intervention(s): The HDR group received an initial test dose of 100 IU/kg of heparin, and an individualized ACT dose-response curve was constructed to determine the dose required to target an ACT of 480 seconds. Controls received standard 400 IU/kg of heparin. Protamine was given post-CPB per protocol in both groups. Measurements and Main Results: In this noninferiority trial, HDR-guided anticoagulation was assessed against conventional weight-based dosing for first-pass attainment of ACT >=480 seconds before CPB. Target ACT was achieved in 72.2% (26/36) of HDR patients versus 83.3% (30/36) of controls (p = 0.396). Although HDR was associated with lower heparin exposure (260 v 420 IU/kg; p < 0.001) and protamine use (4.1 v 4.8 mg/kg; p = 0.002), as well as reduced 24-hour blood loss (5.2 v 6.5 mL/kg; p = 0.03) and packed red blood cell transfusion (6.8 v 8.2 mL/kg; p = 0.04), it did not demonstrate superior first-attempt ACT attainment. Conclusion(s): HDR-guided heparinization reduced heparin and protamine exposure and was associated with less bleeding and transfusion, but it did not improve first-pass ACT attainment. Because ACT is an imperfect surrogate for anticoagulant adequacy in children on CPB, these findings should be interpreted as ACT-guided dosing data rather than proof of equivalent anticoagulation. Larger multicenter studies with mechanistic and clinical endpoints are needed to confirm these results. Copyright © 2026 Elsevier Inc. <64> Accession Number 2038977439 Title Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline. Source International Journal of Cardiology. 436 (no pagination), 2025. Article Number: 133401. Date of Publication: 01 Oct 2025. Author Lamelas P.; Pompeu Sa M.; Izcovich A.; Bottaro F.; Tisi Bana M.; Sosa Liprandi M.I.; Lanas F.; Vilca Mejia O.A.; Zuniga Luna M.; Aubanel P.; Munera A.; Contreras Reyes J.; Bagur R.; Whitlock R.; Garcia Garcia H.; Mamas M.; Cohen M.G.; Ricalde A.; Abizaid A.; Mendiz O.; Araya M.; Costa R.; Santaera O.; Hidalgo P.; Caldonazo T.; Baranchuk A.; Ragusa M.A. Institution (Lamelas, Mendiz) Fundacion Favaloro, Buenos Aires, Argentina (Lamelas, Whitlock) Health Research Methods, Evidence, and Impact, McMaster University, Canada (Pompeu Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco (PROCAPE), University of Pernambuco (UPE), Brazil (Izcovich) Hospital Aleman, Buenos Aires, Argentina (Bottaro) Department of Internal Medicine, Hospital Britanico, Buenos Aires, Argentina (Tisi Bana) Department of Medicine, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina (Sosa Liprandi) Sanatorio Guemes, Buenos Aires, Argentina (Lanas) Universidad de la Frontera, Temuco, Chile (Vilca Mejia) Department of Cardiovascular Surgery, Instuto de Coracao, Universidade de Sao Paulo, Brazil (Zuniga Luna) Department of Interventional Cardiology, Angiografia de Occidente, Cali, Colombia (Aubanel) Hospital del Prado, Tijuana, Mexico (Munera) Clinica Rosario Tesoro, Cardioestudio, Medellin, Argentina (Contreras Reyes) Department of Cardiac Surgery, Universidad de la Frontera, Temuco, Chile (Bagur) Western University, London, ON, Canada (Whitlock) Department of Surgery, McMaster University, Hamilton, ON, Canada (Garcia Garcia) Washington Hospital Center, Washington, United States (Mamas) Keele Cardiovascular Research Group, Keele University, Staffordshire, United Kingdom (Cohen) Cleveland Clinic Florida, Weston, Florida, United States (Ricalde) Hospital ABC, Ciudad de Mexico, Mexico (Abizaid) Instituto do Coracao, Sao Paulo, Brazil (Araya) Clinica Alemana, Universidad del Desarrollo, Santiago de Chile, Chile (Costa) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (Santaera) Clinica privada provincial de Merlo, Buenos Aires, Argentina (Hidalgo) Policlinica Amado, Maracaibo, Bolivia (Caldonazo) Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany (Caldonazo) Department of Cardiothoracic Surgery, Weil Cornell Medicine, New York, United States (Baranchuk) Queens University, Kingston, ON, Canada (Ragusa) Division Clinica Medica, Hospital Fernandez, Buenos Aires, Argentina Publisher Elsevier Ireland Ltd Abstract Background: Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used. Method(s): This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect. Result(s): Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects. Conclusion(s): For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team. Copyright © 2025 The Authors <65> Accession Number 2046032670 Title Antiplatelet therapy for patients with stable coronary artery disease receiving oral anticoagulation: A meta-analysis of randomized controlled trials. Source Journal of Cardiology. 88(2) (pp 136-141), 2026. Date of Publication: 01 Aug 2026. Author Hiruma Y.; Watanabe A.; Aikawa T.; Iwagami M.; Hosseini K.; Slipczuk L.; Briasoulis A.; Takagi H.; Kuno T. Institution (Hiruma) United States Naval Hospital Okinawa, Okinawa, Japan (Watanabe) Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Aikawa) Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (Iwagami) Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (Iwagami) Department of Digital Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan (Hosseini) Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Hosseini) Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark (Hosseini) Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Slipczuk) Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, United States (Briasoulis) Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA, United States (Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan (Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Kuno) Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Publisher Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) Abstract Background Evidence supporting the discontinuation of antiplatelet therapy in patients with stable coronary artery disease who require anticoagulation remains limited and continues to evolve. This study aimed to assess the efficacy and safety of antithrombotic therapy in this population. Methods We reviewed randomized controlled trials comparing the efficacy and safety of oral anticoagulant monotherapy versus oral anticoagulant plus single antiplatelet therapy in patients beyond six months after coronary revascularization requiring anticoagulation. The outcomes included major adverse cardiovascular events (MACE) and major bleeding. MACE was defined as a composite of all-cause death, myocardial infarction, stroke, systemic embolism, and revascularization. A pairwise meta-analysis using a random-effects model was conducted. Results A total of 5924 patients from 6 randomized controlled trials were included: 2970 received oral anticoagulant alone, and 2954 received oral anticoagulant plus single antiplatelet therapy. Anticoagulant monotherapy was associated with a comparable risk of MACE [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.62-1.04] and a significantly lower major bleeding risk (HR, 0.46; 95% CI, 0.32-0.66) than the combined therapy. Conclusion Oral anticoagulant alone may be a reasonable strategy to mitigate bleeding risk while preserving an ischemic risk comparable to combined anticoagulant and antiplatelet therapy. Copyright © 2026 Elsevier Ltd. <66> Accession Number 2047973863 Title Haemoadsorption in Post-Cardiac Arrest Care: A Systematic Review. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S356), 2026. Date of Publication: 01 Aug 2026. Author Batchelor R.; Watkins M.; Bloom J.; Burrell A.; Kaye D.; Stub D. Institution (Batchelor, Watkins, Bloom, Kaye) Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia (Batchelor, Bloom, Burrell, Stub) School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Burrell, Stub) Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Aim: Inflammation is increasingly being recognised as a driver of outcomes following cardiac arrest. Haemoadsorption, an extracorporeal blood purification technique that removes circulating cytokines via adsorbent cartridges, has been proposed to reduce cytokine-mediated injury after cardiac arrest. Method(s): Systematic searches were conducted in MEDLINE, Embase, CENTRAL, and Scopus for articles published from inception to January 2026. Studies evaluating haemoadsorption following in- or out-of-hospital cardiac arrest were included. Primary outcomes of interest were the use haemoadsorption and biochemical and neurological outcomes. Sepsis and cardiac surgery populations were excluded. Two reviewers independently assessed study eligibility, quality and extracted data from identified studies. Result(s): The systematic search strategy yielded eight studies for inclusion: two randomised ontrolled trials (RCTs) and six observational studies. One small RCT (n=21) demonstrated feasibility and a non-significant reduction in interleukin-6 levels at 48 hours. A second RCT in extracorporeal cardiopulmonary resuscitation patients (n=41) showed no reduction in inflammatory markers or improvement in 30-day survival. Observational studies report inconsistent effects on mortality, vasopressor requirements, and organ dysfunction. Most studies were single-centre and included predominantly VA-ECMO-supported patients. Conclusion(s): While early randomised data demonstrates cytokine modulation, consistent improvements in survival or organ function with haemoadsorption following cardiac arrest have not been shown. Adequately powered multicentre clinical trials are needed prior to adoption. Copyright © 2026 <67> Accession Number 2047941433 Title Surgical Thrombectomy and Pannus Removal in Prosthetic Heart Valve Obstruction: A Case-Series of a Single-Center Experience. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 6672344. Date of Publication: 2026. Author Rahmanian M.; Moghadam A.S.; Kalhor A.; Shahriyari S.; Larti F.; Badkoubeh R.S.; Salehi M. Institution (Rahmanian, Salehi) Cardiothoracic Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Moghadam, Kalhor, Shahriyari) School of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Larti, Badkoubeh) Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background: Prosthetic heart valve obstruction (PHVO) due to thrombosis or pannus formation is a significant complication following mechanical valve replacement. Thrombectomy and pannus removal offer a surgical alternative to valve replacement for PHVO. This study aims to evaluate the clinical outcomes of patients undergoing these procedures. Method(s): This single-center case series study included 143 patients with a history of mechanical bileaflet prosthetic heart valve replacements who presented with PHVO and underwent surgical pannus removal or thrombectomy between 2014 and 2022. Patients with infective endocarditis or paravalvular leakage were excluded from the study. The preoperative assessment included echocardiography (transthoracic and/or transesophageal), fluoroscopy, and a laboratory workup. Outcomes, including in-hospital mortality and long-term survival, were recorded. Result(s): Thrombectomy was performed in the aortic position in 43 patients (30%), mitral position in 65 (45.4%), and tricuspid position in 7 (4.8%), with 28 patients (19.5%) undergoing simultaneous cleansing of two valves. The median postoperative hospital stay was nine days, and the in-hospital mortality rate was 9.8%. After a mean follow-up of 4.3 years, a 28.7% overall mortality rate, with half of these deaths attributed to cardiovascular causes, was detected. Four patients experienced recurrent valve thrombosis, and two underwent a second valve cleansing surgery. Conclusion(s): Valve thrombectomy and pannus removal were associated with favorable postoperative outcomes, though in-hospital mortality remained at 9.8%. This study highlights the need for randomized clinical trials to compare surgical options and optimize treatment for PHVO. Copyright © 2026 Mehrzad Rahmanian et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <68> Accession Number 651831996 Title Rationale, Design, and Experiences from the Vanguard Phase of the Bariatric Surgery for the Reduction of Cardiovascular Events (BRAVE) Trial. Source American heart journal. (pp 107544), 2026. Date of Publication: 25 Jul 2026. Author Wong J.A.; Conen D.; Doumouras A.; Van Reekum E.; Bangdiwala S.I.; Balasubramanian K.; Bashir S.; Rangarajan S.; Piche M.-E.; Pettigrew M.; Agapay D.; Maggioni A.P.; Stork S.; Pajecki D.; Davey R.A.; Kouz R.; Villiard R.; Dash S.; Avezum A.; Cohen R.; Castaner O.; Poirier P.; Anvari M.; Yusuf S. Institution (Wong, Van Reekum, Bangdiwala, Yusuf) Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada (Conen) Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada (Doumouras, Anvari) McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare, Hamilton, Ontario, Canada (Balasubramanian, Bashir, Rangarajan, Agapay) Population Health Research Institute, Hamilton, ON, Canada (Piche, Pettigrew, Poirier) Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (Maggioni) ANMCO Research Center - Heart Care Foundation, Florence, Italy (Stork) Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Wurzburg, Wurzburg, Germany (Pajecki) Centro de Pesquisa Clinica do Hospital 9 de Julho, Sao Paulo, Brazil (Davey) Division of Cardiology, Western University, London, ON, Canada (Kouz) Department of Medicine, Hopital du Sacre-Coeur de Montreal, Universite de Montreal, Montreal, QC, Canada (Villiard) Centre hospitalier regional de Lanaudiere, Universite Laval, QC, Canada (Dash) Department of Medicine, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada (Avezum) International Research Center, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil (Cohen) Centre for Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil (Castaner) Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Research Institute, Barcelona, Spain Abstract BACKGROUND: Observational studies suggest that metabolic/bariatric surgery (MBS) reduces mortality and major adverse cardiovascular events in patients with obesity, but adequately powered randomized trials (RCTs) are lacking. The Bariatric Surgery for the Reduction of Cardiovascular Events (BRAVE) trial was designed to address this evidence gap. METHOD(S): BRAVE is an investigator-initiated, multi-center, open-label RCT with blinded endpoint adjudication comparing MBS versus guideline-based medical weight management (MWM) in adults with obesity and high-risk cardiovascular disease (CVD). Eligible participants have a body-mass index >=35 kg/m2 or >=30 kg/m2 with type 2 diabetes or age >55 years, and prior myocardial infarction (MI), coronary intervention, heart failure (HF), atrial fibrillation (AF) with elevated CHA2DS2-VASc score, cerebrovascular disease, or peripheral arterial disease. Participants are randomized 1:1 to MBS (sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch) or MWM, which includes dietary, behavioural, and pharmacologic therapies. The primary outcome is the composite of all-cause death, MI, stroke, HF events, coronary revascularization, AF hospitalization, and renal events. A vanguard phase of 200 participants was implemented to optimize recruitment and logistics. RESULT(S): As of October 2025, 2,514 individuals have been screened from 17 centers in Canada, Brazil, Italy and Spain, with 444 entered MBS work-up, and 200 have been randomized. The randomized cohort (mean age 59.8 years; 37% female; mean BMI 44.0 kg m-2) has high burden of hypertension (82%), diabetes (45%), coronary artery disease (44%), HF (39%), and AF (48%). Recruitment barriers were identified and addressed through targeted education and enhanced patient engagement. CONCLUSION(S): BRAVE is the first large RCT evaluating whether MBS safely reduces major cardiovascular events compared with medical therapy in high-risk patients with obesity. Copyright © 2026. Published by Elsevier Inc. <69> Accession Number 2047980422 Title Efficacy and safety of protamine for preventing complications in transcatheter aortic valve replacement: a meta-analysis. Source Minerva Cardiology and Angiology. 74(4) (pp 538-548), 2026. Date of Publication: 01 Aug 2026. Author Attachaipanich T.; Attachaipanich S.; Kaewboot K. Institution (Attachaipanich) Department of Internal Medicine, Kansas City School of Medicine, University of Missouri, Kansas City, MO, United States (Attachaipanich) Graduate School of Science, Osaka University, Osaka, Japan (Kaewboot) Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand Publisher Edizioni Minerva Medica Abstract BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly performed nowadays, bleeding and vascular complications are not uncommon. Current recommendations for the use of protamine in the post-TAVR setting remain uncertain. This study aimed to evaluate the efficacy and safety of protamine in this setting. METHOD(S): A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 17th, 2024, without language restrictions. The inclusion criteria were studies that compared the efficacy or safety of protamine vs. control in post-TAVR patients. RESULT(S): There were six studies (two randomized and four non-randomized) included in this meta-analysis, involving 3897 participants. We used a random-effects model for this meta-analysis. Protamine was associated with a lower risk of major bleeding compared to the control group, with an odds ratio (OR) of 0.47 (95% CI 0.30 to 0.74, P<0.01). Additionally, protamine was associated with a lower risk of major vascular complications compared to the control, with an OR of 0.45 (95% CI 0.31 to 0.65, P<0.01). Protamine also reduced the risk of minor bleeding and life-threatening bleeding compared to the control. For the safety outcome, the administration of protamine did not increase the risk of stroke and myocardial infarction. CONCLUSION(S): The administration of protamine demonstrated efficacy in reducing bleeding and vascular complications without increasing the risk of thromboembolic complications in the post-TAVR setting. Copyright © 2025 ediZioni Minerva MediCa. <70> Accession Number 2047972712 Title The Cardiac Pharmacomicrobiome: Gut Microbiota Shaping Cardiovascular Therapeutic Outcomes. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S312), 2026. Date of Publication: 01 Aug 2026. Author Dhamoon K.; Rahman R.; Vijayakumar V.; Khair M.; Gilhotra R. Institution (Dhamoon, Rahman, Vijayakumar, Khair) Princess Alexandra Hospital, Woolloongabba, QLD, Australia (Gilhotra) Royal Brisbane and Women's Hospital, Herston, QLD, Australia Publisher Elsevier Ltd Abstract Aim: Interindividual variability in cardiovascular drug responses remains a major clinical challenge. Emerging evidence suggests the gut microbiome influences drug metabolism, bioavailability and therapeutic efficacy through bidirectional host microbe interactions. We systematically reviewed the role of pharmacomicrobiomics in cardiovascular therapeutics. Method(s): A systematic review of human clinical studies published between 2023-2026 was conducted using PubMed, Embase and Cochrane databases. Studies evaluating interactions between gut microbiota and cardiovascular medications were included. Primary outcomes included pharmacokinetic (PK)/pharmacodynamic (PD) variability, microbiota compositional changes and cardiovascular therapeutic outcomes. Result(s): Twelve studies comprising 1,024 patients were included. In a 246 patient cardiac surgery cohort, warfarin anticoagulation variability correlated with gut-derived vitamin K levels (mean VK1 1.34+/-1.12 nmol/mL, 95% CI 0.33-4.08) and enrichment of specific bacterial genera including Prevotella and Eubacterium. Predictive PK/PD models accurately predicted therapeutic INR ranges in only 76.4% of patients. Statin therapy significantly altered gut microbiota composition in a 134 patient cardiometabolic cohort, with depletion of Akkermansia muciniphila and 46 medication microbe associations identified following multivariate adjustment. Bacterial transcriptomic analyses demonstrated statin induced efflux pump upregulation and selective microbial depletion. Conclusion(s): Gut microbiota significantly influences cardiovascular drug responses through vitamin K synthesis, microbial drug metabolism and microbiome compositional shifts. Pharmacomicriobiomics represents an emerging determinant of therapeutic variability with implications for personalised anticoagulation strategies and statin optimisation. Copyright © 2026 <71> Accession Number 2047976150 Title Machine Learning Approaches for the Prediction of 1-Year Mortality After Heart Transplantation: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S413), 2026. Date of Publication: 01 Aug 2026. Author Zaka A.; Mutahar D.; Navani R.; Mustafiz C.; Squires E.; Giri Y.; Ali A.; Abtahi J.; Kovoor P. Institution (Zaka, Mutahar, Navani, Mustafiz, Abtahi) Gold Coast University Hospital, Southport, QLD, Australia (Squires) Flinders University, Adelaide, SA, Australia (Giri) The University of Adelaide, Adelaide, SA, Australia (Ali) The Alfred Hospital, Melbourne, VIC, Australia (Kovoor) Westmead Hospital, Sydney, NSW, Australia Publisher Elsevier Ltd Abstract Aim: We aimed to compare the discrimination between machine learning (ML)-based models and conventional risk scores for predicting 1-year all-cause mortality after heart transplantation. Method(s): This study was conducted in accordance with PRISMA and TRIPOD-AI guidelines. PubMed, EMBASE, Web of Science, and Cochrane were searched to February 2026 for studies directly comparing ML models with conventional risk scores in adult heart transplant recipients. The primary outcome was comparative discrimination for 1-year all-cause mortality, quantified using C-statistics with 95% confidence intervals (CIs). Random-effects meta-analysis pooled discrimination estimates and assessed between-group differences. Prespecified subgroup analyses were performed according to validation status and ML subtype. Result(s): Eight studies including 14 models and 305,186 recipients were analysed (Figure). Summary C-statistic for 1-year mortality was higher for ML than conventional scores (0.68 [0.66-0.70] vs 0.62 [0.60-0.64]; absolute difference 0.06 [0.03-0.08]; p<0.001). Random-forest ensembles were the top performing model on subgroup analysis (0.67 [0.65-0.69]). External validation was reported in 37.5% of models, with inconsistent calibration. Across all SHAP analysis of all models, age, creatinine, and bilirubin were strongest predictors of mortality. Conclusion(s): ML models demonstrated modestly higher discrimination for 1-year mortality after heart transplantation; however, limited external validation and inconsistent calibration restrict immediate clinical applicability. [Formula presented] Copyright © 2026 <72> Accession Number 2047980611 Title Comment on: "Effect of vitamin D on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic review and meta-analysis". Source Minerva Cardiology and Angiology. 74(4) (pp 578-579), 2026. Date of Publication: 01 Aug 2026. Author Salazar Ore J.V.; Redzanova T.; Calderon Martinez E. Institution (Salazar Ore) Faculty of Medical Sciences, University of Buenos Aires, Buenos Aires, Argentina (Redzanova) Crimean State Medical University, Simferopol, Ukraine (Calderon Martinez) Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States Publisher Edizioni Minerva Medica <73> Accession Number 2038393109 Title International Age and Use Criteria for Transcatheter and Surgical Aortic Valve Replacement. Source Reviews in Cardiovascular Medicine. 27(6) (no pagination), 2026. Article Number: 49368. Date of Publication: 01 Jun 2026. Author Sharma R.; Srivats S.; Ata F.; Shuhaiber J. Institution (Sharma) Department of Medicine, Mass General Brigham-Salem Hospital, Salem, MA, United States (Srivats) Department of Hospital Medicine, Catholic Medical Center, Manchester, NH, United States (Ata) Department of Medicine, Hamad Medical Corporation, 3050 Doha, Qatar (Shuhaiber) The Wellman Institute of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Publisher IMR Press Limited Abstract Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have transformed the management of severe aortic stenosis across a wide range of patient risk profiles. As populations age and indications extend to lower-risk and younger patients, determining the appropriate role of age in selecting TAVR versus SAVR has become increasingly complex. Current guidelines emphasize individualized decision-making, yet age-based referral patterns remain common in clinical practice. This review examines how age thresholds are applied in contemporary guidance from the United States (US), Europe, and the Asia-Pacific region. Additionally, this review evaluates whether chronological age alone is a defensible basis for referral or treatment selection. This evidence-based narrative review queried PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2013, through December 31, 2025, using the search terms: ("aortic stenosis" AND ("TAVR" OR "transcatheter aortic valve implantation (TAVI)" OR "SAVR")) AND ("age" OR "appropriateness"). English-language abstracts and full texts were screened in duplicate. Eligible studies included randomized controlled trials, national or continental registries, health economic simulations, and clinical practice guidelines that reported age-stratified outcomes or recommendations. Single-case reports, editorials, and animal studies were excluded. Of the 1628 titles screened, 87 full texts were reviewed, and 45 studies were retained. Across regions, guidelines converge on a core principle: age is informative but insufficient in isolation. U.S. guidance generally favors SAVR in patients younger than 65 years or those with a life expectancy greater than 20 years, and favors transfemoral TAVR in patients older than 80 years or with a life expectancy shorter than 10 years. European guidance typically favors SAVR in patients younger than 75 years and TAVR in those older than 75 years. Meanwhile, Asia-Pacific recommendations adopt a similarly individualized approach but place greater emphasis on bicuspid anatomy, rheumatic disease, local health system infrastructure, and cost. Recent data support a cautious approach in younger patients. In observational U.S. analyses of patients younger than 65 years, TAVR use increased substantially despite guideline preference for surgery, and TAVR was associated with higher long-term mortality or higher pacemaker and readmission burdens in selected cohorts. Contemporary randomized data suggest broadly similar outcomes between TAVR and SAVR in older or intermediate-age populations; however, uncertainty persists in younger low-risk patients, particularly those with bicuspid anatomy and long projected survival. Age-based cutoffs should be interpreted as decision anchors rather than rigid rules. The most defensible framework integrates age with life expectancy, valve durability, anatomy, frailty, comorbidity burden, coronary artery disease, feasibility of future valve-in-valve therapy, and patient preferences within a multidisciplinary heart team. Expansion of TAVR into younger populations should remain measured until more robust long-term durability and lifetime management data become available. Copyright © 2026 The Author(s). <74> Accession Number 2047966740 Title Comparative Performance of Machine Learning and Conventional Risk Scores for Prediction of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S403-S404), 2026. Date of Publication: 01 Aug 2026. Author Mutahar D.; Zaka A. Institution (Mutahar, Zaka) Gold Coast University Hospital, Southport, QLD, Australia Publisher Elsevier Ltd Abstract Aim: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and associated with adverse outcomes. Conventional risk scores show modest discrimination. We compared machine learning (ML) models with conventional risk scores for predicting POAF after cardiac surgery. Method(s): Conducted in accordance with PRISMA and TRIPOD-AI guidelines. PubMed, EMBASE, Web of Science, and Cochrane were searched to January 2026 for studies comparing ML models with conventional risk scores for POAF prediction. POAF was defined as new-onset atrial fibrillation during index hospitalisation. Primary outcome was discrimination measured by C-statistics with 95% confidence interval (Cis). Random-effects meta-analysis pooled C-statistics and between-group differences. Subgroup analyses were performed by validation strategy and ML subtype. Result(s): Nine studies including 70,006 patients and 27 ML models were analysed. The pooled C-statistic was 0.77 (95% CI, 0.73-0.81) for ML models versus 0.68 (95% CI, 0.64-0.73) for conventional scores (between-group difference 0.09; p<0.001) (Figure 1). Random forest ensembles demonstrated the highest discrimination (0.79 [0.74-0.84]). Age was the strongest predictor. External validation occurred in 22% of models, calibration reporting was inconsistent, and overall PROBAST-AI risk of bias was high. Conclusion(s): ML models outperformed conventional risk scores for predicting POAF after cardiac surgery. Clinical use remains uncertain due to limited external validation and methodological heterogeneity. [Formula presented] Copyright © 2026 <75> Accession Number 2047973348 Title Does a Digital Prehabilitation Solution Reduce Healthcare Burden and Improve Outcomes for Patients Awaiting Cardiac Surgery?. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S407), 2026. Date of Publication: 01 Aug 2026. Author Hines C.; Farragher J.; Vlahos R.; Denehy L.; Doull L.; El-Ansary D. Institution (Hines, Farragher, Vlahos, El-Ansary) School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia (Hines, Farragher, El-Ansary) Shanghai University of Medicine and Health Sciences, Shanghai, China (Hines) Royal Melbourne Hospital, Melbourne, VIC, Australia (El-Ansary) Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia (Doull) Bupa, Melbourne, VIC, Australia (Denehy) Department of Physiotherapy; Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia (Denehy) Centre for Health Services Research: Allied Health, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Aim: Prehabilitation before cardiac surgery targets modifiable risk factors to enhance surgical readiness and recovery. While shown to reduce complications and hospital stays, it remains underused in routine care. Remote delivery via digital health provides a promising strategy to expand access and equity for cardiac surgery patients. This systematic review examined the delivery, outcomes, and effectiveness of digital prehabilitation for adults awaiting cardiac surgery. Method(s): This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and was registered with PROSPERO (International Prospective Register of Systematic Reviews). Seven databases were searched to identify studies evaluating digital prehabilitation in cardiac surgery patients. Screening, selection, and data extraction were performed, and outcomes were categorised by feasibility, health outcomes, and healthcare utilisation. Result(s): Eleven primary studies involving 1,796 participants were included. Analysis showed significant findings in favour of digital prehabilitation over standard care with respect to feasibility, efficacy, complications, and costs. Significant reductions were observed in unplanned hospitalisations, healthcare costs, and cardiac complications such as major adverse cardiovascular events (MACE). Interrogation via meta-analysis was unsuitable due to substantial methodological and clinical heterogeneity. Conclusion(s): Digital prehabilitation is a safe, feasible, and potentially effective strategy to improve outcomes and reduce the healthcare burden in cardiac surgery. Future research should focus on multidisciplinary approaches and standardised outcome measures to facilitate integration into routine clinical care. Copyright © 2026 <76> Accession Number 2038442657 Title Efficacy of Sirolimus Versus Paclitaxel-Coated Balloons for Coronary Revascularization: An Updated Meta-Analysis with GRADE Assessment. Source Journal of the Saudi Heart Association. 38(2) (no pagination), 2026. Article Number: 17. Date of Publication: 2026. Author Wijayanto M.A.; Tristan C.D.; Kynaya E.M.; Rahma A.A.; Harimurti P.S.; Mangkuanom A.S.; Alkatiri A.A.; Firman D.; Siswanto B.B. Institution (Wijayanto, Tristan, Kynaya, Rahma) Faculty of Medicine, Universitas Sebelas Maret, Central Java, Surakarta, Indonesia (Harimurti) Faculty of Medicine, Universitas Indonesia, West Java, Depok, Indonesia (Mangkuanom, Alkatiri, Firman, Siswanto) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Publisher Saudi Heart Association Abstract Drug-coated balloons are an emerging strategy for coronary revascularization. Despite their increasing use, the comparative efficacy of sirolimus-versus paclitaxel-coated balloons (SCB vs PCB) remains uncertain. This updated meta-analysis evaluated clinical and angiographic outcomes of SCB and PCB in percutaneous coronary intervention (PCI). A comprehensive search of PubMed, Scopus, and ScienceDirect was performed on August 28, 2025. Studies directly comparing SCB and PCB were included. The primary endpoint was target lesion failure (TLF), which was defined as cardiac death, target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). On follow-up angiography, secondary endpoints consisted of minimal lumen diameter (MLD), late lumen loss (LLL), and diameter stenosis. Pairwise meta-analyses, subgroup analyses, and sensitivity analyses were performed. The certainty of evidence was evaluated with GRADE. Thirteen studies with 5947 patients (4097 SCB and 1850 PCB) were analyzed. SCB and PCB showed no significant differences in TLF (RR 1.10, 95% CI 0.84 to 1.44), cardiac death (RR 1.19, 95% CI 0.56 to 2.53), TLR (RR 1.12, 95% CI 0.91 to 1.37), and TVMI (RR 1.82, 95% CI 0.58 to 5.72). Subgroup analyses by lesion type and study design were consistent. Angiographic outcomes were comparable between groups, except for smaller insegment MLD with SCB (MD-0.10 mm, 95% CI-0.18 to-0.02; p = 0.01), although this finding was not robust in sensitivity analysis. Certainty of evidence was moderate for clinical outcomes and low to moderate for angiographic outcomes, primarily downgraded due to imprecision and inconsistency. In conclusion, SCB and PCB demonstrated comparable efficacy in PCI, with no significant differences in clinical and angiographic endpoints, irrespective of lesion types. Copyright © 2026 Saudi Heart Association. <77> Accession Number 2047993502 Title Structural valve deterioration of a transcatheter aortic bioprosthesis at 4 years in a young adult: a case report. Source European Heart Journal - Case Reports. 10(7) (no pagination), 2026. Article Number: ytag489. Date of Publication: 01 Jul 2026. Author McGuire L.A.; Fox P.; Nic Aodha Bhui B.; Sheahan R.; McAdam B. Institution (McGuire, Fox, Nic Aodha Bhui, Sheahan, McAdam) Cardiology Department, Beaumont Hospital, Beaumont Road, Dublin, Ireland Publisher Oxford University Press Abstract Background: Transcatheter aortic valve implantation (TAVI) is the recommended treatment for severe aortic stenosis (AS) in patients >=70 years old or those deemed high surgical risk. While there is growing interest in the expansion if its use to younger, lower risk patients with AS and select groups of patients with bicuspid aortic valve (BAV), its use in these individuals remains controversial due to limited durability data and the exclusion of these groups from major randomized controlled trials (RCTs). Case summary: A 28-year-old woman with a history of congenital BAV and prior balloon valvuloplasty in infancy, underwent TAVI with a 27 mm SAPIEN-3 valve overseas, aged 24. At four years post-TAVI, she presented to hospital following an episode of presyncope and dyspnoea. ECG showed left bundle branch block (LBBB). Echocardiography demonstrated a well seated TAVI but severe restenosis with a maximum velocity of 5.5 m/s and a mean pressure gradient of 79 mmHg. Normal coronaries without ostial compromise and no significant aortopathy was observed on cardiac computed tomography. The patient underwent surgery with a modified Bentall procedure and implantation of a 23 mm St. Jude mechanical valve. Histology revealed degenerative valvular changes without hypoattenuated leaflet thickening. Her post-operative period was unremarkable. Conclusion(s): This case illustrates the potential risks of performing TAVI in a young patient with severely calcified BAV, including conduction disturbance, structural valve degeneration and avoidable intervention to a normal aorta. The paucity of long-term outcome data precludes the use of TAVI in young, low-risk BAV patients and recommended intervention for severe AS in these individuals remains SAVR. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. <78> Accession Number 2047975485 Title Influence of preoperative albumin on mortality following surgery for infective endocarditis: A systematic review & meta-analysis. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Thet M.S.; Aung M.H.; Htay P.N.; Htet S.M.; Thiha A.; Myat T.; Moscarelli M.; Fujiwara T.; Al-Attar N.; Shaikhrezai K.; Chan-A-Sue T.; Varghese D. Institution (Thet) Department of Surgery and Cancer, Imperial College London, United Kingdom (Aung) Brooklyn Medical Centre, New York, NY, United States (Htay) Faculty of Life Sciences & Medicine, Kings College, London, United Kingdom (Htet) Acute Medicine, Good Hope Hospital, Birmingham, United Kingdom (Thiha) Division of Medicine, Salisbury District Hospital, Salisbury, United Kingdom (Myat) Department of Surgery, Pyin Oo Lwin General Hospital, University of Medicine Mandalay, Mandalay, Myanmar (Moscarelli) Imperial College, London, United Kingdom (Fujiwara, Al-Attar, Shaikhrezai, Varghese) Golden Jubilee National University Hospital, University of Glasgow, Glasgow, United Kingdom (Chan-A-Sue) Papworth Hosptal, Cambridge, England, United Kingdom Publisher SAGE Publications Ltd Abstract Background: Infective endocarditis is a life-threatening condition requiring surgical intervention in certain cases. Despite advances in surgical techniques and medical management, postoperative mortality remains high. Preoperative optimisation, including the assessment of preoperative albumin levels, may play a crucial role in improving surgical outcomes. This systematic review and meta-analysis examine the relationship between preoperative albumin levels and in hospital mortality of patients undergoing cardiac surgery for IE. Material(s) and Method(s): Following the PRISMA guidelines, a comprehensive search of PubMed, MEDLINE via Ovid, Embase, Scopus, ClinicalGov, and Cochrane CENTRAL was performed. Studies including patients with IE who underwent cardiac surgery with documented preoperative albumin levels were selected. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted to evaluate the impact of albumin levels on postoperative mortality. Result(s): A total of nine studies involving 1863 patients met the inclusion criteria. Meta-analysis demonstrated significantly lower preoperative albumin levels in patients who did not survive following surgery. A random-effects meta-analysis showed a significant large effect (SMD = 1.14, 95% CI: 0.63 to 1.64). However, heterogeneity was substantial (I2 = 91%), indicating considerable variability in effect sizes across studies. There was no publication bias with visual inspection of funnel plots and Egger's test (p = 0.388). Conclusion(s): Preoperative hypoalbuminemia is strongly associated with increased mortality in patients undergoing surgery for IE. Given that most IE surgeries are non-emergent, addressing low albumin levels preoperatively may offer a significant therapeutic opportunity to improve surgical outcomes. Copyright © The Author(s) 2026 <79> Accession Number 2038440132 Title Prosthesis-patient mismatch with intra-annular self-expanding valves: an analysis of the PORTICO IDE trial. Source EuroIntervention. 22(13) (pp e741-e747), 2026. Date of Publication: 2026. Author Fontana G.P.; Waksman R.; Salemi A.; Cohen M.; Abernethy W.; Hermiller J.; Baker C.; Montarello J.; Kleiman N.; Sondergaard L.; Gnall E.; Rodriguez R.; Gada H.; Brinkman W.; Weissman N.J.; Mahoney P.; Makkar R. Institution (Fontana) Cardiovascular Institute, HCA Los Robles Health System, Thousand Oaks, CA, United States (Waksman, Weissman) MedStar Washington Hospital Center, Washington DC, United States (Salemi, Cohen) Newark Beth Israel, Newark, NJ, United States (Abernethy) Mission Health & Hospitals, Asheville, NC, United States (Hermiller) St. Vincent Hospital, Carmel, IN, United States (Baker) USC University Hospital, Los Angeles, CA, United States (Montarello) St. Andrew's Hospital, Adelaide, Australia (Kleiman) The Houston Methodist Hospital, Houston, TX, United States (Sondergaard) Rigshospitalet, Copenhagen, Denmark (Sondergaard) Abbott, Santa Clara, CA, United States (Gnall, Rodriguez) Lankenau Institute for Medical Research, Penn Wynne, PA, United States (Gada) Pinnacle Health System, Pittsburgh, PA, United States (Brinkman) The Heart Hospital Baylor Scott and White, Plano, TX, United States (Weissman) MedStar Health Research Institute, Columbia, MD, United States (Mahoney) East Carolina Heart Institute, Greenville, NC, United States (Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States Publisher Europa Group Abstract BACKGROUND: Aortic valve replacement in small aortic annuli is associated with an increased risk of impaired haemodynamics. AIMS: We sought to evaluate haemodynamic outcomes and prosthesis-patient mismatch (PPM) in aortic stenosis (AS) patients treated with Portico, Evolut, and SAPIEN 3 transcatheter aortic valves (TAVs) in small (diameter <=23 mm) and large (diameter >23 mm) aortic annuli. METHOD(S): PORTICO IDE was a prospective, multicentre, international, premarket randomised controlled trial comparing Portico to Evolut and SAPIEN 3 TAVs. An independent core laboratory evaluated the mean transvalvular pressure gradient (MG) and the effective orifice area (EOA), and PPM was calculated based on the core lab results. RESULT(S): A total of 675 patients with severe AS at high or extreme surgical risk were included (Portico: 362 patients; Evolut: 109; SAPIEN 3: 204). At 30 days, the EOA and rates of severe PPM in small aortic annuli were similar between Portico and Evolut (EOA 1.65 cm2 vs 1.78 cm2; p=0.09; PPM 3.3% vs 3.0%; p=1.0) with a higher MG (8.5 mmHg vs 6.9 mmHg; p=0.034) for Portico. No significant differences were observed between Portico and Evolut for large aortic annuli (MG 8.3 mmHg vs 7.4 mmHg; p=0.069; EOA 1.93 cm2 vs 2.02 cm2; p=0.18; PPM 5.4% vs 3.2%; p=0.83). Portico was superior to SAPIEN 3 in both small (MG 8.5 mmHg vs 13.7 mmHg; p<0.0001; EOA 1.65 cm2 vs 1.40 cm2; p<0.0001; PPM 3.3% vs 26.3%; p<0.0001) and large annuli (MG 8.3 mmHg vs 10.9 mmHg; p<0.0001; EOA 1.93 cm2 vs 1.67 cm2; p<0.0001; PPM 5.4% vs 10.9%; p=0.0014). At 5 years, the rate of structural valve deterioration in patients with small aortic annuli was significantly lower in patients treated with Portico (2.2%) versus SAPIEN 3 (13.9%; p=0.03). CONCLUSION(S): Haemodynamic performance was similar for the intra-annular Portico and supra-annular Evolut. Portico haemodynamics outperformed the balloon-expandable SAPIEN 3 for PPM and mean gradient in both small and large aortic annuli. Copyright © Europa Group 2026. All rights reserved. <80> Accession Number 651826884 Title Contemporary evidence for multiarterial grafting in coronary artery bypass surgery. Source Current opinion in cardiology. (no pagination), 2026. Date of Publication: 24 Jul 2026. Author Sun C.; Lee G.S.; Fremes S.E. Institution (Sun) Temerty Faculty of Medicine (Lee, Fremes) Division of Cardiac Surgery, University of Toronto (Fremes) Sunnybrook Research Institute and Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Abstract PURPOSE OF REVIEW: Observational data suggests that multiarterial grafting (MAG) is associated with improved long-term outcomes for coronary artery bypass grafting (CABG), yet adoption remains low due to limited randomized evidence. This review synthesizes contemporary evidence comparing MAG with single arterial grafting (SAG), highlighting recent observational studies and ongoing randomized trials. RECENT FINDINGS: Large registry-based analyses consistently demonstrate a 15-25% relative reduction in long-term mortality and adverse cardiovascular events with MAG compared with SAG. However, randomized evidence is unclear; the Arterial Revascularization Trial (ART) showed no significant survival difference but possessed important methodological limitations. In contrast, randomized data support radial artery use over saphenous vein grafts as a second conduit. The ongoing randomized comparison of the clinical outcome of single vs. multiple arterial grafts (ROMA) trial is expected to provide definitive evidence. SUMMARY: MAG is supported by observational data, but uncertainty persists due to limited randomized evidence and variability in clinical adoption. The results of ROMA will clarify the role of MAG and help determine whether this should become the default strategy for CABG in select patients. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <81> Accession Number 2047981024 Title Vasopressin-Based Versus Norepinephrine-Based Strategy in Vasoplegic Syndrome After Cardiac Surgery: A Randomized Controlled Trial. Source Journal of Intensive Care Medicine. (no pagination), 2026. Date of Publication: 2026. Author Cui H.; Meng Y.; Peng S.; Fan S.; Li L.; Li Z.; Zhang Y. Institution (Cui, Meng, Peng, Fan, Li, Li, Zhang) Adult Surgical Intensive Care Unit, Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (Cui, Meng, Peng, Fan, Li, Li, Zhang) National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Publisher SAGE Publications Inc. Abstract Background: Vasoplegic syndrome (VS) is a prevalent complication associated with cardiac surgery that is typically managed with norepinephrine (NE). We conducted a comparative analysis of clinical and physiological effects of vasopressin (VP)-based strategy versus an NE-based strategy as first-line management for VS following cardiopulmonary bypass (CPB). Method(s): This single-center, randomized controlled trial included 90 patients who underwent VS following CPB. Patients were randomized to a VP-based strategy (0.01-0.1U/min) or an NE-based strategy (0.01-0.1mug/kg/min), with standardized rescue NE allowed in both groups if hemodynamic targets were not met. The primary outcome was the length of hospital stay. Secondary outcomes included hemodynamic stability, lactate clearance, cardiac biomarkers, left ventricular ejection fraction (LVEF), and endocrine markers (copeptin and Arginine Vasopressin(AVP)). Result(s): The VP-based strategy significantly reduced the length of hospital stays compared to NE-based (Median 7.0 days [IQR 6.0-8.0] vs Median 8.0 days [IQR 7.0-11.0]; Per-protocol p = .0036). Patients treated with VP achieved higher mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) at 12 and 24 h (P < .05). Furthermore, the VP-based group showed faster lactate normalization and a more pronounced reduction in cardiac biomarkers. Endocrine markers (copeptin and AVP) peaked significantly higher in the VP-based group but did not correlate with clinical outcomes ( r < .15, p > .05). Adverse event rates were balanced between groups. Conclusion(s): A VP-based strategy provided effective hemodynamic stabilization and is associated with shorter hospital stays compared to NE-based strategy in patients with VS following cardiac surgery. While NE continues to be effective, these findings suggest VP may be considered a viable early alternative or adjunctive vasopressor strategy for managing VS in the post-operative setting. Copyright © The Author(s) 2026 <82> Accession Number 2047980022 Title Combined Transcatheter Aortic Valve Implantation and Endovascular Aortic Repair: A Review. Source Hellenic Journal of Vascular and Endovascular Surgery. 8(2) (pp 65-73), 2026. Date of Publication: 2026. Author Karaolanis G.; Bekas N.; Nikas D. Institution (Karaolanis, Bekas) Vascular Unit, Department of Surgery, University Hospital of Ioannina, School of Medicine, Ioannina, Greece (Nikas) Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece Publisher Rotonda Publications Abstract Background: The coexistence of severe aortic valve stenosis and aortic aneurysmal disease presents a complex therapeutic challenge, particularly in elderly patients at high surgical risk. Advances in minimally invasive techniques have enabled combined transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR / TEVAR) as an alternative to open surgery. Method(s): A comprehensive review of the literature was performed to identify published studies reporting outcomes of combined TAVI and endovascular aortic repair, either as a simultaneous or staged strategy. Study characteristics, procedural details, and reported outcomes were analyzed descriptively. Result(s): The available evidence consists predominantly of case reports and small case series involving high-risk patients. Both simultaneous and staged approaches were reported, with TAVI most commonly performed prior to aortic repair. Procedural success rates were high, and short- to mid-term outcomes were generally favorable. Complications were infrequently reported in small studies, although larger series of isolated procedures indicate that relevant adverse events may occur. Conclusion(s): Combined TAVI and endovascular aortic repair appear to be a feasible and minimally invasive treatment option for selected high-risk patients with concomitant aortic valve and aortic pathology. However, evidence remains limited, and optimal patient selection and procedural sequencing are yet to be defined. Larger studies and prospective registries are required to establish standardized treatment strategies. Copyright © 2026 Rotonda Publications. All rights reserved. <83> Accession Number 2047890648 Title Treadmill Stress Test in Patients With Asymptomatic Severe Aortic Stenosis: A Prespecified Registry-Based Follow-Up of the EARLY TAVR Randomized Clinical Trial. Source JAMA Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Genereux P.; Schwartz A.; Lindman B.R.; Chhatriwalla A.; Ramee S.; Babaliaros V.; Schwartz R.; Sheth T.; Fearon W.F.; Sorajja P.; Beaver T.; Oldemeyer J.B.; Pop A.; Garcia S.; Southard J.; Bailey S.H.; Li W.; Cohen D.J.; Pibarot P.; Leon M.B.; Robinson E.L.; Zhao Y. Institution (Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, United States (Schwartz, Leon) NewYork Presbyterian Hospital, Columbia University Irving Medical Center, New York, United States (Lindman) Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, United States (Chhatriwalla) Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Ramee) John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States (Babaliaros) Emory University, Atlanta, GA, United States (Schwartz) New York University Langone Hospital, Mineola, NY, United States (Sheth) Hamilton Health Sciences, Hamilton, ON, Canada (Fearon) Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States (Fearon) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States (Sorajja) Minneapolis Heart Institute Foundation, Minneapolis, MN, United States (Beaver) Division of Cardiovascular Surgery, University of Florida, Gainesville, United States (Oldemeyer) UCHealth Northern Colorado, Loveland, United States (Pop) Ascension Alexian Brothers Hospital, Elk Grove Village, IL, United States (Garcia) The Christ Hospital, Cincinnati, OH, United States (Southard) University of California Davis Medical Center, Sacramento, United States (Bailey) Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, United States (Li) Edwards Lifesciences, Irvine, CA, United States (Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United States (Cohen) St Francis Hospital and Heart Center, Roslyn, NY, United States (Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada (Robinson, Zhao) Edwards Lifesciences, Irvine, CA, United States Publisher American Medical Association Abstract Importance: In patients with asymptomatic severe aortic stenosis (AS), exercise stress testing is recommended to unmask symptoms and guide the timing of intervention, yet it is infrequently used in clinical practice. This registry-based follow-up of the Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis (EARLY TAVR) trial evaluates how treadmill stress testing (TST), used during screening for EARLY TAVR to confirm asymptomatic status, informed subsequent aortic valve replacement and clinical outcomes. Objective(s): To evaluate clinical outcomes in patients with asymptomatic severe AS and a positive TST result and to identify predictors of a positive TST result. Design, Setting, and Participant(s): This prespecified TST registry of the EARLY TAVR trial involved 75 clinical sites across the US. Between July 2017 and December 2021, apparently asymptomatic patients with severe AS underwent standardized TST. Those with normal TST results were randomized to transcatheter aortic valve replacement or clinical surveillance, whereas those with positive TST results were invited to enroll in a prospective registry and were followed up with through 2 years. Of 1250 patients screened, 962 met trial criteria. Of these, 816 (84.8%) had a normal TST result and 146 (15.2%) had a positive TST result. Of these, 105 consented to enroll in the EARLY TAVR Treadmill Registry. Data were analyzed from August 2025 to January 2026. Exposure: Positive TST result. Main Outcomes and Measures: TST-related safety, 2-year all-cause mortality, and rates of subsequent aortic valve replacement (AVR). Baseline predictors of a positive TST result were identified using multivariable logistic regression models. Result(s): Of the 105 patients included in the present analysis, the mean (SD) age was 76.1 (6.5) years, and 80 participants (76.2%) were male. TST was found to be safe, with no reported deaths, syncope, or cardioversions. Multivariable baseline predictors of a positive TST included higher peak velocity, lower ejection fraction, prior coronary artery bypass, and prior stroke. The 2-year Kaplan-Meier rate for all-cause mortality was 5.7%. Among patients with positive TST results, the rates of AVR at 1 and 2 years were 79.9% and 85.9%, respectively. Rates of mortality and AVR were similar for patients who had a class I indication for AVR (symptoms during testing) and those with a class IIa indication (drop in systolic blood pressure). Conclusions and Relevance: In patients with asymptomatic severe AS, TST was found to be safe and identified symptoms and AVR indication in approximately 15% of patients. However, 20% of those patients remained untreated at 1 year, despite having an indication for prompt treatment. Copyright © 2026 American Medical Association. <84> Accession Number 651826964 Title Impact of Coronary Diameter Stenosis and Proximal Lesion Location on Outcomes Following PCI in Patients Undergoing TAVI: Prespecified NOTION-3 Substudy. Source Circulation. Cardiovascular interventions. (pp e016286), 2026. Date of Publication: 24 Jul 2026. Author Riihiniemi M.; Marquard J.M.; Piuhola J.; Niemela M.; Glinge C.; Jabbari R.; Sabbah M.; Veien K.T.; Freeman P.; Linder R.; Ioanes D.; Terkelsen C.J.; Kajander O.A.; Koul S.; Savontaus M.; Karjalainen P.; Christiansen E.H.; Eftekhari A.; Holmvang L.; Sorensen R.; Ellert-Gregersen J.; Ruck A.; Angeras O.; Bieliauskas G.; Jorgensen T.H.; Junttila J.; Sondergaard L.; De Backer O.; Engstrom T.; Lonborg J. Institution (Riihiniemi, Piuhola, Niemela, Junttila) Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Finland (M.R., M.N (Marquard, Glinge, Jabbari, Sabbah, Holmvang, Sorensen, Bieliauskas, Jorgensen, De Backer, Engstrom, Lonborg) Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, C.G., R.J., M. Sabbah, R.S., Denmark (Piuhola, Niemela, Junttila) Department of Cardiology, Finland (J.P., Oulu University Hospital, M.N (Veien, Ellert-Gregersen) Department of Cardiology, Odense University Hospital, Denmark (Freeman, Linder, Ruck) Department of Medicine, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden (Ioanes, Angeras) Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (Terkelsen, Christiansen) Department of Cardiology, Aarhus University Hospital, Denmark (Kajander) Heart Hospital, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Finland (O.A.K.), Finland (Koul) Department of Cardiology, Lund University, Skane University Hospital (Savontaus) Heart Center, Turku University Hospital, Finland (M. Savontaus), Finland (Karjalainen) Heart and Lung Center, Helsinki University Hospital, Finland (P.K.), Finland (Eftekhari) Department of Cardiology, Aalborg University Hospital, Denmark (Sondergaard) Abbott, Santa Clara, California (L.S.) Abstract BACKGROUND: Optimal treatment of coronary artery disease in patients undergoing transcatheter aortic valve implantation remains debated. Here, our aim was to analyze the impact of the diameter and location of coronary stenosis on outcomes in patients undergoing percutaneous coronary intervention (PCI) with transcatheter aortic valve implantation. METHOD(S): This study was a prespecified subanalysis of the NOTION-3 trial (Nordic Aortic Valve Intervention), which randomized patients with severe symptomatic aortic stenosis and physiologically significant stable coronary artery disease to receive either PCI or conservative treatment of coronary artery disease with transcatheter aortic valve implantation. In this substudy, patients were stratified according to diameter stenosis (<90% or >=90%) and stenosis location (proximal or nonproximal). The primary outcome was major adverse cardiovascular events, a composite of all-cause death, myocardial infarction, and urgent revascularization. RESULT(S): Of 455 randomized patients, 184 (40%) had diameter stenosis <90% and 271 (60%) >=90%. A total of 294 (65%) patients had at least 1 proximal stenosis, while in 161 (35%) patients, stenoses were nonproximal. At a median follow-up of 2 years (interquartile range, 1-4), PCI reduced the absolute risk of major adverse cardiovascular event by 13% in patients with diameter stenosis >=90% (PCI 24% versus conservative treatment 37%; hazard ratio, 0.53 [95% CI, 0.34-0.82]), whereas no benefit was observed in patients with diameter stenosis <90% (31% versus 33%; hazard ratio, 1.04 [95% CI, 0.62-1.73]; P for interaction=0.051). PCI reduced major adverse cardiovascular events in case of proximal stenosis (26% versus 38%; hazard ratio, 0.61 [95% CI, 0.40-0.93]), although the difference in effect remained nonsignificant when compared with patients with nonproximal stenosis (28% versus 32%; hazard ratio, 0.91 [95% CI, 0.52-1.61]; P for interaction=0.27). CONCLUSION(S): The beneficial effect of PCI in patients undergoing transcatheter aortic valve implantation with physiologically significant stable coronary artery disease was seemingly pronounced in patients with high-grade stenosis, while stenosis location was not found to modify the outcome despite an almost similar beneficial effect with PCI in patients with proximal stenosis. <85> Accession Number 2047977706 Title Ward-Based Postoperative Electrolyte Optimisation and New-Onset Atrial Fibrillation Following Elective Cardiac Surgery: A Quality Improvement Audit. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S210), 2026. Date of Publication: 01 Aug 2026. Author McGreal S.; Edelman J. Institution (McGreal, Edelman) Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, WA, Australia (McGreal) University College Cork, Cork, Ireland (Edelman) The University of Western Australia, Perth, WA, Australia Publisher Elsevier Ltd Abstract Introduction: Postoperative atrial fibrillation (POAF) complicates 20%-40% of cardiac surgeries, increasing morbidity, length of stay, and resource use. Meta-analyses suggest perioperative magnesium supplementation reduces POAF risk (RR ~0.55-0.70); however, postoperative electrolyte management on surgical wards is frequently reactive and non-protocolised. This quality improvement (QI) audit evaluated ward-based magnesium (Mg) and potassium (K) control, replacement practices, and their relationship with POAF. Method(s): A retrospective audit of consecutive elective adult cardiac surgical patients was conducted, excluding those with pre-operative atrial fibrillation. Procedures included isolated coronary artery bypass grafting (CABG) (n=44), Valve (n=35), CABG + Valve (n=5), and aortic surgery (n=8). Data included lowest serum Mg and K on POD 2-5, documented electrolyte replacement, and new-onset POAF within 7 days. Associations between Mg and POAF were examined using multivariable logistic regression adjusting for age and procedure type. Findings were reviewed with cardiothoracic surgeons, nursing staff and pharmacy to co-design a standardised replacement protocol targeting maintenance of Mg within the normal range. Result(s): POAF incidence ranged from 20-40% across procedures. Mean lowest Mg varied by surgery type, lowest after aortic surgery (0.799 mmol/L) and highest after CABG (0.840 mmol/L). CABG patients with POAF had lower Mg than those in sinus rhythm (0.821 vs 0.853 mmol/L). Electrolyte replacement was inconsistent; subnormal Mg often not corrected. Discussion(s): Ward-based postoperative electrolyte control is variable and often below proposed anti-arrhythmic thresholds. This audit has led to implementation of a multidisciplinary, protocolised electrolyte optimisation pathway with defined Mg targets, and prospective re-audit is underway to assess improvements in electrolyte control and POAF incidence. Copyright © 2026 <86> Accession Number 651821737 Title Therapeutic donor hypothermia following brain death to improve the quality of transplanted organs. Source The Cochrane database of systematic reviews. 7 (pp CD015190), 2026. Date of Publication: 24 Jul 2026. Author Amarnath D.R.; Tingle S.J.; Hoather T.J.; Thompson E.R.; Wilson C.H. Institution (Amarnath, Tingle, Hoather, Thompson, Wilson) Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (Amarnath, Tingle, Thompson, Wilson) National Institute for Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom (Amarnath, Tingle, Thompson, Wilson) Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom Abstract RATIONALE: Solid organ transplantation is the optimal treatment for patients living with end-stage organ failure. Globally, the majority of organ donors are deceased, most commonly following brainstem death. The process of brain death is known to cause significant injury to organs. Therefore, efforts to optimise the pre-donation care of these donors should be maximised to achieve improved recipient outcomes. OBJECTIVE(S): To assess the benefits and harms of therapeutic donor hypothermia in recipients of organs donated from brain-dead donors. SEARCH METHOD(S): We searched Cochrane Kidney and Transplant's Specialised Register, CENTRAL, MEDLINE, Embase and two trials registers up to 03 September 2025. ELIGIBILITY CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) investigating therapeutic donor hypothermia compared with donor normothermia following brainstem death to improve the quality of transplanted organs. OUTCOME(S): Critical outcomes were post-transplant outcomes (delayed graft function (DGF), graft survival), utilisation and donor adverse events. Important outcomes were patient survival, primary nonfunction, acute rejection, quality of life and cardiovascular disease. RISK OF BIAS: We used Cochrane's risk of bias 1 tool. SYNTHESIS METHODS: Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We used random-effects models for the meta-analysis. We assessed the certainty of evidence using the GRADE approach. INCLUDED STUDIES: We included four studies, enrolling 2096 donors. Two studies compared donor hypothermia versus normothermia in kidney transplantation. Two studies investigated kidney, heart, lung, liver and pancreas transplantations. SYNTHESIS OF RESULTS: Four studies assessed the impact of donor hypothermia compared with normothermia on kidney outcomes. Donor hypothermia may not reduce the rate of kidney DGF compared to donor normothermia (RR 0.87, 95% CI 0.71 to 1.08; I2 = 57%; 4 studies, 3015 participants; low-certainty evidence). Donor hypothermia may not be associated with one-year kidney graft survival (HR 0.77, 95% CI 0.51 to 1.14; I2 = 0%; 3 studies, 2075 participants; low-certainty evidence) or one-year patient survival in kidney transplant recipients (HR 0.81, 95% CI 0.42 to 1.57; 1 study, 526 participants; low-certainty evidence). No studies assessed the impact on primary non-function of the kidney or acute rejection. Evidence from only one RCT was available for other solid organ post-transplant outcomes. Donor hypothermia may show no difference to graft survival (lung transplant: HR 0.73, 95% CI 0.21 to 2.51; 1 study; low-certainty evidence; liver transplant: HR 0.85, 95% CI 0.35 to 2.06; 1 study; low-certainty evidence). Donor hypothermia has no impact on liver utilisation (RR 1.02, 95% CI 0.96 to 1.08; I2 = 0%; 2 studies, 1259 participants; high-certainty evidence) and probably has no impact on the utilisation of the following organs: kidney (RR 0.99, 95% CI 0.95 to 1.03; I2 = 44%; 4 studies, 4265 participants; moderate-certainty evidence); heart (RR 1.03, 95% CI 0.87 to 1.21; I2 = 0%; 2 studies, 1259 participants; moderate-certainty evidence); lung (RR 0.97, 95% CI 0.85 to 1.11; I2 = 0%; 2 studies, 2518 participants; moderate-certainty evidence); pancreas (RR 1.09, 95% CI 0.74 to 1.61; I2 = 0%; 2 studies, 1259 participants; moderate-certainty evidence). Donor hypothermia may not affect the occurrence of donor adverse events (RR 1.28, 95% CI 0.45 to 3.62; I2 = 12%; 3 studies, 2015 participants; low-certainty evidence). No data were available for primary nonfunction, acute rejection, quality of life or cardiovascular diseases. Most studies focused on kidney transplant outcomes, with limited data on other organs. The certainty of the evidence was generally low to moderate, primarily due to imprecision, high risk of reporting bias, or both. AUTHORS' CONCLUSION(S): This review provides low-certainty evidence that donor hypothermia may have no impact on post-transplant outcomes. Donor hypothermia may not be associated with reduced organ utilisation. No safety concerns were identified, and donor hypothermia may not increase donor adverse events. FUNDING: No specific funding was received. REGISTRATION: Protocol (2023): doi:10.1002/14651858.CD015190. Copyright © 2026 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. <87> Accession Number 2047972363 Title Addressing the Impact of Cardiac Rehabilitation on Functional Status Post-Surgery. A DASI (Duke Activity Status Index) Score Analysis in Adult Cardiac Surgery Patients: A Pilot Study. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S195), 2026. Date of Publication: 01 Aug 2026. Author Mortensen M.; Long T.; Le T.; Maiorana A. Institution (Mortensen) Western Norway University of Applied Sciences, Vestland, Bergen, Norway (Long, Maiorana) Fiona Stanley and Fremantle Hospital Group, Murdoch, WA, Australia (Long, Le, Maiorana) Curtin University, Bentley, WA, Australia Publisher Elsevier Ltd Abstract Introduction: Functional outcomes and quality of life (QOL) post-cardiac surgery vary based on pre-surgical fitness and engagement in cardiac rehabilitation (CR) during recovery. This pilot study undertook an evaluation of the effects of CR on the Duke Activity Status Index (DASI) and QOL Scale (QOLs) in patients undergoing cardiac surgery. Method(s): Adults (<70 years) undergoing cardiac surgery were recruited. Questionnaires were completed pre-surgery and after 8-weeks of CR or usual care. Mixed-model analysis of variance (ANOVA) was used to examine time and group effects. Statistical significance was set at p<0.05. Result(s): Eight participants (55.1+/-13.3 years; 6 male) completed baseline and follow-up assessments (Table). For DASI Total Score, there were no significant main (group p=0.41, time p=0.86), or interaction effects (p=0.12). Similarly for DASI predicted VO<inf>2peak</inf>, (group p=0.40, time p=0.86 or interaction p=0.12) and QOLs (group p=0.50, time p=0.25, interaction p=0.38), no significant effects were evident, although there was a tendency for CR to improve these outcomes. Discussion(s): CR may result in clinically meaningful improvements in functional capacity and QOL in patients following cardiac surgery. Early results support the feasibility of using DASI as an outcome measure and will inform the design of a future randomised controlled trial. [Formula presented] Copyright © 2026 <88> Accession Number 2047974589 Title Nurse-Led Postoperative Interventions in Adult Cardiac Surgery: A Systematic Review. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S206), 2026. Date of Publication: 01 Aug 2026. Author Matthews S.; Fredericks S.; Delaney L.; Abbs M.; Guiriba G.; Nasrawi D.; Wynne R. Institution (Matthews, Delaney, Abbs, Guiriba, Wynne) Centre for Quality & Patient Safety in the Institute for Health Transformation, Deakin University-Western Health Partnership, Saint Albans, VIC, Australia (Matthews, Fredericks, Delaney, Abbs, Guiriba, Nasrawi, Wynne) CONNECT: Cardiac Surgery International Nursing & Allied Professional Research Network, London, United Kingdom (Fredericks) Toronto Metropolitan University, Toronto, ON, Canada (Nasrawi) Southern Cross University, Gold Coast, QLD, Australia Publisher Elsevier Ltd Abstract Aim: We aimed to identify nurse-led clinical interventions evaluated in randomised controlled trials (RCT) for adults who had undergone cardiac surgery and assess the effectiveness of these interventions on postoperative clinical and patient-reported outcomes during the acute inpatient phase. Method(s): A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute methodology and PRISMA guideline for reporting. The review protocol was registered with PROSPERO. Eligible studies were RCT of adult (>=18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Result(s): Of 2,690 records, 19 randomised controlled trials (RCT) were eligible, representing 13 countries, and 3,142 participants. Risk of bias varied, with only two low risk trials. Interventions were grouped into six domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care and infection prevention; respiratory and pulmonary function; and postoperative recovery, mobilisation, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. Conclusion(s): Nurse-led inpatient interventions contribute meaningfully to in-patient postoperative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCTs. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty. Copyright © 2026 <89> Accession Number 2047967008 Title Undertreatment and Increased Mortality in Real World Patients With Severe Aortic Stenosis Who Would Have Been Eligible for Transcatheter Randomised Control Trials. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S191-S192), 2026. Date of Publication: 01 Aug 2026. Author Brick C.; Koshy A.; Gibson S.; Calafiore P.; Eskandari M.; Theuerle J.; Yeoh J.; Yudi M. Institution (Brick, Koshy, Gibson, Calafiore, Eskandari, Theuerle, Yeoh, Yudi) Department of Cardiology, Austin Health, Melbourne, VIC, Australia (Koshy) The University of Melbourne, Melbourne, VIC, Australia (Eskandari) Baker Heart and Diabetes Institute, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Aims: Landmark transcatheter aortic valve replacement (TAVR) trials defined severe aortic stenosis (AS) using strict haemodynamic criteria. We sought to evaluate discordance between trial definitions and real-world reporting of severe AS, and the impact on valve intervention. Method(s): 52,704 consecutive adult transthoracic echocardiograms at a tertiary centre (2017-2023) were screened for patients age>=65 years with >=moderate native-AS. Prospectively-maintained data were used to compare those meeting TAVR trial-eligibility criteria to those labelled severe in the echocardiographic report. Aortic valve replacement (AVR-transcatheter/surgical) and mortality were assessed. Result(s): Among 1,097 eligible patients, 807 (73.6%) met trial criteria for severe AS, whereas only 382 (34.8%) were reported as severe. Patients meeting trial-criteria but not reported severe were significantly less likely to undergo AVR compared with those reported severe (34.5% vs 72.3%, p<0.001). Overall, only 422 (52.3%) meeting trial-criteria underwent AVR. Mortality was markedly higher in the untreated group (64.4% vs 17.5%, p<0.001, Figure), and AVR remained associated with survival after adjustment for age and comorbidities (HR 0.19, 95% CI 0.15-0.26, p<0.001). Conclusion(s): More than half of patients meeting trial-criteria for severe AS were not labelled as severe on echocardiographic reports, with lower subsequent intervention rates and high mortality. Whether clearer echocardiographic criteria for severe AS would improve outcomes needs further investigation. [Formula presented] Copyright © 2026 <90> Accession Number 2047867100 Title Effect of Cycle Ergometery on Functional Capacity and Pulmonary Function in Phase - I Cardiac Rehabilitation. Source Acta Medica International. 12(2) (pp 79-85), 2025. Date of Publication: 01 May 2025. Author Mehta J.N.; Parikh S.M.; Rathod K. Institution (Parikh) Department of Physiotherapy, K M Patel Institute of Physiotherapy, Bhaikaka University, Karamsad, Gujarat, Anand, India (Rathod) Department of Physiotherapy, Shree Sahajanand Institute of Physiotherapy, Gujarat, Bhavnagar, India Publisher Parsvnath Publishing House Abstract Background: Pulmonary complications are most common after the coronary artery bypass grafting. The vital role of Cardiac Rehabilitation is to prevent complication, improve functional capacity & enhance QoL of patients. The core component of rehabilitation is aerobic exercise training. Cycle ergometers have been proposed as an alternative in early cardiac rehabilitation. Therefore, the aim of study is to find out the effectiveness of cycle ergometer on functional capacity and pulmonary functions in patients with CABG surgery. Subjects and Methods: A prospective randomized control trial was conducted in patients who underwent for elective CABG surgery. Total 44 patients were screened and 33 patients recruited who met with an inclusion criterion. Those were allocated into two groups i.e., control group and experimental group by Balance block - computer - generated randomization. Control group received conventional therapy and experimental group received cycle ergometer start with 3 minutes and progress up to 5 minutes along with conventional therapy twice a day till the discharge. In the study, 6-minute walk test, Maximum inspiratory pressure (MIP) and Chest expansion were assessed at baseline and at time of discharge. Result(s): There is significant improvement found at time of discharge in 6 MWT distance, MIP and chest expansion as compared to baseline in both the groups. But there is no statistically significant difference seen in 6 MWT distance, MIP and chest expansion as compared to control group. Conclusion(s): Incorporation of cycle ergometer with conventional physiotherapy was not giving any additional benefits to 6-minute walk test distance, Maximum inspiratory pressure and Chest expansion between two groups. Copyright © 2025 Acta Medica International. <91> Accession Number 2047848569 Title Is robotic thoracic surgery associated with lower postoperative pain after lung cancer resection? A systematic review and meta-analysis of pain trajectories and recovery. Source Cardiothoracic Surgeon. 34(1) (no pagination), 2026. Article Number: 34. Date of Publication: 01 Dec 2026. Author Wang D.; Patirelis A.; Ambrogi V.; Elia S.; Bastone S.A.; Chen Y.; Pompeo E. Institution (Wang, Patirelis, Ambrogi, Bastone, Pompeo) Thoracic Surgery Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, Rome, Italy (Elia) Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy (Chen) Department of Oncology, Ordos Central Hospital, Ordos, China Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: This study aimed to evaluate postoperative pain evolution and perioperative rehabilitation in patients undergoing multiportal robotic-assisted thoracic surgery (RATS) versus video-assisted thoracic surgery (VATS) for lung cancer. The primary focus was to delineate the impact of these two surgical modalities on recovery trajectories. Main body of the abstract: We systematically queried PubMed, Embase, Web of Science, and the Cochrane Library through January 2026. Adhering to PRISMA 2020 criteria, 18 studies (N = 2,940) comparing multiportal RATS versus VATS were identified. The primary endpoint was acute pain intensity on postoperative day (POD) 1. Secondary metrics encompassed extended pain evolution (from POD 3 to discharge), drainage duration, postoperative morbidity, and length of stay. Data synthesis was performed using a random-effects model. Evidence certainty was assessed via the GRADE framework. No significant difference was observed in the primary pooled analysis of POD 1 pain (mean difference [MD]: 0.09; 95% CI: -0.62 to 0.79; P = 0.81), which remained non-significant after sensitivity adjustment (MD: 0.00; 95% CI: -0.34 to 0.35; P = 0.98). RATS also demonstrated comparable extended pain intensity from POD 3 onwards (MD: -0.11; 95% CI: -0.47 to 0.25; P = 0.54). RATS exhibited a non-significant trend toward shorter drainage periods initially (MD: -0.29 days; 95% CI: -0.59 to 0.02; P = 0.06), which became statistically significant after sensitivity adjustment for outlier exclusion (MD: -0.41 days; 95% CI: -0.63 to -0.18; P = 0.0005). Furthermore, RATS significantly reduced length of stay (MD: -0.84 days; 95% CI: -1.06 to -0.63; P < 0.00001). The incidence of overall morbidity was statistically comparable between both cohorts (risk ratio [RR]: 0.88; 95% CI: 0.74 to 1.04; P = 0.13). Short conclusion: Multiportal RATS achieved equivalent postoperative pain control at POD 1 compared to multiportal VATS, though clinical recovery efficiency proved superior. These advantages likely stem from technical precision and earlier tube removal. However, due to the predominance of retrospective data, these findings are underpinned by very low evidence certainty. Copyright © The Author(s) 2026. <92> Accession Number 2038434767 Title Insertion of a transesophageal echocardiography probe using McGRATH video laryngoscope in cardiac surgery patients: A prospective randomized study. Source Anaesthesia, Pain and Intensive Care. 30(5) (pp 633-637), 2026. Date of Publication: 01 May 2026. Author Abdalwahab A.; Abuzaid A.; Abdelal I.; Elsherbeny A. Institution (Abdalwahab, Elsherbeny) Anaesthesia Department, Faculty of Medicine Cairo University, Cairo, Egypt (Abdalwahab, Abuzaid, Abdelal, Elsherbeny) Anesthesia Department, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia Publisher Faculty of Anaesthesia, Pain and Intensive Care, AFMS Abstract Background & objective: Insertion of a transoesophageal echocardiography (TEE) probe during cardiac surgery is generally safe but may be associated with oropharyngeal and oesophageal complications. Assistance with a conventional Macintosh laryngoscope can reduce insertion-related injury; however, consistent visualization of the oesophageal inlet is often limited. The McGRATH video laryngoscope provides indirect video imaging and may improve anatomical visualization during probe placement. This study evaluated whether McGRATH-assisted TEE probe insertion improves ease of insertion and reduces insertion-related complications compared with the conventional Macintosh laryngoscope. Methodology: A prospective randomised controlled trial. Was conducted at a large tertiary Cardiac Centre from June to December 2025. 100 adult patients scheduled for elective cardiac procedures under general anaesthesia requiring intraoperative TEE monitoring were randomised to either McGRATH-assisted insertion (M group) or Macintosh-assisted insertion (C group). TEE probe insertion guided by either the McGRATH video laryngoscope or a conventional Macintosh laryngoscope. Primary outcomes included visibility of the oesophageal inlet and duration of probe insertion. Secondary outcomes were number of insertion attempts, insertion-related complications, and anaesthesiologist satisfaction. Result(s): The visibility of the oesophageal inlet was significantly higher in the McGRATH than in the Macintosh group (84% vs 38%, P < 0.001). The duration of TEE probe insertion was significantly shorter in the McGRATH group (P < 0.001). The incidence of complications was significantly lower in the McGRATH group compared with the Macintosh group (2% vs 12%). Conclusion(s): Use of the McGRATH video laryngoscope facilitated TEE probe insertion by improving visualization of the oesophageal inlet, reducing insertion time, and lowering the incidence of insertion-related complications. Copyright © 2026, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved. <93> Accession Number 2047816824 Title Efficacy of intranasal insulin in preventing postoperative delirium and its impact on insulin resistance in elderly non-cardiac surgical patients: a systematic review and meta-analysis. Source Minerva Anestesiologica. 92(7-8) (pp 739-749), 2026. Date of Publication: 01 Jul 2026. Author Qin J.; Zhou W.; Chen S.; Cheng M.; Shen X.; Ma J. Institution (Qin, Zhou, Chen, Cheng, Shen, Ma) Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China Publisher Edizioni Minerva Medica Abstract BACKGROUND: Postoperative delirium (POD) is a common and serious complication in elderly patients and has been established to be associated with insulin resistance (IR), a key marker of dysregulated glucose metabolism. Therefore, this study aims to systematically evaluate the efficacy of intranasal insulin in preventing POD in elderly non-cardiac surgery patients and to further investigate whether its mechanism of action is related to the improvement of IR. METHOD(S): A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journals Database and Chinese Biomedical Literature Database from inception to October 19, 2025, to identify randomized controlled trials that compared elderly patients who were administered intranasal insulin during the perioperative period with those who were not. The primary outcomes of this study were the incidence of POD and the efficacy of different insulin dosing regimens. The secondary outcome was the change in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values before and after surgery. Data from eligible trials were pooled to calculate the combined risk ratio (RR) or standardized mean difference (SMD). RESULT(S): Analysis of seven trials involving 778 elderly patients showed that, compared to placebo, intranasal insulin significantly reduced POD incidence on day one (RR: 0.33; 95%CI: 0.22 to 0.47; P<0.001) and its cumulative incidence over three days (RR: 0.31; 95%CI: 0.22 to 0.44; P<0.001) and five days (RR: 0.32; 95%CI 0.18 to 0.56; P<0.001). In contrast, the change in HOMA-IR across the surgery period did not differ significantly between the two groups (SMD: -0.27; 95%CI: -0.77 to 0.23; P=0.290). CONCLUSION(S): Intranasal insulin is effective in reducing the incidence of POD. This benefit is likely mediated through central nervous system glucose metabolism, rather than by reversing peripheral IR, a premise that requires validation in future trials. Copyright © 2026 EDIZIONI MINERVA MEDICA. <94> Accession Number 2038434939 Title Rhomboid intercostal and sub serratus plane block for post-operative analgesia after laparoscopic cholecystectomy: a randomized control study. Source Anaesthesia, Pain and Intensive Care. 30(5) (pp 591-598), 2026. Date of Publication: 01 May 2026. Author Elhouty M.G.; Elawady M.S.; Elbahrawy K.M. Institution (Elhouty, Elawady, Elbahrawy) Faculty of Medicine, Mansoura University, Egypt Publisher Faculty of Anaesthesia, Pain and Intensive Care, AFMS Abstract Background & objective: The "Rhomboid intercostal and subserratus plane" block (RISS) is a relatively new block technique that proved its efficacy in different thoracic procedures. Its analgesic effect after laparoscopic cholecystectomy is under valuated. The aim of the study was to evaluate the effectiveness of RISS block in providing and maintaining postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Method(s): This prospective trial included 90 patients who were randomly divided into two groups: the RISS group that received the block (n = 45) and the control group that received no block (n = 45). Result(s): Baseline demographic characteristics and operative durations were comparable between the two groups (P > 0.05). The RISS group demonstrated significantly more stable intraoperative hemodynamics, evidenced by lower heart rate and arterial pressure values compared to the control group (P < 0.05). Pain scores were also significantly lower in the RISS group during the first 12 postoperative hours (P < 0.05). Furthermore, the time to first rescue analgesia was markedly prolonged (729.11 vs. 23.89 minutes), and total postoperative fentanyl consumption was substantially reduced (45.11 vs. 153.24 microg) in the RISS group compared to controls (both P < 0.05). Consequently, patients who received the RISS block reported significantly higher satisfaction levels (P < 0.05). Conclusion(s): Bilateral RISS block is an effective option to provide postoperative analgesia for patients undergoing laparoscopic cholecystectomy. It should be performed as a part of a multimodal analgesia. Copyright © 2026, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved. <95> Accession Number 2038435592 Title Efficacy of Beta-blocker Therapy in Post-myocardial Infarction Patients with Preserved or Mildly Reduced Ejection Fraction: A Systematic Review and Meta-analysis. Source Journal of Cardiac Critical Care. 10(3) (pp 163-172), 2026. Date of Publication: 01 Jul 2026. Author Mata E.; Resende B.; Pinto A.M.; Portugues J.; Ribeiro S.; Gameiro J.; Lourenco A.; Goncalves L. Institution (Mata, Pinto, Portugues, Ribeiro, Lourenco) Department of Cardiology, Unidade Local de Saude do Alto Ave, Guimaraes, Portugal (Resende, Gameiro, Goncalves) Department of Cardiology, Unidade Local de Saude de Coimbra, Coimbra, Portugal Publisher Scientific Scholar LLC Abstract Objectives: Beta-blockers improve outcomes after myocardial infarction (MI) in patients with reduced left ventricular ejection fraction (LVEF), but their benefit in patients with preserved ejection fraction (pEF) or mildly reduced ejection fraction (mrEF) remains unclear in the era of modern reperfusion and optimized therapy. This study evaluates the long-term impact of beta-blockers in this population. Material(s) and Method(s): Following a systematic search of four databases, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in post-myocardial infarction patients with LVEF >=40%, comparing long-term beta-blocker therapy with usual care. Primary outcomes were all-cause mortality and recurrent MI; secondary outcomes included cardiovascular (CV) mortality, heart failure hospitalization (HFH), malignant ventricular arrhythmias, ischemic stroke, and unplanned coronary revascularization. Data were pooled using random-effects models. Result(s): Four multicenter RCTs (9892 patients in the beta-blocker group and 9934 in the control group) conducted between 2017 and 2024 were included, with a median follow-up of 3.5-3.7 years. Beta-blocker therapy was not associated with a significant reduction in all-cause mortality (hazard ratio [HR]: 0.98, confidence intervals [CI] 0.85-1.12) or recurrent MI (HR: 0.88, CI 0.74-1.05). No benefit was observed for secondary outcomes, including CV mortality, HFH, malignant arrhythmias, ischemic stroke, or unplanned revascularization. Heterogeneity was low to moderate, and study quality was moderate overall, with high certainty for primary outcomes. Conclusion(s): In contemporary reperfusion-era populations with pEF or mrEF, long-term beta-blocker therapy after MI does not confer significant reductions in mortality or recurrent MI. These findings challenge the historical paradigm of universal post-MI beta-blockade and support a more selective, individualized approach guided by LVEF. Copyright © 2026 Published by Scientific Scholar on behalf of Journal of Cardiac Critical Care TSS. <96> Accession Number 651809983 Title Interpreting troponin elevation after surgery: diagnostic challenges and a pragmatic approach. Source Annals of the Royal College of Surgeons of England. (no pagination), 2026. Date of Publication: 23 Jul 2026. Author Dave M.; Mokrzycki K.; Bailey C. Institution (Dave) Medway NHS Foundation Trust, United Kingdom (Mokrzycki) Kent and Medway Medical School, United Kingdom (Bailey) Maidstone and Tunbridge Wells NHS Trust, United Kingdom Abstract INTRODUCTION: Cardiac troponin is a highly sensitive marker of myocardial injury, although its interpretation after non-cardiac surgery remains challenging. Postoperative troponin elevation is common, frequently asymptomatic and associated with a markedly increased risk of short-term mortality, yet it is often misinterpreted or overlooked in surgical practice. METHOD(S): We performed a narrative review of contemporary evidence and international guidelines addressing perioperative troponin measurement, myocardial injury after non-cardiac surgery (MINS), and perioperative myocardial infarction (MI), with a focus on their relevance to surgical teams. MEDLINE and Embase were searched for adult English-language studies, prioritising the past 10-15 years and key consensus statements. Studies relevant to postoperative outcomes, risk stratification and management were synthesised into a pragmatic stepwise approach for surgical teams. FINDINGS: Studies including VISION and POISE demonstrate that even modest postoperative troponin rises are independently associated with substantially increased 30-day mortality, most often in the absence of ischaemic symptoms. Differentiating type 1 MI, type 2 MI and non-ischaemic myocardial injury is difficult in the perioperative setting because clinical features, electrocardiography and baseline troponin values are frequently non-specific. Contemporary European and North American guidelines now support targeted perioperative troponin surveillance in high-risk patients to allow early detection and risk stratification. CONCLUSION(S): Postoperative troponin elevation represents a powerful prognostic marker rather than a single disease entity. A structured, stepwise approach incorporating preoperative risk assessment, serial troponin measurement, clinical correlation and selective imaging can help surgical teams distinguish clinically significant myocardial injury from chronic or non-ischaemic elevation, enabling timely multidisciplinary management and potentially improving outcomes. <97> Accession Number 2047975234 Title Long-Term Clinical Outcomes of Multiple and Total Arterial Revascularisation Versus Single Arterial Coronary Bypass Grafting: A Bayesian Network Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S204-S205), 2026. Date of Publication: 01 Aug 2026. Author Ren J.; Reid C.; Royse C.; Smith J.; Srivastav N.; Ahmadipour M.; Zhang W.; Siderakis C.; Royse A. Institution (Ren, Royse, Siderakis, Royse) The University Of Melbourne, Melbourne, VIC, Australia (Ren, Zhang) The University of Western Australia, Perth, WA, Australia (Reid) Curtin University, Perth, WA, Australia (Smith) Monash University, Melbourne, VIC, Australia (Srivastav) Cleveland Clinic, Abu Dhabi, United Arab Emirates (Ahmadipour) Fiona Stanley Hospital, Perth, WA, Australia Publisher Elsevier Ltd Abstract Aim: We aimed to compare long-term survival of multiple arterial grafting (MAG) and total arterial revascularisation (TAR) versus conventional single arterial grafting (SAG) using Bayesian network meta-analysis. Method(s): A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to 8 March 2025. Randomised and risk-adjusted observational studies evaluating isolated coronary artery bypass grafting (CABG) with MAG, TAR, or SAG were included. The primary endpoint was long-term all-cause mortality. A random-effects Bayesian network meta-analysis was performed using inverse-variance weighted log-hazard ratios. Surface under the cumulative ranking curve (SUCRA) values were calculated to determine treatment hierarchy. Result(s): Sixty-four studies were included. Compared with SAG, TAR was associated with significantly lower long-term mortality (Hazard ratio [HR] 0.79, 95% credible interval [CrI] 0.70-0.86), as was MAG (HR 0.81, 95% CrI 0.74-0.91) (Figure). Indirect comparison demonstrated a modest but consistent survival advantage of TAR over MAG (HR 0.84, 95% CrI 0.78-0.97). Treatment ranking strongly favoured TAR (SUCRA 0.999), followed by MAG (0.501), while SAG ranked lowest (0.000). Conclusion(s): Both arterial-predominant strategies improve long-term survival compared with conventional SAG. TAR demonstrates the highest probability of being the most effective revascularisation strategy, suggesting that complete avoidance of saphenous vein grafts may provide incremental survival benefit beyond multi-arterial use alone. [Formula presented] Copyright © 2026 <98> Accession Number 2038414098 Title GLOBAL DISTRIBUTION OF AORTIC VALVE STENOSIS ACCORDING TO ETHNIC POPULATIONS: EPIDEMIOLOGY, GENETIC SUSCEPTIBILITY, AND CLINICAL IMPLICATIONS. Source Genetics and Molecular Research. 25(11s) (no pagination), 2026. Date of Publication: 15 Jul 2026. Author Dumani S.; Xhetani M.; Beca V.; Nakuci D. Institution (Dumani) Universtiy Hospital Center "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania (Xhetani) University of Tirana, Faculty of Natural Sciences, Department of Biology, Tirana, Albania (Beca, Nakuci) University Hospital of Obstetrics and Gynecology"Queen Geraldina", Tirana, Albania Publisher Fundacao de Pesquisas Cientificas de Ribeirao Preto Abstract Aortic valve stenosis (AS) represents the most frequent valvular heart disease requiring surgical or transcatheter intervention in developed countries and constitutes an increasing global health burden due to population aging and improved life expectancy. Although the prevalence of aortic stenosis has traditionally been associated with elderly Caucasian populations, accumulating evidence suggests significant ethnic variations in disease prevalence, age at presentation, pathological mechanisms, and clinical outcomes. These differences appear to result from complex interactions between genetic background, environmental exposure, socioeconomic factors, access to healthcare, and distribution of cardiovascular risk factors. Caucasian populations, particularly those of European ancestry, demonstrate the highest reported prevalence of calcific aortic valve stenosis, partly related to increased longevity, higher frequency of bicuspid aortic valve disease, and genetic susceptibility involving pathways associated with lipid metabolism, inflammation, and valve calcification. In contrast, African populations appear to have lower rates of calcific aortic stenosis despite a higher prevalence of hypertension and other cardiovascular risk factors. Asian populations historically showed lower rates of severe aortic stenosis; however, rapid demographic aging and westernization of lifestyle have resulted in a substantial increase in disease burden. Hispanic and South Asian populations represent heterogeneous groups in which metabolic factors, healthcare disparities, and genetic admixture influence disease expression. Understanding ethnic differences in aortic stenosis epidemiology is increasingly important for cardiovascular prevention, early diagnosis, surgical planning, and allocation of healthcare resources. This review summarizes current knowledge regarding global ethnic variations in aortic valve stenosis, emphasizing epidemiological patterns, genetic determinants, and implications for contemporary cardiac practice. Copyright © 2026, Fundacao de Pesquisas Cientificas de Ribeirao Preto. All rights reserved. <99> Accession Number 651803098 Title Long-Term Outcomes After Transcatheter Aortic Valve Replacement. Source Trends in cardiovascular medicine. (no pagination), 2026. Date of Publication: 21 Jul 2026. Author Braasch M.C.; Bai Y.Z.; Kaneko T. Institution (Braasch, Bai, Kaneko) Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States Abstract Transcatheter aortic valve replacement (TAVR) is a more prevalent procedure than surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). With increasing TAVR utilization in young and low-risk patients, understanding long-term outcomes of TAVR is critical. Three randomized TAVR vs SAVR trials in patients with severe AS were identified with outcomes reported beyond 5 years: the NOTION (10-year outcomes), PARTNER 3 (7-year outcomes), and Evolut Low-Risk (6 year overall outcomes and 7 year reintervention data) trials. Primary trial outcomes, all of which were composite outcomes including all-cause mortality, stroke, myocardial infarction, and/or valve-, procedure-, or heart failure-related readmission, demonstrated similar outcomes between TAVR and SAVR (NOTION: 65.5% vs 65.5%, P=0.9; PARTNER 3: 34.6% vs 37.2%, HR 0.87 [95% CI 0.70-1.08]; Evolut Low Risk: 23.3% vs 20.4%, P=0.43). Amongst secondary outcomes, the cumulative incidence of TAVR reintervention was similar to SAVR reintervention in the NOTION trial (4.3% vs 2.2%, P=0.3) and the PARTNER 3 trial (6.7% vs 6.0%, HR 1.11 [0.63-1.94]), but TAVR reintervention was higher than SAVR reintervention in the Evolut Low-Risk trial (9.8% vs 6.0%; p=0.02). Study limitations include small cohort size (145 undergoing TAVR) of older patients undergoing TAVR with early generation self-expanding TAVRs in the NOTION trial and no data yet beyond 7 years in the PARTNER 3 and Evolut Low-Risk trials. Despite limitations, these data highlight the criticality in extremely careful patient selection for TAVR to optimize long term outcomes in the era of lifetime management of AS. Copyright © 2026. Published by Elsevier Inc. <100> Accession Number 651808628 Title Rationale and Design of the TAILOR-HCM Multicenter Randomized Controlled Trial: Transapical Beating-Heart Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy. Source American heart journal. (pp 107543), 2026. Date of Publication: 22 Jul 2026. Author Fang J.; Ma Y.; Chen Y.; Lai Y.; Wang C.; Guo H.; Ma L.; Yan X.; Wang D.; Wan S.; Wei X. Institution (Fang, Ma, Chen) Division of Cardiovascular Surgery, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.; Hubei Engineering Research Center for Diagnostic and Therapeutic Equipment in Precision Cardiovascular Surgery, Wuhan, China.; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences; Organ Transplantation Clinical Medical Research Center of Hubei Province, Wuhan, China (Lai) Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Wang) Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China (Guo) Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Ma) Department of Cardiovascular Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Yan) Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (Wang) Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wan, Wei) Division of Cardiovascular Surgery, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.; Hubei Engineering Research Center for Diagnostic and Therapeutic Equipment in Precision Cardiovascular Surgery, Wuhan, China.; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences; Organ Transplantation Clinical Medical Research Center of Hubei Province, Wuhan, China. Abstract Background Septal myectomy is the gold standard treatment for drug-refractory obstructive hypertrophic cardiomyopathy (oHCM). However, conventional septal myectomy (CSM) has been largely confined to specialized centers owing to its technical complexity. Transapical beating-heart septal myectomy (TA-BSM) can simplify CSM, enabling minimally invasive tailored septal resections in the beating heart under real-time echocardiographic guidance. Despite single-institution experience showed favorable efficacy and safety, whether TA-BSM can achieve similar clinical outcomes as CSM remains unknown since randomized controlled trial comparing the two approaches was unavailable. Methods The TAILOR-HCM trial (Transapical Beating-Heart Septal Myectomy versus Conventional Surgical Myectomy in Patients with Obstructive Hypertrophic Cardiomyopathy) is a multicenter, randomized, controlled, assessor-blinded, noninferiority trial evaluating the safety and efficacy of a novel device-based TA-BSM procedure conducted at 11 experienced CSM centers in China. In total, 216 symptomatic patients with oHCM who meet guideline-directed indications for septal myectomy will be randomly assigned in a 1:1 ratio to TA-BSM or CSM. The primary endpoint is relief of left ventricular outflow tract (LVOT) obstruction at 12 months, defined as a resting LVOT gradient <30 mm Hg and a standardized Valsalva maneuver-provoked LVOT gradient <50 mm Hg. Secondary endpoints include cardiac hemodynamic and structural parameters, procedure-related outcomes, quality of life, and laboratory examinations. The key safety outcome is all-cause mortality within 12 months after surgery. Conclusions TAILOR-HCM is the first multicenter randomized controlled trial evaluating both TA-BSM and CSM in oHCM. Through comparative evidence against CSM, this study will inform future clinical decision-making. If noninferior hemodynamic efficacy with favorable safety is confirmed, TA-BSM may represent an alternative surgical approach that expands therapeutic options and improves access to definitive septal reduction therapy for patients with oHCM. Copyright © 2026. Published by Elsevier Inc. <101> Accession Number 2047831488 Title Intraoperative Molecular Imaging in Thoracic Oncology: Expanding the Observable Disease Space. Source Cancers. 18(14) (no pagination), 2026. Article Number: 2220. Date of Publication: 01 Jul 2026. Author Marostica E.; Singhal S. Institution (Marostica, Singhal) Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Intraoperative molecular imaging (IMI) enables real-time visualization of tumor biology during surgery using fluorescent probes and near-infrared imaging systems. As lung cancer screening increases detection of small and nonpalpable pulmonary nodules, conventional localization and margin assessment techniques remain limited, particularly during minimally invasive surgery. This review summarizes the technical foundations, imaging agents, clinical applications, and future directions of IMI in thoracic oncology. Method(s): We performed a narrative review to synthesize current evidence regarding the technical foundations, molecular imaging agents, clinical applications, and future directions of intraoperative molecular imaging in thoracic oncology. Given the multidisciplinary scope of the field, a narrative approach was selected to integrate mechanistic, translational, and clinical evidence rather than to answer a single narrowly defined clinical question. Result(s): IMI generates dynamic intraoperative contrast based on preferential probe accumulation or activation within malignant tissue. Current approaches include non-specific fluorophores such as indocyanine green, activatable probes targeting tumor-associated proteases or acidic microenvironments, and receptor-targeted agents such as pafolacianine. Across prospective studies and multicenter trials, IMI improved localization of nonpalpable lesions, identified occult synchronous malignancies, and enhanced intraoperative margin assessment, frequently altering surgical management. Phase 2 and 3 studies of folate receptor-targeted imaging demonstrated clinically significant findings in a substantial proportion of patients, including lesions not detected by conventional imaging or palpation. However, performance remains dependent on tumor biology, target expression, lesion depth, and optical constraints. Conclusion(s): IMI represents an emerging transition from anatomy-guided toward biology-informed thoracic surgery by providing real-time molecular information during resection. Current evidence supports its role as a complementary intraoperative technology that augments conventional imaging and surgical techniques, particularly for small, peripheral, and nonpalpable lesions. Copyright © 2026 by the authors. <102> Accession Number 651802659 Title Invited Review: Are the Floodgates Opening? New Indications for TAVI for Asymptomatic Severe and Moderate Aortic Stenosis. Source Seminars in thoracic and cardiovascular surgery. (no pagination), 2026. Date of Publication: 21 Jul 2026. Author Fontana G.P.; Ganapathi A.M. Institution (Fontana, Ganapathi) Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, CA, United States Abstract Transcatheter aortic valve implantation (TAVI) has significantly expanded the access to aortic valve replacement in numerous populations as well as increased the overall volume of aortic valve replacement since its approval. Beyond its use for symptomatic, severe aortic stenosis, the emergence of new data regarding the importance of cardiac damage has led to exploration of the use of TAVI in patients with asymptomatic, severe aortic stenosis and those with moderate aortic stenosis. Data have demonstrated a potential benefit of TAVI in patients, with asymptomatic, severe aortic stenosis, particularly with respect to rehospitalization, however the data are less complete for patients with moderate aortic stenosis, which is the subject of multiple ongoing randomized trials. This review will provide a current overview of the data surrounding the use of TAVI in these two populations as well as explore the future directions of TAVI use in these patients. Copyright © 2026. Published by Elsevier Inc. <103> Accession Number 651799008 Title Systematic Review of Acute Coronary Artery Revascularization During Pregnancy. Source The American journal of cardiology. (no pagination), 2026. Date of Publication: 20 Jul 2026. Author Basala T.R.; Mutlu D.; Romano E.; Wanar A.; Carvalho P.; Rangan B.V.; Sandoval Y.; Sharkey S.W.; Saxena R.; Brilakis E.S. Institution (Basala) The Center for Coronary Artery Disease, Minneapolis Heart Institution Foundation and Minneapolis Heart Institute, Minneapolis, MN, USA; The University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: https://twitter.com/ThomasBasala (Mutlu, Carvalho, Rangan, Sandoval, Brilakis) Center for Coronary Artery Disease, Minneapolis Heart Institution Foundation and Minneapolis Heart Institute, Minneapolis, MN, United States (Romano, Wanar) University of Michigan Medical School, Ann Arbor, MI, United States (Sharkey, Saxena) Penny Anderson Women's Cardiovascular Center, Minneapolis Heart Institution Foundation and Minneapolis Heart Institute, Minneapolis, MN, United States Abstract Acute coronary syndrome during pregnancy is rare but its incidence may rise in the future due to increasing rates of cardiovascular risk factors in young adults. Little is known about revascularization strategies and outcomes among pregnant patients. Therefore, we performed a systematic search of published cases of coronary revascularization during pregnancy with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. A total of 60 cases of PCI (n=42) and CABG (n=19) were included (1 case with both). The median age at presentation was 33 [31,38] years. The median gestational age was 22 [12,32] weeks. Most patients presented in the third trimester (38%). The most common cardiovascular and obstetric risk factors included hypertension (23%), previous (44%) and current tobacco use (34%), and advanced maternal age (37%). Patients most commonly presented with ST-elevated myocardial infarction (63%) and lesions in the left anterior descending artery (72%). The overall procedural complication rate was 11.7% (95% CI 4.8% to 22.6%) for all cases, 16.7% (7.0% to 31.4%) for PCI, and 5.3% (0.1% to 26.0%) for CABG. The overall rate of successful delivery was 83.3% (95% CI 68.6% to 93.0%), with most pregnancies resulting in cesarean deliveries (69%). In conclusion, this systematic review of published cases of coronary artery revascularization during pregnancy found low rates of procedural complications and high rates of successful deliveries. Hypertension, tobacco use, and advanced maternal age were common risk factors preceding presentation. Copyright © 2026 Elsevier Inc. All rights reserved. <104> Accession Number 651805619 Title Endoscopic versus open radial artery harvesting for coronary artery bypass grafting: an updated systematic review, meta-analysis, and GRADE assessment. Source BMC cardiovascular disorders. (no pagination), 2026. Date of Publication: 21 Jul 2026. Author Qazi T.I.; Malik A.A.; Khan M.; Yahya M.; Asad Y.; Idrees S.; Gull M.U.; Khan A.; Munir F.; Khan A.S.; Sadaqat A.; Amjad M.M.; Kotak P.; Rauf M.A.A.; Rehman S.; Yasir M.; Khattak M.H.; Batool A.; Khan H.W.; Khan B.W. Institution (Qazi, Yahya, Gull, Khan, Amjad, Khattak, Khan) Department of Medicine, Khyber Medical College, KPK, Peshawar, Pakistan (Malik, Khan, Asad) Department of Medicine, United Medical and Dental College, Karachi, Sindh, Pakistan (Idrees) Department of Medicine, Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan (Munir) Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Sindh, Pakistan (Khan) Department of Medicine, Plovdiv Medical University, Plovdiv, Bulgaria (Sadaqat) Department of Curative Medicine, Faculty of Medicine, Kateb University, Kabul, Afghanistan (Kotak) Department of Medicine, Liaquat University of Medical and Health Sciences, Sindh, Pakistan (Rauf) Department of Medicine, Abbottabad International Medical College, KPK, Abbottabad, Pakistan (Rehman) Department of Medicine, Government General Hospital Faisalabad, Faisalabad, Punjab, Pakistan (Yasir) Department of Medicine, Ayub Medical College, KPK, Abbottabad, Pakistan (Khan) Department of Surgery, King Edward Medical University, Lahore, Punjab, Pakistan (Batool) Department of Medicine, Sir Syed College of Medical Sciences, Karachi, Sindh, Pakistan (Khan) Department of Surgery, Ayub Teaching Hospital, KPK, Abbottabad, Pakistan Abstract BACKGROUND: Endoscopic radial artery harvesting (ERAH) is a minimally invasive alternative to open radial artery harvesting (ORAH) for coronary artery bypass grafting (CABG), though concerns persist regarding graft patency and neurological outcomes. METHOD(S): PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 21, 2026. Randomized controlled trials and propensity-matched observational studies were included. Risk of bias was assessed using ROB 2 and the Newcastle-Ottawa Scale; certainty of evidence was evaluated using GRADE. Pooled risk ratios and mean differences with 95% confidence intervals were calculated using a random-effects model. RESULT(S): ERAH significantly reduced wound complications (RR = 0.61, 95% CI: 0.39-0.96) and wound infections (RR = 0.57, 95% CI: 0.35-0.93), though this benefit did not persist in RCT-only analysis. Neurological complications were reduced after sensitivity analysis (RR = 0.44, 95% CI: 0.34-0.57). Graft patency was comparable (RR = 1.01, 95% CI: 0.90-1.14), with no significant differences in mortality, MACCE, or myocardial infarction. Observational data showed modest reductions in cardiopulmonary bypass time and hospital stay. CONCLUSION(S): ERAH demonstrates comparable graft patency and major clinical outcomes to ORAH. Donor-site benefits suggested by observational studies are not consistently supported by randomized evidence. Large trials with standardized outcomes and long-term follow-up are needed. TRIAL REGISTRATION: PROSPERO, CRD420261334767. Copyright © 2026. The Author(s). <105> Accession Number 651804198 Title Frailty in patients undergoing video-assisted thoracoscopic surgery for lung cancer: a narrative review of assessment, outcomes and prehabilitation. Source World journal of surgical oncology. (no pagination), 2026. Date of Publication: 21 Jul 2026. Author Xu Y.; Cao M.; Liu Y.; Li X.; Zhang Q. Institution (Xu, Cao, Liu) Second Affiliated Hospital of Shandong First Medical University, Shandong Academy of Medical Sciences, No. 706 Taishan Street, Shandong, China (Li) Thoracic Surgery Department of The First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Suzhou, Jiangsu, China (Zhang) Second Affiliated Hospital of Shandong First Medical University, Shandong Academy of Medical Sciences, No. 706 Taishan Street, Shandong, China Abstract BACKGROUND: Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk. METHODS AND MAIN FINDINGS: This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature. CONCLUSION(S): Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery. Copyright © 2026. The Author(s). <106> Accession Number 2047815704 Title Evolocumab in Patients With Prior Percutaneous Coronary Intervention and No Prior Myocardial Infarction: Results From the VESALIUS-CV Trial. Source Circulation. 154(1) (pp 28-36), 2026. Date of Publication: 07 Jul 2026. Author Bergmark B.A.; Bohula E.A.; Marston N.A.; Park J.-G.; Kuder J.F.; Murphy S.A.; De Ferrari G.; Leiter L.A.; Nicolau J.C.; Averkov O.; Charng M.-J.; Ebenbichler C.; Erglis A.; Gouni-Berthold I.; Montalescot G.; Nicholls S.J.; Sigurdsson A.; Sinnaeve P.R.; Slapikas R.; Tsioufis K.; Verma S.; Viigimaa M.; Bhatia A.; Xin L.; Walsh E.; Ohman E.M.; Giugliano R.P.; Sabatine M.S. Institution (Bergmark, Bohula, Marston, Park, Kuder, Murphy, Giugliano, Sabatine) TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States (De Ferrari) University of Turin, Turin, Italy (Leiter, Verma) St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (Nicolau) Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (Averkov) Pirogov Russian National Research Medical University, Moscow, Russian Federation (Charng) Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan, Taipei, China (Ebenbichler) Innsbruck Medical University, Innsbruck, Austria (Erglis) Pauls Stradins Clinical University Hospital, University of Latvia, Riga (Gouni-Berthold) Center for Endocrinology, Diabetes, and Preventive Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany (Montalescot) ACTION Study Group, Sorbonne University, AP-HP, Hopital Pitie-Salpetriere, Paris, France (Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC, Australia (Sigurdsson) University of Iceland, Reykjavik, Iceland (Sinnaeve) University Hospitals Leuven and KU Leuven, Leuven, Belgium (Slapikas) Lithuanian University of Health Sciences, Kaunas, Lithuania (Tsioufis) National and Kapodistrian University of Athens, Athens, Greece (Verma) University of Toronto, Toronto, ON, Canada (Viigimaa) North Estonia Medical Centre, Tallinn University of Technology (M.V.). (Bhatia, Xin, Walsh, Ohman) Amgen, Inc (A.B., L.X., E.W., E.M.O.) Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - The clinical benefit of intensive LDL cholesterol (LDL-C) lowering with evolocumab in patients with prior percutaneous coronary intervention (PCI) but without a prior myocardial infarction (MI) is not established. METHOD(S): - VESALIUS-CV (The Effect of Evolocumabin Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke) randomized patients with atherosclerosis or high-risk diabetes but without prior MI or stroke and with LDL-C >=90 mg/dL to evolocumab versus placebo. The median follow-up was 4.6 years. The dual primary end points were coronary heart disease death, MI, or ischemic stroke (3-point major adverse cardiovascular event [MACE]) and the same composite plus ischemia-driven revascularization (4-point MACE). For this prespecified subgroup analysis, patients were categorized by whether they had undergone PCI at any time before trial enrollment. RESULT(S): - Among 12 257 randomized patients, 3627 (29.6%) had undergone prior PCI with a median time between PCI and enrollment of 4 years. Their median age was 66 years, and 30.7% were women. The median LDL-C in a lipid substudy at 48 weeks was 41.5 (26.0-67.0) mg/dL versus 107.0 (84.0-135.0) mg/dL in the evolocumab versus placebo arms (P<0.0001). Evolocumab reduced the relative rate of 3-point MACE by 30% (5-year Kaplan-Meier rates 7.0% versus 9.5%; hazard ratio [HR], 0.70 [95% CI, 0.56-0.89]; P=0.004) and 4-point MACE by 18% (17.9% versus 21.7%; HR, 0.82 [95% CI, 0.71-0.96]; P=0.012) as well as both MI by 50% (3.0% versus 6.1%; HR, 0.50 [95% CI, 0.36-0.70]; P<0.001), with the effect apparent as soon as 6 months after randomization, and urgent coronary revascularization by 39% (HR, 0.61 [95% CI, 0.46-0.80]; P<0.001). There were nominally lower rates of cardiovascular death (2.6% versus 3.7%; HR, 0.66 [95% CI, 0.45-0.96]; P=0.030) and all-cause death (8.2% versus 10.2%; HR, 0.76 [95% CI, 0.60-0.95]; P=0.016) with evolocumab. CONCLUSION(S): - Evolocumab reduced the risk of major cardiovascular events in stable patients with prior PCI but no MI. These findings support intensive LDL-C lowering in patients who have undergone PCI even in the absence of prior MI. REGISTRATION: - URL: https://www.clinicaltrials.gov; Unique identifier: NCT03872401. Copyright © 2026 American Heart Association, Inc. <107> Accession Number 2047828183 Title Robotic Thoracic Surgery After Neoadjuvant Chemo-Immunotherapy for NSCLC: A Narrative Review. Source Cancers. 18(14) (no pagination), 2026. Article Number: 2365. Date of Publication: 01 Jul 2026. Author Casiraghi M.; Mazzella A.; Girelli L.; Lo Iacono G.; Bertolaccini L.; Chiari M.; Caffarena G.; Bardoni C.; Spaggiari L. Institution (Casiraghi, Mazzella, Girelli, Lo Iacono, Bertolaccini, Chiari, Caffarena, Bardoni, Spaggiari) European Institute of Oncology (IEO) IRCCS, Department of Thoracic Surgery, Milan, Italy (Casiraghi, Bertolaccini, Spaggiari) Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: The integration of neoadjuvant and perioperative chemo-immunotherapy (CT-IO) has significantly reshaped the treatment of resectable non-small-cell lung cancer (NSCLC), improving pathological response and survival outcomes. However, its impact on surgical management-particularly robotic-assisted thoracic surgery (RATS)-remains incompletely defined. This review provides a practical overview of current evidence and technical considerations for robotic lung resection following neoadjuvant chemo-immunotherapy. Method(s): A narrative review of the literature was performed, focusing on phase III trials, meta-analyses, and surgical series reporting perioperative, oncological, and technical outcomes of minimally invasive-especially robotic-approaches after neoadjuvant or perioperative chemo-immunotherapy. Result(s): Randomized trials have established CT-IO as a standard treatment option for selected patients with resectable stage II-III NSCLC-although the specific standard varies according to stage, molecular and PD-L1 status, and regulatory approval-significantly improving pathological complete response and event-free survival. However, immune-related fibrosis, nodal scarring, and altered tissue planes increase surgical complexity and intra-postoperative complications. Available evidence, largely retrospective and derived from selected patient populations treated at experienced centers, suggest that RATS is feasible and safe, offering enhanced visualization and dexterity that may facilitate dissection in challenging post-induction settings. Vascular management and lymph node dissection remain critical technical aspects, and early conversion to open surgery, when required, should be regarded as an appropriate safety strategy rather than a complication. Conclusion(s): RATS after neoadjuvant chemo-immunotherapy appears feasible and promising in selected patients treated at experienced centers, but current evidence does not yet establish it as the preferred approach for all patients. Careful patient selection, adherence to oncological principles, and surgeon experience are essential. Prospective data are needed to define optimal surgical timing and standardize techniques. Copyright © 2026 by the authors. <108> Accession Number 2047816509 Title One-Year Outcomes of High-Risk Percutaneous Coronary Interventions With Versus Without Mechanical Circulatory Support: Propensity Score-Matched Analysis. Source Catheterization and Cardiovascular Interventions. (no pagination), 2026. Date of Publication: 2026. Author Gasecka A.; Pietrasik A.; Pawlowski T.; Zimodro J.M.; Ciesla D.; Sacha J.; Grygier M.; Kochman J.; Tajstra M.; Dyrbus K.; Wojakowski W.; Mizia-Stec K.; Swiatkowski A.; Francuz P.; Kalarus Z.; Smolka G.; Gasior M. Institution (Gasecka, Pietrasik, Zimodro, Kochman) 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (Pawlowski) National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland (Ciesla) Department of Science and New Technologies, Silesian Center for Heart Diseases, Zabrze, Poland (Sacha) Department of Cardiology, University Hospital in Opole, Opole, Poland (Sacha) Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland (Grygier) 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland (Tajstra, Dyrbus, Gasior) 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland (Wojakowski) Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (Mizia-Stec) 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland (Swiatkowski, Francuz, Kalarus) Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland (Smolka) Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Publisher John Wiley and Sons Inc Abstract Background: Impella is increasingly used as mechanical circulatory support (MCS) during high-risk percutaneous coronary interventions (HR-PCI). Registry-based data provide insights into the efficacy and safety of Impella-assisted HR-PCI. Aim(s): We aimed to evaluate 1-year outcomes of Impella-assisted HR-PCI compared to HR-PCI without MCS. Method(s): One hundred and thirty-eight patients undergoing Impella-assisted PCI, included in the IMPELLA-PL registry, were propensity score-matched with controls from the retrospective CardioSilesia registry who underwent HR-PCI without MCS. Study endpoints included 1-year post-discharge all-cause mortality, myocardial infarction (MI), stroke, rehospitalization for heart failure (HF), and repeat coronary revascularization. Result(s): Clinical and angiographic characteristics were comparable in both groups, with higher rates of dyslipidemia (78.3% vs. 37.7%, p < 0.001), chronic kidney disease (39.9% vs. 16.7%, p < 0.001), and peripheral artery disease (34.1% vs. 8.0%, p < 0.001) in the IMPELLA-PL cohort. Intravascular ultrasound was more frequently used in the Impella-supported patients (44.2% vs. 25.4%, p = 0.002), while staged revascularization was more common among controls (30.4% vs. 15.9%, p = 0.007). At 1 year, rates of post-discharge all-cause mortality, stroke, and repeat coronary revascularization were similar in both groups. MI was less frequent in the IMPELLA-PL cohort (1.4% vs. 10.9%, p = 0.003), alongside a trend toward lower incidence of rehospitalizations for HF (9.4% vs. 18.1%, p = 0.055). Conclusion(s): Despite an unfavorable cardiovascular risk profile, patients who underwent Impella-assisted HR-PCI had similar 1-year post-discharge survival, with a lower rate of MI, compared to propensity score-matched controls who underwent HR-PCI without MCS. Impella may improve HR-PCI outcomes in selected patients, but further randomized controlled trials are required to confirm this finding. Copyright © 2026 Wiley Periodicals LLC. <109> Accession Number 2047862754 Title Perioperative sleep management in cardiac surgery: an evidence-oriented narrative review of pharmacological, behavioral, and respiratory support strategies. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1853937. Date of Publication: 2026. Author Kong B.; Yang Y.; Song M.; Yan M.; Meng Y. Institution (Kong, Yang, Song, Yan, Meng) Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Publisher Frontiers Media SA Abstract Perioperative sleep disturbance is a common problem in patients undergoing cardiac surgery. It may manifest as reduced sleep quality, impaired sleep continuity, and disrupted sleep architecture, and may be associated with postoperative delirium, cognitive decline, and delayed recovery. As an evidence-oriented narrative review, this article summarizes pharmacological interventions, behavioral therapies, and respiratory support strategies for perioperative sleep management in cardiac surgery. Current evidence suggests that melatonin and its receptor agonists may help regulate circadian rhythms and improve subjective sleep quality, but their effects on outcomes such as delirium, length of hospital stay, and objective sleep architecture remain inconsistent. Dexmedetomidine has sedative properties resembling non-rapid eye movement sleep; however, findings across studies are inconsistent, and hemodynamic adverse effects require careful attention. Although GABAergic hypnotics may shorten sleep latency, they may increase the risk of respiratory depression, delirium, and adverse cognitive events. Behavioral interventions and environmental optimization are generally feasible, but much of the supporting evidence comes from patients with chronic insomnia, general surgical populations, or ICU settings; therefore, extrapolation to perioperative cardiac surgical patients should be cautious. CPAP, BiPAP, and high-flow nasal cannula oxygen therapy mainly improve oxygenation and reduce respiratory support requirements, whereas their direct sleep-related benefits remain unclear. Overall, risk-stratified multimodal sleep management is clinically rational, but large-scale, multicenter studies are still needed to further clarify its efficacy, safety, and applicable patient populations. Copyright © 2026 Kong, Yang, Song, Yan and Meng. <110> Accession Number 2047897606 Title Clinical Effectiveness of Acute Normovolemic Hemodilution in Cardiac Surgery: A Systematic Review and Meta-analysis. Source Anesthesia and Analgesia. (no pagination), 2026. Date of Publication: 2026. Author Elfiki M.; Elfeky A.; Ali M.S.; Ibrahim A.; Zayed M.; Fahmy El-Nemr A.; Elshahat A.; Hendawy A.A.; Sobhy A.; Mohamed A.E.; Elnady M. Institution (Elfiki, Elfeky, Ali, Ibrahim, Zayed, Hendawy) Faculty of Medicine, Menoufia University, Menofia, Egypt (Fahmy El-Nemr, Elshahat) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Sobhy, Elnady) Faculty of Medicine, Kafr Elsheikh University, Kafe Elsheikh, Egypt (Mohamed) Faculty of Medicine, Tanta University, Tanta, Egypt Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Acute normovolemic hemodilution (ANH) is endorsed by contemporary patient blood management guidelines as a cost-effective strategy for reducing allogeneic transfusion in cardiac surgery. However, evidence remains inconsistent due to protocol variability and limited statistical power in earlier trials. This systematic review and meta-analysis seek to evaluate the clinical effectiveness of ANH in adult patients undergoing cardiac surgery. METHOD(S): - A comprehensive search of four databases was performed up to October 2025 to identify randomized controlled trials (RCTs) and matched cohort studies comparing ANH with standard intraoperative care. The primary outcome of interest was the incidence of allogeneic red blood cell (RBC) transfusion. Data were pooled using DerSimonian-Laird random-effects models, expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULT(S): - Nineteen studies (15 RCTs, four cohorts) involving 9418 patients were included. ANH significantly reduced the incidence of allogeneic RBC transfusion compared with control (27.6% vs 31.5%; RR = 0.85, 95% CI [0.75-0.96], P = .01). The transfusion reduction was more evident in crystalloid-based protocols (RR = 0.72, 95% CI [0.54-0.96], P = .026) and on-pump surgeries (RR = 0.86, 95% CI [0.76-0.97], P = .01). Matched cohort analyses also confirmed the benefit (RR = 0.87, 95% CI [0.81-0.94], P = .001), whereas RCT-only analysis showed a nonsignificant difference (RR = 0.81, 95% CI [0.64-1.02], P = .07). No significant differences were found in hematocrit, hemoglobin, fresh frozen plasma transfusion, renal dysfunction, myocardial infarction, stroke, or mortality. CONCLUSION(S): - ANH significantly reduces the need for allogeneic transfusions while maintaining a favorable safety profile for patients undergoing cardiac surgery. Copyright © 2026 International Anesthesia Research Society <111> Accession Number 651802094 Title Treadmill Stress Test in Patients With Asymptomatic Severe Aortic Stenosis: A Prespecified Registry-Based Follow-Up of the EARLY TAVR Randomized Clinical Trial. Source JAMA cardiology. (no pagination), 2026. Date of Publication: 22 Jul 2026. Author Genereux P.; Schwartz A.; Lindman B.R.; Chhatriwalla A.; Ramee S.; Babaliaros V.; Schwartz R.; Sheth T.; Fearon W.F.; Sorajja P.; Beaver T.; Oldemeyer J.B.; Pop A.; Garcia S.; Southard J.; Bailey S.H.; Li W.; Cohen D.J.; Pibarot P.; Leon M.B. Institution (Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, United States (Schwartz, Leon) NewYork Presbyterian Hospital and the Columbia University Irving Medical Center, NY, United States (Lindman) Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, United States (Chhatriwalla) Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Ramee) John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States (Babaliaros) Emory University, Atlanta, Georgia (Schwartz) New York University Langone Hospital, Mineola, NY, United States (Sheth) Hamilton Health Sciences, Hamilton, ON, Canada (Fearon) Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States (Fearon) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States (Sorajja) Minneapolis Heart Institute Foundation, Minneapolis, MN, United States (Beaver) Division of Cardiovascular Surgery, University of Florida, Gainesville, United States (Oldemeyer) LovelandUnited States (Pop) Ascension Alexian Brothers Hospital, Elk Grove Village, IL, United States (Garcia) Christ Hospital, Cincinnati, OH, United States (Southard) University of California Davis Medical Center, Sacramento, Mexico (Bailey) Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, United States (Li) Edwards Lifesciences, Irvine, CA, United States (Cohen, Leon) Cardiovascular Research Foundation, NY, United States (Cohen) St Francis Hospital and Heart Center, Roslyn, NY, United States (Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada Abstract Importance: In patients with asymptomatic severe aortic stenosis (AS), exercise stress testing is recommended to unmask symptoms and guide the timing of intervention, yet it is infrequently used in clinical practice. This registry-based follow-up of the Evaluation of TAVR Compared to Surveillance for Patients With Asymptomatic Severe Aortic Stenosis (EARLY TAVR) trial evaluates how treadmill stress testing (TST), used during screening for EARLY TAVR to confirm asymptomatic status, informed subsequent aortic valve replacement and clinical outcomes. Objective(s): To evaluate clinical outcomes in patients with asymptomatic severe AS and a positive TST result and to identify predictors of a positive TST result. Design, Setting, and Participant(s): This prespecified TST registry of the EARLY TAVR trial involved 75 clinical sites across the US. Between July 2017 and December 2021, apparently asymptomatic patients with severe AS underwent standardized TST. Those with normal TST results were randomized to transcatheter aortic valve replacement or clinical surveillance, whereas those with positive TST results were invited to enroll in a prospective registry and were followed up with through 2 years. Of 1250 patients screened, 962 met trial criteria. Of these, 816 (84.8%) had a normal TST result and 146 (15.2%) had a positive TST result. Of these, 105 consented to enroll in the EARLY TAVR Treadmill Registry. Data were analyzed from August 2025 to January 2026. Exposure: Positive TST result. Main Outcomes and Measures: TST-related safety, 2-year all-cause mortality, and rates of subsequent aortic valve replacement (AVR). Baseline predictors of a positive TST result were identified using multivariable logistic regression models. Result(s): Of the 105 patients included in the present analysis, the mean (SD) age was 76.1 (6.5) years, and 80 participants (76.2%) were male. TST was found to be safe, with no reported deaths, syncope, or cardioversions. Multivariable baseline predictors of a positive TST included higher peak velocity, lower ejection fraction, prior coronary artery bypass, and prior stroke. The 2-year Kaplan-Meier rate for all-cause mortality was 5.7%. Among patients with positive TST results, the rates of AVR at 1 and 2 years were 79.9% and 85.9%, respectively. Rates of mortality and AVR were similar for patients who had a class I indication for AVR (symptoms during testing) and those with a class IIa indication (drop in systolic blood pressure). Conclusions and Relevance: In patients with asymptomatic severe AS, TST was found to be safe and identified symptoms and AVR indication in approximately 15% of patients. However, 20% of those patients remained untreated at 1 year, despite having an indication for prompt treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03042104. <112> Accession Number 2047955253 Title Thrombolytic therapy versus cardiac surgery for left-sided prosthetic heart valve thrombosis: A systematic review and meta-analysis. Source American Heart Journal Plus: Cardiology Research and Practice. 69 (no pagination), 2026. Article Number: 100849. Date of Publication: 01 Sep 2026. Author Bagheri B.; Eskandari S.; Soltani S.; Jalalian R.; Charati J.Y.; Moradi M.; Iranian M. Institution (Bagheri, Eskandari, Soltani, Jalalian) Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Charati, Moradi) Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Iranian) Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Elsevier Inc. Abstract Introduction: The optimal treatment of prosthetic heart valve thrombosis (PVT) remains vigorously debated in international guidelines. The present study was designed to compare the efficacy and safety of thrombolytic therapy and surgery in left-sided PVT, incorporating recent data to inform clinical decision-making. Method(s): This study is a systematic review with meta-analysis. We searched PubMed, Scopus, and Embase up to Jun 30, 2025. Eligible studies were those reporting treatment strategies and outcomes of patients with left-sided PVT. The primary outcome was treatment success (survival for surgery; complete or partial improvement of valve function and hemodynamic success not requiring surgery after thrombolysis). Result(s): 114 studies were included, representing 6514 patients with 6744 PVT episodes. The success rate in both treatment groups was the same: 83.9% (95% CI: 82.2-85.4; I2 = 19.8%) for thrombolysis versus 85.1% (95% CI: 83.3-86.7; I2 = 27%) for surgery (P-value = 0.607). The mortality rate was lower with thrombolysis (8.5%; 95% CI: 7.5-9.8; I2 = 0%) than surgery (15%; 95% CI: 13.4-16.8; I2 = 26.3%) (P-value = 0.001). Other secondary outcomes showed no significant differences. In the slow/very slow thrombolytic infusion subgroup analysis, the success rate was 91.4% (95% CI: 87-94; I2 = 44.9%) and the mortality was 2.1% (95% CI: 1.2-3.3; I2 = 0%). Conclusion(s): This systematic review suggests that fibrinolytics are a reasonable option alongside surgery for left-sided PVT, with similar success rates and lower mortality. However, due to observational evidence, results should be interpreted cautiously and randomized controlled trials (RCTs) are needed. Copyright © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <113> Accession Number 651791457 Title Echocardiographic findings for predicting new onset atrial fibrillation in critically ill patients: a systematic review. Source Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum, CCCF 2025. Toronto Canada. 73(1 Supplement) (pp S78-S79), 2026. Date of Publication: 01 May 2026. Author Melaku G.; Faisal A.; Amanda R.W.; Stephanie S. Institution (Melaku, Faisal, Stephanie) Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada (Amanda) Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada Publisher Springer Abstract INTRODUCTION AF is the most common arrhythmia seen in critically ill patients. The ability to predict which patients will develop NOAF could aid clinicians in reducing risk factors and prescribing prophylactic measures for patients at risk. Several prediction models have been developed that account for baseline risk factors, clinical characteristics, and biochemical markers, however, none account for acute cardiac structure and function. POCUS and echocardiography are commonly deployed for patients in the ICU and may provide additional predictive value. This systematic review sought to determine if there were POCUS or echocardiographic parameters that were associated with the development of NOAF and may have predictive utility. OBJECTIVES To evaluate echocardiographic or point of care ultrasound (POCUS) parameters which may predict new-onset atrial fibrillation (NOAF) in critically ill patients. METHODS A comprehensive search was performed on MEDLINE, Cochrane Library, and Embase from inception until July 10, 2024. All observational cohort studies of critically ill patients that measured echocardiographic or POCUS parameters and had the outcome of NOAF were included. Disease specific studies such as myocardial infarction, sepsis, respiratory failure/COVID, and post operative patients were also included if patients were admitted to an ICU. Studies of cardiac surgery patients were excluded. This systematic review was registered on PROSPERO (CRD42024564074) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Newcastle Ottawa scale was used for quality assessments. RESULTS Of 3859 articles identified, 13 studies with 13241 patients were included in this systematic review. Most studies were classified as high quality (12/13) and one as moderate quality. Patients with reduced ejection fraction had a 2.3 to 3.27 times higher risk of developing NOAF was compared to patients with preserved ejection fraction. Among patients who had mild functional mitral regurgitation (MR), moderate/severe MR, and MR the risk of developing NOAF was increased by 1.66, 2.39, and 1.8 times, respectively, compared to those without patients MR. Two studies revealed that the odds of developing NOAF were 2.3 and 11.5 times among patients who had left ventricular dysfunction. The studies found left atrial volume enlargement, increased left atrial systolic diameter, and inter-arterial desynchrony were associated with development of NOAF. CONCLUSION Echocardiography findings of reduced ejection fraction, left ventricular dysfunction, left atrial volume enlargement, and mitral regurgitation could be predictive of NOAF. Larger-scale studies with focus on the timing of echocardiography/POCUS are needed to further validate these findings. <114> Accession Number 2047812488 Title Beyond Surgical Access: Evidence Supporting a Multidimensional Concept of Surgical Invasiveness in Contemporary Cardiac Surgery. Source Journal of Cardiovascular Development and Disease. 13(7) (no pagination), 2026. Article Number: 315. Date of Publication: 01 Jul 2026. Author Poddi S.; Rungatscher A. Institution (Poddi, Rungatscher) Division of Cardiac Surgery, University of Verona Medical Center, Verona, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Minimally Invasive Cardiac Surgery (MICS) has traditionally been defined according to the extent of surgical access, primarily focusing on the avoidance of full sternotomy and the reduction in incision size. However, the rapid evolution of cardiac surgery, including technological innovation, robotic platforms, hybrid procedures, and enhanced perioperative management, has progressively challenged the adequacy of purely anatomical definitions of invasiveness. Contemporary surgical practice suggests that the overall impact of a procedure on the patient extends beyond the surgical incision itself and includes several physiological and patient-centered dimensions. This narrative review discusses the contemporary meaning of invasiveness in cardiac surgery and examines the limitations of conventional definitions of MICS based exclusively on surgical exposure. This narrative review is based on a non-systematic literature search of PubMed, Scopus, and Web of Science, and uses a thematic synthesis approach to explore the multidimensional concept of surgical invasiveness in cardiac surgery. Particular attention is given to the growing role of patient-centered outcomes and perioperative burden in defining procedural invasiveness. Building upon emerging conceptual perspectives in the literature, this review highlights a multidimensional interpretation of MICS, in which technical, physiological, and recovery-related factors collectively contribute to the assessment of surgical invasiveness. Copyright © 2026 by the authors. <115> Accession Number 2047812711 Title GLP-1 Receptor Agonists in Cardiac Surgery: From Metabolic Drug to Potential Perioperative Cardioprotective Agent. Source Journal of Cardiovascular Development and Disease. 13(7) (no pagination), 2026. Article Number: 305. Date of Publication: 01 Jul 2026. Author Androutsopoulou V.; Brecher V.; Xanthopoulos A.; Avgerinos D.V.; Athanasiou T.; Magouliotis D.E. Institution (Androutsopoulou) Department of Cardiothoracic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece (Brecher, Magouliotis) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Xanthopoulos) Department of Cardiology, Faculty of Medicine, University of Thessaly, Larissa, Greece (Avgerinos) Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece (Athanasiou) Department of Surgery and Cancer, Imperial College London, London, United Kingdom Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly evolved from glucose-lowering agents to central players in cardiovascular risk reduction. Evidence from landmark randomized controlled trials has established their capacity to reduce major adverse cardiovascular events, promote anti-inflammatory signaling, attenuate ischemia-reperfusion injury, and improve myocardial metabolic efficiency. As the prevalence of obesity, type 2 diabetes mellitus, and heart failure in the cardiac surgical population grows, GLP-1 RAs are increasingly encountered in the perioperative setting. Yet the cardiac surgery literature has yet to synthesize their emergent role coherently. This is a narrative review; no systematic review or meta-analysis was performed. This narrative review integrates mechanistic, clinical, and translational evidence to reframe GLP-1 RAs as potential perioperative cardioprotective agents in patients undergoing cardiac surgery. We examine receptor-level biology, evidence from the GLOBE randomized trial, observational data linking GLP-1 RA use to reduced postoperative atrial fibrillation after coronary artery bypass grafting, the rationale for the forthcoming REVERSE-TAVR trial, and evolving perioperative management guidelines. Key evidence gaps are identified, including the absence of prospective data in open cardiac surgery, aortic surgery, and high-acuity populations. We propose a research agenda and conceptual framework to guide future investigation into GLP-1 RAs as a new dimension of perioperative cardioprotection. The current evidence is hypothesis-generating; a definitive perioperative cardioprotective benefit has not yet been demonstrated in cardiac surgery populations, and these agents are presented here as potential rather than proven cardioprotective tools. Copyright © 2026 by the authors. <116> Accession Number 651791444 Title Safety of a single high-dose bolus of tranexamic acid in adult trauma patients: a systematic review. Source Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum, CCCF 2025. Toronto Canada. 73(1 Supplement) (pp S198-S200), 2026. Date of Publication: 01 May 2026. Author Desmeules F.; Miazga L.; Malo C.; Blanchard P.-G.; Mercier E.; Emond M.; Benhamed A. Institution (Desmeules, Miazga, Malo, Blanchard, Mercier, Emond) Departement de Medecine Familiale et de Medecine d'Urgence, Faculte de Medecine, Universite Laval, Quebec, Canada (Desmeules, Blanchard, Mercier, Emond) Departement d'Anesthesie et de Soins Intensifs, Faculte de Medecine, Universite Laval, Quebec, Canada (Blanchard, Mercier, Emond) Centre de recherche, CHU de Quebec-Universite Laval, Quebec, Canada Publisher Springer Abstract INTRODUCTION Tranexamic acid (TXA) has been shown to reduce 28-day mortality in trauma patients with significant haemorrhage. Current guidelines recommend an initial 1 g intravenous bolus followed by a 1 g infusion over 8 hours. However, some clinicians employ a single high-dose strategy (>= 2 g or >= 30 mg/kg) to reduce the risk of administration errors and omissions. While common in cardiac surgery, high-dose TXA remains understudied in trauma. Consequently, the efficacy and safety of single high-dose bolus of TXA in the trauma setting are not well established. OBJECTIVES To compare the efficacy (mortality) and safety (thromboembolic events, seizures, multiple organ dysfunction syndrome (MODS), hypersensitivity reactions, acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS)) of a single high-dose bolus of TXA (defined as >= 2 g or >= 30 mg/kg) versus the standard dosing regimen in trauma patients aged >= 16 years. METHODS A systematic review was conducted according to a pre-registered protocol (PROSPERO: CRD420250622669), following Cochrane and SIGN methodological guidance. MEDLINE, Embase, and CINAHL were searched for eligible studies, including randomized controlled trials (RCTs), observational studies, and case series published prior to November 20, 2024, without language restrictions. The primary outcome was mortality; secondary outcomes included the aforementioned adverse events. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using RoB 2, ROBINS-I, and the JBI Checklist. RESULTS Five studies (3 RCTs, 1 observational study, and 1 case series) comprising 1,681 patients were included. Of these, 77.5% sustained a blunt trauma. Mean age ranged from 26 to 40 years old, and the proportion of male participants ranged from 56% to 90%. High-dose TXA (>= 2 g or >= 30 mg/kg) did not demonstrate a mortality benefit compared to placebo or the standard protocol with mortality ranging from 0% to 21% across studies. One trial reported a higher incidence of thromboembolic events with doses up to 4 g (32% versus 12% in the placebo group (HR: 5.33 [95% CI: 1.94-14.63], p = 0.001)). This finding was not repeated in the other studies (n=4). Two studies reported higher occurrences of seizures in high-dose groups. No significant increases in MODS, AKI, or ARDS were observed and no hypersensitivity reactions were reported. Risk of bias across studies ranged from low to high. CONCLUSION Compared with the standard initial 1 g intravenous bolus followed by a 1 g infusion over 8 hours, a single high-dose bolus of TXA (>= 2 g or >= 30 mg/kg) in adult trauma patients does not appear to influence mortality but may be associated with an increased risk of thromboembolic events and seizures. Nonetheless, current evidence remains insufficient to confidently support the safety of this dosing strategy. Larger and methodologically robust studies are needed to better define the risk-benefit profile of this strategy. <117> Accession Number 651794319 Title Safety and Efficacy of Ticagrelor with Aspirin DAPT vs. Aspirin Alone in Patients Undergoing CABG Following ACS: A Systematic Review and Meta-Analysis. Source Cardiovascular & hematological disorders drug targets. (no pagination), 2026. Date of Publication: 17 Jul 2026. Author Mahajan K.; Dutta D.; Kamrul-Hasan A.B.M.; Mahajan N.; Sharma J.; Himral S.; Vohra S.; Pradhan A. Institution (Mahajan, Sharma, Himral) Department of Cardiology, Mandi, Himachal Pradesh, India (Dutta) Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India (Kamrul-Hasan) Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh (Mahajan) Department of Research Methodology, Translational Research and Data Science Consultant, Freelancer, St. Louis, United States (Vohra) Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, NY, United States (Pradhan) Department of Cardiology, King George Medical College, Lucknow, India Abstract BACKGROUND: It remains uncertain whether Dual Antiplatelet Therapy (DAPT) or aspirin alone is better for patients following Coronary Artery Bypass Grafting (CABG) post-Acute Coronary Syndrome (ACS). Currently available Systematic Reviews and Meta-Analyses (SRMA) are limited to the analysis of different combinations of DAPT across various clinical conditions of cardiovascular disease and are not restricted to CABG post-ACS. This SRMA aimed to evaluate the safety and efficacy of Ticagrelor with Aspirin (TA) versus aspirin alone in patients who underwent CABG following ACS. METHOD(S): Electronic databases were searched for studies involving patients who underwent CABG after ACS and received TA in the intervention arm versus aspirin in the control arm. The primary outcomes were death and major bleeding. The secondary outcomes were Composite Cardiovascular Outcomes (CCO), Myocardial Infarction (MI), stroke, saphenous vein graft patency, revascularization, and side effects. RESULT(S): Data from five studies (4 RCTs and one cohort study; 9,659 patients) were analysed. The risk of death [OR 1.18 (95% CI 0.60-2.28); P =0.63; I2=46%] and major bleeding [OR 1.65 (95% CI 0.95-2.86); P =0.07; I2=44%] was numerically higher with TA than with aspirin alone, although these differences were not statistically significant. Composite cardiovascular outcomes [OR 0.96 (95% CI 0.74-1.24); P=0.74; I2=0%], myocardial infarction [OR 0.99 (95% CI 0.67- 1.46); P =0.94; I2=0%], stroke [OR 0.60 (95% CI 0.33-1.08); P =0.09; I2=0%], saphenous vein graft patency [OR 1.75 (95% CI 0.93-3.27); P =0.08; I2=75%], and revascularisation [OR 1.21 (95% CI 0.46-3.15); P =0.70; I2=49%] were similar between the two groups. DISCUSSION(S): These findings suggest that the theoretical advantage of intensified platelet inhibition with ticagrelor-based DAPT does not translate into improved clinical outcomes in patients undergoing CABG after ACS. The pathophysiology of graft failure, which is often driven by technical factors and progressive atherosclerosis rather than platelet-mediated thrombosis alone, may partly explain the absence of additional benefit from potent dual antiplatelet therapy. At the same time, the observed numerical increase in bleeding events highlights the potential trade-off associated with more aggressive platelet inhibition in the postoperative setting. CONCLUSION(S): In patients undergoing CABG following ACS, ticagrelor-aspirin DAPT does not confer significant improvement in ischemic outcomes compared with aspirin monotherapy and may increase bleeding risk. Aspirin alone appears to provide comparable protection, supporting its continued role as the cornerstone of antiplatelet therapy after surgical revascularization. Nevertheless, antiplatelet therapy after CABG should be individualised according to each patient's ischaemic/thrombotic and bleeding risk rather than applied uniformly. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net. <118> Accession Number 2047743566 Title AI-WAR: a novel warfarin management software with a bidirectional LSTM dosing model improves time in therapeutic range. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1750503. Date of Publication: 2026. Author Li Y.; Xu N.; Song L.; Liu Y.; Pei Q.; Kuang Y.; Yang G. Institution (Li, Liu, Kuang, Yang) Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China (Xu, Yang) Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, China (Song) Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China (Pei) Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China Publisher Frontiers Media SA Abstract Background - Warfarin remains the preferred anticoagulant in patients after heart valve replacement. However, its narrow therapeutic window, substantial interindividual variability, and dependence on frequent INR monitoring make effective management challenging. The quality of anticoagulation in real-world practice is often suboptimal, particularly in primary care settings with limited resources. Methods - We developed an artificial intelligence-based warfarin management system (AI-WAR) integrating remote follow-up, systematic data management, and individualized dosing prediction models. A randomized controlled trial (n = 624) and a prospective registry study (n = 176) were used for model training, while an independent real-world cohort (n = 200) served for external validation. We compared anticoagulation quality and clinical outcomes between conventional management and AI-WAR, and evaluated prediction performance of long short-term memory (LSTM) and bidirectional LSTM (Bi-LSTM) models. Results - Compared with conventional management, AI-WAR significantly improved median TTR (48.7% vs. 81.3%, P < 0.001), increased time in target INR (36.3% vs. 61.9%, P < 0.001), and reduced both elevated INR percentage (12.0% vs. 16.8%) and overall adverse event rate (9.6% vs. 19.7%, P < 0.001). The Bi-LSTM model exhibited superior dose prediction accuracy (80.3% vs. 66.6%) and achieved 93.2% accuracy for stable dose prediction, while significantly reducing overdose predictions (11.9%, P < 0.001). Subgroup analyses demonstrated robust performance across different genotypes and in scenarios with missing genetic information. Conclusion - The integration of AI-WAR software and Bi-LSTM prediction models provides an effective and safe decision-support tool for warfarin individualized dosing. This system not only improves anticoagulation quality and reduces adverse events but also shows practical advantages in remote management and primary healthcare settings, supporting broader implementation of precision anticoagulation therapy. Copyright © 2026 Li, Xu, Song, Liu, Pei, Kuang and Yang. <119> Accession Number 651796659 Title Evaluation of the effect of Healing Touch on coronary artery bypass grafting recovery: A randomized controlled trial. Source Nursing. 56(8) (pp 49-55), 2026. Date of Publication: 01 Aug 2026. Author Klein B.; Wilson R.; Berndt J. Institution (Klein) St. Cloud, St. Cloud State University and Nursing Excellence Consultant, College of Saint Benedict/Saint John's University and Staff Nurse at St. Cloud Hospital, Bridget Klein is a Staff Nurse at St. Cloud HospitalMN and a Certified Healing Touch Practitioner and Instructor at Healing Beyond Borders. Roxanne Wilson is Professor of NursingCentraCare Research. Jodi Berndt is Associate Professor Abstract BACKGROUND: Healing Touch (HT) is used to provide holistic care, improve outcomes, and provide comfort. However, there is minimal published literature on its effects among inpatients undergoing coronary artery bypass grafting (CABG), who often experience anxiety, postoperative atrial fibrillation, and postoperative delirium. PURPOSE: To explore the effects of HT on preoperative and postoperative anxiety and postoperative rates of atrial fibrillation and delirium among patients who are having CABG surgery. METHOD(S): This randomized controlled trial collected data over 9 months at a 489-bed, level II trauma center and 5-time Magnet-designated hospital in the midwestern United States. A total of 111 HT sessions (37 preoperative and 74 postoperative) were provided to the 37 patients in the intervention group. The 42 control group participants received standard nursing care, including pharmacologic, nonpharmacologic, and educational interventions. Data collection included administering the Subjective Units of Distress Scale (SUDS) and conducting a retrospective chart review for postoperative atrial fibrillation rates and Confusion Assessment Method scores. Descriptive statistics, paired and unpaired sample t-tests, and chi-square tests were used for analysis. RESULT(S): Among the intervention group participants, patient-reported SUDS scores decreased after receiving an HT session (P < .01), indicating lower levels of anxiety and distress for both preoperative and postoperative phases. No statistically significant difference in the incidence of atrial fibrillation or delirium was found between the intervention and control groups. CONCLUSION(S): The study findings suggest that HT may be an effective intervention to reduce preoperative and postoperative anxiety among patients undergoing CABG surgery. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <120> Accession Number 2047812698 Title Right Atrial Cardiac Calcified Amorphous Tumors in Young Women: Two Case Reports and a Narrative Review of the Literature. Source Journal of Cardiovascular Development and Disease. 13(7) (no pagination), 2026. Article Number: 312. Date of Publication: 01 Jul 2026. Author Grande A.M.; Alloni A.; Imo D.; Ghio S.; Arbustini E.; Aseni P.; D'Armini A.M. Institution (Grande, Alloni, Imo, D'Armini) Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy (Ghio) Department of Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy (Arbustini) Centre for Inherited Cardiovascular Diseases and Transplant Research Area, IRCCS Fondazione Policlinico San Matteo, 27100, Pavia, Italy (Aseni) Department of Emergency Medicine, ASST GOM, Niguarda Hospital, 20162, Milan, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Cardiac calcified amorphous tumours (CATs) are rare non-neoplastic intracardiac masses characterized by calcified nodules within an amorphous fibrinous matrix and may clinically mimic thrombi or cardiac neoplasms. We report two uncommon cases of right atrial CAT occurring in young women and provide a narrative review of the literature. Method(s): Two patients with right atrial CAT underwent multimodality imaging evaluation, including echocardiography, computed tomography, and cardiac magnetic resonance, followed by surgical excision and histopathological examination. A narrative review of published cases identified through PubMed and Embase between 1972 and 2025 was also performed. Result(s): The first patient presented with a calcified right atrial mass extending into the superior vena cava, associated with superior vena cava syndrome and autoimmune disease. The second patient, affected by end-stage renal disease on hemodialysis and thrombophilia, presented with a large calcified right atrial mass associated with a retained dialysis catheter fragment. Histopathological examination confirmed CAT in both cases. The literature review identified 112 published reports comprising 143 patients, including the two cases presented herein, highlighting frequent associations with end-stage renal disease, mitral annular calcification, and embolic complications. Conclusion(s): Cardiac CAT remains a rare and likely underrecognized entity with heterogeneous clinical presentation and significant embolic potential. Multimodality imaging is essential for diagnosis and surgical planning, while early surgical excision should be considered in symptomatic or high-risk patients. Copyright © 2026 by the authors. <121> Accession Number 2047787442 Title Transseptal Access to the Left Atrium: A Narrative Review of Techniques, Indications, and Device Innovations. Source Life. 16(7) (no pagination), 2026. Article Number: 1179. Date of Publication: 01 Jul 2026. Author Rosu A.M.; Badea T.G.; Tomescu F.L.; Radu E.S.; Tanasescu M.-D.; Cismas E.G.; Popa O.A. Institution (Rosu, Radu, Popa) Prof. Dr. Agripa Ionescu Emergency Hospital, Department of Cardiology, Balotesti, Romania (Badea, Tomescu) Prof. Dr. Agripa Ionescu Emergency Hospital, Department of Radiology, Balotesti, Romania (Tomescu) Carol Davila University of Medicine and Pharmacy, Department of Radiology, Bucharest, Romania (Tanasescu) Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Department of Semiology, Bucharest, Romania (Cismas) "Sf. Ioan" Emergency Clinical Hospital, Department of Cardiology, Bucharest, Romania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Transseptal puncture (TSP) is a critical technique for accessing the left atrium in various structural and electrophysiological cardiac procedures. Originally introduced for diagnostic catheterization in the mid-20th century, it has evolved into a cornerstone of modern interventional cardiology. This article was designed as a targeted narrative review, rather than a systematic or comprehensive review, and synthesizes selected peer-reviewed evidence spanning 1955 to 2025, retrieved through a targeted literature search. We explore the anatomical foundations of TSP, its historical development, and modern refinements such as radiofrequency-assisted puncture, balloon septoplasty, and fluoroless or image-fusion-guided access. Clinical applications-including mitral valve interventions, left atrial appendage closure, and decompression during extracorporeal membrane oxygenation (ECMO)-are reviewed alongside safety considerations and complication management strategies. Advances in imaging modalities, including three-dimensional echocardiography and computed tomography, have enhanced precision and safety. Because of the narrative design, the review emphasizes clinical relevance, procedural applicability, and evidence synthesis without formal risk-of-bias scoring or quantitative evidence grading. Overall, TSP demonstrates a high success rate and low complication profile when performed with appropriate imaging and operator expertise. Ongoing innovation in technique and technology continues to expand its utility across cardiac disciplines. Copyright © 2026 by the authors. <122> Accession Number 651791581 Title The role of empiric inotrope use in high-risk cardiac patients undergoing sedation: a scoping review. Source Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum, CCCF 2025. Toronto Canada. 73(1 Supplement) (pp S217-S219), 2026. Date of Publication: 01 May 2026. Author Wannamaker R.; Jelani M.; Gouda P.; Kashur R. Institution (Wannamaker, Jelani, Gouda, Kashur) Department of Cardiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada (Gouda) Canadian Vigor Centre, University of Alberta, Edmonton, AB, Canada Publisher Springer Abstract INTRODUCTION Procedural sedation is commonly utilized in high-risk cardiac patients and critical care settings. Sedative agents are known to be myocardial depressants. They are frequently associated with adverse hemodynamic effects, including hypotension, shock, and can lead to cardiac arrest. Severe ventricular systolic dysfunction is a known risk factor for such complications. The role of prophylactic use of inotropic agents to prevent hemodynamic complications in high-risk patients undergoing procedural sedation remains unclear. OBJECTIVES This scoping review aims to summarize the current literature examining the utility of prophylactic inotrope use to prevent hemodynamic complications in patients with ventricular systolic dysfunction undergoing sedation/anesthesia. METHODS PubMed, MEDLINE, Embase, and Scopus databases were systematically searched through March 7, 2025, to identify studies examining the effects and outcomes of prophylactic inotrope use in patients with ventricular systolic dysfunction undergoing sedation/anesthesia. Data extracted from identified studies included echocardiographic findings, invasive and non-invasive hemodynamic parameters including mean arterial pressure (MAP) and blood pressure, cardiac index (CI), post-capillary wedge pressure (PCWP), and the need for vasoactive medications, along with post-operative complications and morbidity, intensive care (ICU) and hospital length of stay (LOS), and mortality at any time point. Due to studies of heterogeneity and quality limitations, no metanalysis was performed. RESULTS Sixteen studies were identified with 2460 total patients all under general anesthesia: a total of 11 clinical trials, 15 studies involved cardiac surgery, 13 of which used cardiopulmonary bypass (CPB) during surgery, and 1 study was a retrospective analysis of mitral valve repair in the cardiac catheterization laboratory. Cardiac dysfunction in these studies included any left ventricular dysfunction (14 studies), right ventricular dysfunction (1 study), and symptomatic mitral regurgitaiton (1 study). Levosimendan was the only inotrope commonly examined across studies. Levosimendan was associated with favorable hemodynamic effects including higher Cardiac Index and lower Pulmonary Capillary Wedge Pressure in 8 studies. In 8 studies, Levosimendan translated into improved clinical outcomes such as LOS and reduced organ dysfunction. Only 1 study found a difference in mortality with levosimendan (30-day mortality 0% vs. 41.7%, p=0.04). In the study identified outside of cardiac surgery (n=54), levosimendan was not associated with changes in echocardiographic or clinical outcomes. CONCLUSION The benefits of prophylactic inotrope use to prevent hemodynamic complications in patients with severe ventricular systolic dysfunction undergoing sedation and anesthesia remain unclear. Despite numerous studies demonstrating improved hemodynamics and clinical outcomes, no consistent mortality benefit was observed. Notably, prophylactic inotropes use in high-risk cardiac patients undergoing conscious sedation has not been studied. Further randomized controlled trials examining this question are recommended. (Figure presented). <123> Accession Number 651792196 Title Treatment of left main coronary artery disease: an unresolved question. Source European Heart Journal: Acute Cardiovascular Care. Conference: ESC Acute Cardiovascular Care 2026. Lisbon Portugal. 15(Supplement 1) (pp i208-i209), 2026. Article Number: zuag046.130. Date of Publication: 01 May 2026. Author Barahona P.; Costa D.; Lalli E.; Barbosa M.; Palacios R.; Jacome P.; Muzio M.; Coronel R.; Navia V.; Garcia J.; Paucar C.; Di Gregorio F.; Garibaldi S. Institution (Barahona, Costa, Lalli, Barbosa, Palacios, Jacome, Muzio, Coronel, Navia, Garcia, Paucar, Di Gregorio, Garibaldi) Sanatorio Sagrado Corazon, Buenos Aires, Argentina Publisher Oxford University Press Abstract Background: Atherosclerotic disease of the left main coronary artery (LMCA) is found in a considerable percentage of patients undergoing diagnostic coronary angiography. The optimal revascularization strategy for these lesions remains a topic of debate. Evidence over time has shown conflicting and opposing results regarding the best treatment approach for such patients. Among the most relevant studies to consider is the SYNTAX trial, which compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and found no significant difference in mortality among patients with LMCA disease. Similar findings were reported in the EXCEL study, which included only patients with LMCA lesions, whereas the NOBLE study demonstrated superior outcomes with CABG in terms of cardiovascular events during follow-up. For this reason, we aimed to conduct an analysis of patients undergoing different revascularization strategies within our own setting. Objective(s): The aim of this study was to describe the characteristics of the study population and the five-year survival of patients with LMCA disease treated with PCI or CABG. Material(s) and Method(s): A retrospective observational study was conducted, comparing a group of 213 patients treated for LMCA disease with a 5-year follow-up. Patients were divided into two groups: 96 patients underwent PCI and 117 underwent CABG. Clinical characteristics were obtained from electronic medical records, and follow-up was performed through both medical records and telephone calls. Events considered included all-cause mortality and acute myocardial infarction (AMI), both during hospitalization and in follow-up. An adjusted Cox model was used to compare events between groups, employing the likelihood ratio test. A p-value < 0.05 was considered statistically significant. All calculations were performed using R version 4.3.0. Result(s): The characteristics of both patient groups are shown in Table 1. Intravascular imaging techniques (IVUS) were used in 94.8% of PCI cases. The overall five-year mortality was 13.5% in the PCI group and 13.7% in the CABG group. Figure 1 (Panel A) shows the Kaplan-Meier survival curves. In the adjusted Cox model, no statistically significant difference was found for this outcome (HR 0.89, 95% CI 0.44-2.77, p=0.82). Conversely, the overall incidence of AMI during follow-up was 9.4% in the PCI group and 3.0% in the CABG group, as shown in Figure 1 (Panel B), with a statistically significant difference observed in the adjusted Cox model (HR 0.10, 95% CI 0.01-0.87, p = 0.037). Conclusion(s): The findings of our analysis are consistent with those of meta-analyses of randomised clinical trials, showing that the risk of death is similar between CABG and PCI in patients with LMCA disease, although PCI is associated with a higher long- term risk of myocardial infarction. (Table presented). (Figure presented). <124> Accession Number 651794308 Title Theoretical-Causal Validation of Risk Factors for the Nursing Diagnosis of Decreased Cardiac Output: A Systematic Review of the Literature with Meta-Analysis. Source International journal of nursing knowledge. (pp 20473087261460960), 2026. Date of Publication: 20 Jul 2026. Author Silva Junior J.A.D.; Silva A.B.; Lopes M.V.O.; Dos Santos IK.; Almeida D.R.Q.; Andrade C.M.; Fernandes T.A.A.M.; do Nascimento E.G.C. Institution (Silva Junior, Silva, Dos Santos, Almeida, Andrade, Fernandes, do Nascimento) Universidade do Estado do Rio Grande do Norte, Mossoro, Brazil (Lopes) Universidade Federal do Ceara, Fortaleza, Brazil Abstract PurposeThis systematic review aimed to identify risk factors related to decreased cardiac output in adults, thereby supporting the theoretical-causal validation of the nursing diagnosis Risk for Decreased Cardiac Output.MethodsA systematic review of etiology and risk was conducted in accordance with recognized guidelines, including meta-analysis of studies published between 1987 and 2024. Observational studies involving adult and older adult populations were selected from major electronic databases. Data extraction and quality appraisal were independently performed by multiple reviewers. Effect measures were synthesized using a random-effects model, with heterogeneity assessed across studies.FindingsSixty-three studies were included, the majority with cohort designs. Key risk factors identified for decreased cardiac output were lower body surface area and lower body weight, with advanced age and female sex recognized as significant risk population characteristics. Associated conditions contributing to elevated risk included a history of stroke, shock, emergency cardiac surgery, diabetes, renal and pulmonary diseases, lower ejection fraction, and heart failure. Methodological variability in cardiac output measurement and significant heterogeneity among studies were notable challenges.ConclusionsSeveral significant risk factors for decreased cardiac output were identified and classified, providing scientific support for the theoretical-causal validation process of this nursing diagnosis. Addressing study heterogeneity and standardizing measurement methods are recommended for future research.Implications for Nursing PracticeThe findings reinforce the clinical relevance of the nursing diagnosis Risk for Decreased Cardiac Output and highlight the need for tailored interventions by nursing professionals to prevent complications among at-risk cardiovascular patients. <125> Accession Number 2047760054 Title Sufentanil in Intensive Care: A Narrative Review. Source Journal of Clinical Medicine. 15(14) (no pagination), 2026. Article Number: 5684. Date of Publication: 01 Jul 2026. Author Gomez J.M.; Navarro P.; Mingote-Llado A.; Cardinal-Fernandez P. Institution (Gomez) Hospital General Universitario Gregorio Maranon, Madrid, Spain (Gomez, Navarro, Cardinal-Fernandez) School of Medicine, Universidad Camilo Jose Cela, Madrid, Spain (Mingote-Llado) School of Medicine, CEU San Pablo University, Madrid, Spain (Mingote-Llado) Altan Pharmaceuticals, Madrid, Spain (Cardinal-Fernandez) Intensive Care Unit, Torrelodones University Hospital, Madrid, Spain Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Modern intensive care paradigms prioritize optimal analgesia over heavy sedation. While morphine, fentanyl, and remifentanil are widely used, sufentanil is relatively unknown in several countries. Aimed primarily at intensive care physicians, this narrative review evaluates the utilization of sufentanil in critically ill adult patients across four fundamental dimensions: (1) translational pharmacology (chemical structure, pharmacokinetics, pharmacodynamics, and pharmacogenomics); (2) indications and safety precautions; (3) clinical evidence in ICU patients; and (4) therapeutic positioning in contemporary ICU analgosedation and future research directions. Method(s): A comprehensive literature search was conducted in PubMed/MEDLINE focusing on the translational pharmacology, safety parameters, and clinical studies of sufentanil critically ill adults. The synthesis was structured according to SANRA principles for high-quality narrative reviews and includes articles published up to February 2026. Result(s): Sufentanil exhibits an exceptionally high affinity for the micro-opioid receptor, providing a potency 10-fold greater than fentanyl and 1000-fold greater than morphine. It has an experimental therapeutic index (LD50/ED50) nearly two orders of magnitude wider than that of fentanyl, enabling safe, highly granular bedside titration. Unlike morphine, hepatic CYP3A4 biotransformation yields completely inactive metabolites, preventing toxic accumulation during acute kidney injury. Furthermore, receptor-binding dynamics suggest a lower propensity for recruiting beta-arrestins and activating NMDA pathways, potentially reducing opioid-induced hyperalgesia (OIH). Clinically, pilot trials in neurocritical cohorts demonstrate that sufentanil maintains reliable cerebral hemodynamic stability. In postoperative cardiac surgery and large ICU registries, sufentanil may reduce the mechanical ventilation duration, accelerate extubation, and shorten ICU length of stay. Conclusion(s): For critically ill adults, sufentanil is an excellent alternative to traditional opioids because it offers high-precision titratability, potent analgesia, and a safer metabolic profile. Copyright © 2026 by the authors. <126> Accession Number 2047832394 Title Pharmacologic Strategies for Intraoperative Hypotension When Ephedrine Is Unavailable: An Evidence-Based Review. Source Journal of Personalized Medicine. 16(7) (no pagination), 2026. Article Number: 384. Date of Publication: 01 Jul 2026. Author Duarte-Medrano G.; Nuno-Lambarri N.; Chavez-Munoz D.; Elguezabal Rodelo R.G.; Gonzalez-Chon O.; La Via L. Institution (Duarte-Medrano, Chavez-Munoz, Elguezabal Rodelo, Gonzalez-Chon) Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City, Mexico (Nuno-Lambarri) Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City, Mexico (Nuno-Lambarri) Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Escolar 411A, Copilco Universidad, Coyoacan, Mexico City, Mexico (La Via) Department of Anesthesia and Intensive Care 1, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Intraoperative hypotension (IOHs) affects up to 87% of patients under general anesthesia and is consistently associated with acute kidney injury, myocardial damage, stroke, and mortality. The intermittent unavailability of ephedrine across healthcare systems underscores the need for evidence-based alternatives. This review critically evaluates pharmacological options for IOH when ephedrine is unavailable, focusing on receptor pharmacodynamics, population-specific evidence, and clinical consequences of inadequately managed hypotension. Method(s): A narrative, evidence-based review was conducted examining mechanisms of action, dosing strategies, adverse effect profiles, and clinical applicability of key vasoactive agents: ephedrine, phenylephrine, norepinephrine, and epinephrine. Population-specific evidence across obstetric, pediatric, and elderly cohorts was synthesized from randomized controlled trials, meta-analyses, and observational studies. The clinical impact of IOH on neurological, cardiovascular, and renal outcomes was reviewed. Result(s): Each vasopressor exhibits a distinct receptor-selectivity profile that determines its hemodynamic effect and optimal clinical context. Norepinephrine's favorable alpha1/beta1 balance tends to preserve cardiac output better than pure alpha1-agonists and has emerged as a promising alternative in obstetric and elderly populations, although the optimal agent ultimately depends on the underlying mechanism of hypotension and individual patient characteristics. Epinephrine provides combined vasopressor and inotropic support for hypotension with myocardial depression. IOH is associated with a greater than twofold increase in postoperative AKI and significantly elevated risks of myocardial infarction and stroke, with outcomes driven by cumulative hypotensive exposure rather than isolated pressure nadirs. Conclusion(s): Effective management of IOH requires individualized vasopressor selection guided by underlying pathophysiology, cardiovascular profile, and surgical context. A physiology-based strategy-rather than protocol-driven drug substitution-enables anesthesiologists to achieve precise hemodynamic control and preserve end-organ perfusion even when ephedrine is unavailable. Copyright © 2026 by the authors. <127> Accession Number 2047810897 Title Transcatheter Aortic Valve Replacement in Patients Aged 65 Years and Younger: Unresolved Issues and Future Directions. Source Life. 16(7) (no pagination), 2026. Article Number: 1075. Date of Publication: 01 Jul 2026. Author Jelisejevas J.; Cioffi G.M.; Skalidis I.; Puricel S.; Husain A.; Wood D.A.; Akodad M.; Wenaweser P.; Meier P.; Togni M.; Cook S. Institution (Jelisejevas, Cioffi, Skalidis, Puricel, Wenaweser, Meier, Togni, Cook) Department of Cardiology, University and Hospital Fribourg, Chemin des Pensionnats 2-6, Fribourg, Switzerland (Husain) Sheikh Jaber Al-Ahmad Hospital, Kuwait City, Kuwait (Wood) Dilawri Cardiovascular Institute, Vancouver, BC, Canada (Akodad) Institut Cardiovasculaire Paris-Sud, Hopital Jacques Cartier, Massy, France Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Introduction: Transcatheter aortic valve replacement (TAVR) has become the predominant treatment for severe aortic stenosis across all surgical risk categories. However, its role in patients aged 65 years and younger remains uncertain, and current guideline recommendations continue to favor surgical aortic valve replacement (SAVR) in this population. Despite this, contemporary real-world data demonstrate a marked increase in TAVR utilization among younger patients, creating an important gap between guidelines and clinical practice. Method(s): This review synthesizes contemporary observational evidence evaluating TAVR in patients <=65 years, with a focus on patient selection, clinical outcomes, and lifetime management considerations. Result(s): Available studies demonstrate that younger patients undergoing TAVR often represent a highly selected and clinically complex population with greater comorbidity burden, higher surgical risk, and shorter life expectancy than age-matched SAVR recipients, yet substantial hospital-level variation in TAVR utilization exists even after risk adjustment. Mid-term observational data suggest higher mortality and heart failure readmission rates following TAVR compared with SAVR, although these findings are likely influenced by substantial baseline differences between treatment groups. No randomized controlled trial has specifically compared TAVR and SAVR in patients <=65 years. Furthermore, long-term issues including valve durability, coronary access, redo-TAVR feasibility, and THV optimization remain incompletely understood. Conclusion(s): TAVR recipients <=65 are often a clinically distinct group characterized by significantly heavier comorbidity burdens than SAVR recipients of the same age with standard surgical risk models possibly underestimating the true clinical risk. Despite this, significant hospital-level variation in TAVR utilization persists even after risk adjustment, suggesting that institutional practice patterns and other non-clinical factors continue to influence treatment selection. Copyright © 2026 by the authors. <128> Accession Number 2038396892 Title ENHANCED RECOVERY AFTER SURGERY (ERAS). Source International Journal of Medicine and Public Health. 16(3) (pp 612-616), 2026. Date of Publication: 01 Jul 2026. Author Kumar G.B.; Ramu P.; Rambabu S.P. Institution (Kumar, Rambabu) Department of General Surgery, Gandhi Medical College, Telangana, Secunderabad, India (Ramu) Department of General Surgery, Government Medical College, Telangana, Yadadribhuvangiri, India Publisher Pink Petals Publications Pvt Ltd Abstract Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway that aims to minimize the physiological stress of surgery, accelerate recovery, and improve patient outcomes. Objective(s): To review the current evidence on the principles, implementation, clinical outcomes, and future perspectives of ERAS across different surgical specialties. Material(s) and Method(s): A comprehensive literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Cochrane Library. Randomized controlled trials, systematic reviews, meta-analyses, and international guidelines published between 2015 and 2025, along with landmark studies, were reviewed. Data on ERAS interventions, postoperative outcomes, complications, hospital length of stay, readmission, mortality, and patient satisfaction were synthesized narratively. Result(s): The reviewed evidence consistently demonstrated that ERAS improves perioperative outcomes across multiple surgical specialties. Meta-analyses have shown reductions in postoperative complications, shorter hospital stays, decreased opioid use, earlier mobilization, faster return of bowel function, and lower healthcare costs without increasing readmission or mortality. The greatest benefits were observed in colorectal surgery, with increasing evidence supporting ERAS in gynecological, orthopedic, urological, hepatobiliary, thoracic, and cardiac procedures. Conclusion(s): ERAS is a safe, effective, and cost-efficient perioperative care model that enhances recovery and improves surgical outcomes. Successful implementation requires multidisciplinary collaboration, adherence to standardized protocols, and continuous quality improvement. Wider adoption of ERAS is expected to further improve patient care and healthcare efficiency. Copyright © 2026, Pink Petals Publications Pvt Ltd. All rights reserved. <129> Accession Number 2047812238 Title Update in Perioperative Ischemic Workup: Integrating 2024 AHA/ACC Guidelines and Contemporary Evidence. Source Journal of Cardiovascular Development and Disease. 13(7) (no pagination), 2026. Article Number: 309. Date of Publication: 01 Jul 2026. Author Mangano N.; Ganesan V.; Shibly Y.; Yu A.; Wang M.; Bergese S.D. Institution (Mangano, Ganesan, Shibly, Wang, Bergese) Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY, United States (Yu) Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Perioperative myocardial ischemia and myocardial injury after noncardiac surgery (MINS) remain prevalent contributors to postoperative morbidity and mortality. Recent advances, including high-sensitivity biomarkers and updated 2024 American Heart Association/American College of Cardiology (AHA/ACC) guidelines, have modified the clinical approach to preoperative ischemic evaluation. This review intends to synthesize contemporary evidence and provide a framework for perioperative ischemic workup. A narrative review of the current literature and major society guidelines was conducted, focusing on perioperative risk stratification, functional capacity assessment, biomarker utilization, noninvasive and invasive diagnostic modalities, and perioperative medical optimization strategies. Contemporary perioperative evaluation favors a stepwise, risk-based approach that uses clinical risk indices, functional capacity, and selective diagnostic testing. Biomarkers such as natriuretic peptides and cardiac troponins enhance risk prediction and enable the detection of MINS, which is strongly associated with increased mortality. Evidence does not support routine preoperative stress testing or prophylactic coronary revascularization in stable patients. Guideline-directed medical therapy, including sustained statin use and attentive management of antiplatelet and beta-blocker therapy, remains central to risk mitigation. Modern perioperative ischemic workup prioritizes individualized, evidence-based evaluation over routine testing. Integration of biomarkers, structured risk assessment, and multidisciplinary management may improve outcomes, though additional research is needed to define optimal strategies for detecting and treating MINS. Copyright © 2026 by the authors. <130> Accession Number 651791674 Title Impact of intermittent opioid injections versus continuous infusions in critically ill patients: a scoping review. Source Canadian Journal of Anesthesia. Conference: Critical Care Canada Forum, CCCF 2025. Toronto Canada. 73(1 Supplement) (pp S108-S110), 2026. Date of Publication: 01 May 2026. Author Stewart A.; Tajdari H.; Beaucage-Charron J.; Cheung A.; Burry L.; Williamson D. Institution (Stewart) Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada (Tajdari) Department of Biology, York University, Toronto, Canada (Beaucage-Charron) Pharmacy department, CIUSSS de l'Est-de-l'ile-de-Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada (Beaucage-Charron, Williamson) Faculty of Pharmacy, Universite de Montreal, Montreal, Canada (Beaucage-Charron) Centre de recherche de l'Hopital Maisonneuve-Rosemont, Montreal, Canada (Cheung, Burry) Department of Pharmacy and Medicine, Sinai Health, University of Toronto, Toronto, Canada (Williamson) Pharmacy department, CIUSSS du Nord-de-l'ile-de-Montreal, Sacre-Coeur Hospital, Montreal, Canada (Williamson) Centre de recherche CIUSSS NIM, Montreal, Canada Publisher Springer Abstract INTRODUCTION The introduction of an analgosedation framework in intensive care unit (ICU) PADIS guidelines has increased the utilization of opioids in critically ill patients by prioritizing pain relief over sedation. The current PADIS guidelines primarily focus on sedation strategies rather than recommendations for analgesic administration, particularly the optimal method of opioid delivery.1 Studies show approximately 50% of mechanically ventilated patients receive opioid infusions in the ICU.2 Continuous intravenous (IV) opioid infusions have very different pharmacokinetic properties compared to intermittent IV opioid injections, with prolonged context-sensitive half-lives that may lead to drug accumulation.3 This may result in over-sedation, prolonged mechanical ventilation or ICU stay and increased risk of delirium.4 OBJECTIVES The aim of this scoping review is to evaluate the existing literature on comparisons of continuous opioid IV infusion versus intermittent IV dosing in patients admitted to the ICU. It sought to address the current gap in guidance by exploring effectiveness, safety and clinical outcomes associated with each approach. This review adds to the literature by offering insight into a more conservative approach to ICU analgesia. METHODS This scoping review followed the PRISMA-ScR guideline. A systematic search was performed on August 14, 2025 in the following databases: MEDLINE, Embase, CINAHL and Scopus. Studies were selected for inclusion if participants were admitted to an ICU, older than one year, and the study compared intravenous opioid continuous infusions with intermittent injections. Individual case reports and case series were excluded. Two reviewers (AS and HT) independently screened titles and abstracts and conflicts were resolved through discussion. Full-text review was also conducted independently by both reviewers to determine the final inclusion. Following screening, data was extracted from each paper without quality appraisal to stay consistent with the purpose of a scoping review to identify the extent of available literature. One reviewer (AS) extracted key information, including study design, patient population, intervention, comparator, outcomes and key findings. The study results were divided into 3 categories by type of outcome: (a) opioid effectiveness, (b) safety outcomes and (C) clinical outcomes (eg. duration in goal analgesia, risk of delirium and ICU length of stay). RESULTS The systematic search identified 1,709 citations, of which 16 studies met the criteria. Full-text review and analysis are ongoing, and updated results will be presented at the forum. Preliminary findings indicate that most included studies are retrospective, involving 570 mechanically ventilated patients who were exposed to either intermittent fentanyl injection (n=218) or continuous fentanyl infusions (n=352). The reported outcomes are varied but suggest benefits associated with intermittent administration. Specifically, these studies have found the intermittent fentanyl injections had shorter ICU stay (8.4 vs 6.7 days, p=0.03), mortality (58.2% vs 44.8%, p=0.01) and risk of delirium (72.4% vs 41.9%, p=0.017) compared to fentanyl infusion. Furthermore, a continuous infusion of morphine led to a longer hospital stay (8.4 vs 4.9 days, p=0.04) after pediatric cardiothoracic surgery. CONCLUSION This scoping review identified limited literature on the differences in intermittent IV opioid injections compared to continuous IV infusions in critically ill patients. Studies were primarily of retrospective design. Data suggested that intermittent fentanyl IV injections may be associated with beneficial clinical outcomes and increased safety compared to prolonged infusions. However, the small number of studies and their observational design limit the strength of these conclusions. Ultimately, a prospective clinical trial is necessary to determine optimal opioid administration strategies and to inform evidence-based ICU practice. <131> Accession Number 2047761127 Title Angiotensin II Type 1 Receptor Expression and Anti-AT1R Antibodies in Heart Transplantation: A Systematic Review of Distinct but Related Non-HLA Immune Pathways. Source Journal of Clinical Medicine. 15(14) (no pagination), 2026. Article Number: 5419. Date of Publication: 01 Jul 2026. Author Gopalan R.; Mohamed M.R.; Mahar J.; Sunkara A.; Kalya A.; Hafez A.; Reinsmoen N.; Arabia F. Institution (Gopalan, Mahar, Sunkara, Kalya, Arabia) Cardiology Department, Banner University Medical Center, Phoenix, AZ, United States (Mohamed) Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States (Hafez) Mayo Clinic, Department of Cardiovascular Medicine, Phoenix, AZ, United States (Reinsmoen) HLA and Immunogenetics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Heart transplantation (HT) remains the definitive therapy for end-stage heart failure, yet rejection and cardiac allograft vasculopathy (CAV) continue to limit long-term outcomes. Beyond donor-specific HLA antibodies, non-HLA antibodies, particularly anti-angiotensin II type 1 receptor antibodies (AT1R-Abs), have been implicated in allograft injury, but published findings are heterogeneous. Aim(s): The aim of this study is to systematically evaluate the evidence linking AT1R gene expression and anti-AT1R antibodies with key post-heart transplant outcomes. Method(s): We conducted a systematic review in accordance with PRISMA guidelines. Scopus, PubMed, Web of Science, and the Cochrane Library were searched (December 2025) for cohort and case-control studies evaluating AT1R gene expression and/or AT1R-Ab status in HT recipients and their association with post-transplant outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the NIH Quality Assessment Tool. Result(s): Twelve studies encompassing 951 recipients met the inclusion criteria. Five studies evaluated AT1R mRNA expression, reporting variable patterns: several observed reduced AT1R/AT2R transcription after transplantation without clear clinical correlation, whereas others associated higher donor or recipient AT1R expression with transplant coronary artery disease and recurrent rejection. AT1R-Ab prevalence varied widely and appeared to increase after mechanical circulatory support, with substantial seroconversion reported during LVAD support in initially antibody-negative patients. Associations between AT1R-Ab and acute cellular rejection and antibody-mediated rejection were inconsistent across studies, and survival findings were inconclusive; however, some reports linked elevated AT1R-Abs to poorer long-term freedom from adverse events. Evidence regarding CAV was mixed, with signals of increased vasculopathy risk in some cohorts but not others. Conclusion(s): Current evidence suggests a potential role for AT1R expression and AT1R-Abs in cardiac allograft dysfunction, including rejection phenotypes and vasculopathy. Larger prospective studies with harmonized testing strategies are needed to define clinically meaningful AT1R-Ab cutoffs and clarify their utility in risk stratification and targeted therapeutic trials. Copyright © 2026 by the authors. <132> Accession Number 651784077 Title Valve-specific structural vulnerability in infective endocarditis: a narrative review of surgical complexity and outcomes. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 17 Jul 2026. Author Abd Rani N.H.; Mohamed A.; Md Isa Z.; Kadiman S.; Kamarudin T.A. Institution (Abd Rani) Non-Invasive Cardiovascular Laboratory, National Heart Institute, Kuala Lumpur, Malaysia (Abd Rani, Kamarudin) Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia (Mohamed) Centre for Diagnostic, Therapeutic & Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia (Md Isa) Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia (Kadiman) Department of Anaesthesiology and Critical Care, National Heart Institute, Kuala Lumpur, Malaysia Abstract BACKGROUND: Infective endocarditis (IE) carries in-hospital mortality of 15-20% and 1-year mortality approaching 40%, with surgery required in 40-50% of cases. IE is not uniformly distributed across cardiac valves aortic 30-45%, mitral 25-30%, tricuspid 5-10%, pulmonary < 2%, PVE 10-30% and this distribution reflects valve-specific anatomical determinants governing surgical complexity and outcomes. Despite the 2023 ESC Guidelines, a unified structural framework linking anatomical vulnerability to surgical decision-making remains absent. OBJECTIVE(S): To propose a valve-specific structural vulnerability framework and examine its implications for surgical complexity, perioperative outcomes, and re-surgery risk across all cardiac valve types. METHOD(S): A narrative review of peer-reviewed literature (2015-2025) was conducted across PubMed, Scopus, and MEDLINE. Systematic reviews, meta-analyses, multicentre registries, and guideline documents were synthesised narratively. KEY FINDINGS: A structural vulnerability gradient (prosthetic valves > aortic > mitral > tricuspid > pulmonary) is proposed as a conceptual model of valve-specific disease behaviour. Aortic IE carries maximal vulnerability through peri-annular extension, 30-40% of cases, requiring radical root reconstruction with elevated operative mortality. Mitral IE exhibits conditional vulnerability; repair yields superior outcomes over replacement. Tricuspid IE is predominantly IVDU-associated with comparatively lower operative mortality. PVE carries the highest operative risk, with prolonged operative times and significant reoperation rates. CONCLUSION(S): IE is best understood as a valve- and substrate-specific disease in which anatomical determinants drive surgical complexity and clinical prognosis. This proposed vulnerability hierarchy may enable preoperative risk stratification, inform valve-specific surgical planning, and provide a mechanistic framework for understanding differential outcomes across valve types. Prospective outcome registries and standardised complexity metrics are needed to validate and refine this conceptual model. Copyright © 2026. The Author(s). <133> Accession Number 651784853 Title Preoperative echocardiographic predictors of atrial fibrillation after coronary artery bypass graft surgery (CABG): a systematic review and meta-analysis. Source BMC cardiovascular disorders. (no pagination), 2026. Date of Publication: 17 Jul 2026. Author Teimouri-Jervekani Z.; Samadi-Broujeni N.; Bahrani S.; Soleimani A. Institution (Teimouri-Jervekani, Soleimani) Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of (Samadi-Broujeni, Soleimani) Chamran Cardiovascular Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of (Bahrani) Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of Abstract BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), which is associated with increased morbidity, longer hospital stays, and higher healthcare costs. Preoperative echocardiographic parameters may play an important role in predicting the risk of POAF. OBJECTIVE(S): To identify and evaluate preoperative echocardiographic parameters that can predict the development of POAF in patients undergoing CABG. METHOD(S): A systematic search was performed from January 2010 to October 2025 in PubMed, Scopus, Embase, and Web of Science. Risk of bias was assessed with ROBINS-I tool for observational studies. RESULT(S): Twenty-three studies (n = 2,983 patients) were included. POAF incidence ranged from 22% to 40%, with a pooled rate of 28.8% (95% CI: 21%-34%). Meta-analyses showed no significant pooled associations for left atrial volume index (LAVI) (OR 1.31; 95% CI: 0.92-1.87; I2 = 99.9%), peak atrial longitudinal strain (PALS) 0.65 (95% CI: 0.38-1.11); I2 = 99.9%), or LA contraction strain (LASRa) (OR 1.91; 95% CI: 0.83-4.41; I2 = 98.1%). Heterogeneity was substantial across all outcomes. Limited data suggested potential predictive value for right atrial indices and single-study parameters such as LA kinetic energy. CONCLUSION(S): Current echocardiographic markers including LAVI, PALS, and LASRa, do not demonstrate consistent or robust predictive value for POAF when pooled across heterogeneous studies. Standardized measurement protocols and larger prospective cohorts are needed to clarify the role of atrial structural and functional indices in POAF risk stratification. Copyright © 2026. The Author(s). <134> Accession Number 651775383 Title Pre- and Immediate Postoperative Prediction Model for Organ Dysfunction or Death Early After Cardiac Surgery: A Post Hoc Analysis of a Multicenter Randomized Trial. Source Journal of the American Heart Association. (pp e044394), 2026. Date of Publication: 17 Jul 2026. Author Dresen E.; Heyland D.K.; Lee Z.Y.; O'Brien B.; Elke G.; Radke D.I.; Meybohm P.; Schoenrath F.; Sundermann S.H.; von Dossow V.; McDonald B.; Christopher K.B.; Fremes S.E.; Mohammadi S.; Niemann B.; Boning A.; Mazer C.D.; Ke L.; Zarbock A.; Day A.G.; Stoppe C. Institution (Dresen, Lee, Meybohm, Stoppe) Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wurzburg Wurzburg Germany, Germany (Heyland, Day) Clinical Evaluation Research Unit and Department of Critical Care Medicine Queen's University Kingston Ontario Canada, Canada (Lee) Department of Anaesthesiology, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia, Malaysia (Lee, O'Brien, Stoppe) Department of Cardiac Anesthesiology and Intensive Care Medicine Deutsches Herzzentrum der Charite Berlin Germany, Germany (Lee, O'Brien, Schoenrath, Sundermann, Stoppe) Charite - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin Berlin Germany, Germany (O'Brien, Schoenrath, Sundermann, Stoppe) German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany, Germany (Elke) Department of Anaesthesiology, Intensive Care, Pain and Emergency Medicine St. Bernward Hospital Hildesheim Germany, Germany (Radke) Department of Anesthesiology and Intensive Care Medicine University Medical Center Schleswig-Holstein, Campus Kiel Kiel Germany (Schoenrath, Sundermann) Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charite Berlin Germany, Germany (von Dossow) Heart and Diabetes Centre North Rhine Westphalia, Institute of Anesthesiology and Pain Therapy Ruhr-University Bochum Bad Oeynhausen Germany, Germany (McDonald) Division of Cardiac Anesthesiology University of Ottawa Heart Institute Ottawa Ontario Canada, Canada (Christopher) Division of Renal Medicine Brigham and Women's Hospital Boston Massachusetts USA (Fremes) Division of Cardiac Surgery, Sunnybrook Health Sciences Centre, Schulich Heart Centre University of Toronto Toronto Ontario Canada, Canada (Mohammadi) Quebec Heart and Lung University Institute Laval University Quebec City Quebec Canada, Canada (Niemann) Department of Thoracic and Cardiovascular Surgery University Medical Center Gottingen Gottingen Germany, Germany (Boning) Department of Adult and Pediatric Cardiovascular Surgery Giessen University Hospital Giessen Germany, Germany (Mazer) Li Ka Shing Knowledge Institute of St. Michael's Hospital and Departments of Anesthesiology and Pain Medicine, Physiology, Pharmacology St. Michael's Hospital, University of Toronto Toronto Ontario Canada, Canada (Ke) Department of Critical Care Medicine Jinling Hospital, Medical School of Nanjing University Nanjing Jiangsu China, China (Ke) National Institute of Healthcare Data Science Nanjing University Nanjing China, China (Zarbock) Department of Anesthesiology, Intensive Care and Pain Medicine University Hospital Munster Munster Germany, Germany (Zarbock) Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School The University of Texas Health Science Center at Houston Houston Texas USA (Zarbock, Stoppe) Center for Outcomes Research and Department of Anesthesiology UTHealth Houston Texas USA (Day) Kingston Health Sciences Centre - Research Institute Kingston Ontario Canada, Canada Abstract BACKGROUND: Development of organ dysfunction or death is still common in patients undergoing cardiac surgery. Yet, current risk stratification tools fail to adequately incorporate both preoperative vulnerability and immediate postoperative physiological derangements. This study aims to develop a predictive model integrating these critical timepoints to identify high-risk patients for presence of organ dysfunction or death 48 hours after surgery. METHOD(S): This is a post hoc analysis of an international, multicenter, randomized, controlled trial in patients undergoing cardiac surgery (n=1394). Prespecified patient characteristics (age, Clinical Frailty Scale, at nutrition risk, combined procedures, urgent surgery, moderate-severe chronic kidney disease, left ventricular ejection fraction, European System for Cardiac Operative Risk Evaluation II, cardiopulmonary bypass duration, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score) were included in logistic regression models employing bootstrap validation. RESULT(S): A total of 434 (31.1%) patients had organ dysfunction or died 48 hours after surgery. The preoperative model identified Clinical Frailty Scale, nutrition risk, urgent surgery and European System for Cardiac Operative Risk Evaluation II as significant predictors of organ dysfunction or death 48 hours after surgery (optimism-corrected area under the receiver operating characteristic curve, 0.644 [95% CI, 0.610-0.678]). Incorporation of postoperative variables (Sequential Organ Failure Assessment score at intensive care unit admission, and cardiopulmonary bypass duration) improved predictive performance (area under the receiver operating characteristic curve, 0.773 [95% CI, 0.745-0.801]). CONCLUSION(S): Incorporation of variables collected the day of surgery substantially improved the ability to predict organ dysfunction or death 48 hours after surgery compared with using presurgical variables only. This pragmatic, clinically actionable model may enable targeted resource allocation and personalized interventions and may provide a stratification tool for future research. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT02002247. <135> Accession Number 651776899 Title Adverse events in neonates with congenital heart disease after cardiovascular surgery: a systematic review and meta-analysis. Source BMC pediatrics. (no pagination), 2026. Date of Publication: 16 Jul 2026. Author Nunes E.; de Campos Pereira Silveira R.C.; Gimenes F.R.E.; Pereira R.A.; Gabiattia D. Institution (Nunes, de Campos Pereira Silveira, Gimenes, Pereira, Gabiattia) Ribeirao Preto College of Nursing, University of Sao Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, Sao Paulo, 14040-902, Brazil Abstract INTRODUCTION: Neonates with congenital heart disease (CHD) undergoing cardiovascular surgery are exposed to complex postoperative care and may experience adverse events. METHOD(S): A systematic review and meta-analysis was conducted. Searches were performed in the Cochrane Central Register of Controlled Trials, LILACS, CINAHL, EMBASE, PubMed, Web of Science Core Collection, and Scopus. Observational cohort studies evaluating adverse events in neonates were eligible for inclusion. Data extraction was performed independently by two reviewers; in the event of disagreement, a third reviewer was consulted. Search results were exported to the online reference management software EndNote Basic for duplicate removal and subsequently imported into the Rayyan platform. RESULT(S): Of the 60 articles identified, 20 studies comprising a total of 25,422 neonates with congenital heart disease in the postoperative period were included. The overall prevalence of adverse events was 14%. The most prevalent events were central venous catheter (CVC)-related incidents (14%), healthcare-associated infections (12%), and extubation failure (11%). CONCLUSION(S): The prevalence of adverse events in neonates with CHD undergoing cardiovascular surgery is substantial and likely underreported. Further studies are needed to improve the detection, mitigation, and reduction of these events. Copyright © 2026. The Author(s). <136> Accession Number 651788409 Title Selective and non-selective carotid ultrasound screening and perioperative stroke incidence in the coronary artery bypass grafting population: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 19 Jul 2026. Author King-O'Reilly B.; Graves D.L.; Sandrasekaran K.; Briffa N. Institution (King-O'Reilly) Cardiothoracic Department, University of Sheffield Medical School, Sheffield, United Kingdom (King-O'Reilly) Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield, United Kingdom (Graves, Sandrasekaran, Briffa) Cardiothoracic Department, University of Sheffield Medical School, Sheffield, United Kingdom (Briffa) Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre: Northern General Hospital Cardiothoracic Centre, Sheffield, United Kingdom Abstract OBJECTIVES: A systematic review and meta-analysis was performed to observe the incidence of perioperative stroke associated with selective and non-selective carotid ultrasound (CU) screening in the isolated coronary artery bypass grafting (CABG) population. METHOD(S): PubMed, Scopus and CENTRAL databases were searched for studies published between January 1995 and October 2025. Inclusion criteria for the review focused on studies reporting primary data related to perioperative stroke in adult patients scheduled to undergo non-emergency isolated CABG who underwent either selective or non-selective preoperative CU screening. The primary outcome was perioperative stroke. Study quality was assessed using the ROBINS-I tool. Data related to the primary outcome was synthesised using an exploratory random-effects model meta-analysis. This review was reported as per PRISMA guidelines. RESULT(S): 2398 studies were identified to undergo title and abstract screening; 63 studies were identified to undergo full-text screening of which 15 studies were eligible for inclusion within the review (Total N = 25,931). For the 13 studies utilising a non-selective screening strategy, the pooled perioperative stroke rate was 1.78% (95% CI: [1.28;2.48]). Independently, the two cohorts utilising a selective screening strategy reported perioperative stroke rates of 1.16% and 1.23%. Due to the structural limitations of the existing literature these findings are presented as independent descriptive cohorts. CONCLUSION(S): This review provides a descriptive synthesis of perioperative stroke rates across the two previously mentioned screening cohorts and does not establish comparative effectiveness. Although the low absolute event rates observed within the selective screening cohort align with current guideline recommendations, the structural limitations and high disproportion of the available evidence base prevent definitive comparison. Copyright © 2026. The Author(s). <137> Accession Number 651788250 Title A visualization analysis of research hotspots and trends in enhanced recovery after surgery (ERAS) for elderly patients based on web of science and scopus. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 18 Jul 2026. Author Xiao C.; Wang Y.; Sun Y.; Zou S.; Yang X. Institution (Xiao, Zou, Yang) Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China (Wang) Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China (Sun) Binzhou People's Hospital, Binzhou, Shandong, China Abstract AIMS: To analyze the research landscape and thematic evolution of enhanced recovery after surgery (ERAS) in elderly patients from 2009 to 2025 using bibliometric methods. METHOD(S): Publications were retrieved from the Web of Science Core Collection and Scopus databases, limited to English articles and reviews. CiteSpace and VOSviewer were used to analyze annual publication trends, international and institutional collaboration networks, keyword co-occurrence, clustering, and burst detection. RESULT(S): A total of 773 publications were included. Annual publication output increased markedly after 2017. China (183 publications, 23.7%) and the United States (152 publications, 19.7%) were the leading contributors. Keyword clustering identified nine major thematic clusters (Q = 0.4617,S = 0.7527),with "lung neoplasms" and "esophagus resection" emerging as independent clusters. A sub-analysis revealed that 37 publications (4.8%) specifically addressed thoracic surgery, indicating that thoracic ERAS represents an emerging but still underdeveloped subfield within the overall ERAS research landscape. Among the top 20 high-frequency keywords, "aged" (519 occurrences, 67.1%) and "enhanced recovery after surgery" (504 occurrences, 65.2%) were the most prominent. Burst detection revealed 25 keywords with significant citation surges. Recent high-intensity bursts included "functional status" (strength = 7.18), "preoperative exercise" (strength = 6.28), and "physiotherapy" (strength = 5.38), indicating a shift toward functional recovery and prehabilitation. Major research themes focused on frail older populations, colorectal and oncologic surgical applications, perioperative analgesia, and prehabilitation strategies. Temporal overlay and burst analyses indicated sustained prominence of terms such as "functional status", "frailty", and "preoperative exercise". CONCLUSION(S): Research on ERAS in elderly patients has evolved into a multi-thematic knowledge structure with an increasing emphasis on functional outcomes and personalized perioperative management. Copyright © 2026. The Author(s). <138> Accession Number 651783825 Title Efficacy and safety of prothrombin complex concentrate versus fresh frozen plasma in adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 17 Jul 2026. Author Hameed M.S.; Razzaq A.; Zia A.; Iftihar A.; Zaeem M.; Tariq A.; Javaid M.U.; Alvi S.; Munir I.; Truong V.T.; Hassan M.H.U.; Zaidi S.R.H.; Qaiser S.; Fatima R.; Naveed M.U. Institution (Hameed, Razzaq, Iftihar, Zaeem, Tariq) Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Zia) Department of Medicine, Foundation University Medical College, Islamabad, Pakistan (Javaid) Department of Medicine, Faderal Medical and Dental College, Islamabad, Pakistan (Alvi) Department of Medicine, Ascension St.Joseph Hospital, Chicago, United States (Munir) Department of Medicine, UC Davis Medical Center, Sacramento, United States (Truong) Department of Cardiology, Christ Hospital Health Network Ohio Heart and Vascular Center, Cincinnati, OH, United States (Hassan, Fatima) Department of Medicine, South Brooklyn Health, Brooklyn, United States (Zaidi) Department of Medicine, UC Health Parkview Medical Center, United States (Qaiser) Department of Medicine, Rutgers Health Community Medical Center, United States (Naveed) Department of Medicine, Nangarhar Medical University, kab-ul-jalalabad highway, Jalalabad, Afghanistan Abstract BACKGROUND: Postoperative bleeding is a common and potentially life-threatening complication following cardiac surgery, often exacerbated by multifactorial coagulopathy from cardiopulmonary bypass, hypothermia, and platelet dysfunction. While fresh frozen plasma (FFP) has traditionally been used for coagulation correction, it has significant limitations, including large volume requirements, slow onset, and increased risk of transfusion-related complications. Prothrombin complex concentrate (PCC) has emerged as a potential alternative, offering rapid coagulation correction with reduced volume load and no ABO compatibility requirements. This systematic review and meta-analysis compared the efficacy and safety of PCC versus FFP in managing coagulopathic bleeding in adult cardiac surgery patients. METHOD(S): We conducted a systematic review and meta-analysis following PRISMA guidelines. Electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) were searched using MeSH terms and keywords related to "Cardiothoracic Surgery", "Prothrombin Complex Concentrate", and "Fresh Frozen Plasma", from inception to Jan 2026. Cohort studies and randomized controlled trials comparing PCC and FFP in patients aged > 18 years undergoing cardiac surgery complicated by bleeding or coagulopathy were included. Primary outcomes were RBC transfusion requirement, chest tube drainage, and thromboembolic events. Secondary outcomes included surgical re-exploration for bleeding, stroke, duration of mechanical ventilation, hospital and ICU stays, and acute kidney injury. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for RCTs and the Newcastle-Ottawa Scale for observational studies. Statistical analysis was conducted using Review Manager (RevMan) version 5.4, applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under protocol number CRD420251088737. RESULT(S): This meta-analysis included ten studies with 2,643 patients. PCC use moderately reduced RBC transfusion in the first 24 h (RR = 0.84; 95% CI: 0.76-0.93; p = 0.05; I2 = 47%), 12-24-h chest tube drainage (MD = - 188.89 mL; 95% CI: - 248.48 to - 125.30; p < 0.00001; I2 = 50%), and hospital stay (MD = - 1.19 days; 95% CI: - 2.21 to - 0.18; p = 0.004; I2 = 67%). No significant differences were observed for surgical re-exploration (RR = 0.81; 95% CI: 0.66-1.00; p = 0.05; I2 = 0%), mechanical ventilation (MD = - 0.08; 95% CI: - 0.34 to 0.19; p > 0.05; I2 = 73%), ICU stay (MD = - 0.07 days; 95% CI: - 0.59 to 0.45; p = 0.78; I2 = 59%), all-cause mortality (RR = 1.10; 95% CI: 0.82-1.50; p = 0.51; I2 = 0%), thromboembolic events (RR = 1.22; 95% CI: 0.80-1.85; p = 0.35; I2 = 0%), stroke (RR = 1.10; 95% CI: 0.75-1.63; p = 0.63; I2 = 0%), acute kidney injury (RR = 1.08; 95% CI: 0.74-1.56; p = 0.70; I2 = 77%), serious adverse events (RR = 0.78; 95% CI: 0.56-1.09; p = 0.15; I2 = 35%), and any adverse event (RR = 0.95; 95% CI: 0.81-1.11; p = 0.54; I2 = 53%). Moderate to high heterogeneity was noted in several outcomes, for which subgroup analyses were performed. CONCLUSION(S): This meta-analysis demonstrates that PCC is superior to FFP in reducing RBC transfusion requirements, 12-24-h chest tube drainage, and hospital length of stay in adult cardiac surgery patients, while maintaining a comparable safety profile. Further large-scale, high-quality RCTs are warranted to strengthen the evidence base and inform future guidelines. Copyright © 2026. The Author(s). <139> Accession Number 2047894350 Title Repeat revascularization: a reflection of durability, not a trivial endpoint. Source Hellenic Journal of Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Angouras D.C. Institution (Angouras) Department of Cardiac Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Street, Chaidari, Athens, Greece Publisher Hellenic Cardiological Society <140> Accession Number 2047867327 Title Effects of Levosimendan on Hemodynamic Parameters in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Randomized, Double-Blind, Placebo- Controlled Trial. Source Acta Medica International. 13(1) (pp 216-219), 2026. Date of Publication: 01 Jan 2026. Author Khatoon S.; Ali N.; Mazumderpinaki Institution (Khatoon) Department of Anaesthesiology, Pt JNM Medical College, Chhattisgarh, Raipur, India (Ali) Department of Anaesthesiology, DKS superspeciality Hospital, Chhattisgarh, Raipur, India (Mazumderpinaki) Department of Anaesthesiology, Medical College Hospital, West Bengal, Kolkata, India Publisher Parsvnath Publishing House Abstract Background: Levosimendan, a calcium-sensitizing agent, possesses positive inotropic and peripheral vasodilatory effects mediated through ATP-sensitive potassium channels. In off-pump coronary artery bypass grafting (OPCABG), hemodynamic instability during cardiac manipulation remains a challenge. The effects of levosimendan on afterload and perfusion pressure in this surgical situation are not definitively established. Material(s) and Method(s): This is a prospective, randomized and masked study in which 30 patients undergoing elective OPCABG were randomized to either group L(n=15) or group P(n=15). Group L patients received Levosimendan (0.07 microg/kg/min), whereas group P patients received placebo. Predefined amounts of time (before and after surgery) were taken in which the aim was to record hemodynamic variables (Mean arterial pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), systemic vascular resistance (SVRI) and central venous oxygen saturation (ScvO<inf>2).</inf> Results: There was better MAP among patients who used levosimendan (as compared to placebo) during the fourth hour after surgery up to 24 hours (p<0.05). At the same time, the levels of SVR and SVRI were significantly lower in the levosimendan arm than at the third-hour mark and beyond (p < 0.05). The CVP level was temporarily elevated in the levosimendan arm during the first 3 hours. Intergroup differences in CO, CI, SVI and ScvO2 at any time point were not significant statistically(p value >0.05). Conclusion(s): OPCABG, supported by levosimendan administration, results in sustained decreases in systemic vascular resistance, preservation of elevated mean arterial pressure and cardiac output and unimpaired global tissue perfusion. Copyright © 2026 Acta Medica International.

EPICORE Embase Updates

Tuesday, August 11, 2026

EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Followers

Blog Archive

About Me