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Total documents retrieved: 175 Results Generated From: Embase <1980 to 2026 Week 35> Embase Weekly Updates (updates since 2026-08-21) - (175 records) <1> Accession Number 2047900783 Title Radially adjustable Tigertriever demonstrates higher reperfusion compared to self-expanding stent-retrievers during mechanical thrombectomy of large vessel occlusions: a systematic review and meta-analysis. Source Frontiers in Neurology. 17 (no pagination), 2026. Article Number: 1839128. Date of Publication: 2026. Author Tariq Z.; Shahzad F.; Jannat N.E.; Hashmi T.M.; Amin S.; AlMajali M.; Bashir Q.; Saver J.L.; Shami B.; Chaudhari A. Institution (Tariq, Chaudhari) Department of Neurointervention, Mercy Health St. Vincent Medical Center, Toledo, OH, United States (Shahzad, Jannat, Hashmi) Department of Neurology, Rawalpindi Medical University, Rawalpindi, Pakistan (Amin, Chaudhari) Department of Neurointervention, Dignity Health Mercy Medical Center, Redding, CA, United States (AlMajali) Department of Neuroendovascular Surgery, Ochsner Lafayette General, Lafayette, LA, United States (Bashir) Department of Neuroendovascular Surgery, Punjab Institute of Neurosciences, Lahore, Pakistan (Saver) Department of Interventional Neuroradiology, University of California, Los Angeles, CA, United States (Shami) Department of Neurology, University of Aleppo, Aleppo, Syrian Arab Republic Publisher Frontiers Media SA Abstract Introduction - Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusions. Conventional self-expanding stent retrievers (SE-SRs) deploy with fixed radial force, whereas Tigertriever is a radially adjustable operator-controlled device that allows tailored expansion and modulation of vessel wall pressure. This study systematically compared the efficacy and safety of Tigertriever with SE-SRs in large vessel occlusion thrombectomy. Methods - A systematic search of PubMed, Cochrane, Embase, and ClinicalTrials.gov was conducted in line with PRISMA guidelines. Eligible studies compared Tigertriever with SE-SRs, with outcomes including rate of successful reperfusion (mTICI >= 2b), procedural adverse events (PAEs; composite of procedure-related vasospasm, dissection, perforation, distal emboli, emboli to new territory, and subarachnoid hemorrhage), symptomatic intracranial hemorrhage (sICH) within 24h post-procedure, functional independence (mRS 0-2) at 90days and all-cause mortality at 90days. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using the Mantel-Haenszel method. Risk of bias was assessed using ROBINS-I, and certainty of evidence using the GRADE approach. Results - Three retrospective cohort studies with 476 patients (210 Tigertriever, 266 SE-SR) were included. Target intracranial vessel occlusion locations were internal carotid artery (ICA), middle cerebral artery (MCA) M1, MCA M2 and basilar artery. Tigertriever achieved significantly higher successful reperfusion compared with SE-SRs [82.8% vs. 77.8%; OR 1.74 (1.07-2.83); p=0.03; I2 =0%]. There was a trend towards fewer PAEs, but the difference did not reach statistical significance [17.1% vs. 27.4%; OR 0.72 (0.44-1.16); p=0.17; I2 =0%]. Rates of sICH within 24h, functional independence at 90days and mortality at 90days were similar. The overall risk of bias was low to moderate. GRADE-assessed certainty for different outcomes was overall moderate. Conclusion - In this exploratory meta-analysis of retrospective cohorts, Tigertriever was associated with significantly higher reperfusion rates, while safety and functional outcomes appeared comparable between groups. Findings should be interpreted cautiously given study-level heterogeneity, limited sample size, inconsistent procedural reporting, and the observational nature of included studies. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251161491. The protocol for this meta-analysis was registered on PROSPERO. ID: CRD420251161491. Copyright © 2026 Tariq, Shahzad, Jannat, Hashmi, Amin, AlMajali, Bashir, Saver, Shami and Chaudhari. <2> Accession Number 2048495138 Title Biological and mechanistic effects of selenium and zinc in coronary artery bypass surgery: preoperative and postoperative evaluation. Source BioMetals. (no pagination), 2026. Date of Publication: 2026. Author Erdogan G.; Coskun Y.; Karademir B.C.; Rabus M.B. Institution (Erdogan) Faculty of Pharmacy, Analytical Chemistry Department, Marmara University, Istanbul, Turkey (Coskun) Marmara University, Institute of Health Sciences, Maltepe, Istanbul, Turkey (Karademir, Rabus) Department of Cardiovascular Surgery, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Turkey (Karademir) Clinic of Cardiovascular Surgery, Republic of Turkey Ministry of Health, Ankara Etlik City Hospital, Ankara, Yenimahalle, Turkey Publisher Springer Science and Business Media B.V. Abstract Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide. Trace elements such as selenium (Se) and zinc (Zn) play important roles in the development of hypertension and cardiovascular diseases through direct effects on the vascular system and indirect effects on lipoprotein metabolism. Se and Zn are essential components of the antioxidant defense system that help reduce oxidative stress associated with cardiac disorders. In this study, serum Se and Zn levels were evaluated in patients undergoing coronary artery bypass surgery and compared with those of healthy controls. The study population comprised patients diagnosed with coronary heart disease and a control group of healthy individuals. Serum Zn concentrations were measured using flame atomic absorption spectrometry (AAS), while Se levels were determined by graphite furnace atomic absorption spectrometry (GFAAS). Statistical analysis was performed using analysis of variance (ANOVA), followed by Bonferroni-adjusted pairwise test. The mean preoperative serum Se concentration in patients was 25.49 +/- 16.83 microg/L, which increased postoperatively to 31.55 +/- 22.19 microg/L and to 40.97 +/- 30.17 microg/L pre-discharge. In contrast, the control group had a significantly higher Se level of 70.88 +/- 13.18 microg/L. Similarly, Zn levels in patients were 116.53 +/- 27.85 microg/L preoperatively, decreased to 88.43 +/- 23.32 microg/L postoperatively, and increased to 98.43 +/- 21.53 microg/L pre-discharge, while controls had 120.46 +/- 17.58 microg/L. Both Se and Zn levels were significantly lower in patients compared to controls (p < 0.0001). Based on these findings, we highlight that low Se and Zn levels are associated with coronary heart disease; therefore, randomized controlled trials are needed to determine whether Se and Zn supplementation under medical supervision provides clinically significant benefits. Copyright © The Author(s), under exclusive licence to Springer Nature B.V. 2026. <3> Accession Number 2048556583 Title Innovations in transcatheter interventions for hypoplastic left heart syndrome and borderline left heart structures from fetal to neonatal life: current evidence and systematic review of recent advances (2016-2025). Source European Journal of Pediatrics. 185(9) (no pagination), 2026. Article Number: 686. Date of Publication: 01 Sep 2026. Author Sperotto F.; Recco D.P.; Kizilski S.B.; Porras D.; Quinn B.P.; Esch J.J.; Tworetzky W.; Maschietto N. Institution (Sperotto, Porras, Quinn, Esch, Tworetzky, Maschietto) Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA, United States (Recco, Kizilski) Department of Cardiac Surgery, Boston Children's Hospital, and Department of Surgery, Harvard Medical School, Boston, MA, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Alongside advances in surgical and medical care, catheter-based interventions have reshaped the care of fetuses and neonates with hypoplastic left heart syndrome (HLHS) or borderline left heart structures over the last decades. These interventions include fetal aortic valvuloplasty (FAV), fetal and neonatal atrial septal interventions, the hybrid Stage-1 procedure (HS1P), and the emerging total transcatheter Stage-1 procedure (TTS1P). We summarize the current evidence on catheter-based interventions for HLHS and borderline left heart structures from fetal to neonatal life and systematically review recent advances (2016-2025). Among 361 studies identified (+ 12 manually), 68 were included (17: FAV, 4: fetal/neonatal atrial septal interventions, 39: HS1P, 8: TTS1P). FAV outcomes have continued to improve over time, confirming its potential to alter the progression to HLHS in selected patients. In patients with HLHS and an intact or severely restrictive atrial septum, fetal and neonatal atrial septal interventions can mitigate severe perinatal respiratory failure; however, outcomes in this population remain significantly burdened by underlying lung disease. In the neonatal period, both HS1P and TTS1P offer less invasive alternatives to the surgical Stage-1 procedure, spanning both univentricular and biventricular recruitment pathways. HS1P offers a cardiopulmonary bypass-sparing strategy with favorable outcomes in experienced centers. TTS1P further reduces invasiveness by eliminating both sternotomy and cardiopulmonary bypass and has demonstrated promising early results. As techniques, devices, and patient selection continue to evolve, further research will be critical to establish the most appropriate application of each approach and to align prenatal and postnatal management pathways to optimize outcomes. Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026. <4> Accession Number 2048488652 Title Evolving Trends and Core Contributors: A Bibliometric Update on Liposomal Bupivacaine. Source Pain Research and Management. 2026(1) (no pagination), 2026. Article Number: 9222122. Date of Publication: 2026. Author Zhai W.; Yu Z.; Zhao X.; Liu H.; Li M. Institution (Zhai, Yu, Zhao, Liu, Li) Department of Anesthesiology, Peking University Third Hospital, No. 49 North Garden Road Haidian District, Beijing, China Publisher John Wiley and Sons Ltd Abstract Purpose: This study aims to examine the academic output, key research hotspots, collaborative networks, and trends in liposomal bupivacaine research using bibliometric methods. By providing a broad overview, we seek to clarify the knowledge structure and emerging trends in its clinical applications in perioperative analgesia. Method(s): We searched the Web of Science Core Collection database on November 4, 2025, to find relevant articles and reviews. Analytical tools such as CiteSpace and VOSviewer were used to evaluate publication years, countries/regions, institutions, journals, highly cited literature, terms, collaboration networks, and cocitation clusters. Result(s): The dataset comprised 1,069 valid publications from 101 countries/regions, involving 3,256 institutions and 13,736 authors. The annual publication output grew slowly before 2015, increased rapidly after 2016, and reached a peak in 2021. The United States (US) was the leading contributor with 775 publications, followed by China with 155 publications. The Harvard University System and the University of Texas System were identified as central research institutions. Journal of Arthroplasty published the largest number of articles, while Anesthesia and Analgesia recorded the highest average citations per article. Term co-occurrence and burst analyses identified four major research clusters: formulation and pharmacological foundations, safety considerations, procedure-specific analgesia, and emerging regional anesthesia techniques. Recent research hotspots included erector spinae plane block, thoracic surgery, and paravertebral block, indicating a shift toward novel nerve block applications and complex surgical scenarios. Conclusion(s): Research on liposomal bupivacaine has evolved from formulation development to a clinically oriented field with strong interdisciplinary integration and expanding procedural applications. The US remained the leading contributor to global research and collaboration. These findings provide a structured overview of the evolving evidence base and might help guide future procedure-specific research and perioperative analgesia strategies. Copyright © 2026 Wenwen Zhai et al. Pain Research and Management published by John Wiley & Sons Ltd. <5> Accession Number 2044869803 Title Metabolic Conditioning for Renal Protection During Cardiopulmonary Bypass: A Narrative Review. Source Artificial Organs. 50(8) (pp 1118-1124), 2026. Date of Publication: 01 Aug 2026. Author El Dsouki Y.; Hallak P.; Condello I.; Lorusso R. Institution (El Dsouki, Lorusso) Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (El Dsouki, Lorusso) Cardiovascular Research Centre Maastricht (CARIM), Maastricht, Netherlands (Hallak) Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Condello) School of Medicine and Surgery, University of Insubria, Varese, Italy Publisher John Wiley and Sons Inc Abstract Background: Acute kidney injury (AKI) remains one of the most frequent and prognostically relevant complications following cardiac surgery, even in the era of modern cardiopulmonary bypass (CPB) management and goal-directed perfusion. Cardiac surgery-associated AKI (CSA-AKI) is associated with increased postoperative morbidity, prolonged hospitalization, neurocognitive complications, and reduced early as well as long-term survival. Although optimization of macrocirculatory parameters and oxygen delivery has demonstrated benefits, renal injury often occurs despite apparently adequate perfusion and oxygenation. Recent evidence suggests that CPB-related metabolic stress and protein catabolism contribute to renal vulnerability. Indeed, intravenous amino acid administration has emerged as a novel metabolic strategy for renal protection. Material(s) and Method(s): This narrative review was informed by a structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library, covering publications from database inception through March 2025. Search terms included combinations of "acute kidney injury," "cardiac surgery," "cardiopulmonary bypass," "amino acids," "intravenous amino acid infusion," "renal protection," and "goal-directed perfusion". Randomized controlled trials, meta-analyses, systematic reviews, secondary analyses, and relevant narrative reviews published in English were considered. Particular emphasis was placed on high-quality evidence, including the PROTECTION randomized trial, contemporary meta-analyses, and consensus or expert reviews addressing cardiac surgery-associated acute kidney injury and perioperative metabolic interventions. Result(s): The literature search identified 124 records; 18 articles were included in the final narrative synthesis after title, abstract, and full-text evaluation. The selected literature comprised a multicenter randomized controlled trial, secondary analyses of randomized data, meta-analyses/systematic reviews, narrative or expert reviews, and observational or mechanistic studies addressing CSA-AKI. The evidence indicates that CSA-AKI results from an interaction between altered renal perfusion, inflammation, ischemia-reperfusion injury, and CPB-induced metabolic derangement. Intravenous amino acid infusion was consistently associated with reduced postoperative AKI incidence, particularly in patients with preexisting chronic kidney disease, without significant safety concerns. These findings support amino acid administration as a metabolic adjunct to goal-directed perfusion rather than a standalone intervention. Conclusion(s): Intravenous amino acid infusion is a recent strategy to reduce AKI in cardiac surgery. By targeting the CPB-induced metabolic stress, amino acid administration complements goal-directed perfusion and expands current AKI prevention paradigms beyond hemodynamic optimization alone. Future research should focus on CPB-specific timing, dosing strategies, and integration of metabolic support into multimodal AKI prevention bundles. Copyright © 2026 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <6> Accession Number 2048222063 Title The impact of different intervention methods (anesthetic adjuvant drugs, anesthetic techniques, and non-pharmacological interventions) on postoperative cognitive function in patients undergoing cardiac surgery: a systematic review and Bayesian network meta-analysis. Source Frontiers in Neurology. 17 (no pagination), 2026. Date of Publication: 24 Jul 2026. Author Xue J.; Wang X.; Qiu Y. Institution (Xue, Wang, Qiu) Department of Anesthesiology Center, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Nei Mongol, China Publisher Frontiers Media SA Abstract Objective - Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery, with inconsistent evidence regarding preventive strategies. This network meta-analysis aims to evaluate and compare multiple interventions to establish an evidence-based framework for optimizing clinical management. Methods - A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted for randomized controlled trials (RCTs) involving patients undergoing cardiac surgery. The study, adhering to PRISMA-NMA guidelines, included various interventions such as anesthetic agents, adjunctive drugs, and cognitive training. Methodological quality was assessed using the Cochrane Risk of Bias tool. We performed a Bayesian network meta-analysis. Rankings were interpreted according to the prespecified favorable outcome direction; therefore, lower SUCRA values denoted greater preventive effectiveness. Results - The analysis included 46 RCTs, encompassing 9, 928 patients and 20 different intervention strategies. Most studies demonstrated a low risk of bias. Because POD and POCD were adverse-event incidence outcomes and MMSE change was coded so that smaller unfavorable postoperative decline represented benefit, lower SUCRA values were interpreted as indicating greater intervention effectiveness. Intranasal insulin, gastrodin, and cognitive training showed the lowest SUCRA values for POD-related outcomes. Gastrodin, esketamine, and dexmedetomidine showed the lowest SUCRA values for POCD-related outcomes. MMSE-change rankings were interpreted cautiously because they were based on fewer studies and were sensitive to the coding direction of change scores. Conclusion - This network meta-analysis suggests that intranasal insulin, gastrodin, cognitive training, esketamine, and dexmedetomidine may reduce POD or POCD after cardiac surgery. However, the comparative rankings are uncertain for interventions supported by few studies, and the MMSE-change findings remain exploratory. Further high-quality RCTs are required to confirm these results. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251128365, identifier (CRD420251128365). Copyright © 2026 Xue, Wang and Qiu. <7> Accession Number 2045600131 Title Anticoagulation Strategies in Adults Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis. Source Artificial Organs. 50(8) (pp 1103-1117), 2026. Date of Publication: 01 Aug 2026. Author Scharner V.; Lenz K.; Herkner H.; Buchtele N.; Staudinger T.; Schaden E.; Wiegele M.; Gratz J. Institution (Scharner, Lenz, Schaden, Wiegele, Gratz) Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria (Herkner) Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria (Buchtele, Staudinger) Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria (Schaden) Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria (Gratz) Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charite - Universitatsmedizin Berlin, Berlin, Germany Publisher John Wiley and Sons Inc Abstract Background: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe cardiac or respiratory failure, but it is associated with a high risk of thrombotic and bleeding complications. Unfractionated heparin (UFH) remains the most frequently used anticoagulant, largely due to historical practice and longstanding clinical familiarity, despite the absence of robust evidence from randomized controlled trials. Alternative strategies-including direct thrombin inhibitors (DTIs), low-molecular-weight heparins (LMWHs), nafamostat mesylate (NM), and no anticoagulation-are increasingly being explored. However, a comprehensive and contemporary comparison of these approaches has been lacking. Method(s): We conducted a comprehensive search of PubMed/MEDLINE, EMBASE, and CENTRAL through March 2025, supplemented by manual searches of reference lists. We included randomized controlled trials and observational studies including patients 16 years or older receiving ECMO for >= 24 h that compared any anticoagulation strategy with another or with no anticoagulation. The primary outcome was thromboembolic events; secondary outcomes included bleeding and mortality. Risk of bias was assessed using validated tools. Meta-analyses were performed using a multivariable random-effects model, with prespecified subgroup analyses by ECMO modality (venoarterial [VA], venovenous [VV], or mixed) and subsequent sensitivity analyses. Result(s): Twenty-one observational studies involving 2 775 adult ECMO patients were included, with UFH serving as the comparator in all studies. DTIs showed reduced thromboembolism (OR 0.73; 95% CI: 0.53-0.99) and were associated with significantly lower bleeding (OR 0.51; 95% CI: 0.39-0.67) and mortality (OR 0.70; 95% CI: 0.52-0.94), confirmed in a sensitivity analysis. LMWH was associated with significantly reduced odds of thromboembolic events (OR 0.26; 95% CI: 0.13-0.55), as well as showing a favorable bleeding profile (OR 0.46; 95% CI: 0.25-0.87), yet no significant difference in mortality (OR 0.80; 95% CI: 0.30-2.14). While no anticoagulation reduced the odds for bleeding (OR 0.17; 95% CI: 0.07-0.38) and NM showed no significant differences, both had wide confidence intervals, limiting interpretation. Heterogeneity for LMWH was low for efficacy and bleeding, yet substantial for mortality; for DTI, low to moderate; for no anticoagulation, low; and for NM, substantial to high on all comparisons. Conclusion(s): In this systematic review and meta-analysis, DTIs and LMWH appear to be effective and safe alternatives to UFH in adult ECMO, with consistent reductions in thromboembolic and bleeding events and a survival benefit observed for DTIs. These findings support reconsideration of UFH as the default anticoagulant and favor a more prominent role for alternative strategies in clinical practice. Trial Registration: PROSPERO CRD42022363588. Copyright © 2026 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <8> Accession Number 2048203658 Title Intravenous amino acids to prevent acute kidney injury in cardiac surgery with cardiopulmonary bypass: a meta-analysis of randomized controlled trials. Source IJC Heart and Vasculature. 66 (no pagination), 2026. Article Number: 101986. Date of Publication: 01 Oct 2026. Author Pantaleao A.N.; Mutarelli A.; Kang J.; Braga M.A.P.; Passos F.S.; Caldonazo T.; Kirov H.; Doenst T.; Bagchi A.; Melnitchouk S. Institution (Pantaleao, Mutarelli) School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (Kang, Melnitchouk) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Braga) Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Passos) Department of Thoracic Surgery, Hospital MaterDei, Salvador, Brazil (Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany (Bagchi) Department of Anesthesia and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Publisher Elsevier Ireland Ltd Abstract Background: The efficacy of intravenous amino acids (AA) in preventing cardiac surgery-associated acute kidney injury (CSA-AKI) remains uncertain. Method(s): Three libraries were searched for randomized controlled trials (RCTs) comparing intravenous AA versus placebo or standard care to reduce the risk of CSA-AKI after cardiac surgery with cardiopulmonary bypass (CPB). The primary endpoint was the incidence of CSA-AKI, overall and stratified by KDIGO stage. Secondary endpoints were need for renal replacement therapy (RRT), 30-day mortality, and 90-day mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Result(s): Five studies were included, comprising 4499 patients, of whom 2247 (50%) were randomized to intravenous AA infusion. Compared with placebo or standard care, intravenous AA administration significantly reduced the risk of CSA-AKI (RR 0.81, 95% CI 0.70-0.94; p = 0.005), predominantly driven by one trial. The relative risk reduction was more important for stage 2 or 3 AKI (RR 0.69, 95% CI 0.48-0.99; p = 0.046). No significant differences were observed in the need for RRT (p = 0.223), 30-day mortality (p = 0.893), or 90-day mortality (p = 0.581). Conclusion(s): Intravenous AA administration is associated with a reduced risk of CSA-AKI across the spectrum of AKI severity, without showing an association with other major clinical outcomes. Copyright © 2026 The Author(s) <9> Accession Number 2048427087 Title Immediate versus staged complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease: A meta-analysis. Source JRAAS - Journal of the Renin-Angiotensin-Aldosterone System. 27 (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Tu X.; Xiang K.; Song Q.; Tang Q.; Tang T. Institution (Tu, Xiang, Song, Tang, Tang) Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Hunan, Changsha, China (Tu, Xiang, Song) Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Hunan, Changsha, China Publisher SAGE Publications Ltd Abstract Background: The comparative outcomes of immediate versus staged complete revascularization (CR) in patients with ST-segment-elevation myocardial infarction (STEMI) and multivessel disease remain unclear. Method(s): We searched the PubMed, Web of Science, EMBASE and Cochrane Library databases until December 11, 2025. The primary endpoints included a composite outcome, all-cause mortality and recurrent MI. We expressed continuous outcome data as mean differences (MDs) and dichotomous outcome data as risk ratios (RRs). Result(s): Eight randomized controlled trials involving 4133 patients were included. Pooled results showed that no significant difference was detected between immediate versus staged CR on the composite outcome (RR,0.91; 95% CI,0.67-1.23;), all-cause mortality (RR,1.33; 95% CI,0.99-1.79) and recurrence MI (RR,0.74; 95% CI,0.50-1.10). ICR did not confer significant differences for individual secondary outcomes (cardiac-cause mortality, repeat revascularization, hospitalization for heart failure, and major bleeding) compared with staged PCI. Additionally, subgroup analyses suggested that treatment effects may vary according to the deferral interval and drug-eluting stent (DES) generation. Conclusion(s): In patients with STEMI and multivessel disease, immediate and staged CR were associated with comparable clinical outcomes. However, the timing of staged PCI and DES generation may influence outcomes. Copyright © The Author(s) 2026 <10> Accession Number 2048345291 Title Rapid Inflation-Deflation vs Pressure-Optimized Stenting During Primary PCI. Source JACC: Cardiovascular Interventions. 19(16) (pp 2234-2246), 2026. Date of Publication: 24 Aug 2026. Author Hakeem A.; Ishaq H.; Memon F.F.; Shah J.A.; Ahmed I.; Mengal M.N.; Lakho A.A.; Solangi B.; Haq E.U.; Kumar R.; Shar G.S.; Bhatti K.I.; Ali A.; Mandokhail Z.I.; Zada S.; Mir A.; Kumari S.; Rai L.; Lehri W.A.; Kumar M.; Muhammad A.S.; Akhtar B.; Bai P.; Shabbir A.; Hussain A.; Naqvi K.Z.; Jabran I.; Modi N.; Brohi A.; Kumar D.; Khan A.; Rabia H.; Rehman I.; Humza A.; Karim M.; Saghir T. Institution (Hakeem, Ishaq, Ali, Shah, Mengal, Lakho, Solangi, Haq, Kumar, Shar, Bhatti, Ali, Mandokhail, Zada, Mir, Kumari, Kumar, Lehri, Kumar, Muhammad, Bai, Shabbir, Naqvi, Jabran, Modi, Rabia, Rehman, Humza, Karim, Saghir) National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan (Memon, Rai, Hussain, Brohi, Kumar, Khan) Sindh Institute of Cardiovascular Diseases (SICVD), Hyderabad, Pakistan (Ahmed, Akhtar) Sindh Institute of Cardiovascular Diseases (SICVD), Lyari, Pakistan Publisher Elsevier Inc. Abstract Background Incomplete microvascular reperfusion during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains a major challenge. Objectives This study sought to determine whether the pressure optimization protocol (POP) improves reperfusion outcomes compared with conventional rapid inflation-deflation stenting in patients undergoing primary PCI for STEMI. Methods In this multicenter randomized trial with blinded endpoint assessment, patients undergoing primary PCI were assigned 1:1 to POP (stent inflation to >=14 atm maintained until pressure stability, defined as no pressure drop >=0.3 atm over 30 seconds) or conventional rapid inflation-deflation stenting. The primary endpoint was hierarchical reperfusion success, analyzed using the Finkelstein-Schoenfeld unmatched WIN ratio: ST-segment resolution >=70% at 90 minutes, final TIMI grade 3, and absence of slow-flow/no-reflow. Results Between September 30, 2024, and November 11, 2025, 607 patients underwent randomization (POP arm, n = 307; conventional arm, n = 300). POP improved the primary hierarchical reperfusion endpoint (WIN ratio: 1.42; 95% CI: 1.11-1.79; P = 0.004). The net WIN difference was +12.64% (95% CI: 3.69-20.98), driven mainly by the first 2 hierarchical components, ST-segment resolution >=70% (+5.70%; 95% CI: -1.89 to 12.56) and final TIMI grade 3 flow (+5.95%; 95% CI: 1.80-10.00). Postdilation was less frequent with POP (213 of 326 stents [65.3%] vs 294 of 323 [91.0%]; P < 0.001). At median follow-up of 30 days (IQR: 29-32), major adverse cardiovascular events (death, myocardial infarction, stent thrombosis, or stroke) occurred in 6 of 307 vs 12 of 300 patients; Kaplan-Meier estimated event rates were 2.0% (95% CI: 0.4-3.5) and 4.1% (95% CI: 1.8-6.3), respectively (HR: 0.49; 95% CI: 0.18-1.31; P = 0.15). Conclusions Among patients with STEMI undergoing primary PCI, pressure-optimized stent inflation resulted in significantly higher rates of successful reperfusion than conventional stenting and reduced need for post dilation. A trend toward fewer 30-day major adverse cardiovascular events was observed. Larger trials are warranted to assess effects on longer-term clinical outcomes. (RAPID-POP: A Randomized Controlled Trial; NCT06430892 ) Copyright © 2026 American College of Cardiology Foundation. <11> Accession Number 651994942 Title Refractory Angina in Palliative Care: Bridging Cardiology and Symptom Management. Source Journal of Pain and Symptom Management. Conference: Annual Assembly of Hospice and Palliative Care. Denver United States. 71(6) (pp e1172-e1173), 2026. Date of Publication: 01 Jun 2026. Author Kommineni S.S.; Mai H.; Beaver E.; Minor S. Institution (Kommineni, Mai, Beaver, Minor) University of Oklahoma Health Sciences Center, United States Publisher Elsevier Inc. Abstract Background. Refractory angina is a chronic, debilitating condition characterized by persistent chest pain due to myocardial ischemia despite optimal medical and revascularization therapy. Although not directly life-threatening, it can profoundly impact quality of life, functional capacity, and psychological well-being. However, palliative care is still underutilized in this population, highlighting the long-standing gap in recognizing chronic ischemic pain as an appropriate indication for supportive care[1]. Methods. We conducted a systematic search on PubMed, Embase, and Scopus using the terms "refractory angina," "palliative care," "quality of life," and "symptom management'. About twelve eligible studies were identified published between 2000 and 2024. These studies were discussed in a narrative review of pharmacologic, device-based, and supportive interventions used in palliative care. The focus was on incorporating treatment with patient preference, psychosocial and existential distress, as well as interdisciplinary collaboration between cardiology and palliative medicine [2]. Results. Management of refractory angina needs a multimodal strategy combining pharmacologic agents (eg, ranolazine, ivabradine, opioids), nonpharmacologic therapies (eg, cognitive behavioral therapy, relaxation techniques), and device-based interventions (eg, enhanced external counterpulsation, spinal cord stimulation)[3]. Coronary sinus narrowing with the Reducer device is a recent advancement which demonstrated improved angina class and quality of life in appropriately selected patients[4]. Angiogenic cell therapy and extracorporeal shockwave myocardial revascularization are other experimental treatment modalities still under investigation[5]. Palliative paradigms also target other unmeasured burdens such as caregiver stress and spiritual despair to enhance patient-reported outcomes and limit unwanted hospitalizations. Conclusions. Refractory angina serves as an important condition through which palliative care serves a considerable benefit by addressing patients' symptoms in an integrated way and by providing goal-concordant care. Greater awareness of its involvement, organized referral pathways and ongoing assessment of newer therapies is required in order to enhance outcomes in this neglected group. <12> Accession Number 2045819235 Title Right internal thoracic artery versus radial artery as the second-best arterial conduit in multi-arterial coronary artery bypass grafting. Source Asian Cardiovascular and Thoracic Annals. 34(6) (pp 515-522), 2026. Date of Publication: 01 Jul 2026. Author Asai T. Institution (Asai) Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa Prefecture, Japan Publisher SAGE Publications Inc. Abstract Background: Multi-arterial coronary artery bypass grafting (maCABG) improves long-term outcomes compared to single internal thoracic artery grafting. Choosing the second arterial conduit-the right internal thoracic artery (RITA) or the radial artery (RA)-is critical. RITA offers superior biological integrity but raises deep sternal wound infection (DSWI) concerns; RA provides ease of harvest but is susceptible to vasospasm and patency issues. Method(s): This narrative review synthesizes recent high-quality clinical investigations, including propensity-matched cohort studies and meta-analyses, comparing RITA and RA as the second conduit in left internal thoracic artery-based CABG. We analyzed comparative long-term survival, graft patency, and complication rates. Finding(s): Multiple propensity score-matched studies demonstrate the superiority of RITA/bilateral internal thoracic artery (BITA) use, reporting significantly improved long-term survival and major adverse cardiac event-free survival compared to RA. BITA use was associated with a 35% reduction in the long-term hazard of death. Conversely, recent large-scale registries and randomized trials increasingly support the use of RA. The risk of DSWI with BITA use can be mitigated through skeletonized harvesting; however, this technique requires significant expertise to ensure graft patency. Conclusion(s): The second arterial graft selection must be individualized, balancing patient-specific risks-such as diabetes and obesity-against the surgeon's proficiency in multi-arterial revascularization. Copyright © The Author(s) 2026 <13> Accession Number 2046176828 Title A Bayesian re-analysis of hypothermic oxygenated perfusion versus static cold storage in the NIHP2019 heart transplantation trial. Source Journal of Heart and Lung Transplantation. 45(9) (pp 1422-1426), 2026. Date of Publication: 01 Sep 2026. Author Heuts S.; Lebreton G.; Dellgren G.; Wallinder A.; Rega F.; Para M.; Michel S.; Schramm R.; Begot E.; Vandendriessche K.; Kamla C.; Gerosa G.; Berman M.; Boeken U.; Clark S.; Ranasinghe A.; Ius F.; Forteza A.; Pivodic A.; Hennig F.; Guenther S.; Kaul P.; Goerler A.; Aliabadi-Zuckermann A.; Gummert J.F.; Van Cleemput J.; Zuckermann A.; Knosalla C. Institution (Para) Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Universite Paris Cite, Paris, France (Michel, Kamla) Clinic of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany (Michel, Kamla) Munich Heart Alliance, German Center for Cardiovascular, Research, Munich, Germany (Schramm, Guenther, Gummert) Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany (Begot) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Vandendriessche) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Gerosa) Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy (Berman, Kaul) Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (Boeken) Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany (Clark) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (Ranasinghe) Cardiac Surgery, Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Trust, Birmingham, United Kingdom (Ius, Goerler) Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany (Forteza) Department of Cardiac Surgery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain (Pivodic) APNC Sweden, Molndal, Sweden (Hennig, Knosalla) Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany (Hennig, Knosalla) Charite-Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Germany (Aliabadi-Zuckermann, Zuckermann) Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Van Cleemput) Department of Cardiology, University Hospitals Leuven, Leuven, Belgium (Heuts, Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands (Lebreton) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Dellgren) Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Dellgren, Wallinder) Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Publisher Elsevier Inc. Abstract The NIHP2019-trial compared hypothermic oxygenated perfusion (HOPE) with static cold storage (SCS) during heart transplantation and investigated clinical outcomes. This post hoc Bayesian re-analysis estimated the probability of clinically meaningful overall treatment effects. In total, 204 patients were analyzed at 12 months (HOPE n = 101, SCS n = 103). Bayesian models with minimally informative priors were used to derive relative risks (RR), absolute risk differences (ARD), and posterior probabilities. In these Bayesian models, HOPE was associated with lower rates of the primary composite endpoint (RR 0.71, 95%CrI 0.49-0.99; ARD -13.8%, 95%CrI -26.8; -0.4%). The probability of any benefit was 97.8%, and the probability of a clinically relevant effect exceeded 90%. For all-cause mortality, the probability of benefit was 90.5%, with a >85% probability of a clinically relevant effect. The results were robust across sensitivity analyses. These findings demonstrate clinically meaningful benefits with HOPE and provide a complementary interpretation of the NIHP2019-trial's results. Copyright © 2026 The Authors. <14> Accession Number 651850201 Title Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial. Source Circulation. Arrhythmia and electrophysiology. 19(8) (pp e014755), 2026. Date of Publication: 01 Aug 2026. Author Lakkireddy D.; Wilber D.J.; Mittal S.; Tschopp D.R.; Ellis C.R.; Rasekh A.; Hounshell T.; Hoyt R.; Evonich R.F.; Chandhok S.; Berger R.D.; Horton R.; Hoskins M.; Calkins H.; Yakubov S.J.; Khalique O.K.; Pulerwitz T.C.; Badhwar N.; Dewland T.; Weiner S.; Valsaiwala S.; Katapadi A.; Simons P.; Walker P.; Ndilkintum N.; DiBiase L.; Natale A.; Lee R.J. Institution (Lakkireddy, Katapadi) Overland Park (D.L. (Wilber, Valsaiwala) Loyola University Chicago Stritch School of Medicine, Maywood, United States (Mittal) Valley Health System, Ridgewood, United States (Tschopp, Horton, Natale) Texas Cardiac Arrhythmia Institute, R. Horton (Ellis) Vanderbilt University Heart-EP, Nashville, United States (Rasekh) Baylor College of Medicine, Houston, United States (Hounshell, Hoyt) MercyOne Iowa Heart Center, R. Hoyt), West Des Moines, United States (Evonich) Upper Peninsula Health System-Marquette (Chandhok) PA (S.C.) (Berger, Calkins) Johns Hopkins University, Baltimore, United States (Hoskins) New Mexico Heart Institute, Mexico (Yakubov) Ohio Health Heart & Vascular (Khalique) St. Francis Hospital & Heart Center, Roslyn, United States (Pulerwitz) Columbia University Irving Medical Center, NY, United States (Badhwar) Stanford University (Dewland, Lee) University of California San Francisco, San Francisco (T.D. (Weiner) Christus Health, Tyler, United States (Simons, Ndilkintum, Lee) MasonUnited States (Walker) MarlboroughNew Zealand (DiBiase) Albert Einstein College of Medicine at Montefiore Health System, Bronx, United States (Natale) University of Tor Vergata, Rome, United States (Natale) Case Western Reserve University, Cleveland, United States Abstract BACKGROUND: Large left atrial volume (LAV) is a strong predictor of advanced left atrial substrate and is associated with less successful outcomes following pulmonary vein isolation (PVI) alone. Prespecified variables of the aMAZE trial (Left Atrial Appendage Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation) were evaluated to access for the impact of LAV and left atrial appendage ligation on atrial fibrillation (AF) outcomes. METHOD(S): The aMAZE trial was a multicenter, randomized-controlled study evaluating the effects of LAV on freedom from atrial arrhythmias (AA) following PVI-only compared with LARIAT and PVI (LARIAT+PVI). In total, 610 drug-refractory patients with nonparoxysmal AF were randomized 2:1 to LARIAT versus PVI alone. Freedom from AA was assessed 12 months postprocedure. LAV was independently assessed by a core laboratory from cardiac computed tomography performed before ablation. (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02513797). RESULT(S): There were 404 patients in the LARIAT+PVI group and 206 in the PVI-only group. Logistic regression performed within each subgroup for primary effectiveness with LAV demonstrated that the recurrence of AA after PVI was directly related to increasing LAV. Freedom from recurrence of AA in the LARIAT+PVI arm was independent and preserved irrespective of LAV. Similar results were seen with LAV index. A tercile analysis of early persistent AF (perAF) patients (AF >7 days and <6 months) and LARIAT+PVI in the highest (>148 cm3) LAV tercile showed statistically significant freedom from AA compared with PVI-only (69% versus 49%; P=0.02). Significant differences (P<0.04) between groups in the early perAF cohort began at an LAV of 130 cm3 and an LAV index of 65 cm3/m2. CONCLUSION(S): The correlation of LAV with PVI effectiveness in this study demonstrates that AA recurrence after PVI alone is directly related to increasing LAV. Freedom from AA after left atrial appendage ligation in addition to PVI is independent of increasing LAV, and left atrial appendage ligation may therefore provide an adjunctive benefit in patients with nonparoxysmal AF and enlarged LAV. <15> Accession Number 2048456486 Title Exercise After Coronary Stenting: Potential Effects on in-Stent Restenosis. Source Current Atherosclerosis Reports. 28(1) (no pagination), 2026. Article Number: 82. Date of Publication: 01 Dec 2026. Author Spadafora L.; Cacciatore S.; Salvi M.; Russo F.; Lo Sasso L.; Lauretti A.; Perone F.; Pierucci N.; Sabouret P.; Zangari G.; De Vito A.; Zoccai G.B.; Bernardi M. Institution (Spadafora, Lauretti, Bernardi) Division of Cardiology and Interventional Cardiology, Santa Maria Goretti Hospital, Latina, Italy (Spadafora, Zoccai) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (Cacciatore) Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States (Cacciatore) School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland (Salvi) Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy (Russo) Division of Cardiology, Sant'Andrea University Hospital, Rome, Italy (Lo Sasso) Catholic University of the Sacred Heart, Rome, Italy (Perone) Cardiac Rehabilitation Unit, Rehabilitation Clinic "Villa delle Magnolie", Castel Morrone, Caserta, Italy (Pierucci) Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences "Sapienza", University of Rome, Rome, Italy (Sabouret) Cardiology Department, Institut de Cardiologie, Centre Hospitalier Universitaire La Pitie-Salpetriere, Sorbonne Universite, Paris, France (Zangari, De Vito) Sapienza University of Rome, Rome, Italy (Zoccai) Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy Publisher Springer Abstract Purpose of Review: Structured exercise is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI), yet its specific relationship with in-stent restenosis (ISR) is less well characterized. This narrative review summarizes the biological rationale, clinical evidence, safety, and practical prescription of exercise training in patients with coronary stents, with a focus on its potential impact on ISR. Recent Findings: Exercise training improves endothelial nitric oxide bioavailability, reduces systemic inflammation, and favorably modulates neointimal proliferation in experimental and clinical studies. Pooled clinical data suggest that exercise-based cardiac rehabilitation after PCI is associated with a reduction in angiographically defined restenosis, although individual trials, largely from the bare-metal and early drug-eluting stent (DES) eras, have shown inconsistent results on binary restenosis endpoints. Available contemporary data do not suggest an excess risk of stent thrombosis, clinically relevant arrhythmias, or adverse ventricular remodeling when exercise is initiated in clinically stable patients using an individualized and supervised approach. Summary: The direct anti-restenotic effect of exercise remains biologically plausible and clinically suggestive but is not yet firmly established, particularly in the contemporary thin-strut DES era. Nevertheless, the well-documented benefits of exercise on functional capacity, endothelial health, and cardiovascular prognosis justify its role as an essential, time-sensitive component of post-PCI care. Larger, contemporary trials with standardized intracoronary imaging endpoints are needed to clarify whether, and in which patient subsets, exercise meaningfully affects the biology of ISR. Copyright © The Author(s) 2026. <16> Accession Number 2046228246 Title Randomized Clinical Trial Comparing Effects of Pulsatile vs Nonpulsatile Cardiopulmonary Bypass on Neurologic Outcomes. Source Annals of Thoracic Surgery. 122(3) (pp 669-678), 2026. Date of Publication: 01 Sep 2026. Author Rajesh S.; Dayi K.; Lussier M.J.; McKeone D.J.; Halstead E.S.; Kunselman A.R.; Myers J.L.; Undar A. Institution (Rajesh, Dayi, Lussier, McKeone, Halstead, Kunselman, Myers, Undar) Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, United States (McKeone) Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States (Halstead) Division of Pediatric Hematology/Oncology, Division of Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States (Halstead) Department of Molecular and Precision Medicine, Penn State College of Medicine, Hershey, PA, United States (Kunselman) Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States (Myers, Undar) Division of Pediatric Cardiology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States (Myers, Undar) Department of Surgery, Penn State College of Medicine, Hershey, PA, United States (Undar) Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, PA, United States Publisher Elsevier Inc. Abstract Background The objective of this secondary analysis was to examine the impact of 2 perfusion modalities on S100 calcium-binding protein B (S100B) levels and neural injury outcomes in patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods Pediatric patients (aged <18 years) were randomly assigned to nonpulsatile or pulsatile perfusion. S100B levels were measured in patients at 5 time points (baseline before incision, 3 to 5 minutes on pump, right before weaning from CPB, 1 hour after CPB, and 24 hours after CPB). All patients were assessed for short-term clinical outcomes and with chart review for postsurgical neural injury: stroke, seizure, white matter injury, developmental delays, behavioral issues, memory loss, unexplained loss of consciousness, hearing impairment, and attention-deficit/hyperactivity disorder. Results A total of 144 consecutive patients were enrolled (70 nonpulsatile, 74 pulsatile). Pulsatile perfusion produced CPB characteristics similar to those of nonpulsatile perfusion and created a greater pulsatility index in the middle cerebral artery and arterial line. S100B levels at all measured time points were similar between both perfusion modalities. A total of 36 patients had neural injuries (15 nonpulsatile, 21 pulsatile). Additionally, S100B levels at all measured time points were similar in patients with and without neural injury. In all groups, S100B levels rose during CPB and were greatest before weaning from CPB and 1 hour after CPB. The 24-hour S100B levels had a weak association with clinical outcomes (0.25 < r <inf> S </inf> <0.5). Conclusions The choice of perfusion modality did not appear to affect S100B levels. Additionally, the measurements of S100B may not be sufficiently sensitive to predict neural injury reliably in patients with congenital heart defects who are undergoing CPB. Copyright © 2026 The Society of Thoracic Surgeons. <17> Accession Number 2047402647 Title Dexmedetomidine for the prevention of postoperative atrial fibrillation: A systematic review and meta-analysis. Source Journal of International Medical Research. 54(7) (no pagination), 2026. Date of Publication: 01 Jul 2026. Author Chen Y.-J.; Xu S.-S.; Shen Q.-H.; Yu D.-H. Institution (Chen) Department of Anesthesiology, Sir Run Run Shaw Hospital Affiliated with the Zhejiang University, China (Xu, Shen, Yu) Department of Anesthesiology, Affiliated Hospital of Jiaxing University, China Publisher SAGE Publications Ltd Abstract Objective: Postoperative atrial fibrillation, a prevalent complication following cardiac surgery, significantly increases patient morbidity and healthcare expenditures. Although dexmedetomidine has been proposed as a potential strategy to mitigate the risk of postoperative atrial fibrillation risk, existing evidence from randomized controlled trials has shown conflicting results. Method(s): To evaluate the efficacy of perioperative dexmedetomidine in adult cardiac surgery patients, we conducted a systematic search across four major electronic databases: (a) PubMed; (b) Embase; (c) the Cochrane Library; and (d) Web of Science. Our search sought all relevant randomized controlled trials on this specific intervention and patient population. We utilized random-effects models to synthesize treatment effects, expressed as risk ratios with 95% confidence intervals. Furthermore, trial sequential analysis and the Grading of Recommendations Assessment, Development, and Evaluation framework were applied to determine the robustness and certainty of the evidence, respectively. Result(s): Our analysis included 22 randomized controlled trials, involving a total of 4063 patients. Dexmedetomidine administration significantly lowered the risk of postoperative atrial fibrillation risk compared with control groups (risk ratio 0.80, 95% confidence interval: 0.70-0.93; I2 = 28%). Subgroup analysis specifically indicated a significant reduction in postoperative atrial fibrillation risk in placebo-controlled trials, while no notable difference was observed when dexmedetomidine was compared with other active sedative agents. In addition, dexmedetomidine was associated with a reduced risk of postoperative delirium (risk ratio 0.62, 95% confidence interval: 0.44-0.87; I2 = 56%). Conclusion(s): Perioperative dexmedetomidine appears to reduce the risk of both postoperative atrial fibrillation risk and delirium in adult cardiac surgery patients, particularly compared with placebo. However, its efficacy relative to alternative active prophylactic agents remains unclear, necessitating rigorous comparative effectiveness trials. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <18> Accession Number 2044968795 Title Adenotonsillar Hypertrophy in Children: Surgery Improves Right Ventricular Cardiac Functions. Source Clinical Pediatrics. 65(8) (pp 1027-1034), 2026. Date of Publication: 01 Sep 2026. Author Sharma S.; Thakur J.S.; Gupta P.; Negi P.C.; Thakur A. Institution (Sharma, Thakur, Gupta) Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, India (Negi) Department of Cardiology, Indira Gandhi Medical College, Shimla, India (Thakur) Department of Pharmacology, Indira Gandhi Medical College, Shimla, India Publisher SAGE Publications Inc. Abstract Objective: To determine the effect of surgical and conservative treatment of adenotonsillar hypertrophy on right ventricular functions in children. Method(s): An interventional study was conducted in 50 children with a mean age of 8.72 +/- 4.72 years and 7.32 +/- 3.84 years and randomized in medical and surgical groups. Cardiac parameters were observed at the time of enrollment, first month, third month, and sixth month after medical or surgical intervention. Result(s): The patients in the medical group did not show any resolution of symptoms at the end of the third month, while 36% of patients had resolution of symptoms at the end of the sixth month. Patients of this group had improvement only in right ventricular outflow tract systolic excursion at the end of the final follow-up. However, the surgical group found 88% of patients with complete resolution of symptoms at the end of the sixth month. The echocardiographic parameters of both the groups had improvements in the number of cardiac parameters like tricuspid annular plane systolic excursion, right ventricular outflow tract systolic excursion, pulmonary artery pressure, and pulmonary flow acceleration time at the end of the final follow-up (6 months); however, the inter-group analysis found significant improvement in the surgical group compared to the medical group. Conclusion(s): Adenotonsillar hypertrophy is known to affect right ventricular functions, and these can be improved better with surgery than with conservative management. Hence, surgery should be prioritized in adenotonsillar hypertrophy to reduce the immediate or risks in adulthood of cardiovascular diseases in few selected patients. Copyright © The Author(s) 2026 <19> Accession Number 2036793403 Title Quality of life measured by EQ-5D at different treatment time points for coronary artery disease: protocol for a systematic review and meta-analysis. Source BMJ Open. 10(7) (no pagination), 2020. Article Number: e039311. Date of Publication: 29 Jul 2020. Author Lum E.; McCreanor V.; Luo N.; Graves N. Institution (Lum, Graves) Health Services & Systems Research, Duke-NUS Medical School, Singapore (Lum) School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia (McCreanor) Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia (McCreanor) Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia (Luo) Saw Swee Hock School of Public Health, National University of Singapore, Singapore Publisher BMJ Publishing Group Abstract Introduction Cardiovascular disease is estimated to affect 423 million people globally. It caused 18 million deaths in 2017 and is projected to cost US$1 trillion by 2030 worldwide. Coronary artery disease (CAD) is the most common type of cardiovascular disease; CAD treatments can affect patients' quality of life. Valuations of quality of life or health utilities are important for economic evaluations to ascertain relative health benefit when comparing treatments, and can be expected to change for individuals over time. The purpose of this systematic review is to estimate the quality of life of patients with CAD reported through the EuroQol 5 Dimension (EQ-5D) questionnaire, from short to longer term time points following different treatments. Methods and analysis PubMed, Embase, Web of Science, the Cochrane Database of Systematic Reviews and the EuroQol website will be systematically searched from January 2003-March 2020. Published, peer-reviewed, English language studies assessing quality of life of patients with CAD using the EQ-5D will be included. One researcher will conduct the search; two researchers will independently screen titles and abstracts for potential inclusion. Full texts of potentially eligible studies will be retrieved for a second round of independent screening against inclusion and exclusion criteria by two researchers. The final list of included studies will be assessed for risk of bias using the RoB 2 and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tools for randomised and non-randomised studies, respectively. Data extraction will be done by one researcher, with data extraction for a random 10% of included studies checked by a second researcher. Mean utility weights for individual studies will be combined using random effects model meta-analyses. A model will be run separately for each time point and treatment. Treatment time points of interest include baseline, 30 days, 6 months, 12-24 months and more than 24 months. Subgroup analysis of patients with diabetes who received interventional treatments-coronary artery bypass graft or percutaneous coronary intervention with or without stents, will be conducted for the same selected time points. Ethics and dissemination Ethics approval is not required for systematic reviews. Results of the review will be disseminated via publication in a peer-reviewed journal. Copyright © Author(s) (or their employer(s)) 2020. <20> Accession Number 2044833595 Title Tirzepatide therapy reduces subclinical leaflet thrombosis and paravalvular leak after transcatheter aortic valve replacement in obese patients: The TAVR-MET trial. Source Cardiovascular Revascularization Medicine. 89 (pp 87-90), 2026. Date of Publication: 01 Aug 2026. Author Thirugnanam A.M.; Chandrakanth; Pruthvi Institution (Thirugnanam, Chandrakanth, Pruthvi) Department of Interventional Cardiology, TX Hospitals, Telangana, Hyderabad, India Publisher Elsevier Inc. Abstract Background Obesity is increasingly recognized as a critical modifier of outcomes following transcatheter aortic valve replacement (TAVR), predisposing patients to subclinical leaflet thrombosis (SLT), hypo-attenuated leaflet thickening (HALT), and paravalvular leak (PVL). Metabolic inflammation, endothelial dysfunction, and pro-thrombotic states associated with obesity contribute to impaired bioprosthetic valve healing. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated robust metabolic, anti-inflammatory, and vascular protective effects. However, its impact on post-TAVR valve performance has not been previously evaluated. Objectives To determine whether tirzepatide therapy initiated before TAVR and continued post-procedure reduces the incidence of HALT and PVL in obese patients undergoing TAVR. Methods TAVR-MET was a prospective, randomized, open-label, multicenter trial enrolling obese patients (BMI >= 30 kg/m2) undergoing transfemoral TAVR. Patients were randomized to tirzepatide therapy or standard care. The primary endpoint was HALT incidence at 6 months assessed by 4D-CT or transesophageal echocardiography (TEE). Secondary endpoints included PVL severity, major adverse valve events (MAVE), inflammatory biomarker changes, weight reduction, and bleeding outcomes. Results Among 260 randomized patients, tirzepatide therapy significantly reduced HALT incidence (8.4% vs 21.6%, p = 0.002) and >= mild PVL (10.7% vs 25.3%, p = 0.006) at 6 months. Tirzepatide was associated with marked reductions in CRP and body weight without an increase in major bleeding. Multivariable analysis identified tirzepatide use, CRP reduction >30%, and BMI <32 kg/m2 at follow-up as independent predictors of HALT absence. Conclusions Metabolic modulation with tirzepatide significantly improves post-TAVR valve healing and hemodynamics in obese patients. These findings introduce a novel cardio-metabolic strategy to reduce structural valve complications following TAVR. Trial summary: TAVR-MET study The TAVR-MET trial was a prospective, randomized, multicenter study designed to evaluate whether metabolic modulation with tirzepatide , a dual GIP/GLP-1 receptor agonist, could improve bioprosthetic valve outcomes following transcatheter aortic valve replacement (TAVR) in obese patients. Obesity is increasingly recognized as a key determinant of post-TAVR complications, particularly subclinical leaflet thrombosis (HALT) and paravalvular leak (PVL) , driven by chronic inflammation, endothelial dysfunction, and a prothrombotic state. Tirzepatide has demonstrated potent weight-reducing, anti-inflammatory, and vascular protective effects, but its role in structural valve outcomes had not previously been explored. The trial enrolled 260 obese patients (BMI >= 30 kg/m 2 ) undergoing transfemoral TAVR across eight high-volume centers. Participants were randomized to receive tirzepatide initiated four weeks before TAVR and continued for 12 months , or standard care alone. All patients received guideline-directed antithrombotic therapy. The primary endpoint was the incidence of HALT at six months assessed by advanced imaging. Secondary endpoints included PVL severity, major adverse valve events, inflammatory biomarker changes, weight reduction, and bleeding outcomes. At six months, tirzepatide therapy was associated with a significant reduction in HALT compared with standard care, as well as a marked decrease in >= mild paravalvular leak . These structural valve improvements were accompanied by substantial weight loss and significant reductions in systemic inflammatory markers , without an increase in major bleeding or adverse safety signals. Multivariable analysis confirmed tirzepatide use and inflammation reduction as independent predictors of improved valve outcomes. In conclusion, the TAVR-MET trial provides the first clinical evidence that targeted metabolic therapy can favorably influence bioprosthetic valve healing after TAVR . These findings support a novel cardio-metabolic strategy for improving post-TAVR outcomes in obese patients and highlight the importance of addressing metabolic inflammation alongside procedural excellence in contemporary structural heart interventions. Copyright © 2026 Elsevier Inc. <21> Accession Number 2044616828 Title "Real-world prognostic performance of different severe and advanced heart failure definitions: Data from the Swedish Heart Failure Registry". Source Journal of Heart and Lung Transplantation. 45(9) (pp 1380-1393), 2026. Date of Publication: 01 Sep 2026. Author Guidetti F.; Lund L.H.; Benson L.; Hage C.; Lindberg F.; Basile C.; Villaschi A.; Musella F.; Stolfo D.; Scorza R.; Baudry G.; Ljungman C.; Braun O.; Valente V.; Bozkurt B.; Metra M.; Savarese G. Institution (Guidetti, Benson, Lindberg, Basile, Villaschi, Musella, Stolfo, Scorza, Valente, Savarese) Department of Clinical Science and Education, Sodersjukhuset; Karolinska Institute, Stockholm, Sweden (Guidetti) Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland (Lund, Benson, Hage) Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (Villaschi) Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (Musella) Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy (Stolfo) Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy (Baudry) Universite de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithematique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France (Baudry) REICATRA, Universite de Lorraine, Vandoeuvre-les-Nancy, France (Ljungman) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Braun) Department of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden (Bozkurt) Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, United States (Metra) Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy Publisher Elsevier Inc. Abstract Background A valid definition of severe heart failure (HF) is essential for earlier identification, timely referral for advanced therapies, and to optimize clinical trial design. Objectives To assess the prevalence, prognostic performance, and 1-year outcomes associated with different definitions of severe and advanced HF (AdvHF) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We included 15,153 patients with EF <40%, HF duration >6 months, and no prior left ventricular assist device or heart transplant, from the Swedish Heart Failure Registry. Several definitions of severe/AdvHF were evaluated: a simplified Heart Failure Association (HFA) definition (NYHA III-IV, EF <30%, >=2 HF hospitalizations in 12 months), the GALACTIC-Severe-definition (NYHA III-IV, EF <30%, >=1 hospitalization in 6 months), and variations adding/removing criteria such as NT-proBNP levels and diuretic dose to the HFA-AdvHF definition. Predictive performance and 1-year outcomes were analyzed. Results The HFA-definition identified 6.4% of patients, with a 1-year cardiovascular death/HF hospitalization risk of 70% and all-cause mortality of 45% (AUC = 0.72). The GALACTIC-Severe definition identified 12.6% of patients with slightly lower but still substantial event rates (59% and 38%, respectively; AUC = 0.73). Definitions incorporating NT-proBNP >=2000 pg/ml had the highest prognostic accuracy (AUC = 0.75). Conclusions The HFA-AdvHF definition selected a smaller, high-risk group, while the GALACTIC-Severe criteria identified a broader population, with a lower, but still high risk. NT-proBNP, HF hospitalization history, and diuretic dose might represent valuable enrichment tools for future trials. Copyright © 2026 The Authors. <22> Accession Number 2041658013 Title Effects of intraoperative higher versus lower positive end-expiratory pressure during one-lung ventilation for thoracic surgery on postoperative pulmonary complications (PROTHOR): a multicentre, international, randomised, controlled, phase 3 trial. Source The Lancet Respiratory Medicine. 14(1) (pp 17-28), 2025. Date of Publication: 01 Jan 2025. Author Senturk M.; Kiss T.; de Abreu M.G.; Cinnella G.; Edmond C.; El Tahan M.R.; dos Reis Falcao L.F.; Gil M.G.; Gregoretti C.; Hachenberg T.; Hollmann M.W.; Jankovic R.J.; Waheedullah K.; Krassler J.; Licker M.; Loop T.; Nandor M.; Mills G.H.; Murrell M.T.; Neskovic V.; Neto A.S.; Nisnevitch-Savarese Z.; Rossaint R.; Schultz M.J.; Senturk N.M.; Severgnini P.; Szegedi L.L.; de Anda G.F.V.; Tamas V.; Voyagis G.; Wittenstein J.; Zhong J.; Abbenhuis J.; Abdulmomen A.; Abdyli A.; Abu Elyazed M.M.; Puig P.A.; Akbudak I.H.; Aksu C.; Alagoz A.; Alhamdi M.; Almadhati S.; Altorki N.K.; Alvarez S.A.; Arun O.; Azizoglu M.; Baar W.; Balde D.; Balla B.; Seker M.B.; Basheer M.; Bauer W.O.; Bence J.; Bernardi M.H.; Bigatello L.M.; Bignami E.; Bluth T.; Bonney I.; Bouhemad B.; Bradic N.; Brescianini L.; Bruthans J.; Bulte C.S.E.; Cadar G.; Cakmak G.; Cali P.; Cantatore L.P.; Chai X.; Chang Y.-T.; Chen J.; Christofaki M.; Sanches L.C.; Constantin A.; Contreras V.; Corsi L.; da Silva E.; Defosse J.; Deluca R.; Diaper J.; Didden L.; Dimitriou E.; do Nascimento P.; Domi R.; Dorfinger L.; Douradinho C.; Globokar M.D.; Duran F.M.; Eldawlatly A.; El-Gendy H.M.; Elmazny M.I.; Elsherif S.E.I.; Emara M.M.; de los Santos S.T.E.; Farnell-Ward S.; Ferrufino R.; Gao L.; Geyik D.; Gnezda D.; Goeden S.; Gorjup K.; Guerra R.E.G.; de Castro Pereira M.G.; Guinot P.G.; Guven A.; Hager H.; Han L.; Hatipoglu Z.; Hayashi M.; Hell J.; Hofland J.; Hu J.; Hudacek K.; Huti G.; Ilic M.; Jegarl A.; Andujar M.-J.J.; Jin D.; Kammerer T.; Karadza V.; Kawagoe I.; Paudel S.I.K.; Koch T.; Kolaric N.; Koning N.J.; Kostopanagiotou K.; Kostroglou A.; Kovac P.; Kramer T.; Kreft T.; Kumrular Y.; Kuut M.; Lan L.; Li P.-C.; Li X.-F.; Li L.-T.; Liu Y.; Longo F.; Lopez-Baamonde M.; Luise S.; Luo W.; Lv H.; de los Angeles Macias Jimenez M.; Magalhaes D.D.; Martuscelli M.; Mavko A.; Meco B.C.; Mermer H.A.; Miao C.; Michalek P.; Aragon E.M.; Mirabella L.; Molyneux M.; Montrano L.; Mosqueira L.; Mourisse J.; Navarro-Ripoll R.; Negru F.; Nikolic M.; de la Vega J.A.N.; Noto A.; Nyktari V.; Sungur M.O.; Ozdemir L.; Ozolina A.; Ozturk T.; Pace M.C.; Neto E.P.; Paloczi B.; Papaioannou A.; Papamichail K.; Patroniti N.; Pektas Y.; Matalobos D.P.; Persec J.; Petrovic S.; Pirc D.; Plismanis G.; Amendola C.P.; Prazetina M.; Radovic N.; Rauseo M.; Richter T.; Vallejo L.R.; Ruiz J.J.R.; Rondovic G.; Rosser J.; Sanchez Garcia F.J.; Sansone P.; Saracoglu A.; Saracoglu K.T.; Sazak H.; Scharffenberg M.; Schiavoni L.; Schilling T.; Sediq A.; Semmelmann A.; Bingul E.S.; Sertcakacilar G.; Sfika E.; Shelley B.; Shin S.H.; Sidiropoulou T.; Silva J.M.; Socci L.; Socorro T.; Soulioti E.; Spadaro S.; Spicek-Macan J.; Spray D.; Stamenkovic D.; Stefanakis G.; Stoica R.; Stojanovic M.; Stopora P.; Sungur Z.; Svareniece-Karjaka E.; Szamos K.; Tanase N.-V.; Tanriverdi C.; Tempel F.; Terwindt L.E.; Theilen R.; Tipura D.; Tire Y.; Tomaselli E.; Onari N.T.; Tunc M.; Turhan O.; Turktan M.; Ugliola D.; Ulugol H.; Vegh T.; Vetrugno L.; Vitali C.; Volta C.A.; von Dossow V.; Vukovic R.; Vukovic A.Z.; Waeschle R.M.; Wall D.; Wang H.; Wang D.; Winroth D.; Wu Q.; Xu P.; Yaldir O.; Sirzai E.Y.; Yang X.; Yapici D.; Yildirim O.; Guclu C.Y.; Yu H.; Tanriverdi S.Y.; Zarbock A.; Zeba S.; Zhang Y.; Zhang X.; Zhang Z.; Zhang J.; Zhang G.-W.; Ziemann S. Institution (Cinnella, Cantatore, Mirabella, Montrano, Rauseo, Ugliola) University of Foggia, Foggia, Italy (Edmond) Department of Anesthesiology, The Mount Sinai Hospital, New York, United States (El Tahan) Mansoura University, Mansoura, Egypt (dos Reis Falcao, Brescianini, Douradinho, Shin) Federal University of Sao Paulo, Brazil (Kiss, de Abreu) Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstrase 74, Dresden, Germany (Gil) Valencia University, Spain (Gregoretti) Intensive Care Unit and Anesthesiology Service, G Giglio Foundation Cefalu (PA), MED41 Unicamillus University, Rome, Italy (Hachenberg, Schilling) Department of Anesthesiology and Intensive Care, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany (Hollmann, Bauer, Terwindt) Department of Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands (Jankovic) Clinic for Anesthesiology, Reanimathology and Intensive Therapy, University Clinical Center Nis, Serbia (Kiss) Department of Anaesthesiology, Intensive-, Pain- and Palliative Care Medicine, Radebeul Hospital, Academic Hospital of the Technische Universitat Dresden, Radebeul, Germany (Krasler, Stopora) Lung centre Coswig, Lung centre Coswig Centre for pneumology, allergology, respiratory medicine and thoracic surgery, Coswig, Saxony, Germany (Licker) Department of Cardiothoracic Anesthesia & Critical Care, University Hospital of Martinique, Fort de France, Martinique (Loop) Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (Nandor) Division of Anaesthesia, Pain Medicine and Intensive Care, Imperial College London, Royal Brompton & Harefield Hospitals, Guy's & St. Thomas' NHS, London, United Kingdom (Zhong, Jin, Liu, Luo, Miao, Wu, Xu, Zhang) Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (Mills, Rosser) Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom (Murrell, Jegarl) Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States (Neskovic, Radovic, Rondovic, Vukovic, Zeba) Clinic for Anesthesia and Critical Care, Military Medical Academy, Belgrade, Serbia (Neto) Monash University, Data Analytics Research and Evaluation Centre, University of Melbourne, Austin Hospital, Australia (Nisnevitch-Savarese) Penn State Hershey Anesthesiology & Perioperative Medicine, Hershey, United States (Rossaint) Klinik fur Anasthesiologie, Uniklinik RWTH Aachen, Germany (Schultz) Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (Senturk, Senturk) Department of Anesthesiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey (Severgnini) Department Biotechnology and Sciences of Life, Azienda Ospedaliera Fondazione Macchi, University of Insubria, Varese, Italy (Szegedi) Department of Anesthesiology, Universite Libre de Bruxelles, H.U.B Hopital Erasme, Bruxelles, Belgium (de Anda) School of Medicine, State of Mexico Autonomous University, Mexico (Tamas, Balla, Paloczi, Szamos, Vegh) Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary (Voyagis) Department of Anesthesiology, Sotiria Chest Hospital, Athens, Greece (Kiss, de Abreu, Wittenstein, Bluth, Dorfinger, Koch, Kramer, Richter, Scharffenberg, Tempel, Theilen) Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstrase 74, Dresden, Germany (Senturk) Acibadem University, School of Medicine, Turkey (Nandor) Department of Anesthesia and Intensive Care, Semmelweis University, Budapest, Hungary (Abdulmomen, Alhamdi, Eldawlatly) College of Medicine, King Saud University, Riyadh, Saudi Arabia (Abdyli) American Hospital 3, Tirana, Albania (Abu Elyazed, El-Gendy, Elmazny, Elsherif) Department of anesthesia and surgical ICU, Faculty of medicine, Tanta university, Tanta, Egypt (Puig, Matalobos) Hospital Alvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain (Akbudak, Tanriverdi, Tanriverdi) Department of Anesthesiology and Reanimation, Pamukkale University, Faculty of Medicine, Denizli, Pamukkale, Turkey (Aksu) Department of Anesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Izmit, Turkey (Alagoz, Sazak, Tunc) Department of Anesthesiology, University of Health Sciences, Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey (Tanase) Department of Anesthesiology and Intensive Care Medicine, Central University and Emergency Military Hospital Dr. Carol Davila, Bucharest, Romania (Almadhati, Sediq) Azadi heart center, Iraq (Altorki) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, United States (Alvarez, Aragon, Sanchez Garcia) Department of Anesthesiology, La Ribera University Hospital, Alcira, Valencia, Spain (Arun) Selcuk University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey (Azizoglu, Ozdemir, Yapici) Mersin University School of Medicine, Turkey (Loop, Baar, Hell, Semmelmann, Winroth) Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (Balde, Contreras, Mosqueira) Division Anestesiologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile (El Tahan) Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Seker) City Hospital Antalya, Turkey (Basheer) King Abdullah Medical City, Makkah, Saudi Arabia (Waeschle) DZHK (German Centre for Cardiovascular Research), Partner site Gottingen, Gottingen, Germany (Bence) Department of Anaesthesia and Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom (Bernardi, Hager, Wall) Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Vienna, Austria (Bigatello) Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States (Bignami) Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy (Papamichail, Sfika) "Sotiria"Athens Chest Hospital, Greece (Bonney, Ferrufino) Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States (Bouhemad, Guinot) Departement d'Anesthesie-Reanimation, Centre Hospitalier Universitaire de Dijon, Universite de Bourgogne Franche-Comte, Dijon, France (Bradic, Ilic, Nikolic, Persec, Prazetina, Tipura) Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia (Voyagis) University of Patras, Patras, Greece (Bruthans, Michalek) Department of Anesthesiology, Intensive Care and Resuscitation, General University Hospital, Prague, Czechia (Abbenhuis, Bulte) Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands (Cadar) Department of Anesthesia and Intensive Care, Institute of Pneumoftiziology Marius Nasta, Bucharest, Romania (Cakmak, Saracoglu, Sirzai) Marmara University School of Medicine, Istanbul, Turkey (Cali, Deluca) AOU G. Martino Messina, Italy (Papaioannou) Anaesthesiology Department, University Hospital of Heraklion, Crete, Greece (Chai, Chen, Hu, Wang, Yang) Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China (Chang) Department of Anesthesiology, Taichung Veterans General Hospital, Taiwan (Republic of China) (Tanriverdi, Tanriverdi) Department of Anesthesiology and Reanimation, Denizli State Hospital, Denizli, Merkezefendi, Turkey (Christofaki, Stefanakis) University Hospital of Heraklion, Crete, Greece (Stoica) Faculty of Medicine "Titu Maiorescu", Bucharest, Romania (Sanches, de Castro Pereira, Amendola, Onari) Hospital de Amor de Barretos, SP, Barretos, Brazil (Constantin) Department of Pulmonology, Institute of Pneumoftiziology Marius Nasta, Bucharest, Romania (Socci) Bristol Royal Infirmary (BRI), University Hospitals Bristol and Weston, United Kingdom (Corsi) IRCCS San Martino Policlinico Hospital, Genoa, Italy (da Silva, Magalhaes, Neto) Hospital Sao Vicente de Paulo, Passo Fundo city, Brazil (Defosse) Klinik fur Anasthesiologie und operative Intensivmedizin, Kliniken Koln, Klinikum der Universitat Witten, Herdecke, Koln, Germany (Senturk) Acibadem University, School of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey (Diaper, Luise) Department of Anesthesia, University of Geneva, Switzerland (Didden) Department of Intensive Care, Bernhoven Ziekenhuis, Uden, Netherlands (Dimitriou) University Hospital of Patras, Greece (do Nascimento) Department of Surgical Specialties and Anesthesiology, Clinics Hospital, Botucatu Medical School, University of Sao Paulo State, UNESP, Botucatu, Sao Paulo, Brazil (Domi) Faculty of Medicine, University of Medicine, Tirana, Albania (Persec) University North Department of Biomedical Sciences Croatia, Croatia (Persec) University of Zagreb School of Dental Medicine Croatia, Croatia (Patroniti) IRCCS Ospedale Policlinico San Martino, Genoa, Italy (Globokar, Gnezda, Gorjup, Kovac, Pirc) Clinical Department of Anesthesiology and Intensive Care, University Medical Center, Ljubljana, Slovenia (Duran) Department of Thoracic Surgery, Konya City Hospital, University of Health Sciences, Konya, Turkey (Meco) Ankara University, Brain Research Center (BAUM), Ankara, Turkey (Noto) Division of Anesthesia and Critical Care, Department of Human Pathology of the adult and evolutive age "Gaetano Barresi", University of Messina, Messina, Italy (Pace, Sansone) Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli ", Naples, Italy (Andujar, Lopez-Baamonde, Navarro-Ripoll, Vallejo) Institut d'Investigacions Biomediques Agusti Pi i Sunyer (IDIBAPS), Barcelona, Spain (Emara) Department of Anesthesiology and Intensive Care and Pain Medicine, Mansoura University Hospitals, Mansoura University, Faculty of Medicine, Mansoura, Egypt (de los Santos) Anesthesia Department, National Institute for Respiratory Diseases, Ismael Cosio Villegas, Mexico City, Mexico (Farnell-Ward, Spray) Department of Cardiothoracic Anaesthesia and Critical Care, St George's University Hospitals NHS Trust, London, United Kingdom (Huti) American Hospital, Tirana, Albania (Gil) Consorcio Hospital General Universitario of Valencia, Spain (Gao, Lv, Wang, Zhang) Department of Anesthesiology, Fudan University, Shanghai Cancer Center, Shanghai, China (Geyik, Saracoglu) Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey (Contreras) Departamento de Salud del Adulto y Senescente, Escuela de Enfermeria, Pontificia Universidad Catolica de Chile, Santiago, Chile (Goeden, Koning) Department of Anesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, Netherlands (Bradic) Department of Biomedical Sciences, University North, Varazdin, Croatia (Neskovic, Rondovic, Stamenkovic, Zeba) Faculty of Medicine, MMA, Belgrade, Serbia (Guerra, de los Angeles Macias Jimenez, de la Vega) Anesthesia Department, National Institute for Respiratory Diseases, Ismael Cosio Villegas, Mexico City, Mexico (Mills) University of Sheffield, Sheffield, United Kingdom (Licker) Faculty of Medicine, University of Geneva, Geneva, Switzerland (Guven, Meco, Guclu) Department of Anesthesiology and ICU, Ankara University, Faculty of Medicine, Ankara, Turkey (Nyktari) School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece (Han) Department of Anesthesiology, Shanghai Tongren Hospital, Tongren Hospital Shanghai, Jiao Tong University School Of Medicine, Shanghai, China (Hatipoglu, Turktan) Cukurova University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey (Hayashi, Kawagoe) Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan (de Abreu) Outcomes Research Consortium, Department of Anesthesiology, Integrated Health Care Institute, Cleveland Clinic, Cleveland, OH, United States (Hofland) Department of Anesthesiology, Pain- and Palliative Care Medicine, Radboud University Medical Centre, Nijmegen, Netherlands (de Abreu) Division of Intensive Care and Resuscitation, Department of Anesthesiology, Integrated Health Care Institute, Cleveland Clinic, Cleveland, OH, United States (Waheedullah) JenaGermany (Hudacek) Department of Anaesthesia, Resuscitation and Intensive Care Medicine, Faculty of Medicine, University Hospital Brno, Brno, Czechia (Huti) University of Medicine, Tirana, Albania (Ziemann) Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany (Jankovic, Stojanovic, Vukovic) Clinic for Anesthesiology, Reanimatology and Intensive Therapy, University Clinical Center Nis, Serbia (Andujar, Lopez-Baamonde, Navarro-Ripoll, Vallejo) Anaesthesiology and Intensive Care Department, Hospital Clinic de Barcelona, University of Barcelona, Spain (Zhang) Department of Anesthesiology, West China (Airport) Hospital, Sichuan university, Chengdu, China (Zhang) Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University, School of Medicine, Shanghai, China (Kammerer) Klinik fur Anasthesiologie und Operative Intensivmedizin, Universitatsklinikum Koln (AoR), Koln, Germany (Karadza, Kolaric, Spicek-Macan) Department of Anesthesiology and ICU, University Hospital Centre Zagreb, Zagreb, Croatia (Zhang) Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai Geriatric Medical Center, Shanghai, China (Paudel, Ulugol) Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey (Zarbock) Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Munster, Germany (Waeschle) Department of Anaesthesiology, University Medical Centre Gottingen, Gottingen, Germany (Molyneux) University Hospitals Bristol and Weston NHSFT, Department of Anaesthesia, Bristol, United Kingdom (von Dossow) Institut fur Anasthesiologie und Schmerztherapie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitatsklinik der Ruhr, Universitat Bochum, Med. Fakultat OWL, Universitat Bielefeld, Bad Oeynhausen, Germany (Kostopanagiotou) Department of Thoracic Surgery, Attikon University Hospital, Athens, Greece (Kostroglou, Sidiropoulou, Soulioti) Department of Anesthesiology, Attikon University Hospital, Athens, Greece (Vetrugno) Department of Medicine, University of Udine, Udine, Italy (Tanase) University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (Negru) Department of Anesthesiology, Institute of Pneumoftiziology Marius Nasta, Bucharest, Romania (Kreft) Universitatsklinikum Magdeburg A. o. R., Medizinische Fakultat, Otto-von-Guericke Universitat Magdeburg, Magdeburg, Germany (Kumrular, Ozturk, Yaldir, Yildirim) Manisa Celal Bayar University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey (Kuut, Mourisse) Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands (Lan) The first affiliated hospital of Guangzhou Medical University, Guangzhou, China (Li) Department of Anesthesiology, Chang Gung Memorial Hospital, Chiayi, Taiwan (Republic of China) (Li, Yu) Department of Anesthesiology, West China Hospital, Sichuan university, Chengdu, China (Li) Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China (Stoica) Department of Anesthesiology Sanador Clinical Hospital, Bucharest, Romania (Stamenkovic) Military Medical Academy, Belgrade, Serbia (Longo, Martuscelli, Schiavoni, Tomaselli) Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Fondazione Policlinico Universitario, Campus Bio-Medico, Rome, Italy (Spadaro, Vitali, Volta) Department of Translational Medicine, University of Ferrara, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy (Socci) Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom (Silva) Instituto de Assistencia Medica ao Servidor Publico Estadual de S. Paulo, SP, Sao Paulo, Brazil (Shelley) Golden Jubilee National Hospital, West of Scotland Heart and Lung Centre, University of Glasgow, Academic Unit of Anaesthesia, Pain and Critical Care, Scotland, Clydebank, United Kingdom (Sertcakacilar) Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey (Bingul, Sungur, Turhan) Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey (Sungur) Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Faculty of Medicine, Turkey (Ozolina) Department of Anesthesiology, Riga East University Hospital, Riga Stradins University, Riga, Latvia (Mavko) Clinical Department of Thoracic Surgery, University Medical Center Ljubljana, Slovenia (Ruiz, Socorro) Insular Hospital, Gran Canaria, Spain (Mermer, Tire) Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Sciences, Konya, Turkey (Plismanis, Svareniece-Karjaka) Department of Anesthesiology, Riga East University Hospital, Riga, Latvia (Petrovic) Institute For Pulmonary Diseases of Vojvodina, Thoracic Surgery Clinic, Anaesthetic Department, University of Novi Sad, Serbia (Pektas) Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey (Patroniti) Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy Publisher Elsevier Ltd Abstract Background: The effect of higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres aimed at lung expansion as compared with lower PEEP without recruitment manoeuvres aimed at permissive atelectasis on postoperative pulmonary complications (PPCs) in patients undergoing one-lung ventilation (OLV) during thoracic surgery is unclear. We aimed to determine the contribution of an intraoperative lung expansion strategy to preventing PPCs. Method(s): In this multicentre, randomised, controlled, international phase 3 trial (PROTHOR) conducted at 74 sites in 28 countries, we enrolled adult patients (aged >=18 years) with a BMI of less than 35 kg/m2 who were scheduled for open thoracic or video-assisted thoracoscopic surgery under general anaesthesia requiring one-lung ventilation with a double-lumen tube, with a planned operative time of more than 60 min, and an expected duration of one-lung ventilation longer than that of two-lung ventilation. Patients were randomly assigned (1:1), using permuted blocks of random size (4, 6, and 8) and stratified by study site, to receive one-lung ventilation with either a higher PEEP of 10 cm H<inf>2</inf>O and periodic lung recruitment manoeuvres (high PEEP group) or a lower PEEP of 5 cm H<inf>2</inf>O without routine recruitment manoeuvres (low PEEP group). All patients received protective tidal volumes of 5 mL/kg predicted body weight during one-lung ventilation and 7 mL/kg predicted body weight during two-lung ventilation. Postoperative assessors were masked to treatment allocation. The primary outcome was a composite of PPCs during the first 5 postoperative days, including aspiration pneumonia, moderate or severe respiratory failure, acute respiratory distress syndrome (ARDS), pulmonary infection, atelectasis, cardiopulmonary oedema, pleural effusion, non-operative pneumothorax, pulmonary infiltrates, prolonged air leak, purulent pleuritis, pulmonary embolism, and pulmonary haemorrhage. A modified intention-to-treat analysis was performed, with patients analysed according to their assigned treatment group, except in cases of withdrawal of informed consent, cancellation of surgery, and or loss to follow-up. This trial is registered with ClinicalTrials.gov (NCT02963025) and is completed. Finding(s): Between Jan 3, 2017, and Feb 12, 2024, 2200 patients were randomly allocated: 1099 to the high PEEP group and 1101 to the low PEEP group. 43 patients in the high PEEP group and 33 in the low PEEP group were excluded from the modified intention-to-treat analysis after randomisation. The primary outcome occurred in 555 (53.6%) of 1036 patients in the high PEEP group and 592 (56.4%) of 1049 patients in the low PEEP group (absolute risk difference -2.68 percentage points [95% CI -6.36 to 1.01]; p=0.155). Intraoperative complications occurred in 484 (49.8%) of 972 patients in the high PEEP group and in 305 (31.3%) of 974 patients in the low PEEP group (absolute risk difference 18.09 percentage points [95% CI 14.41-21.77]), among which hypotension (360 [37.3%] of 966 patients in the high PEEP group vs 140 [14.3%] of 978 in the low PEEP group) and new arrhythmias (89 [9.9%] of 899 vs 37 [3.9%] of 956) were more frequent in the high PEEP group, while hypoxaemia rescue manoeuvres were more frequent in the low PEEP group (29 [3.3%] of 888 vs 86 [8.8%] of 982). The proportions of patients with extrapulmonary postoperative complications (110 [10.6%] of 1036 vs 107 [10.2%] of 1049 patients), and the numbers of adverse events (209 vs 204 events), did not differ between groups. Interpretation(s): In patients with a BMI of less than 35 kg/m2 undergoing thoracic surgery, one-lung ventilation using higher PEEP with recruitment manoeuvres, compared with lower PEEP without recruitment manoeuvres, did not reduce PPCs. The choice for intraoperative lung expansion or permissive atelectasis should take the individual gas-exchange and haemodynamic conditions into account, which might vary during the intraoperative period. Funding(s): Clinical Trials Network of the European Society of Anaesthesiology and Intensive Care; Department of Anaesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universitat Dresden (Dresden, Germany); Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (Brasilia, Brazil); and the Association of Anaesthetists of GB and Ireland. Copyright © 2025 Elsevier Ltd <23> Accession Number 2032790215 Title Safety and efficacy of cerebral embolic protection systems in transcatheter aortic valve replacement: a systematic review and meta-analysis. Source Expert Review of Cardiovascular Therapy. 22(12) (pp 681-688), 2024. Date of Publication: 2024. Author Kheyrbek M.; Alsabti S.; Niroula S.; Ahmad E.; Choucair M.; Bhatia U.; Wernette A.; Chhabra K.; Strubchevska K.; Hanson I.; Halalau A. Institution (Kheyrbek, Alsabti, Niroula, Ahmad, Choucair, Bhatia, Wernette, Chhabra, Strubchevska, Halalau) Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States (Hanson) Department of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States (Hanson, Halalau) Oakland University William Beaumont School of Medicine, Rochester, MI, United States Publisher Taylor and Francis Ltd. Abstract Background: Stroke is a potential complication of Transcatheter Aortic Valve Replacement (TAVR). Recent trials evaluating Cerebral Embolic Protection Systems (CEPS) to reduce the incidence of stroke after TAVR have been conflicting. Method(s): Multiple databases were searched for studies comparing TAVR with or without CEPS and that reported on the primary outcome of periprocedural stroke. Two authors individually screened the titles, the abstracts and the full texts using Covidence. Risk of bias was assessed using Cochrane's ROB-2 and ROBINS-I tools. Result(s): A total of 15 studies (3 randomized controlled trials, 7 national registries, and 5 cohort studies) met the eligibility criteria and were included in our review. CEPS was associated with lower rates of periprocedural stroke [OR 0.71 (95% CI 0.55, 0.93) p = 0.012], as well as lower rates of mortality [OR 0.60 (95% CI 0.49, 0.74) p < 0.001]. There was no significant difference between the two groups in the incidence of acute kidney injury [OR 0.91 (95% CI 0.82, 1.01) p = 0.087], major vascular complications [OR 0.97 (95% CI 0.83, 1.14) p = 0.734], and major life-threatening bleeding [OR 0.89 (95% CI 0.73, 1.07) p = 0.222]. Conclusion(s): Our findings suggest that the use of CEPS in TAVR is associated with a lower risk of periprocedural stroke and mortality. Registration: The PROSPERO identification number is CRD42022374055. Copyright © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. <24> Accession Number 2048449625 Title Repurposing of colchicine: critical examination of clinical trials and scoping review. Source European Journal of Clinical Pharmacology. 82(9) (no pagination), 2026. Article Number: 238. Date of Publication: 01 Sep 2026. Author Bindel L.J.; Seifert R. Institution (Bindel, Seifert) Institute of Pharmacology, Hannover Medical School, Hannover, Germany Publisher Springer Science and Business Media Deutschland GmbH Abstract Purpose: Drug repurposing represents a cost-effective and time-efficient strategy to expand therapeutic treatment options. Colchicine, traditionally used for gout and familial Mediterranean fever, has gained attention as a candidate for diverse conditions. This study aimed to provide a comprehensive and critical overview of clinical trials on colchicine repurposing, with particular focus on reliability, significance, and safety outcomes. Method(s): A structured search of clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) was completed on July 07 2026. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline, PubMed and Scopus were searched using the term "colchicine AND repurposing". Result(s): 40 clinical trials were included. Nine addressed COVID-19, 26 cardiovascular conditions or related interventions, and five with other indications. Evidence in COVID-19 was inconsistent. Cardiovascular evidence was strong for chronic coronary artery disease and prevention after myocardial infarction. Findings in acute coronary syndromes, percutaneous coronary intervention, surgery and heart failure were mixed and often limited to surrogate endpoints. Other indications did not observe a significant benefit. Most frequent adverse effects were gastrointestinal, particularly diarrhoea. Increased non-cardiovascular mortality in individual trials highlights toxicity potential. Conclusion(s): Current evidence most consistently supports colchicine for secondary cardiovascular prevention in established coronary disease. No reliable evidence is found for benefit across broader cardiovascular conditions, COVID-19 or other indications. A narrow therapeutic index and high drug-interaction potential necessitate careful patient selection and monitoring. Well-powered and methodologically robust clinical trials are required to investigate and confirm potential benefits. Copyright © The Author(s) 2026. <25> Accession Number 2034706678 Title Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis. Source Journal of Clinical Medicine. 14(10) (no pagination), 2025. Article Number: 3280. Date of Publication: 01 May 2025. Author Rybaczek M.; Mariak Z.; Grabala P.; Lyson T. Institution (Rybaczek, Mariak, Grabala, Lyson) Department of Neurosurgery, Medical University of Bialystok, M. Sklodowskiej-Curie 24A, Bialystok, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Method(s): A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Result(s): Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of -4.68 (95% CI: -8.77; -0.59, p = 0.032). However, a high heterogeneity (I2 = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusion(s): Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Copyright © 2025 by the authors. <26> Accession Number 2030680225 Title Exploring heart rate variability in polycystic ovary syndrome: implications for cardiovascular health: a systematic review and meta-analysis. Source Systematic Reviews. 13(1) (no pagination), 2024. Article Number: 194. Date of Publication: 01 Dec 2024. Author Mirzohreh S.T.; Panahi P.; Heidari F. Institution (Mirzohreh, Panahi) Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of (Heidari) Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of Publisher BioMed Central Ltd Abstract Objectives: Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. It has significant implications for female endocrine function, reproductive health, and metabolic disturbances, including insulin resistance, impaired glucose tolerance, and dyslipidemia. Studies have shown that decreased heart rate variability (HRV), a marker of autonomic dysfunction, is associated with adverse cardiovascular events. Recent research has focused on investigating autonomic function in PCOS, and some studies have suggested altered autonomic drive in these patients. The aim of this systematic review and meta-analysis was to evaluate cardiac autonomic function by analyzing HRV in women with PCOS. Method(s): This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI). Result(s): Seventeen articles were included in the final analysis, varied in quality, ranging from a "low" to a "high risk of bias". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases. Conclusion(s): The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group. Copyright © The Author(s) 2024. <27> 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. 137(3) (pp 676-689), 2026. Date of Publication: 01 Sep 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/ <28> Accession Number 2046649048 Title From legacy to future: A global bibliometric analysis of the Ross procedure over 60 years. Source Asian Cardiovascular and Thoracic Annals. (no pagination), 2026. Article Number: 02184923261458925. Date of Publication: 2026. Author Cubas W.S.; Alfabeto A.; Kawaguchi Y.; Guo L.-R.; Chu M.W.A. Institution (Cubas, Alfabeto, Kawaguchi, Guo, Chu) Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada Publisher SAGE Publications Inc. Abstract Background: The Ross procedure, introduced in 1967, transformed cardiac surgery. This study presents one of the first global bibliometric analyses, to the best of our knowledge, mapping research trends, collaborations, and authorship to identify future directions in this field. Method(s): A global bibliometric analysis of Ross procedure publications (1967-2025) was performed using Scopus and PubMed. Data processed in R (bibliometrix, biblioshiny) explored productivity, collaborations, authorship, and thematic evolution. Future publication trends to 2050 were forecast using a linear extrapolation model with 95% confidence intervals. Result(s): A total of 2370 Ross procedure publications were identified (1967-2025), showing an 8.1% average annual growth rate. Original articles dominated (65%), followed by reviews/meta-analyses (13.9%) and case reports (13.5%). Among 6228 authors (69.5% male), collaboration averaged 4.9 coauthors/document, with 12.6% international partnerships. The USA (32.3%), the Netherlands (19.3%), and Germany (14.5%) led in productivity. Top institutions were Erasmus University Medical Center (4.3%), Mount Sinai Health System (3.0%), and University Heart Center Lubeck (2.2%). Major journals included Annals of Thoracic Surgery (13.5%), Journal of Thoracic and Cardiovascular Surgery (12.2%), and European Journal of Cardio-Thoracic Surgery (7.6%). Faculty surgeons authored 66% of first-author papers. Main research themes involved allograft reintervention, durability, suture technique, failure, and postoperative complications. Linear regression predicted 164 annual publications by 2050. Conclusion(s): This analysis reveals an exponentially increasing and sustained global interest in the Ross procedure, which continues to shape cardiac surgery worldwide. The findings highlight growing research output, robust international collaboration, and a focus on clinical innovation, ensuring ongoing advancements in surgical techniques, patient outcomes, and global cardiovascular surgical excellence. Copyright © The Author(s) 2026 <29> Accession Number 2036904960 Title Percutaneous coronary intervention for stable late ST-elevation myocardial infarction with symptoms onset between 12 and 72 h - A systematic review. Source Cardiovascular Revascularization Medicine. 78 (pp 1-9), 2025. Date of Publication: 01 Sep 2025. Author Fatima S.; Harinstein M.E.; Hussain M.; Pacella J.J. Institution (Fatima) Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve Medical University, United States (Harinstein, Pacella) Heart and Vascular Institute, University of Pittsburgh Medical Center, United States (Hussain) Department of Medicine, Allied Hospital, Faisalabad, Pakistan Publisher Elsevier Inc. Abstract Background: There exists clinical equipoise regarding whether and when an invasive approach should be preferred over conservative treatment in the management of stable late ST-elevation myocardial infarction (STEMI) presenting within 12 to 72 h of symptom onset. Objective(s): To perform a systematic review to identify the most effective treatment strategy between percutaneous coronary intervention (PCI) and medical therapy in stable late STEMI presenters by comparing their respective outcomes as well as determine the optimal timing of PCI by evaluating the outcomes of urgent versus non-urgent PCI approach in this patient population. Method(s): PubMed, Embase, and Cochrane databases were queried from inception until March 2024 for studies comparing the outcomes of PCI versus medical therapy, as well as urgent versus non-urgent PCI, in stable late STEMI patients presenting with symptom onset within 12-72 h. Quality of the studies and risk of bias were assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria and the Cochrane Risk of Bias (ROBINS-I 2016) tool, respectively. Result(s): A total of 8 studies were included in this systematic review that met the inclusion criteria. Among these, 5 studies (1 randomized controlled trial (RCT), 1 post-hoc analysis, and 3 observational studies) with an aggregate of 3820 participants compared PCI and medical therapy in stable late STEMI presenters. They found that PCI was associated with statistically significant better short- and long-term outcomes by lowering all-cause mortality, recurrent myocardial infarction (MI), and infarct size, and by improving myocardial salvage index (P < 0.001). Similarly, a non-statistically significant improvement was seen in the events of cardiac death, heart failure, and revascularization as well as ejection fraction percentage with PCI (P > 0.05). The other 3 studies, involving 1270 participants, were observational and compared urgent versus non-urgent PCI and did not find any statistically significant difference in clinical outcomes between the two approaches (P > 0.05). The included studies were significantly heterogeneous in methodologies, follow-up intervals, and reporting of outcomes. Most of the studies provided moderate quality of evidence and had moderate to serious risk of bias. Conclusions and relevance: Revascularization through PCI is associated with superior short- and long-term outcomes compared to medical therapy in stable late STEMI patients presenting within 12-72 h of symptom onset. However, the optimal timing of PCI needs further investigation. Copyright © 2024 Elsevier Inc. <30> [Use Link to view the full text] Accession Number 2045463222 Title Surgical versus percutaneous revascularization in multivessel non-ST-elevation acute coronary syndrome: a meta-analysis of 77 989 patients. Source Coronary Artery Disease. 37(6) (pp 470-484), 2026. Date of Publication: 01 Sep 2026. Author Elbahloul M.A.; Elbataa A.; Hajali M.; Kasem A.W.; Alalalmeh S.O.; El-Moslemani M.; Zanaty M.A.; Shawky A.; Awad A.K.; Amabile A.; Baudo M.; Torregrossa G.; Hirji S. Institution (Elbahloul) Faculty of Medicine, Kafr El-Shaikh University, Kafr El-Shaikh, Egypt (Elbataa, Kasem) Faculty of Medicine, Al Azhar University of Cairo, Cairo, Egypt (Hajali) Faculty of Medicine, Hashemite University, Zarqa, Jordan (Alalalmeh) Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates (El-Moslemani) Faculty of Medicine, Al-Azhar University, Damietta, Egypt (Zanaty) Faculty of Medicine, South Valley University, Qena, Egypt (Shawky) Faculty of Medicine, Benha University, Qalyubia, Egypt (Awad) Department of Cardiothoracic Surgery, Ain-Shams University, Cairo, Egypt (Amabile) Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute, Pittsburgh, United States (Baudo, Torregrossa) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, United States (Torregrossa) Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, United States (Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, United States Publisher Lippincott Williams and Wilkins Abstract Multivessel coronary artery disease (MVD) significantly complicates the management of patients with non-ST-elevation acute coronary syndrome, worsening their clinical and angiographic outcomes. However, the optimal revascularization strategy in this subset of patients is still controversial. Our systematic review and meta-analysis aimed to compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with MVD and non-ST-elevation acute coronary syndrome. We performed a comprehensive search of four electronic databases (PubMed, Scopus, WOS, and Cochrane) from inception till 15 December 2024. The outcomes were reported as a relative risk (RR) and 95% confidence interval (CI) in the random-effect model. Our primary outcome was all-cause mortality, while the secondary outcomes were major adverse cardiovascular events (MACCE), myocardial infarction (MI), cardiac death, repeated revascularization, and stroke. Fourteen studies, comprising 77 989 patients, were included. CABG was associated with lower risk of all-cause mortality (RR: 0.80, 95% CI: 0.68-0.93), MACCE (RR: 0.70, 95% CI: 0.59-0.83), MI (RR: 0.53, 95% CI: 0.42-0.67), cardiac death (RR: 0.77, 95% CI: 0.68-0.89), and repeated revascularization (RR: 0.41, 95% CI: 0.33-0.51) in long-term follow-up. However, stroke incidence was higher with CABG in long-term follow-up (RR: 1.36, 95% CI: 1.07-1.73). CABG and PCI showed no significant difference in clinical outcomes at 30-day follow-up. This meta-analysis showed that CABG was associated with favorable long-term outcomes compared to PCI, including lower mortality, MACCE, MI, and repeated revascularization. Time-dependent hazard ratio showed that CABG was associated with better survival over a 16-year follow-up period. perioperative outcomes were comparable in both CABG and PCI. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <31> Accession Number 2046634217 Title Critical Appraisal of "Continued versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients with Atrial Fibrillation: A Meta-Analysis". Source American Journal of Therapeutics. 33(4) (pp e341-e342), 2026. Date of Publication: 01 Aug 2026. Author Tahir M.; Akhtar I.; Javaid M.H. Institution (Tahir, Akhtar) Department of Medicine, Ayub Medical College, Abbottabad, Pakistan (Javaid) Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan Publisher Lippincott Williams and Wilkins <32> Accession Number 2048445038 Title Intramyocardial injection of allogeneic human induced pluripotent stem cell-derived cardiomyocytes in advanced ischemic heart failure: an early-stage randomized trial. Source Nature Medicine. (no pagination), 2026. Date of Publication: 2026. Author Zhang H.; Menasche P.; Fan J.; Gao L.; Luo H.; Xue Y.; Zhu X.; Wang Q.; Li C.; Xu Y.; Zhang A.; Wang J.; Wang D. Institution (Zhang, Luo, Xue, Zhu, Wang) Department of Cardiac Surgery, Nanjing Drum Tower Hospital Affiliated Hospital of Medical School, Nanjing University, Nanjing, China (Menasche) Department of Cardiovascular Surgery, University Paris-Cite, INSERM Unit 970, Paris Cardiovascular Research Center (PARCeC), Hopital Europeen Georges Pompidou, Paris, France (Fan, Wang, Li, Xu, Zhang, Wang) HELP Therapeutics, Nanjing, China (Gao) Institute for Regenerative Medicine, State Key Laboratory of Cardiology and Medical Innovation Center, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China Publisher Nature Research Abstract A treatment for heart failure that could promote myocardial regeneration has long been sought. Here we conduct the HEAL-CHF trial (n = 20; 18 male and 2 female), in which patients with advanced heart failure with reduced ejection fraction (left ventricular ejection fraction <=45%) were randomized to receive intramyocardial injections of allogeneic human induced pluripotent stem cell-derived cardiomyocytes or were uninjected. Both groups received concomitant coronary artery bypass grafting. The primary endpoint was safety, defined as the incidence of sustained ventricular tachycardia during the 1- to 6-month postoperative period and tumorigenicity at 12 months of follow-up. Neither sustained ventricular tachycardia nor tumorigenicity was observed in either patient group. Early post-transplantation ventricular arrhythmias occurred in patients in the cell therapy group during the first 4 weeks, as all 10 patients in this group developed accelerated idioventricular rhythm, typically emerging 5 to 7 days post-transplantation. Clinically significant ventricular tachycardia (>140 bpm), which occurred in 2 patients, peaked at 2 to 3 weeks post-procedure and resolved completely after cardioversion. Secondary efficacy analyses indicated that cell transplantation provided significantly greater improvements in 6-min walk distance, global myocardial perfusion (as assessed by the summed rest score on 99mTc single-photon emission computed tomography-computed tomography) and relative wall thickening, compared with coronary artery bypass grafting alone. No significant between-group differences were observed for left ventricular ejection fraction, left ventricular volumes, myocardial scar size, New York Heart Association functional class or Minnesota Living with Heart Failure Questionnaire scores at 12 months. In view of the arrhythmic events observed, future studies will need to determine the risk-to-benefit ratio associated with human induced pluripotent stem cell-derived cardiomyocyte therapy. ClinicalTrials.gov registration: NCT03763136. Copyright © The Author(s), under exclusive licence to Springer Nature America, Inc. 2026. <33> Accession Number 651452542 Title Postoperative outcomes of combined interpectoral-pectoserratus versus combined deep-superficial serratus anterior plane blocks in minimally invasive coronary artery bypass surgery: A prospective randomized study. Source Scientific reports. 16(1) (no pagination), 2026. Date of Publication: 08 Jun 2026. Author Yildirim A.K.; Ensarioglu M.; Demirdas E.; Karabacak K. Institution (Yildirim) Department of Cardiovascular Surgery, Gulhane Training and Research Hospital, Ankara, Turkey (Ensarioglu) Department of Anesthesiology and Reanimation, Gulhane Training and Research Hospital, Ankara, Turkey (Demirdas, Karabacak) Department of Cardiovascular Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey Abstract Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive direct coronary artery bypass (MIDCAB) reduce surgical trauma compared with sternotomy but remain associated with significant postoperative pain that may delay recovery and contribute to complications. Although regional analgesic techniques are increasingly used to reduce opioid requirements, comparative data on different block strategies are limited. This study evaluated the effects of combined interpectoral-pectoserratus and combined deep-superficial serratus anterior plane blocks on postoperative pain, analgesic consumption, recovery quality, and clinical outcomes. In this prospective randomized single-center clinical study, 180 patients undergoing MICS-CABG or MIDCAB were randomized into three groups: combined interpectoral-pectoserratus plane block (Group P, n = 60), combined deep-superficial serratus anterior plane block (Group S, n = 60), and control (n = 60). All blocks were ultrasound guided and performed by experienced anesthesiologists. Pain intensity was assessed using the visual analog scale (VAS) at 6, 12, 24, and 48 h after extubation. Quality of recovery was evaluated using the QoR-40 questionnaire preoperatively and on postoperative days 1 and 2. Secondary outcomes included time to first rescue analgesia, total analgesic consumption, extubation time, ICU and hospital length of stay, and postoperative complications. VAS scores were significantly lower at all postoperative time points in both block groups compared with the control group, with no difference between block techniques. Time to first rescue analgesia was longer and total postoperative analgesic consumption was lower in both block groups. ICU and hospital stays were significantly shorter in patients receiving combined blocks. QoR-40 scores were better preserved throughout follow-up in both block groups. The incidence of atelectasis was lower in block groups, whereas other postoperative complications were infrequent and did not differ significantly between groups. Combined interpectoral-pectoserratus and combined deep-superficial serratus anterior plane blocks provide effective postoperative analgesia, reduce opioid requirements, enhance early recovery, and shorten ICU and hospital stays after minimally invasive CABG. Both techniques may represent practical opioid-sparing options for perioperative pain management in this setting. This study was also registered with the ISRCTN registry (ISRCTN32677289; first posted 16/02/2026). Copyright © 2026. The Author(s). <34> Accession Number 2048557146 Title Expanding the thoracic donor Pool: Ethical implications of contemporary donor selection and organ preservation strategies. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101047. Date of Publication: 01 Dec 2026. Author Melia-Saez F.J.; Gil-Marques B. Institution (Melia-Saez) Department of Anesthesiology and Pain Medicine, Hospital Universitari Francesc de Borja, Gandia, Spain (Melia-Saez, Gil-Marques) Faculty of Medicine and Health Sciences, Universidad Catolica San Vicente Martir, Valencia, Spain Publisher Elsevier Inc. Abstract Background: To address high waiting-list mortality and severe donor shortages in thoracic transplantation, clinical protocols have expanded donor selection criteria to include marginal, elderly, and controlled donation after circulatory death (cDCD) candidates. Concurrently, ex-vivo lung perfusion (EVLP), ex-vivo heart perfusion (EVHP), and normothermic regional perfusion (NRP) have reconfigured organ preservation. This study evaluates the clinical-ethical challenges triggered by these strategies to optimize graft utilization safely. Method(s): A systematic review was conducted evaluating peer-reviewed literature (2016-2026) following the PRISMA 2020 statement across PubMed/MEDLINE, Scopus, and Web of Science. Combined search strategies targeting intensive care logistics and thoracic transplantation were employed. Retrieved records were systematically screened at the title, abstract, and full-text levels according to predefined inclusion criteria. Peer-reviewed studies addressing Intensive Care Unit (ICU) donor management, withdrawal of life-sustaining treatment (WLST), and advanced thoracic procurement logistics were qualitatively analyzed. Result(s): Nineteen studies fulfilled all inclusion criteria. Expanding thoracic donor selection targets relies heavily on precise functional warm ischemia time (fWIT) management and the chronological independence of WLST decisions. While advanced in-situ NRP and ex-vivo EVLP/EVHP preservation techniques maximize cardiothoracic donor assessment and reconditioning, they introduce critical tensions regarding the Dead Donor Rule (DDR) and the definition of circulatory irreversibility. Conclusion(s): Safely expanding the thoracic donor pool requires strict operational separation between end-of-life care and procurement teams. Evolving bioethical frameworks serve as analytical safeguards, reinforcing systemic integrity by ensuring advanced preservation technologies respect the donor's bodily integrity and the transition of dying without compromising clinical governance. Copyright © 2026 <35> Accession Number 2048461914 Title CRT and CABG Improve Survival and Reduce Readmissions in Ischemic Heart Failure: A Systematic Review and Meta-Analysis. Source PACE - Pacing and Clinical Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Zanati Saeed T.; Mohamed A.A.; Hanna M.; Badawy E.Y.; Mohamed B.; Azzawi M.A.D.A.; Rashwan I.; Alhussaini M. Institution (Zanati Saeed) Faculty of Medicine, Assiut University, Assiut, Egypt (Mohamed) Faculty of Medicine, Zagazig University, Zagazig, Egypt (Hanna) Cardiovascular section, Department of Internal Medicine, University of Oklahoma Health Science Center, OK, United States (Badawy) Faculty of Medicine, Mansoura University, Mansoura, Egypt (Mohamed) Department of Public Health and Community Medicine, Faculty of Medicine, Benha University, Benha, Egypt (Azzawi) Faculty of Medicine, The National Ribat University, Khartoum, Sudan (Rashwan) Cardiothoracic Surgery Department, Misr University for Science and Technology, Cairo, Egypt (Alhussaini) Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt Publisher John Wiley and Sons Inc Abstract Introduction: Heart failure (HF) continues to be the leading cause of death and rehospitalization among cardiomyopathic patients undergoing coronary artery bypass grafting (CABG). Objective(s): To systematically evaluate the effect of adding cardiac resynchronization therapy (CRT) to CABG versus CABG alone for patients with concomitant ischemic cardiomyopathy and electromechanical dyssynchrony. (PROSPERO ID: CRD420251006918). Method(s): A comprehensive literature search was conducted using PubMed, Web of Science, and Scopus to identify clinical trials and cohort studies evaluating the impact of inserting a CRT device during CABG surgery on survival and rehospitalization outcomes. A total of 3 studies involving 300 patients were included: 150 underwent CABG alone, and 150 received both CABG and CRT. Result(s): The meta-analysis of two studies (n = 200) showed that adding CRT during CABG was associated with lowering the probability of HF readmission (RR = 0.25, 95% CI [0.13-0.49], P < 0.0001) and of all-cause mortality (RR = 0.44, 95% CI [0.25-0.78], p = 0.0048) in the targeted patient population. Analyses according to study design demonstrated consistent treatment effects across randomized and observational evidence, with no significant subgroup differences. Conclusion(s): In patients with ischemic cardiomyopathy and electromechanical dyssynchrony undergoing CABG, perioperative epicardial CRT implantation may be associated with decreased HF rehospitalization and all-cause mortality rates. However, given the limited number of included studies and small cumulative sample size, these findings should be considered hypothesis-generating, and large-scale confirmatory randomized trials are warranted. Registration: The study protocol was prospectively registered in PROSPERO. (CRID: CRD420251006918). Copyright © 2026 Wiley Periodicals LLC. <36> Accession Number 2048336125 Title Effects of remote ischemic preconditioning on postoperative gastrointestinal function in patients undergoing off-pump coronary artery bypass grafting: a randomized controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 490. Date of Publication: 01 Dec 2026. Author Yang W.; Liu Q.; Wang X.; Han W.; Li H.; Wang T. Institution (Yang, Liu, Wang, Wang) Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China (Li) Department of Cardiac Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China (Han) Beijing Municipal Geriatric Medical Research Center, Beijing Geriatric Healthcare Center, Beijing, China (Han) Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China Publisher BioMed Central Ltd Abstract Background: Postoperative gastrointestinal function is one of the important factors influencing the prognosis of off-pump coronary artery bypass grafting (OPCAB) patients. Remote ischemic preconditioning (RIPC) is a noninvasive intervention that may offer multiorgan protection. This study aimed to evaluate the impact of preoperative RIPC on postoperative gastrointestinal function and clinical outcomes in OPCAB patients. Method(s): This prospective, assessor- and statistician-blinded, sham-controlled, randomized clinical trial included 106 patients scheduled to undergo elective OPCAB. They were randomly assigned to the RIPC (n = 53) or sham-RIPC (n = 53) group. The RIPC group received bilateral upper limb ischemia/reperfusion cycles (200 mmHg, 5-min ischemia/5-min reperfusion, repeated for 5 cycles) twice daily for 3 consecutive preoperative days. The primary outcome was the incidence of postoperative gastrointestinal intolerance (POGI), defined as an I-FEED score of 3-5 within 7 days postoperatively. The secondary outcomes included markers of intestinal injury (intestinal fatty acid-binding protein (I-FABP)), systemic inflammation (interleukin-6 (IL-6), C-reactive protein (CRP)), and S-100 protein beta subunit (S-100beta). The exploratory outcomes comprised gut microbiota analysis and other clinical parameters. Result(s): The incidence of POGI was lower in the RIPC than in the sham-RIPC group (35.4% vs. 56.5%, P = 0.040). The postoperative serum levels of I-FABP, IL-6, CRP, and S-100beta were also lower in the RIPC group. Moreover, the relative abundance of Gemella and Dorea decreased in the RIPC group postoperatively. Notably, the abundance of Gemella showed a positive correlation with the postoperative levels of I-FABP and IL-6, whereas that of Dorea exhibited a positive correlation with the postoperative I-FABP levels. Conclusion(s): The preoperative application of RIPC was associated with a lower risk of POGI, with no observed safety concerns. This effect of RIPC may be related to attenuated intestinal mucosal injury, reduced systemic inflammation, and potential modulation of the gut microbiota. Trial registration: This study was registered on May 30, 2024 (ChiCTR2400085044). Copyright © The Author(s) 2026. <37> Accession Number 2048330054 Title Dynamic Urinary Albumin/Creatinine Ratio Patterns Predict Adverse Outcomes in HFpEF: TOPCAT Cohort Analysis. Source Clinical Cardiology. 49(8) (no pagination), 2026. Article Number: e70446. Date of Publication: 01 Aug 2026. Author Xiao W.; Wang Z.; Yan D.-E.; Peng M.-A.; Zhou X. Institution (Xiao, Yan) Department of Endocrinology, Ji'an Central People's Hospital, Jiangxi, Ji'an, China (Wang, Zhou) Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Peng) Department of Cardiology, Ji'an Central People's Hospital, Jiangxi, Ji'an, China Publisher John Wiley and Sons Inc Abstract Background: Urinary albumin-to-creatinine ratio (uACR) is a recognized cardiovascular risk marker, but its dynamic changes in heart failure with preserved ejection fraction (HFpEF) remain underexplored. We aimed to identify distinct uACR trajectory patterns and their associations with clinical outcomes in HFpEF patients. Method(s): We analyzed 746 HFpEF patients with >= 3 uACR measurements from the TOPCAT trial. Latent Class Trajectory Modeling identified uACR patterns. The primary outcome was cardiovascular death, aborted cardiac arrest, or heart failure hospitalization. Cox proportional hazards models assessed associations between trajectories and outcomes. Result(s): Three uACR trajectory patterns emerged: stable (70.5%), decreasing (16.5%), and fluctuating high (13.0%). The primary endpoint occurred in 15.02%, 25.20%, and 36.08% of patients, respectively (p < 0.001). In adjusted models, the fluctuating high group showed increased risk for the composite endpoint (HR 1.91, 95% CI 1.25-2.91) and heart failure hospitalization (HR 1.91, 95% CI 1.19-3.06), while the decreasing group showed an association with myocardial infarction based on few events (HR 3.00, 95% CI 1.33-6.76). Adding trajectory information produced a modest improvement in risk prediction (C-index 0.758 to 0.765; AUC 0.786 to 0.792 at 4 years and 0.832 to 0.845 at 6 years, p = 0.0149). Conclusion(s): This study first identified distinct uACR trajectory patterns in HFpEF patients. The fluctuating high trajectory was associated with increased cardiovascular risk and heart failure hospitalization, while the association between the decreasing trajectory and myocardial infarction was exploratory and requires validation. Copyright © 2026 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC. <38> Accession Number 2046873729 Title Spindle Cell Cardiac Lipoma in an Adolescent: A Case Report and Systematic Review of Cases. Source JACC: Case Reports. 31(33) (no pagination), 2026. Article Number: 108811. Date of Publication: 19 Aug 2026. Author Soh S.L.; Wee I.J.Y.; Murray Binti Jeffery Murray R.L.; Sivalingam S.; Roslan A. Institution (Soh, Murray Binti Jeffery Murray, Sivalingam) Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia (Wee) Health Services Research Unit, Singapore General Hospital, Singapore, Singapore (Roslan) Department of Cardiology, Sunway Medical Centre, Kuala Lumpur, Malaysia Publisher Elsevier Inc. Abstract Background: Spindle cell lipoma is a benign adipocytic neoplasm that typically arises in subcutaneous soft tissues and is exceptionally rare in the heart. Case Summary: A 13-year-old male patient was referred for evaluation of a cardiac murmur. Transthoracic echocardiography demonstrated multiple intracardiac masses involving the aortic valve, interventricular septum, and posterior left ventricular wall, resulting in severe aortic regurgitation and moderate aortic stenosis. Cardiac magnetic resonance imaging revealed a large lobulated mass arising from the left coronary cusp of the aortic valve with extension into the left ventricular outflow tract. Given diagnostic uncertainty, surgical resection with mechanical aortic valve replacement was performed. Histopathology confirmed a spindle cell lipoma. Recovery was uncomplicated, with no residual mass on follow-up imaging. Discussion(s): A systematic review identified only 2 previously reported adult cases, both involving cardiac valves. Imaging was nonspecific, and definitive diagnosis relied on histopathology. Take-Home Message: Spindle cell cardiac lipoma is a rare but clinically significant cause of valvular cardiac masses; histopathological confirmation is essential, and surgical excision appears curative. Copyright © 2026 The Authors <39> Accession Number 2040499637 Title Long-Term Outcomes and Complications of Pulmonary Valve Replacement: A Meta-Analysis of Mechanical Versus Biological Prostheses. Source Pediatric Cardiology. 47(6) (pp 2534-2543), 2026. Date of Publication: 01 Aug 2026. Author Vahidshahi K.; Mofidi S.A.; Oraee S.; Ghafourian K.; Firouzabadi S.R.; Mohammadi I.; Soltani S.M.; Shayesteh H.; Dastjerdi P.; Ghotbi N.; Abdollahi M.; Meysami A.; Mesdaghi M.; Fatahi S. Institution (Vahidshahi) Modarres Teaching Hospital, Pediatric cardiology ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Vahidshahi, Mesdaghi, Fatahi) Research and Intervention Academic leadership (HATAM), Clinical Research Development Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Mofidi, Oraee, Ghafourian, Firouzabadi, Mohammadi, Soltani) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Shayesteh) Student Research Committee, Islamic Azad University, Mashhad Branch, Mashhad, Iran, Islamic Republic of (Dastjerdi) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Ghotbi) Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran, Islamic Republic of (Abdollahi) Medical Student, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Meysami) Medical Student, Tehran University of Medical Science, Tehran, Iran, Islamic Republic of (Mesdaghi) Department of Immunology and Allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Fatahi) Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Springer Abstract This meta-analysis exclusively examines pulmonary valve replacement (PVR) outcomes in congenital heart disease (CHD) patients. CHD affects nearly 1% of live births globally, with a significant subset eventually requiring PVR due to valve dysfunction following primary repair procedures. Choosing between mechanical and biological valves is challenging, as both have significant limitations, including thrombosis, bleeding, degradation, and the need for reoperations. This study systematically evaluates the long-term outcomes and complications of PVR options to provide evidence-based guidance. Its goal is to optimize care and improve outcomes for pediatric CHD patients. This systematic review and meta-analysis followed PRISMA guidelines to compare outcomes and complications of mechanical versus biological PVR in congenital heart disease patients. A comprehensive search was conducted in PubMed, World of Science, and Scopus, screening studies based on defined inclusion and exclusion criteria. Data extraction and analysis were performed independently by two reviewers, with pooled prevalence rates calculated using a random-effects model. Ethical approval was not required as only published data were analyzed. This meta-analysis included 158 studies with a marked imbalance between valve types: 145 biological PVR studies (20,499 patients) versus only 13 mechanical PVR studies (1060 patients) from 7178 screened articles. This 19:1 patient ratio reflects the clinical rarity of mechanical PVR in CHD patients. For biological PVR, valve dysfunction rates increased over time: 4% at 1 year, 8% at 2-3 years, 12% at 4-6 years, 31% at 7-10 years, and 27% at 15-20 years. Reintervention rates also rose: 3% at 1 year, 7% at 2-3 years, 12% at 4-6 years, 29% at 7-10 years, and 43% at 15-20 years. Redo-PVR rates followed a similar trend: 2% at 1 year, 4% at 2-3 years, 8% at 4-6 years, 22% at 7-10 years, and 26% at 15-20 years. Mortality rates remained stable: 4% at 1-3 years, 6% at 4-6 years, and 6% at 15-20 years. Complications included arrhythmias (5%), infective endocarditis (3%), and overall complications (11%). For mechanical PVR, valve dysfunction was 4%, reoperation 6%, and redo-PVR 5%. Thrombosis occurred in 9%, bleeding in 4%, and mortality was 1%. Mechanical valves showed lower reintervention rates but higher thrombosis risks compared to biological valves. PVR shows low long-term mortality and complication rates for both mechanical and biological valves, though mechanical valves reduce redo-PVR but increase thrombosis and bleeding risks. The limited mechanical PVR data necessitates cautious interpretation due to small sample sizes and potential selection bias. Future research should explore outcomes across diverse patients, CHD types, and implantation methods. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025. <40> Accession Number 2048096305 Title Association of pectoral nerve (PECS) and Serratus Anterior Plane (SAP) blocks with intraoperative left internal mammary artery free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting: a randomized controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 470. Date of Publication: 01 Dec 2026. Author Tekeli A.E.; Eker E.; Sahinalp S.; Yuzkat N.; Caliskan R.; Catulay D.; Uzlas M.; Elkassabany N. Institution (Tekeli, Yuzkat, Catulay, Uzlas) Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Eker) Department of Anesthesiology and Reanimation, Memorial Bodrum Hospital, Mugla, Turkey (Sahinalp) Department of Cardiovascular Surgery, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Caliskan) Department of Cardiovascular Surgery, Health Sciences University Dr. Siyami Ersek Chest, Heart, and Vascular Surgery Training and Research Hospital, Istanbul, Turkey (Elkassabany) Department of Anesthesiology and Perioperative Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States Publisher BioMed Central Ltd Abstract Background: Ultrasound-guided pectoral nerve (PECS) and serratus anterior plane (SAP) blocks are increasingly used for perioperative analgesia in cardiac surgery. However, their effect on intraoperative physiological parameters, such as left internal mammary artery (LIMA) blood flow, remains unclear. This study aimed to evaluate the association of PECS and SAP blocks with intraoperative LIMA free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting (CABG). Method(s): In this prospective, randomized controlled trial, 150 adult patients undergoing elective, isolated, on-pump CABG were allocated to three groups: control (no block), PECS block, or SAP block (n = 50 per group). Blocks were performed preoperatively under ultrasound guidance. LIMA free blood flow was measured intraoperatively after harvesting under standardized hemodynamic conditions and expressed as mL/min. Hemodynamic responses to surgical incision, intraoperative opioid requirements, and vasoactive drug use were also recorded. Result(s): Baseline characteristics were comparable among groups. LIMA free blood flow was higher in the PECS and SAP groups compared with the control group (mean +/- SD: 83.1 +/- 23.8 and 92.5 +/- 21.0 vs. 60.6 +/- 20.0 mL/min, respectively; p < 0.001), with higher values observed in the SAP group compared with the PECS group (p < 0.01). Both block groups demonstrated significantly attenuated increases in mean arterial pressure and heart rate in response to surgical incision (p < 0.001 for all comparisons) and reduced rescue opioid requirements. Vasoactive drug use prior to LIMA flow measurement was comparable among groups. Conclusion(s): PECS and SAP blocks were associated with attenuated hemodynamic responses to surgical incision and higher measured LIMA free blood flow under standardized conditions in patients undergoing CABG. These findings suggest that chest wall regional anesthesia techniques may influence intraoperative physiological parameters beyond their established analgesic effects. However, this study does not demonstrate improved graft patency, myocardial perfusion, or clinical outcomes. Further studies are warranted to determine whether these intraoperative differences translate into clinically meaningful benefits. Trial registration: ClinicalTrials.gov NCT05907798. Registered on 23 May 2023, before the initiation of patient recruitment at our institution. Copyright © The Author(s) 2026. <41> Accession Number 2048065557 Title Perioperative dexmedetomidine is associated with improved respiratory outcomes in patients undergoing cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 465. Date of Publication: 01 Dec 2026. Author Guo Y.; Wei Y.; Yu S. Institution (Guo) Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China (Wei) Department of Anesthesiology, Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China (Yu) Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China Publisher BioMed Central Ltd Abstract Background: Over 2 million cardiac surgeries are performed annually, with significant risks such as systemic inflammation and postoperative pulmonary complications (PPCs). Dexmedetomidine has shown promise in reducing PPCs in thoracic surgeries. This review evaluates its effects on PPCs and respiratory outcomes in cardiac surgery. Method(s): A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to include randomized controlled trials comparing intravenous dexmedetomidine and other drugs in terms of respiratory outcomes in adult patients undergoing cardiac surgery. Primary Outcome: PPC incidence. Secondary Outcomes: PaO<inf>2</inf>, PaCO<inf>2</inf>, SpO<inf>2</inf>, oxygenation index, respiratory index, time to extubation, length of ICU stay, and adverse events. Risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models. Result(s): Sixteen studies comprising 1,668 patients were included in this meta-analysis. The perioperative use of dexmedetomidine was associated with a reduced incidence of overall postoperative pulmonary complications (RR = 0.57; 95% CI: 0.38 to 0.87; P = 0.0078). Additionally, participants who received intravenous dexmedetomidine had a shorter ICU stay (MD = -0.56 h; 95% CI: -1.12 to -0.00; P = 0.0480). Furthermore, perioperative dexmedetomidine significantly improved postoperative SpO<inf>2</inf> (MD = 0.46% points; 95% CI: 0.17 to 0.74; P = 0.0018) and respiratory index (MD = -0.16; 95% CI: -0.27 to -0.05; P = 0.0057). Conclusion(s): Perioperative dexmedetomidine may be associated with improved respiratory outcomes in cardiac surgery patients. However, the evidence for reduction in overall PPCs remains limited, and dexmedetomidine may increase the risk of bradycardia. Larger, high-quality RCTs are needed to confirm its safety and benefits. Copyright © The Author(s) 2026. <42> Accession Number 2043741703 Title Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure. Source JACC: Heart Failure. 14(8) (no pagination), 2026. Article Number: 102999. Date of Publication: 01 Aug 2026. Author Angermann C.E.; Gerhardt T.; Blatchford J.P.; Biegus J.; Collins S.P.; Kosiborod M.; Ferreira J.P.; Nassif M.E.; Psotka M.A.; Tromp J.; Kraus B.J.; Ponikowski P.; Teerlink J.R.; Voors A.A. Institution (Angermann) Comprehensive Heart Failure Centre, University and University Hospital of Wurzburg, Wurzburg, Germany (Gerhardt) Friede Springer Center for Cardiovascular Prevention at Charite, Berlin, Germany (Gerhardt) DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany (Gerhardt) Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Blatchford) Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany (Biegus, Ponikowski) Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland (Collins) Department of Emergency Medicine, Vanderbilt University Medical Center and Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville, TN, United States (Kosiborod) Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States (Kosiborod) George Institute for Global Health and the University of New South Wales, Sydney, NSW, Australia (Ferreira) Universite de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France (Ferreira) Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal (Nassif) Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO, United States (Psotka) Inova Heart and Vascular Institute, Falls Church, VA, United States (Tromp) Saw Swee Hock School of Public Health, National University of Singapore, and the National University Health System, Singapore (Kraus) Boehringer Ingelheim International GmbH, Ingelheim, Germany (Teerlink) Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, CA, United States (Voors) Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands Publisher Elsevier Inc. Abstract Background In EMPULSE (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure), the sodium-glucose cotransporter 2 inhibitor empagliflozin improved clinical outcomes in patients hospitalized for heart failure (HF). Objectives This prespecified analysis examined efficacy, safety, and tolerability of empagliflozin in subgroups with de novo heart failure (NHF) vs acute decompensated heart failure (ADHF). Methods After stabilization, participants were randomized 1:1 to empagliflozin 10 mg/d or placebo, stratified by HF status (NHF: n = 175; ADHF: n = 355). The primary endpoint was a hierarchical composite of death, worsening HF, or >=5-point difference in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) change at day 90, assessed using a win ratio. Results Participants with NHF were younger, had fewer comorbidities, had higher blood pressure and heart rate, and better KCCQ-TSS. Prescription of diuretic agents was similar between subgroups. The win ratio was 1.29 (95% CI: 0.89-1.89) for NHF and 1.39 (95% CI: 1.07-1.81) for ADHF ( P <inf>interaction</inf> = 0.759). There were no interactions between NHF and ADHF for the primary endpoint, its components, or secondary endpoints, except diuretic response, which was greater with empagliflozin in NHF than in ADHF from day 15 (mean difference vs placebo: -5.11 [Q1-Q3: -7.89 to -2.32] vs -0.97 [Q1-Q3: -2.91 to 0.96] kg per mean daily loop diuretic dose, P <inf>interaction</inf> = 0.017), with even greater between-group differences at days 30 and 90. Frequencies of adverse events were consistently lower with empagliflozin vs placebo. Conclusions In-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated. This supports in-hospital initiation of empagliflozin in all patients with acute HF (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure [EMPULSE]; NCT04157751 ) Copyright © 2026 The Authors. <43> Accession Number 2047446307 Title Impact of Radiation-Attenuating Drape on Exposure in a Contemporary Cardiac Catheterization Laboratory: The ATTENUATE Trial. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(8) (no pagination), 2026. Article Number: 105511. Date of Publication: 01 Aug 2026. Author Medranda G.A.; Bliagos D.; Case B.C. Institution (Medranda) St Francis Heart Center at Good Samaritan University Hospital, West Islip, NY, United States (Bliagos) NYU Langone Hospital - Long Island, Mineola, NY, United States (Case) MedStar Washington Hospital Center, Washington, DC, United States Publisher Elsevier B.V. Abstract Background Despite recent improvements in radiation safety, interventionalists are increasingly exposed to radiation during cardiac catheterization laboratory (CCL) procedures. The RADPAD was designed as a protective scatter-radiation absorbing shield with early studies demonstrating a 20% to 62% reduction in scatter-radiation. The objective of this study was to examine the impact of the protective scatter-radiation absorbing shield in a large contemporary randomized controlled trial across multiple CCL procedures. Methods The investigator-initiated, prospective, randomized, controlled ATTENUATE (rAdpad proTecTion drapE iN redUcing rAdiaTion Exposure) trial randomized CCL procedures 1:1 to use of the RADPAD vs no use of the RADPAD. The primary outcome of interest was the most proximal operator's dose area product (DAP)-normalized operator dose (E). Results A total of 1000 CCL procedures were randomized 1:1 to use of the protective scatter-radiation absorbing shield (n = 500) vs no use (n = 500). The use of the protective scatter-radiation absorbing shield was associated with a 45.1% relative reduction in the DAP-normalized operator dose compared with no use of the protective scatter-radiation absorbing shield (0.64 vs 0.35 muSv/Gycm2; P < .0001). Coronary cases (n = 720) saw a 21.9% relative reduction in the DAP-normalized E using the RADPAD (0.33 vs 0.43 muSv/Gycm2; P < .001), and structural cases (n = 210) saw a 54.4% relative reduction in the DAP-normalized E using the RADPAD (0.30 vs 0.66 muSv/Gycm2; P = .1094). Conclusions In the largest randomized controlled trial to date evaluating the RADPAD protective scatter-radiation absorbing shield, encompassing contemporary coronary and structural CCL procedures, use of the protective scatter-radiation absorbing shield led to a marked decrease in proximal operator radiation exposure when adjusted for the total radiation delivered during each procedure. Copyright © 2026 The Author(s). <44> Accession Number 2048110355 Title von Willebrand disease: an illustrated review. Source Research and Practice in Thrombosis and Haemostasis. 10(5) (no pagination), 2026. Article Number: 106838. Date of Publication: 01 Jul 2026. Author Abou-Ismail M.Y.; Kouides P.A.; James P.D.; Connell N.T. Institution (Abou-Ismail) Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States (Kouides) Department of Hematology, Rochester General Hospital, Rochester, NY, United States (James) Queen's University, Department of Medicine, Kingston, ON, Canada (Connell) Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States Publisher Elsevier B.V. Abstract First described 100 years ago, von Willebrand disease (VWD) is the most common inherited bleeding disorder, characterized by a quantitative or qualitative deficiency of von Willebrand factor (VWF), a large multimeric glycoprotein central to hemostasis. Despite its prevalence, VWD remains globally underdiagnosed. Accurate diagnosis requires thorough clinical assessment and specialized laboratory evaluation. Although international evidence-based guidelines have advanced care, significant diagnostic and management challenges remain. Management focuses on treating and preventing bleeding, ensuring periprocedural safety, and improving quality of life through individualized strategies and the use of various hemostatic agents and therapeutic strategies. Optimal management approaches in complex clinical scenarios remain challenging. In this comprehensive illustrated review, we cover the biology and physiology of VWF, along with the pathophysiology, diagnosis, and management of VWD. We review current clinical practice recommendations and provide practical guidance for challenging scenarios such as surgery, pregnancy, cardiovascular disease, aging, and acquired von Willebrand syndrome. We also highlight emerging therapeutics and models of care in VWD. Copyright © 2026 The Authors. Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <45> Accession Number 2047932874 Title Rhythm vs. rate control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1820175. Date of Publication: 01 Jul 2026. Author Dairi M.S.; Tarabzoni M.; Tarola C.; Sehmbi H.; Alwafi H.; Alghamdi S.M.; Khan S.; Alotaibi W.T.; Hegazy A.F. Institution (Dairi) Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Tarabzoni) Cardiovascular and Thoracic Surgery Department, King Salman Heart Centre, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia (Tarola) Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Sehmbi) Department of Anesthesia, Waterloo Regional Health Network, McMaster University, Hamilton, ON, Canada (Alwafi) Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Alghamdi) Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia (Khan) General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia (Alotaibi) Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Hegazy) Division of Critical Care Medicine, Department of Medicine, University of Western Ontario, London, Ontario, ON, Canada (Hegazy) Cardiac Surgery Intensive Care Unit, Department of Critical Care Medicine, Madinah Cardiac Centre, Madinah, Saudi Arabia Publisher Frontiers Media SA Abstract Background - We aimed to compare the clinical impact of treatment with a rhythm control strategy to a rate control strategy in postcardiac surgery atrial fibrillation patients. Methods - A comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and ClinicalTrials.gov was conducted from inception to October 2025. Our meta-analysis included randomized controlled trials (RCTs) comparing therapeutic rhythm control interventions with rate control interventions. We used the Cochrane risk-of-bias tool to appraise the quality of included RCTs, the GRADE framework to evaluate the strength of the evidence, and adhered to the PRISMA guidelines for reporting. Results - Eight RCTs (n = 894 patients) met the inclusion criteria. There was no difference in hospital length of stay (4 RCTs) between rhythm control and rate control [MD: -0.41 days (95% CI: -3.23, 2.42)]. An aggressive rhythm control strategy (ibutilide, procainamide, propafenone, or electric cardioversion) was associated with higher odds of in-hospital conversion to sinus rhythm [OR: 4.01 (95% CI: 1.30, 12.39)] and a higher risk of medication-related adverse events (hypotension, bradycardia, and syncope) [RR: 3.05 (95% CI: 1.05, 8.89)]. Conclusion - Among postcardiac surgery patients with new-onset atrial fibrillation, there was no evidence that a rhythm control treatment strategy resulted in better outcomes than a rate control strategy. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD42019128559, identifier CRD42019128559. Copyright © 2026 Dairi, Tarabzoni, Tarola, Sehmbi, Alwafi, Alghamdi, Khan, Alotaibi and Hegazy. <46> Accession Number 2038475369 Title Heterotopic Caval Valve Implantation for Severe Tricuspid Regurgitation: A Systematic Review and Recommendations for Implantation and Futility. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 51423. Date of Publication: 01 Jul 2026. Author Corrado D.; Nenna A.; Jawabra M.; Ferraresi B.; Dominici C.; Casali G.; Toriello F.; Carugo S.; Chello M.; Lusini M. Institution (Corrado, Jawabra, Ferraresi, Chello, Lusini) Cardiac Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy (Nenna, Dominici, Toriello, Carugo) Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Casali) Cardiac Surgery, Azienda Ospedaliero Universitaria Maggiore della Carita di Novara, Novara, Italy (Carugo) Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy Publisher IMR Press Limited Abstract Background: Heterotopic transcatheter caval valve implantation (CAVI) has emerged as a palliative yet promising therapeutic strategy for treating severe tricuspid regurgitation (TR), which aims to reduce systemic venous congestion by implanting bioprosthetic valves in the venae cavae rather than in the native tricuspid annulus. However, despite encouraging procedural success, clinical improvement and survival remain highly variable. Method(s): A systematic review of published registries and case series was performed, focusing on the outcomes, procedural success, mortality, and safety of CAVI. Data were extracted from multicenter registries and observational series describing the use of transcatheter stented bioprosthesis or bioprosthesis alone. Result(s): Across published cohorts and registries, procedural success rates ranged from 90% to 100%, with 30-day mortality ranging from 5% to 25%. The TRICUS EURO study, which included 35 patients across 12 European centers, demonstrated significant improvements in New York Heart Association (NYHA) functional class and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at 6 months, with minimal device-related complications and adverse events. The ongoing TRICAV-II pivotal trial (NCT06458907) and EuroTR registry (NCT06307262) are expected to provide larger real-world datasets. Smaller case series and individual reports, typically involving <=10 patients, confirmed feasibility and symptomatic benefits, particularly reductions in peripheral edema and ascites. However, long-term outcome data remain limited. This study highlights right ventricle (RV) dysfunction, severe pulmonary hypertension, advanced end-organ failure, and clinical frailty as major determinants of unfavorable outcomes. Conclusion(s): Heterotopic CAVI represents a viable alternative for high-risk patients with severe TR, offering symptomatic improvement and reduced venous congestion when conventional surgery or orthotopic repair is not feasible. However, current evidence is derived primarily from non-randomized studies and limited registries. Ongoing prospective registries and pivotal trials are crucial for defining patient selection, procedural optimization, and long-term survival benefit. Early intervention and multidisciplinary patient selection appear crucial for avoiding futile procedures and identifying patients who may derive true symptomatic and prognostic benefit from CAVI. Copyright © 2026 The Author(s). <47> Accession Number 2048329392 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. 301 (no pagination), 2026. Article Number: 107543. Date of Publication: 01 Nov 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, Wan, Wei) Division of Cardiovascular Surgery, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Fang, Ma, Chen, Wan, Wei) Hubei Engineering Research Center for Diagnostic and Therapeutic Equipment in Precision Cardiovascular Surgery, Wuhan, China (Fang, Ma, Chen, Wan, Wei) 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 Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China (Ma) Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Yan) Peking University First Hospital, Peking University Clinical Research Institute, Beijing, China (Wang) Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom Publisher Elsevier Inc. 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 2 approaches was unavailable. Methods The TAILOR-HCM trial (Transapical Beating-Heart Septal Myectomy vs 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. Clinical Trial Registration https://www.chictr.org.cn . Unique Identifier: ChiCTR2400087414. Copyright © 2026 Elsevier Inc. <48> Accession Number 2046499311 Title Concomitant Left Atrial Appendage Occlusion and Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(8) (no pagination), 2026. Article Number: 105446. Date of Publication: 01 Aug 2026. Author Gajula K.S.; Lingamsetty S.S.P.; Pamreddy H.R.; Banga A.; Jitta S.R.; Doma M.; Cherukuri K.; Vahdat K.; Ramsaran E.; Goldsweig A.M. Institution (Gajula, Cherukuri, Vahdat, Ramsaran) Department of Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, MA, United States (Lingamsetty) Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Pamreddy) Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, United States (Banga) Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, United States (Jitta) Department of Internal Medicine, Mercy Health St. Louis, St. Louis, MO, United States (Doma) Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center, and Division of Cardiology, University of Massachusetts-Baystate, Springfield, MA, United States Publisher Elsevier B.V. Abstract Background Atrial fibrillation (AF) is prevalent among patients undergoing transcatheter aortic valve replacement (TAVR) and increases risks of thromboembolism and bleeding with chronic anticoagulation. Concomitant left atrial appendage occlusion (LAAO) during TAVR may reduce long-term stroke and bleeding risks. Methods PubMed, Embase, and Cochrane databases were searched through May 2025 for studies comparing TAVR + LAAO versus TAVR + standard medical therapy in patients with atrial fibrillation. Random-effects models were used to pool risk ratios (RRs) or mean differences with 95% CIs. Results Four studies (2 randomized controlled trials, 2 observational; n = 563, mean age 82 years) were included; 279 patients (49.5%) underwent TAVR + LAAO. Thirty-day outcomes showed no differences in mortality (RR 0.91; 95% CI, 0.28-3.01), stroke/transient ischemic attack (RR 0.27; 95% CI, 0.04-1.66), or major bleeding (RR 0.27; 95% CI, 0.04-1.66). Over a 9.8-month to 2-year follow-up, all-cause mortality (RR 0.95; 95% CI, 0.68-1.32), cardiac death (RR 0.95; 95% CI, 0.60-1.50), stroke/transient ischemic attack (RR 1.33; 95% CI, 0.30-5.83), and major bleeding (RR 1.06; 95% CI, 0.71-1.59) remained similar. Contrast use and hospital length of stay were comparable. Conclusions Concomitant TAVR plus LAAO appears feasible, with no statistically significant differences in short-term outcomes versus TAVR plus standard medical therapy; however, certainty is low, and findings are hypothesis-generating, warranting larger randomized trials and prospective registries. Copyright © 2026 The Author(s). <49> Accession Number 2046061810 Title Sex-Stratified Outcomes of Drug-Eluting Resorbable Scaffolds Versus Balloon Angioplasty for Below-the-Knee Revascularization: Insights From the LIFE-BTK Trial. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(8) (no pagination), 2026. Article Number: 105388. Date of Publication: 01 Aug 2026. Author Bajakian D.R.; Farhan S.; O'Connor D.J.; N'Dandu Z.; Kane K.; Parikh S.A.; DeRubertis B.G.; Varcoe R.L.; Yu S.; Ruster K.; Martinsen B.J.; Meinen J.; Igyarto Z.; Krishnan P. Institution (Bajakian) Columbia University Irving Medical Center, New York, NY, United States (Farhan) Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, United States (Farhan) Cardiovascular Institute, Northwell Health, New Hyde Park, NY, United States (O'Connor) Hackensack University Medical Center, Hackensack, NJ, United States (N'Dandu) Ascension Sacred Heart, Pensacola, FL, United States (Kane) Fort Worth Vascular, TCU School of Medicine Department of Surgery, Fort Worth, TX, United States (Parikh) Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States (DeRubertis) NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, United States (Varcoe) The Prince of Wales Hospital and University of New South Wales, Randwick, Australia (Yu, Ruster, Martinsen, Meinen, Igyarto) Abbott Vascular, Santa Clara, CA, United States (Krishnan) Mount Sinai Hospital, New York, NY, United States Publisher Elsevier B.V. Abstract Background Women with chronic limb-threatening ischemia remain historically underrepresented in peripheral artery disease trials and often exhibit distinct anatomic and clinical profiles. The LIFE-BTK randomized trial demonstrated superiority of an everolimus-eluting resorbable scaffold (DRS) over percutaneous transluminal angioplasty (PTA) for below-the-knee revascularization. This analysis assessed whether sex influenced baseline characteristics, procedural details, or clinical outcomes after DRS compared with PTA. Methods LIFE-BTK randomly assigned 261 patients (2:1 DRS/PTA) with Rutherford-Becker class 4-5 ischemia across 50 global sites. Sex-stratified outcomes at 1 and 2 years were evaluated using descriptive statistics, multivariate models, and Kaplan-Meier estimates. The primary efficacy end point was freedom from above-ankle amputation, target vessel occlusion, clinically-driven target lesion revascularization (CD-TLR), and binary restenosis. The primary safety end point was freedom from major adverse limb events and perioperative death. Both end points are presented here as event rates. Results Female patients (32% of cohort) were older and had smaller reference vessel diameters and lower ankle-brachial index values; male patients had higher tobacco use and cardiovascular comorbidities. At 1 year, DRS significantly reduced event rates for the primary efficacy end point vs PTA in both sexes (female: 23.5% vs 57.1%; male: 26.5% vs 56.0%). Benefits persisted at 2 years (female: 34.1% vs 68.4%; male: 40.7% vs 66.7%). Binary restenosis and CD-TLR were lower with DRS. Multivariate analysis showed sex was not significantly associated with outcomes, and no sex-by-treatment interaction was observed. Female patients demonstrated higher restenosis but lower CD-TLR rates, suggesting discordance between anatomic and clinical failure. Conclusions DRS provided durable benefit over PTA irrespective of sex. Although sex did not modify treatment effect, differences in vessel size, ischemia severity, and restenosis-reintervention patterns highlight the need for sex-specific surveillance and personalized below-the-knee treatment strategies. Copyright © 2026 The Author(s). <50> Accession Number 2048331223 Title Transcatheter mitral edge-to-edge repair vs optimal medical therapy in secondary mitral regurgitation: a meta-analysis. Source REC: Interventional Cardiology. 8(3) (no pagination), 2026. Date of Publication: 01 Jul 2026. Author Paulino-Gonzalez D.; Pardino-Vega M.A.; Garcia-Loera A.L.; Zuniga-Montano K.P.; Navarro-Martinez D.A. Institution (Paulino-Gonzalez) Facultad de Medicina, Universidad Autonoma Metropolitana, Mexico City, Mexico (Paulino-Gonzalez) Departamento de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico (Pardino-Vega, Garcia-Loera) Escuela Superior de Medicina, Instituto Politecnico Nacional, Mexico City, Mexico (Zuniga-Montano) Facultad de Medicina, Universidad Catolica Boliviana, Santa Cruz, Bolivia (Navarro-Martinez) Department of Medicine, Indiana University School of Medicine, IN, United States Publisher Sociedad Espanola de Cardiologia Abstract Introduction and objectives: Mitral regurgitation is one of the most common heart valve diseases. Valve replacement surgery is a guideline-recommended option; however, in a significant proportion of patients, this option is not feasible. In such cases, mitral transcatheter edge-to-edge repair (M-TEER) is a potential therapeutic alternative. Nevertheless, the results of a randomized clinical trial have shown divergent results. Recently, the results of the RESHAPE-HF2 trial were published, providing additional insights. The objective of this work is to evaluate whether there are any differences between performing M-TEER and keeping patients under guideline-directed medical therapy (GDMT). Method(s): We conducted a meta-analysis following the PRISMA guidelines. We searched for studies across the PubMed, Embase, and Cochrane databases until February 2025. We establish the following inclusion criteria: patients with secondary mitral regurgitation, studies comparing M-TEER plus GDMT vs GDMT alone, and who reported hospitalization due to heart failure (HF) or mortality. Result(s): A total of 3 randomized clinical trials meet the inclusion criteria, including a total of 1423 patients: 704 received M-TEER and 719, GDMT alone. M-TEER was associated with a reduced risk of HF-related hospitalization with a risk ratio (RR) of 0.71 (95%CI, 0.56-0.90; P = .004). We did not find any differences in all-cause mortality with a RR of 0.80 (95%CI, 0.63-1.02; P = .07). Conclusion(s): In this meta-analysis, M-TEER plus GDMT shows a lower risk of HF-related hospitalization vs GDMT alone. We did not find any differences in the risk of all-cause mortality or cardiac death. Copyright © 2025 Sociedad Espanola de Cardiologia. Published by Permanyer Publications. This is an open access journal under the CC BY-NC-ND 4.0 license. <51> Accession Number 2048195305 Title Feasibility and Preliminary Effectiveness of a Transitional Care Program on Cardiac Self-Efficacy and Transitional-Care Knowledge Among Patients Awaiting Elective Coronary Artery Bypass Graft: A Pilot Randomized Controlled Trial. Source International Journal of Drug Delivery Technology. 16(74 Supplement) (pp 725-733), 2026. Date of Publication: 2026. Author Rani R.; Bhupali P.R. Institution (Rani, Bhupali) KLE's institute of nursing sciences, Karnataka, Belagavi, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Patient who are going to undergo CABG surgery face stressful situations that affect their cardiac self-efficacy and recovery. TCPs that link hospital and home environments can make a difference in their self-management and psychological functioning. Aim(s): Feasibility and preliminary effects of a nurse-led TCP in improving transitional care knowledge, cardiac self-efficacy, depression, anxiety, and stress of patients undergoing CABG surgery in India. Method(s): This parallel-group pilot randomized controlled study included 20 adults who needed a CABG procedure. Participants were assigned randomly to receive either TCP intervention along with usual care (10 subjects) or usual care alone (10 subjects). The TCP comprised educational activities regarding lifestyle modification, stress management (through yoga and breathing techniques), and drug compliance. Measurements were taken before and after the intervention through a transitional-care knowledge scale that consisted of 40 items, Cardiac Self-Efficacy Scale of 13 items, and Depression, Anxiety, and Stress Scale (DASS-21). Result(s): All 20 subjects who had been randomized successfully went through both the pre- and post-test measures within a span of 7 weeks, thus establishing high feasibility of this research project. After conducting the intervention session, the experimental group showed improvement with respect to their transitional care knowledge (decrease in poor knowledge from 6 to 1 member). The participants in the experimental group had shown a marked increase in their cardiac self-efficacy scores (pre-test 17-29 and post-test 20-41), while the control group had low-to-moderate scores (pre-test 15-31 and post-test 15-34). Furthermore, the experimental group showed favorable shifts toward milder depression and reduced severe stress and anxiety, outperforming the control group. Conclusion(s): The nurse-led TCP was highly feasible and demonstrated positive trends towards improvement in transitional care knowledge, cardiac self-efficacy, and psychological well-being. A fully powered randomized control trial is needed. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <52> Accession Number 2048433363 Title Transseptal versus left atrial approach for mitral valve surgery: A systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. (no pagination), 2026. Article Number: 02184923261476111. Date of Publication: 2026. Author Paramkusam S.M.C.; Paramkusam A.V.; Abuzayed B.; Omaruddin L.; Pavuluri K.S.; Ghosh A.; Basri A.; Malik A.B.; Ramkhalawon S.V.; Mukunde A.-C.; Imam B.; Ezhil S.R. Institution (Paramkusam) Katuri Medical College and Hospital, Andhra Pradesh, Guntur, India (Paramkusam) Jonelta Foundation School of Medicine - UPHSD, Las Pinas, Philippines (Abuzayed) Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom (Omaruddin) (Pavuluri) ESH, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom (Ghosh) Nazareth Hospital, Philadelphia, PA, United States (Basri) Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan (Malik) Washington University in St Louis, St Louis, United States (Ramkhalawon) SAJ Flacq Hospital, Flacq, Mauritius (Mukunde) Universidad de Montemorelos, Montemorelos, Mexico (Imam) University of Pittsburgh Medical Center, Pittsburgh, United States (Ezhil) M.S. Ramaiah Medical College, Bangalore, India (Paramkusam, Paramkusam, Abuzayed) Publisher SAGE Publications Inc. Abstract Objective: Surgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS. Method(s): This meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation. Result(s): Twenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07-1.95]; P = 0.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group. Conclusion(s): Our meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence. Copyright © The Author(s) 2026 <53> Accession Number 2046489444 Title Hemodynamic Response to Laryngoscopy and Endotracheal Intubation With Conventional Macintosh Laryngoscope Versus C-MAC Video Laryngoscope in Patients Undergoing Elective Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Source Anesthesiology Research and Practice. 2026(1) (no pagination), 2026. Article Number: 2771364. Date of Publication: 2026. Author Khan S.; Hameed M.; Khan W.R.; Yousuf M.S.; Samad K. Institution (Khan, Hameed, Khan, Yousuf, Samad) Department of Anesthesiology, Aga Khan University, Karachi, Pakistan Publisher John Wiley and Sons Ltd Abstract Background: Laryngoscopy and endotracheal intubation evoke significant hemodynamic responses, particularly in patients undergoing coronary artery bypass grafting (CABG) who have compromised cardiac reserves. This study aimed to compare the hemodynamic effects of the C-MAC video laryngoscope (VL) with those of the conventional Macintosh laryngoscope (MC) in patients undergoing elective CABG. Method(s): This randomized controlled trial included 86 patients scheduled for elective CABG, who were randomly assigned to intubation with either the MC group or the C-MAC VL group. Hemodynamic parameters, including heart rate, systolic, diastolic, and mean arterial pressures, were recorded at five time points (prelaryngoscopy baseline to 10 min postintubation). Secondary outcomes included the intubation success rate, duration of laryngoscopy and intubation, glottic visualization, and complications. Result(s): Two-way repeated measures ANOVA revealed no significant group effect or group-by-time interaction for any hemodynamic variable (all p > 0.05), confirming equivalent hemodynamic profiles across all time points. A significant time effect was observed for all variables (all p < 0.001). First-attempt intubation success was 88.4% (VL) versus 74.4% (MC) (p = 0.166). The C-MAC provided significantly better glottic visualization (modified CL grade, p < 0.001). No major complications occurred in either group. Conclusion(s): In patients undergoing CABG, C-MAC VL and conventional MC result in similar hemodynamic responses. The choice of laryngoscope may be guided by airway considerations and operator experience rather than anticipated cardiovascular effects. Trial Registration: Clinicaltrials.gov_identifier: NCT04433884. Copyright © 2026 Sehrish Khan et al. Anesthesiology Research and Practice published by John Wiley & Sons Ltd. <54> Accession Number 2038464461 Title Systematic Review When Time Matters in Aortic Stenosis: Can Transcatheter Aortic Valve Replacement Make a Difference in Non-Elective Cases?. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 49738. Date of Publication: 01 Jul 2026. Author Etchegoyen C.V.; Chollet L.; Ahmed M.; Bilauca C.; Farina J.M.; Pereyra M.; Scalia I.G.; Razaghi M.; Abdelfattah F.E.; Awad K.; Hafez A.; Ahmed S.; Ayoub C.; Alsidawi S.; Sweeney J.P.; Lester S.J.; Lee K.S.; Fortuin D.; Sell-Dottin K.A.; Arsanjani R. Institution (Etchegoyen, Ahmed, Bilauca, Farina, Sell-Dottin) Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, United States (Chollet, Farina, Pereyra, Scalia, Razaghi, Abdelfattah, Awad, Hafez, Ahmed, Ayoub, Alsidawi, Sweeney, Lester, Lee, Fortuin, Arsanjani) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States Publisher IMR Press Limited Abstract Background: The development of symptoms or left ventricular dysfunction in severe aortic stenosis (AS) is associated with high morbidity and mortality. While elective transcatheter aortic valve replacement (TAVR) is supported by robust randomized evidence, data on TAVR performed in non-elective settings (urgent, emergent, or salvage) remain limited and heterogeneous. In these settings, outcomes may be influenced more by baseline clinical severity than by procedural factors. This study aimed to systematically evaluate the safety and effectiveness of non-elective TAVR and to compare the associated outcomes with those of elective TAVR. Method(s): This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. The PubMed, Embase, and Scopus databases were searched for studies published after 2002 evaluating urgent, emergent, or salvage TAVR in adult patients with severe AS. Eligible studies were required to include elective TAVR as a comparator. Outcomes included mortality and major procedural complications. Prespecified era-based analyses and sensitivity analyses excluding studies at critical risk of bias were performed. Risk of bias was assessed using the ROBINS-I tool. Result(s): A total of 17 observational studies published between 2015 and 2025 were included, comprising 215,141 patients. Compared with elective patients, those undergoing non-elective TAVR had more advanced heart failure, higher NYHA class, greater comorbidity burden, and higher surgical risk scores, whereas baseline echocardiographic severity of AS was similar. Pooled outcomes for non-elective TAVR showed in-hospital, 30-day, and 1-year mortality rates of 5.1%, 12.4%, and 26.7%, respectively. Non-elective TAVR was associated with higher mortality at all time points compared with elective procedures meanwhile, rates of stroke, vascular complications, and permanent pacemaker implantation were similar, while major bleeding and acute kidney injury were more frequent. Era-based analyses showed a stable relative mortality risk over time. Conclusion(s): Although non-elective TAVR is associated with worse outcomes than elective procedures, these differences appear to be largely driven by baseline clinical severity rather than by the transcatheter intervention. In unstable patients with severe AS, non-elective TAVR remains the most effective definitive treatment option compared with balloon aortic valvuloplasty or conservative management. The PROSPERO Registration: CRD420251239620, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251239620. Copyright © 2026 The Author(s). <55> Accession Number 2045256180 Title Mothership and Drip-and-Ship Strategies in Mechanical Thrombectomy for Acute Ischemic Stroke. Source Annals of Emergency Medicine. 88(3) (pp 290-310), 2026. Date of Publication: 01 Sep 2026. Author Guo L.; Zhang J.; Tang G.; Wang J.; Yang S.; Li C.; Liu Y.; Xiang Y.; Guo F. Institution (Guo, Zhang) Department of Neurology, Xindu District People's Hospital of Chengdu, Chengdu, China (Tang) Department of Emergency, West China Hospital, Sichuan University, Chengdu, China (Wang, Yang, Xiang, Guo) Department of Neurology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Li, Liu) Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China Publisher Elsevier Inc. Abstract Study objective The optimal out-of-hospital referral pathway for patients with acute ischemic stroke due to large vascular occlusion (AIS-LVO)-direct transport to a comprehensive center (mothership) versus initial evaluation at a local hospital followed by transfer (drip-and-ship)-remains controversial. This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of mothership and drip-and-ship strategies on clinical outcomes. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 18, 2025, to identify studies comparing mothership and drip-and-ship paradigms in AIS-LVO patients treated with mechanical thrombectomy. Random-effects meta-analyses were conducted to calculate pooled odds ratios (ORs) for primary outcomes, including 90-day modified Rankin Scale (mRS) 0 to 2, 90-day mRS 0 to 3, successful recanalization, symptomatic intracranial hemorrhage, and 90-day mortality. Results A total of 42 studies comprising 25,005 patients were included. Clinically, mothership was associated with an increased likelihood of achieving 90-day mRS 0 to 2 (OR 1.15, 95% confidence interval [CI] 1.03 to 1.29, I2=53%). However, no differences were observed for 90-day mRS 0 to 3 (OR 1.12, 95% CI 0.97 to 1.29; I2=52%), successful recanalization (OR 1.03, 95% CI 0.90 to 1.18; I2=60%), symptomatic intracranial hemorrhage (OR 0.84, 95% CI 0.69 to 1.02; I2=22%), and 90-day mortality (OR 0.99, 95% CI 0.85 to 1.15; I2=60%). Conclusion The mothership strategy may improve 90-day mRS 0 to 2 compared with the drip-and-ship, whereas no significant differences were observed in broader functional outcomes, recanalization rates, hemorrhagic complications, or mortality. Copyright © 2026 American College of Emergency Physicians. <56> Accession Number 2048400469 Title Minimally invasive extracorporeal circulation protects against postoperative pulmonary endothelial injury in elderly cardiac surgery via suppressing the C5a-mtDNA-cGAS-STING axis: a mechanistic randomized controlled trial. Source International Immunopharmacology. 188 (no pagination), 2026. Article Number: 117281. Date of Publication: 01 Jan 2026. Author Zhao Y.; Wang J.; Yang Z.; Ma W.; Wang C.; Wei L.; Zhao D.; Zhang S. Institution (Zhao, Wang) Department of Cardiac Surgery, Shanghai Geriatric Medical Center, Shanghai, China (Yang, Ma, Wang, Wei, Zhao, Zhang) Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China Publisher Elsevier B.V. Abstract Background: Elderly patients undergoing cardiac surgery are highly susceptible to postoperative pulmonary complications triggered by conventional extracorporeal circulation (CECC)-driven systemic inflammation and subsequent pulmonary endothelial injury. Minimally invasive extracorporeal circulation (MiECC) lowers perioperative hemodilution and systemic inflammatory load, yet the underlying intracellular protective mechanisms in aged populations remain incompletely understood. This study therefore aimed to delineate the C5a-mtDNA-cGAS-STING signaling cascade as the central pathway mediating MiECC's pulmonary protective effect. Method(s): This prospective randomized controlled trial enrolled 94 patients >=70 years undergoing elective valve or coronary bypass surgery, randomly allocated to MiECC (n = 46) or CECC (n = 48). Perioperative hemoglobin trajectories and 7-day postoperative adverse events were compared using appropriate statistical tests. For mechanistic validation, serum from 5 propensity-matched patient pairs (matched by age, surgery type, and CPB duration) was used to stimulate human pulmonary microvascular endothelial cells (HPMECs). Quantitative phenotypic assays, including fluorometric quantification coupled with high-content screening, were employed to evaluate endothelial barrier integrity, apoptosis, mitochondrial dysfunction, and activation of the cGAS-STING signaling axis. Two targeted pharmacological rescue experiments were conducted using C5a receptor antagonist PMX53 and STING selective inhibitor C-176, to establish the hierarchical causality of this proposed signaling axis. Result(s): No perioperative mortality was recorded in either cohort. The MiECC group exhibited markedly higher intraoperative hemoglobin levels and a 52.6% relative risk reduction in postoperative pulmonary exudative complications, with no extension of postoperative recovery timelines. Postoperative serum levels of complement C5a, pro-inflammatory cytokines, and endothelial injury biomarkers were significantly lower in the MiECC cohort. Quantitative analyses demonstrated that MiECC serum significantly attenuated endothelial hyperpermeability and reduced apoptosis rates. At the mechanistic level, MiECC serum suppressed mitochondrial superoxide accumulation (38.2% reduction) and preserved mitochondrial membrane potential, resulting in a 46.5% reduction in cytosolic mtDNA leakage. Consequently, MiECC serum downregulated cGAS and STING protein expression and suppressed nuclear translocation of phosphorylated IRF3 (p-IRF3). The dual inhibitor rescue demonstrated that pretreatment with PMX53 fully reversed all CECC serum-induced pathological phenotypes, whereas the STING inhibitor C-176 selectively ameliorated downstream endothelial injury without rescuing upstream mitochondrial dysfunction or cytosolic mtDNA leakage. Dual inhibitor rescue demonstrated that PMX53 completely reversed all pathological phenotypes, whereas C-176 only rescued downstream endothelial injury without correcting upstream mitochondrial damage or mtDNA release. Conclusion(s): MiECC is a safe, effective perfusion strategy that mitigates postoperative pulmonary exudation in elderly cardiac surgical recipients. At the mechanistic level, MiECC restricts CPB-induced C5a overproduction, thereby preventing C5a-driven mitochondrial impairment and mtDNA release, which initiates the cGAS-STING inflammatory cascade. Selective C5aR blockade fully interrupts this pathological axis, providing robust translational evidence to support broader adoption of MiECC in high-risk elderly patients and identifying C5aR as a tractable therapeutic target for CPB-associated lung injury. Copyright © 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <57> Accession Number 651314172 Title A randomised trial of carbon dioxide flushing to reduce vascular brain injury in patients undergoing TAVI. Source EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 22(16) (pp 883-890), 2026. Date of Publication: 17 Aug 2026. Author Khawaja S.A.; Hanna L.; Singh A.; Lucarelli C.; Garg P.; Malik I.; Hadjiloizou N.; Ruparelia N.; Hartley A.; Khamis R.; Shin M.S.; Gibbs R.; Mikhail G.W. Institution (Khawaja, Hanna, Singh, Lucarelli, Garg, Malik, Hadjiloizou, Ruparelia, Hartley, Khamis, Shin, Gibbs, Mikhail) Imperial College Healthcare NHS Trust, London, United Kingdom (Khawaja, Hanna, Lucarelli, Khamis, Gibbs, Mikhail) Imperial College London, London, United Kingdom Abstract BACKGROUND: Stroke remains a significant concern in patients undergoing transcatheter aortic valve implantation (TAVI). Despite advances in TAVI technology and techniques, stroke rates have remained unchanged, with trials of cerebral embolic protection devices failing to reduce rates. The concept of air emboli has not been previously investigated in TAVI procedures. We hypothesised that gaseous emboli could play a significant role in TAVI and that carbon dioxide (CO2) flushing of the TAVI valves could reduce the incidence of new neurological lesions post-TAVI. AIMS: We aimed to demonstrate the neuroprotective benefits of CO2 flushing in TAVI patients. METHOD(S): INTERCEPTavi is a single-centre, blinded, randomised controlled pilot trial that studied the effects of flushing TAVI valves with CO2 versus conventional saline on neurological outcomes post-TAVI, assessed using magnetic resonance imaging (MRI) and transcranial Doppler (TCD). Patients with aortic stenosis were randomised after obtaining vascular access. Periprocedural TCD assessed solid and gaseous emboli to the brain. Post-procedure, patients underwent brain MRI to detect lesions. Here, we report the primary outcome of feasibility, as well as the secondary MRI and mechanistic TCD outcomes. RESULT(S): A total of 60 patients were recruited and randomised 1:1 to CO2 and saline flushing (TAVI-CO2) versus saline flushing only (TAVI-S). CO2 flushing significantly reduced the average number of lesions per patient (TAVI-CO2: 4 lesions/patient vs TAVI-S: 8.5 lesions/patient; p=0.031). The total infarct area was numerically lower in the TAVI-CO2 group (40.32 mm2 vs 93.20 mm2), although this did not reach statistical significance (p=0.111). Similarly, TCD showed fewer microembolic signals in the TAVI-CO2 arm, primarily due to a reduction in gaseous emboli, but this difference was not statistically significant (p=0.5). CONCLUSION(S): INTERCEPTavi is a pioneering, first-in-human randomised trial that demonstrated that CO2 flushing of the TAVI valve reduces the number of cerebral lesions measured on MRI. CO2 flushing is an accessible, cost-effective method that can be easily implemented in any catheter laboratory to provide neurological advantages. <58> Accession Number 2045455419 Title Impact of Restrictive Versus Liberal Oxygenation on Pulmonary Decline After Cardiac Surgery: A Substudy of the GLORIOUS Randomized Clinical Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(9) (pp 2837-2844), 2026. Date of Publication: 01 Sep 2026. Author Mikkelsen A.D.; Wiberg S.; Schultz H.H.L.; Moller-Sorensen P.H.; Hofsten D.; Kober L.; Chemtob R.A.; Jakobsen P.C.H.; Nilsson J.C.; Moller C.H.; Hassager C.; Kjaergaard J. Institution (Mikkelsen, Hofsten, Kober, Hassager, Kjaergaard) Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Wiberg, Moller-Sorensen, Nilsson) Department of Cardiothoracic Anaesthesiology and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Schultz, Chemtob, Jakobsen) Section for Heart and Lung Transplant, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Moller) Department of Cardiac Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Wiberg, Hassager, Kjaergaard) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Publisher W.B. Saunders Abstract Objectives: Pulmonary dysfunction is a known complication of cardiac surgery. High fractions of inspired oxygen (FiO<inf>2</inf>) during the critical pulmonary reperfusion phase of cardiopulmonary bypass (CPB) weaning is a proposed pathophysiological contributor yet remains sparsely investigated. Design(s): Predefined, exploratory substudy of the GLORIOUS randomized, clinical trial. Setting(s): Single tertiary center with cardiothoracic surgery expertise. Participant(s): Adult patients undergoing nonemergent coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement. Intervention(s): Restrictive (FiO<inf>2</inf> 50%) versus liberal (FiO<inf>2</inf> 100%) oxygenation during CPB and the first hour after weaning or until patient transfer from the operating table. Pulmonary function (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, and diffusion capacity of carbon monoxide) was measured preoperatively and 3 months postoperatively. Measurements and Main Results: A total of 878 patients were included in the study. Postoperatively, at the 3-month mark, pulmonary function declined across all parameters in the overall study population (median FEV1 [% predicted] by 8.3 percentage points [95% CI 6.6 to 8.3], FVC [% predicted] by 6.1 percentage points [95% CI 5.2 to 7.0], FEV1/FVC by 1.6 percentage points [95% CI 1.0 to 2.1], and diffusion capacity of carbon monoxide [% predicted corrected] by 7.7 percentage points [95% CI 6.2 to 9.1], all p< 0.001). However, no significant between-group differences in decline were observed (all p > 0.3), including in subgroup analyses. Conclusion(s): While pulmonary function exhibited a mild-to-moderate decline 3 months after cardiac surgery, a restrictive (FiO<inf>2</inf> 50%) oxygenation strategy during CPB did not attenuate this decline compared with a liberal (FiO<inf>2</inf> 100%) strategy. Findings are hypothesis-generating. Copyright © 2026 The Author(s) <59> Accession Number 2047999210 Title Predictive value of the QFR combined with early exercise tolerance testing for long-term prognosis after coronary intervention. Source European Journal of Medical Research. 31(1) (no pagination), 2026. Article Number: 1075. Date of Publication: 01 Dec 2026. Author Deng Q.; Chen Q.; Zhao Y.; Dong J.; Tang J.; Wu R.; Du S.; Jia F.; Wang S. Institution (Deng, Chen, Zhao, Dong, Tang, Wu, Jia, Wang) Shijiazhuang People's Hospital, Shijiazhuang, China (Deng, Jia) Hebei Medical University, Shijiazhuang, China (Du) Beijing BOE Hospital, Beijing, China Publisher BioMed Central Ltd Abstract Objective: To evaluate the predictive value of the quantitative flow ratio (QFR) combined with early exercise tolerance testing (CPET) for long-term prognosis after coronary intervention. Method(s): Patients with unstable angina (UA) and 50-90% stenosis scheduled for elective PCI were randomly assigned to the QFR group (undergoing intervention if QFR < 0.80) or the conventional group (empirical PCI). Cardio-Pulmonary Exercise Test (CPET) was performed 1-3 weeks postoperatively to record the anaerobic threshold (AT), peak metabolic equivalent (MET), peak oxygen uptake (peakVO<inf>2</inf>), VE/VCO<inf>2</inf> slope, oxygen uptake/work rate (VO<inf>2</inf>/WR), oxygen uptake/heart rate (VO<inf>2</inf>/HR), Weber cardiac function classification, and cardiac reserve function. One-year follow-up assessed MACE events (including cardiovascular death, non-fatal arrhythmia, ischemia-driven revascularization, and rehospitalization for unstable angina). Result(s): The QFR group demonstrated superiority over the conventional group in key CPET parameters including AT, peak MET, peak VO<inf>2</inf>, and VO<inf>2</inf>/HR (p < 0.05). Ischemia-driven revascularization was significantly lower in the QFR group (8.6% vs 19.5%, p = 0.046), with significantly shorter stent lengths (20 mm vs 26 mm, p = 0.001) and higher postoperative QFR values (0.92 vs 0.90). Logistic regression analysis demonstrated that improved QFR values significantly reduced MACE risk. PeakVO<inf>2</inf> was an independent protective factor for MACE (OR = 0.47, p = 0.017). ROC curve analysis revealed that the QFR curve had an area under the curve (AUC = 0.928), peakVO<inf>2</inf> AUC = 0.948). Optimal cutoff values were set at QFR = 0.885 and peakVO<inf>2</inf> = 16.8 mL kg-1 min-1. Patients were reclassified into four groups based on these cutoffs: dual-normal, single-abnormal, and dual-abnormal groups. Logistic regression analysis showed combined indicator p = 0.081 < 0.05, with combined indicator AUC 0.977 indicating good calibration (HL P = 0.624, Brier 0.049). Decision curve analysis demonstrated superiority over single-indicator models. Conclusion(s): QFR-guided PCI enables precise ischemia localization, reduces implantations, and enhances exercise tolerance. Combining QFR with peakVO<inf>2</inf> accurately identifies high-risk patients, and intensive rehabilitation improves long-term outcomes. Copyright © The Author(s) 2026. <60> Accession Number 2045129277 Title Neurodevelopmental outcomes after cardiac surgery for congenital heart disease in India: A narrative review. Source Indian Heart Journal. 78(4) (pp 209-212), 2026. Date of Publication: 01 Jul 2026. Author Bakhshi S.; Faisal N.V.; Naim M.Y.; Gupta S.K. Institution (Bakhshi) Department of Pediatrics, Children's Hospital of Michigan, Detroit, United States (Faisal, Gupta) Department of Cardiology, AIIMS, New Delhi, India (Naim) Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States Publisher Elsevier B.V. Abstract Neurodevelopmental outcomes among survivors post-surgery for congenital heart disease (CHD) in India remain insufficiently characterized. Structured searches in PubMed and Google Scholar for studies on neurodevelopmental outcomes published between January 2000 and December 2025 identified six studies from India: five single-centre and one multicentric cohort. Across studies, early motor delay was reported in 14-33% of children and mental or cognitive delay in 15-24%. Risk factors included syndromic association, prolonged postoperative illness, and socioeconomic disadvantage. Long-term, longitudinal, and regionally representative data remain sparse. Integration of structured neurodevelopmental follow-up into CHD care is needed. Copyright © 2026 Cardiological Society of India <61> Accession Number 2037880166 Title Surgical Repair of Post-Infarction Ventricular Septal Rupture with or without Concomitant Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Outcomes and Prognostic Implications. Source Cor et Vasa. 67(6) (pp 677-685), 2025. Date of Publication: 2025. Author Irawan E.; Sembiring Y.E. Institution (Irawan, Sembiring) Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia (Irawan, Sembiring) Department of Thoracic, Cardiac and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Publisher Czech Society of Cardiology Z.S Abstract Introduction: Post-myocardial infarction ventricular septal rupture (VSR) is a rare but fatal complication that requires urgent surgical repair. The benefit of adding concomitant coronary artery bypass grafting (CABG) remains controversial. While CABG may protect viable myocardium in patients with coronary artery disease, it also increases operative complexity and ischemic time. This review evaluates the prognostic impact of concomitant CABG during VSR repair. Method(s): A systematic literature search was conducted in PubMed, ScienceDirect, BMC, and Springer data-bases according to PRISMA guidelines. Studies reporting surgical VSR repair with and without CABG were included. The primary endpoint was survival, analysed through meta-analysis, and prognostic variables were also reviewed. Result(s): Twelve retrospective studies involving 2,050 patients were identified, including 857 who underwent concomitant CABG and 1,193 who had isolated VSR repair. Baseline demographics were broadly comparable, although CABG patients more frequently presented with multivessel disease. Patch closure was the predominant repair technique. CABG was associated with longer cross-clamp times but not with higher perioperative complications. Survival events occurred in 547/857 (63.8%) of CABG patients versus 780/1,193 (65.4%) without CABG. The pooled odds ratio for survival was 1.02 (95% CI, 0.84-1.24; p = 0.83), with negligible heterogeneity (I2 = 0%). These findings suggest concomitant CABG can be performed safely, with potential value in patients with complex coronary disease, although increased operative time may pose risk in elderly or unstable individuals. Conclusion(s): Concomitant CABG during VSR repair does not provide a universal survival advantage but remains a safe option, particularly for patients with multivessel disease. Surgical decisions should be individualized, and further prospective studies are needed to refine treatment strategies. Copyright © 2025, Czech Society of Cardiology Z.S. All rights reserved. <62> Accession Number 2048010792 Title Robotic-assisted surgery in vascular surgery: a 29-year bibliometric analysis and emerging research trends. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 790. Date of Publication: 01 Dec 2026. Author Shi Q.; Zhu C.; Liu N. Institution (Shi) The Second Clinical Medical College,Shandong Medical and Pharmaceutical University, Shandong, Yantai, China (Zhu, Liu) Central Laboratory, Clinical Medical Research Center, Linyi People's Hospital, Shandong Second Medical University, North Side of the Intersection of Wuhu Mountain Road and Wuhan Road, Lanshan District, Shandong, Linyi, China Publisher Springer Nature Abstract In many medical specialties, robot-assisted surgery has become a crucial option for surgical interventions. However, its adoption in vascular surgery remains limited, with this discipline lagging behind other fields in both research and application of this technology. The rapid advancement of robot-assisted surgery presents both an opportunity and a challenge for the development of vascular surgery. Bibliometrics can systematically and quantitatively summarize research achievements, key research directions, and emerging trends in this field, thereby guiding future research efforts on the application of robot-assisted surgery in vascular surgery. All eligible literature in this research was retrieved from the Web of Science Core Collection, covering publications released from 1997 to 2025 that focus on the clinical applications of robot-assisted surgery within vascular surgery. Two bibliometric software programs, VOSviewer 1.6.20 and CiteSpace 6.4.R2, were adopted to implement multiple analytical procedures, including author collaboration analysis, literature co-citation analysis and keyword co-occurrence analysis. Meanwhile, the citation burst detection function embedded in CiteSpace was applied to pinpoint prevailing research hotspots and emerging frontiers in this discipline. This study included 375 eligible publications from 1,777 researchers across 503 institutions in 39 countries. Annual publication output showed a steady increase, with two notable peaks in 2022 and 2025 after a marked rise post-2020. The United States led globally with 130 papers (34.6%) and 3,687 citations, followed by China, Japan, Italy, and the UK. The Beijing Institute of Technology was the most prolific institution. Key scholars including Shuxiang Guo, Norihiko Ishikawa, and Go Watanabe shaped the field's foundation, while the International Journal of Medical Robotics and Computer Assisted Surgery and The Annals of Thoracic Surgery were the primary publishing venues. Keyword clustering identified five major research themes: robotic surgery, angioplasty, force sensing, abdominal aortic aneurysm, and percutaneous coronary intervention. Temporal keyword analysis revealed a clear shift from traditional open cardiovascular procedures (e.g., coronary artery bypass grafting, laparoscopic aortic bypass) toward robotic-assisted endovascular and extravascular interventions, such as percutaneous coronary intervention and integrated robotic revascularization. Over the past twenty-nine years, China's research institutions and scholars have achieved certain accomplishments in the application research of robot-assisted surgical techniques in the field of vascular surgery. Vascular surgery has evolved from traditional open cardiovascular procedures to novel robot-assisted surgical methods suitable for both intravascular and extravascular operations. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <63> Accession Number 2046502373 Title Anticholinergic Burden as a Modifiable Risk Factor in Cardiac Surgery: A Randomized Controlled Study. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(9) (pp 2761-2772), 2026. Date of Publication: 01 Sep 2026. Author Cobas M.; Demir Z.A.; Aykut A.; Ozsan N.; Yigit C.A.; Kurtbeyoglu S.; Katipoglu B.; Akca O. Institution (Cobas, Demir, Aykut, Ozsan, Yigit, Kurtbeyoglu) Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey (Katipoglu) Department of Geriatrics, University of Health Sciences, Balikesir Ataturk City Hospital, Balikesir, Turkey (Akca) Department of Anesthesiology & Critical Care Medicine, School of Medicine, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD, United States Publisher W.B. Saunders Abstract Objectives: This study assessed whether reducing immediate perioperative anticholinergic burden improves functional recovery in older patients undergoing coronary artery bypass grafting (CABG). Design(s): Prospective randomized controlled study. Setting(s): Single-institution tertiary care hospital. Participant(s): One hundred twenty-two patients aged >=60 years with preoperative Anticholinergic Cognitive Burden scores >=3. Intervention(s): Patients were assigned to either standard anesthetic and/or analgesic care including anticholinergic drugs (standard group) or a deprescribing strategy avoiding perioperative anticholinergic anesthetic and analgesic drugs (deprescribing group). Measurements and Main Results: Primary outcomes were functional recovery on postoperative day 90 assessed using the Katz Index and the Clinical Frailty Scale. On postoperative day 90, full independence (Katz Index score of 6) was significantly more frequent in the deprescribing group than in the standard group (75.0% v 41.1%, p < 0.001). Frailty scores were significantly lower in the deprescribing group at 90 days (median, 3 [interquartile range (IQR), 3-3] v 4 [IQR, 3-4]; p < 0.001). Multivariate logistic regression identified perioperative use of anticholinergic anesthetic and analgesic drugs as an independent predictor of 90-day total complications (odds ratio, 2.430; 95% confidence interval, 1.031-5.726; p = 0.042). Within-group analyses showed decreased frailty scores and increased Katz Index scores from baseline to day 90 in the deprescribing group (p < 0.001 for both), whereas the standard group showed increased frailty (p < 0.001) with no significant change in Katz Index scores (p = 0.317). Conclusion(s): In older CABG patients, immediate perioperative deprescribing of anticholinergic medications improved 90-day functional recovery trajectories and was associated with fewer cardiac and pulmonary complications. Anticholinergic burden may represent a modifiable perioperative risk factor that should be routinely addressed in surgical care pathways to optimize outcomes in older adults. Copyright © 2026 Elsevier Inc. <64> Accession Number 2047545947 Title Intermittent Bolus versus Continuous Infusion Erector Spinae Catheters for Median Sternotomy Incisions:A Randomized Controlled Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(9) (pp 2792-2799), 2026. Date of Publication: 01 Sep 2026. Author Forrest P.B.; Guerra-Londono C.E.; Nowak K.; Meadows A.; Dexter F. Institution (Forrest, Guerra-Londono, Nowak, Meadows) Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, MI, United States (Dexter) Department of Anesthesia, University of Iowa, Iowa City, IA, United States Publisher W.B. Saunders Abstract Objective: To compare the analgesic efficacy of programmed intermittent boluses (PIB) and continuous infusion via indwelling erector spinae plane (ESP) catheters following open heart surgery. It was hypothesized that the use of PIB would result in superior analgesia compared to continuous infusion of local anesthetics through ESP catheters after cardiac surgery. Design(s): An Institutional Review Board-approved parallel-group, prospective, randomized, double-blind trial. Setting(s): A large academic hospital in the midwestern United States. Participant(s): Adults undergoing open heart surgery via midline sternotomy and scheduled ESP analgesia with bilateral indwelling catheters. Intervention(s): Continuous infusion versus PIB of ropivacaine 0.2% via an electronic infusion pump. Measurements and Main Results: The primary outcome was postoperative opioid consumption in oral morphine milligram equivalents (OMME) through 72 hours. The secondary outcomes included postoperative pain intensity on a numerical rating scale, length of stay, quality of recovery (QoR-15), time to first bowel movement, and antiemetic use. A total of 240 participants were randomized at a 1:1 ratio to PIB or continuous infusion. The PIB group had an estimated 1.08-fold greater OMME than the continuous infusion group (95% confidence interval [CI], 0.90-1.31; p = 0.40). The mean difference was 4.1 OMME greater per day for the PIB group (95% CI, -5.6 to +13.8 mg; p = 0.41). There were no statistically significant differences in secondary outcomes between the 2 groups. Conclusion(s): In adults undergoing open heart surgery, ESP catheter-based analgesia via PIB did not significantly reduce early postoperative opioid consumption compared to a continuous infusion method. Copyright © 2026 The Authors <65> Accession Number 2047907303 Title Clonal Hematopoiesis of Indeterminate Potential in Cardiovascular Disease: Gene-Specific Mechanisms and Therapeutic Implications. Source International Journal of General Medicine. 19 (no pagination), 2026. Article Number: 626604. Date of Publication: 2026. Author Zhang X.; Zhang H.; Fu J.; Feng S.; Wang Y. Institution (Zhang) Department of Thoracic Surgery, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping DistrictLiaoning, Shenyang, China (Zhang, Fu, Feng) Department of Cardiology, The First Hospital of China Medical University, Liaoning, Shenyang, China (Wang) Department of Thoracic Surgery, The First Hospital of China Medical University, Liaoning, Shenyang, China Publisher Dove Medical Press Ltd Abstract Clonal hematopoiesis of indeterminate potential (CHIP) denotes the age-associated expansion of hematopoietic clones carrying acquired somatic variants, conventionally identified at a variant allele frequency of at least 2% in people without overt hematologic malignancy. Once viewed mainly through the lens of premalignant hematology, CHIP is now repeatedly linked to excess cardiovascular morbidity and mortality. The earliest cardiovascular signal centered on atherosclerotic cardiovascular disease (ASCVD), but the phenotype has broadened to include calcific aortic valve disease, atrial fibrillation, heart failure, stroke, and venous thromboembolism. Cardiovascular biology also differs substantially by driver gene. TET2 loss-of-function favors inflammasome-linked IL-1beta/IL-6 signaling and has been connected to plaque vulnerability and myocardial inflammation; DNMT3A mutations reshape myeloid epigenetic programs through overlapping but non-identical inflammatory states; ASXL1 mutations promote myeloid-skewed hematopoiesis and have been associated with adverse cardiac remodeling and arrhythmia susceptibility; and JAK2 V617F, a prototypic gain-of-function lesion, produces a particularly thromboinflammatory profile through amplified NET formation. Although these drivers diverge upstream, several CHIP subtypes ultimately converge on inflammatory effector pathways involving IL-1beta and IL-6, supporting the concept of anti-inflammatory precision prevention. Exploratory CANTOS analyses suggest that IL-1beta inhibition may be especially beneficial in TET2-CHIP carriers, but this observation remains hypothesis-generating and requires adequately powered, CHIP-stratified outcome trials. Current translational work includes CHIP-enriched studies of inflammasome and IL-1-pathway blockade, ongoing large outcome trials targeting IL-6 in residual inflammatory risk, and gene-informed strategies for thromboinflammatory CHIP subtypes. This article is a narrative review that synthesizes mechanistic, epidemiologic, and translational evidence rather than a systematic review based on a formal search strategy. This review develops a gene-centric framework that connects molecular mechanisms, cardiovascular phenotypes, and emerging therapeutic opportunities, while emphasizing the evidence gaps that must be closed before CHIP-directed precision cardiology can be considered clinically actionable. Copyright © 2026 Zhang et al. <66> Accession Number 2047940330 Title Impact of an early, graduated mobilization program on recovery and postoperative outcomes after cardiac revascularization with extracorporeal circulation. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1801971. Date of Publication: 2026. Author Liu J.; Jiang M.; Zhao X.; Liang Y.; Liu Y.; Pan R. Institution (Liu, Jiang, Zhao, Liang, Liu, Pan) Cardiac Surgery Department, The First Hospital of Jilin University, Jilin Province, Changchun, China Publisher Frontiers Media SA Abstract Objective - This randomized controlled trial evaluated the effects of an early, graduated mobilization program on functional recovery (primary endpoint: postoperative day-5 forced vital capacity [FVC]; secondary endpoints: activities of daily living [ADL] scores, handgrip strength, Short Physical Performance Battery [SPPB] scores, postoperative pulmonary complications [PPCs], and postoperative length of stay) in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods - Between March to September 2025, 92 patients underwent on-pump CABG; after screening, 80 consecutive eligible patients (sample size calculated based on PPC incidence, n = 42 per group before attrition adjustment) were randomized 1:1 using a random number table with allocation concealment to a control group (n = 40) or an intervention group (n = 40). Results - On postoperative day 5, the intervention group demonstrated significantly better FVC, ADL scores, handgrip strength, and SPPB scores (all P < 0.05). PPC incidence was markedly lower (10% vs. 62.5%, P < 0.0001), and postoperative length of stay was shorter (7.13 +/- 2.36 vs. 9.18 +/- 2.66 days, P = 0.0006). Conclusion - The early graduated mobilization program was safe, feasible, and associated with improved short-term functional recovery, reduced PPCs, and shorter postoperative hospital stay after on-pump CABG. Larger multicenter studies with longer follow-up are required to confirm long-term safety and effectiveness. Copyright © 2026 Liu, Jiang, Zhao, Liang, Liu and Pan. <67> Accession Number 2043730146 Title Effect of Stellate Ganglion Block on Internal Mammary Artery Dynamics: A Randomized Controlled Clinical Trial. Source Seminars in Cardiothoracic and Vascular Anesthesia. 30(3) (pp 172-182), 2026. Date of Publication: 01 Sep 2026. Author Aboelnile D.B.; Ghallab M.A.; Attia E.H.A.; Hawas A.Y.; Kamal Eldin F. Institution (Aboelnile, Ghallab, Attia, Hawas, Kamal Eldin) Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt Publisher SAGE Publications Inc. Abstract The left internal mammary artery (LIMA) is commonly selected as the graft of choice for coronary artery bypass procedures. Various pharmacological agents have been used to enhance LIMA blood flow. Left stellate ganglion block (LSGB) has been utilized to achieve sympathetic blockade, promote vasodilation in the upper extremities, and manage refractory angina. This randomized controlled clinical trial aimed to evaluate the effect of preoperative LSGB on LIMA blood flow in patients undergoing elective coronary artery bypass grafting (CABG). Seventy patients (aged 18-80 years, of both genders) scheduled for elective CABG were equally divided into two groups: the LSGB group and the control group. Patients in the intervention group received an ultrasound-guided LSGB using 8 mL of 0.25% bupivacaine. Both groups received topical nitroglycerin during LIMA harvesting. LIMA diameter was measured at baseline and again after an equal time interval before the induction of anaesthesia. Additionally, LIMA free flow after harvesting and mean graft flow were measured using a transit time flow metre (TTFM). LIMA free blood flow was significantly increased in the LSGB group (50.57 +/- 5.79 mL/min) compared to the control group (46.86 +/- 8.32 mL/min), with a P-value = 0.034. Similarly, the LIMA diameter was significantly greater in the LSGB group (2.38 +/- 0.17 mm) than in the control group (2.31 +/- 0.14 mm), with a P-value = 0.04, suggesting that preoperative LSGB significantly enhances LIMA blood flow and diameter in patients undergoing CABG. Copyright © The Author(s) 2026 <68> Accession Number 2047814744 Title Contemporary evidence for multiarterial grafting in coronary artery bypass surgery. Source Current Opinion in Cardiology. 41(5) (pp 414-421), 2026. Date of Publication: 01 Sep 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 Publisher Lippincott Williams and Wilkins 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. <69> Accession Number 2047119340 Title Ivabradine in Heart Transplant Recipients with Sinus Tachycardia: A Systematic Review and Meta-Analysis. Source Journal of Cardiovascular Pharmacology. 88(2) (pp 86-95), 2026. Date of Publication: 01 Aug 2026. Author Hamzah K.A.; Kurmasha Y.H.; Rasheed W.M.; Al-Shammari A.S.; Shahzaib M.; Akoum A.; Shweliya M.A.; Ramadan A.; Al-Taii H.; Refaat M.M. Institution (Hamzah) Department of Internal Medicine, Alkindy College of Medicine, University of Baghdad, Baghdad, Iraq (Kurmasha) Department of Internal Medicine, College of Medicine, University of Kufa, Najaf, Iraq (Rasheed) Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Al-Shammari, Shweliya) Department of Internal Medicine, University of Baghdad College of Medicine, Baghdad, Iraq (Shahzaib) Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan (Akoum) Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, United States (Ramadan) Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt (Al-Taii) Department of Cardiology, Aultman Hospital, Canton, OH, United States (Refaat) Department of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon Publisher Lippincott Williams and Wilkins Abstract Abstract: - Sinus tachycardia is common after heart transplantation (HTx) and may worsen graft function through increased oxygen demand and remodeling. Ivabradine, a selective If channel inhibitor, lowers heart rate (HR) independently of sympathetic activity. This meta-analysis evaluates its efficacy and safety versus standard care in HTx recipients. A comprehensive search of PubMed, Embase, WoS, Scopus, and Cochrane was conducted through September 2025. Eligible studies included randomized and nonrandomized comparative trials. Data were pooled with a random-effects model to estimate mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes. Six studies, including 852 adult HTx recipients, were included. Ivabradine consistently reduced HR across all time points. Statistical significance was reached at 24 months (MD -16.82 bpm; P = 0.04) and 36 months (MD -12.94 bpm; P = 0.04). A significant reduction was observed in left ventricular mass index (MD -11.10 g/m2; 95% confidence interval -17.15 to -5.06; P < 0.05; I^2 = 0%). While left ventricular mass (LVM) and left ventricular ejection fraction (LVEF) showed trends toward improvement at the final follow-up (MD = -11.23 for LVM and +2.94% for LVEF), neither reached statistical significance (P = 0.06 and P = 0.48, respectively). No significant differences were found between the ivabradine and control groups regarding all-cause mortality (RR 1.16 at the final follow-up; P = 0.90), graft rejection (RR 1.14; P = 0.87), or systolic blood pressure (MD 0.50 mm Hg; P = 0.83). Ivabradine lowers HR after HTx but shows no clear benefit on mortality, rejection, or ejection fraction. It does not significantly affect blood pressure, supporting its tolerability, particularly when beta-blockers are not tolerated. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <70> Accession Number 2045818018 Title Short-term physical compatibility of milrinone and epoprostenol for inhalation in cardiac surgery. Source Canadian Journal of Anesthesia. 73(6) (pp 621-622), 2026. Date of Publication: 01 Jun 2026. Author Denis-Mdawar E.; Audet S.; Friciu M.; Denault A.; Jarry S. Institution (Denis-Mdawar, Denault, Jarry) Department of Anesthesiology, Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada (Audet) Department of Pharmacy, Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada (Friciu) Faculty of Pharmacy, Universite de Montreal, Montreal, QC, Canada Publisher Springer <71> Accession Number 2046442388 Title Outcomes in provisional one-stent versus dedicated two-stent coronary bifurcation stenting techniques: a systematic review and meta-analysis. Source Egyptian Heart Journal. 78(1) (no pagination), 2026. Article Number: 45. Date of Publication: 01 Dec 2026. Author Agrawal H.; Dubey P.; Tewari J.; Neupane S.; Singh V.; Shunk K.; Perera M.; Dwivedi A.K.; Mukherjee D. Institution (Agrawal, Neupane) Washington Hospital Healthcare System, Fremont, United States (Dubey) Santa Clara University, Santa Clara, United States (Tewari) Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, United States (Singh) King George's Medical University, Lucknow, India (Shunk) San Francisco VA Medical Center, San Francisco, United States (Perera, Dwivedi) University of Missouri, Columbia, United States (Mukherjee) Texas Tech University Health Sciences Center El Paso, El Paso, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: The optimal long-term strategy for coronary bifurcation PCI remains debated. Earlier meta-analyses limited to long-term data suggested better outcomes with a provisional approach versus routine two-stent techniques. Method(s): We conducted an updated, comprehensive meta-analysis of randomized controlled trials comparing provisional versus two-stent strategies. MEDLINE, Embase, and the Cochrane Library were searched through September 2025. Fifteen RCTs (n = 6978) met inclusion criteria. Using Stata 16.1, random-effects (DerSimonian-Laird) risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for prespecified outcomes. Result(s): Relative risks (95% CIs) for provisional vs two-stent were: all-cause mortality 0.97 (0.72-1.30); cardiovascular mortality 0.98 (0.68-1.40); myocardial infarction 0.86 (0.62-1.19); target lesion revascularization 1.07 (0.80-1.44); stent thrombosis 1.36 (0.81-2.29); and MACE 1.27 (0.81-1.99). Across endpoints, pooled estimates did not show statistically significant differences between strategies. Conclusion(s): In this updated synthesis of randomized trials, the available evidence did not demonstrate clear superiority of either provisional or two-stent strategies for major clinical outcomes. Unlike prior long-term-only analyses, we did not observe higher mortality or myocardial infarction with two-stent approaches. Technique selection should remain individualized according to lesion anatomy, procedural complexity, and operator expertise. These findings should not be interpreted as proof of equivalence or non-inferiority. Trial registration CRD420251167534. Copyright © The Author(s) 2026. <72> Accession Number 2048461684 Title Rationale and design of a pilot randomized control trial of permissive hypotension after cardiac surgery: The PHACS trial. Source American Heart Journal Plus: Cardiology Research and Practice. 70 (no pagination), 2026. Article Number: 100852. Date of Publication: 01 Oct 2026. Author Miranda D.W.; Makarem A.; Liquori C.; Galvis A.; Bagchi A.; Nikolic I.; Aguirre A.D.; Bloom J.P.; Rabi S.A.; D'Alessandro D.A.; Melnitchouk S.; Jassar A.S.; Langer N.B.; Hosseini M.; Kreso A.; Sundt T.M.; Osho A.A.; Silverman M.G. Institution (Miranda, Makarem, Bloom, D'Alessandro, Melnitchouk, Jassar, Langer, Hosseini, Kreso, Sundt, Osho) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Liquori) University of Massachusetts Chan Medical School, Worcester, MA, United States (Galvis) Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States (Bagchi) Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Nikolic) Division of Cardiology, Los Angeles General and USC Medical Center, Los Angeles, CA, United States (Aguirre, Silverman) Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Rabi) Division of Cardiovascular Surgery of the Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada Publisher Elsevier Inc. Abstract Background: Vasopressors are frequently used in the early postoperative period after cardiac surgery to treat hypotension and support organ perfusion. However, increasing evidence suggests that excessive vasopressor exposure may lead to adverse outcomes. In critically ill populations, permissive hypotension has been shown to reduce vasopressor use without increasing harm. This strategy has not been studied in postoperative cardiac surgery patients. Study design: The Permissive Hypotension After Cardiac Surgery (PHACS) Trial is a pilot single-center, open-label, pragmatic randomized controlled trial of adult patients undergoing non-emergent cardiac surgery. Patients who develop hypotension requiring vasopressor support within the first 24 h of intensive care unit (ICU) admission are randomized 1:1 to a permissive hypotension arm (target mean arterial pressure [MAP] 60-65 mmHg) or usual care. The primary outcome is hourly MAP during vasopressor therapy. Secondary outcomes include vasopressor and inotrope exposure, ICU and hospital length of stay, end-organ injury and support requirements, and in-hospital mortality. Conclusion(s): The PHACS Trial is designed to address a critical gap in postoperative cardiac surgical care by evaluating whether a permissive hypotension strategy can safely reduce vasopressor exposure. The study results will help define optimal vasopressor use and blood pressure targets in cardiac surgery patients where evidence-based targets remain undefined. Results from this pilot trial will inform the development of a larger multicenter trial. Trial registration: NCT 06476613. Copyright © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <73> Accession Number 2048329540 Title Risk stratification in acute myocardial infarction: from triage decision to outcome prediction. Source European Heart Journal: Acute Cardiovascular Care. 14(11) (pp 687-689), 2025. Date of Publication: 01 Nov 2025. Author Dharmakumar R.; Boeddinghaus J.; Daniels L.B.; Mair J.; Mills N.L. Institution (Dharmakumar) Cardiovascular Imaging Research Center, Medical Imaging Research Institute, Indiana University School of Medicine, Suite 124E-950 W Walnut Street, Indianapolis, IN, United States (Boeddinghaus) Cardiovascular Research Institute Basel (CRIB) and Clinic of Cardiology, University Hospital Basel, Basel, Switzerland (Boeddinghaus, Mills) BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (Daniels) Department of Medicine, Sulpizio Cardiovascular Center, University of California, La Jolla, San Diego, CA, United States (Mair) Department of Internal Medicine III-Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria Publisher Oxford University Press <74> Accession Number 2048418965 Title Efficacy and safety of concomitant catheter ablation and left atrial appendage closure compared to catheter ablation only - a meta-analysis. Source Journal of Interventional Cardiac Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Rattka I.; Poch C.; Deichsel T.; Martens E.; Laugwitz K.-L.; Steger A.; Rattka M. Institution (Rattka, Poch, Deichsel, Martens, Laugwitz, Steger, Rattka) School of Medicine and Health, Department of Clinical Medicine-Clinical Department of Cardiology, University Medical Centre, Technical University of Munich, Ismaninger Strase 22, Munich, Germany Publisher Springer Abstract Background: Atrial fibrillation (AF) carries a substantial ischemic stroke risk originating predominantly from the left atrial appendage (LAA). Catheter ablation (CA) is the most effective rhythm-control strategy, while percutaneous LAA closure (LAAC) provides mechanical stroke prophylaxis. Combining both in a single one-stop procedure is increasingly performed, yet data on its rhythmic and periprocedural consequences remain scarce. Method(s): We performed a systematic review and meta-analysis to compare the efficacy and safety of combined CA + LAAC versus CA-only in patients with AF. PubMed, Scopus and Web of Science were searched through June 12th 2026. The primary efficacy and safety outcomes were arrhythmia recurrence and periprocedural pericardial effusion requiring drainage, respectively. Binary endpoints were pooled as odds ratios (OR), continuous endpoints as mean differences (MD), using a random-effects model with heterogeneity reported as I2. Result(s): Fourteen studies comprising 3,274 patients (1,505 CA + LAAC; 1,769 CA-only) were included. Arrhythmia recurrence was significantly more frequent after combined CA + LAAC (OR = 1.56, 95% CI = 1.11-2.19, I2 = 47%). Systemic thromboembolism was numerically lower but did not differ significantly (OR = 0.66, 95% CI = 0.37-1.21, I2 = 0%). Total procedure time was significantly longer for the combined procedure (MD = + 9.34 min, 95% CI = 0.63-18.05, I2 = 90%). Periprocedural pericardial effusion requiring drainage did not differ between groups (OR = 1.19, 95% CI = 0.59-2.44, I2 = 0%). Conclusion(s): Combined CA + LAAC was associated with significantly higher arrhythmia recurrence than CA-only, potentially attributable to limited substrate modification in the one-stop setting. The primary safety outcome, pericardial effusion requiring drainage, did not differ between groups. Randomised controlled trials are warranted to confirm these findings. Copyright © The Author(s) 2026. <75> [Use Link to view the full text] Accession Number 2045854488 Title Optimizing conduits and intraoperative graft quality in coronary artery bypass graft surgery. Source Current Opinion in Cardiology. 41(5) (pp 445-451), 2026. Date of Publication: 01 Sep 2026. Author Majeed H.; Pelletier M. Institution (Majeed) Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada (Pelletier) Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, United States Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Optimization of conduits and intraoperative graft assessment remain central determinants of long-term success in coronary artery bypass grafting (CABG). This review is timely, given the recent publication of randomized data refining conduit selection, harvesting strategies, and modalities for physiologic graft verification. Recent findings - Over the past year, accumulating randomized and registry-based evidence has strengthened support for multi-arterial revascularization, while clarifying the risks and benefits of certain arterial grafting and associated techniques. Parallel investigations have emphasized atraumatic great saphenous vein (GSV) harvesting and no-touch techniques, to mitigate endothelial injury and enhance patency. Intraoperative graft assessment has increasingly shifted toward routine use of objective physiologic tools, particularly transit-time flow measurement (TTFM) with adjunctive Doppler/ultrasound or fluorescence angiography, and emerging data refining quantitative thresholds and quality benchmarks. Summary - Contemporary evidence underscores that durable surgical revascularization depends on integrated biologic, technical, and physiologic optimization. Standardizing conduit selection, minimizing conduit injury, and adopting routine intraoperative graft assessment may reduce early technical failure and improve long-term graft performance. Ongoing trials and implementation research will determine how best to translate these advances into consistent, high-quality CABG practice. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <76> Accession Number 2048135737 Title A meta-analysis of randomized controlled trials on atenolol's impact on postoperative atrial fibrillation in adults undergoing cardiac surgery. Source Medicine (United States). 105(31) (no pagination), 2026. Article Number: e50029. Date of Publication: 31 Jul 2026. Author Deng J.-H.; He F.-R.; Yao Y.-T. Institution (Deng) Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (He) Department of Obstetrics and Gynecology, The Air Force Hospital of Southern Theater Command, Guangzhou, China (Yao) Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (Yao) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China (Yao) Center of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston, TX, United States (Yao) Outcomes Research Consortium, Houston, TX, United States Publisher Lippincott Williams and Wilkins Abstract Prior research has conducted a limited number of studies on the efficacy of atenolol in preventing atrial fibrillation following cardiac surgery (CS). Consequently, a comprehensive evaluation and meta-analysis were undertaken to assess the effectiveness and safety of atenolol in patients undergoing CS for the prevention of postoperative atrial fibrillation (POAF). A meta-analysis of randomized controlled trials was performed. Searches were conducted across multiple databases up to December 1, 2024. The primary focus was the incidence of POAF. Risk ratios (RRs) for treatment effects on dichotomous variables were calculated. The data analysis encompassed 6 randomized controlled trials involving a total of 870 patients. The meta-analysis revealed that atenolol significantly reduces the incidence of POAF in adult patients undergoing CS (RR, 0.55; 95% confidence interval [CI]: 0.32-0.93; P = .03) with moderate heterogeneity (I2 = 57%; P = .10). Atenolol did not demonstrate superiority over sotalol in reducing POAF (RR, 2.39; 95% CI: 1.41-4.04; P = .001) with moderate heterogeneity (I2 = 40%; P = .19). Furthermore, no significant difference was observed between atenolol and the control group (comprising propafenone, metoprolol, nebivolol, and digoxin) in the prevention of POAF (RR, 1.28; 95% CI: 0.76-2.16; P = .35) with moderate heterogeneity (I2 = 43%; P = .15). Recent studies suggest that atenolol could be a safe and effective intervention for the prevention of POAF in adult patients undergoing CS. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC. <77> Accession Number 2043624729 Title Efficacy of Hemoadsorption in Cardiac Surgery with Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(9) (pp 2966-2978), 2026. Date of Publication: 01 Sep 2026. Author Samaniego-Laguna M.A.; Queiroz I.; Pinilla J.; Ruelas M.G.; Piedra-Calle C.A.; Giorgi J.; Katz J.N. Institution (Samaniego-Laguna) Universidad Autonoma Metropolitana, Mexico City, Mexico (Queiroz) Department of Medicine, Catholic University of Pernambuco, Brazil (Pinilla) School of Medicine, CES University, Medellin, Colombia (Ruelas) Instituto de Investigacion Nutricional, Lima, Peru (Piedra-Calle) Hospital Universitario Son Espases, Palma de Mallorca, Spain (Giorgi) Hospital Sirio Libanes, Sao Paulo, Brazil (Giorgi) Hospital Albert Einstein, Sao Paulo, Brazil (Katz) Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States (Katz) Cardiolog, y Department, Bellevue Hospital, New York, NY, United States Publisher W.B. Saunders Abstract Objectives: To evaluate the efficacy of intraoperative hemoadsorption (HA) during cardiopulmonary bypass (CPB) in reducing acute kidney injury (AKI) and other major postoperative complications in patients undergoing cardiac surgery. Design(s): Systematic review and meta-analysis of randomized controlled trials (RCTs) conducted in accordance with PRISMA guidelines, with a protocol registered in PROSPERO (CRD42025638656). Setting(s): Multicountry, multi-institutional hospital-based studies of patients undergoing cardiac surgery with CPB. Participant(s): A total of 1133 patients from 16 RCTs comparing CPB with versus without intraoperative HA. Intervention(s): Intraoperative HA using sorbent-based devices (e.g., CytoSorb, oXiris, Jafron HA 380). Measurements and Main Result: Primary outcomes included AKI incidence, renal replacement therapy requirement, and mortality. Secondary outcomes included intensive care unit/hospital length of stay, postoperative delirium, stroke, sepsis, and reoperation. HA significantly reduced the incidence (RR 0.75; 95% CI 0.59-0.96; p = 0.020). No significant differences were observed for renal replacement therapy (RR 0.64; p = 0.58) or mortality (RR 0.96; p = 0.861). No significant effects were found for secondary outcomes. Conclusion(s): Intraoperative HA during CPB reduces the risk of AKI but does not significantly affect other major postoperative outcomes. Further studies are needed to determine its clinical relevance and optimal patient selection. Copyright © 2026 Elsevier Inc. <78> Accession Number 2048098842 Title Viability testing for guiding revascularization in ischemic cardiomyopathy. Source Current Opinion in Cardiology. 41(5) (pp 452-458), 2026. Date of Publication: 01 Sep 2026. Author Li K.Y.; Dhingra N.K.; Patel R.; Kalra S.; Rabi A. Institution (Li, Dhingra, Rabi) Division of Cardiovascular Surgery (Patel, Kalra) Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Myocardial viability testing has traditionally been used to guide revascularization decisions in ischemic cardiomyopathy on the assumption that identifying dysfunctional but viable myocardium predicts functional recovery and improved survival following revascularization. Recent trials have challenged this assumption, highlighting the need to re-evaluate the clinical role of viability testing in the context of contemporary revascularization strategies and modern guideline-directed medical therapy. Recent findings - The STICH trial and its extended follow-up demonstrated that CABG improves long-term survival independently of viability status and independently of whether ejection fraction improves, challenging the mechanistic assumption of viability-guided revascularization. REVIVED-BCIS2 showed that PCI may not improve survival benefit, even in patients selected with demonstrated viability. A prespecified imaging substudy of REVIVED identified scar burden, rather than the presence of viable myocardium, as the strongest independent predictor of adverse outcomes, reframing the prognostic question from the detection of viable tissue toward the quantification of irreversible myocardial loss. Summary - Viability should be reconceptualized as a continuous spectrum rather than a binary construct. Scar quantification, particularly through late gadolinium enhancement cardiac magnetic resonance (CMR), may offer greater prognostic utility than viability detection alone. A prospective randomized trial integrating contemporary imaging with modern guideline-directed medical therapy is needed to resolve the clinical role of viability-guided revascularization. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <79> Accession Number 2048378970 Title Cardiac Autotransplantation for Cardiac Tumors: A Systematic Review. Source Journal of Surgical Research. 326 (pp 779-785), 2026. Date of Publication: 01 Oct 2026. Author Rahimov D.; Cooper M.B.; Callesano M.C.; Nasher N.; Jones A.J.; Mallick A.B.; Storozynsky E.; Hoopes C.W.; Tchantchaleishvili V. Institution (Rahimov, Cooper, Callesano, Nasher, Jones, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States (Cooper) The Lawrenceville School, Lawrenceville, NJ, United States (Mallick) Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States (Storozynsky) Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States Publisher Academic Press Inc. Abstract Introduction: Cardiac autotransplantation is a rarely used surgical technique for managing complex left-sided cardiac tumors. Although its use has been reported in select series, robust data on clinical outcomes remain limited. This study aimed to synthesize all available evidence to provide a comprehensive overview of its application and outcomes. Method(s): A systematic search was conducted in June 2025 to identify case reports and series describing cardiac autotransplantation for tumor resection. A total of 22 studies comprising 56 patients were included, and patient-level data were extracted for analysis. Result(s): The median age was 36 [interquartile range, 26-47] years, and 42% (20/48) were female. Primary cardiac tumors accounted for 98% (55/56) of the cases, with sarcoma being the predominant histologic type (52%, 29/56). Tumors were located in the left atrium in 80.3% (45/56) and in the left ventricle in 10.7% (6/56). Tumor invasion involved the lungs in 27% (12/45) of cases and pulmonary veins in 23% (10/44), and resulted in mitral stenosis in 19% (6/31). Neoadjuvant chemotherapy was administered in 29% (12/41), adjuvant chemotherapy in 54% (27/50), and adjuvant radiotherapy in 8% (4/50) of the patients. In-hospital or 30-day mortality was 11% (6/56) and was significantly higher with pneumonectomy (36.4%, 4/11) compared with autotransplantation alone (4.4%, 2/45; P = 0.002). At a median follow-up of 365 [91-870] days, overall survival was 63% (35/56). Conclusion(s): Cardiac autotransplantation is a feasible approach for tumor resection with acceptable surgical risk in carefully selected patients. Concomitant pneumonectomy significantly increases perioperative mortality, reflecting the higher risk of complications inherent to this procedure and the greater extent of disease. Copyright © 2026 Elsevier Inc. <80> 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. 40(9) (pp 2845-2855), 2026. Date of Publication: 01 Sep 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. <81> Accession Number 2048319737 Title Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized controlled trial. Source Journal of Clinical Anesthesia. 114 (no pagination), 2026. Article Number: 112300. Date of Publication: 01 Sep 2026. Author Perdomo-Linares J.; Lopez-Baamonde M.; Mellado-Artigas R.; Tort-Merino A.; Garavito-Henao L.; Arguis M.J.; Navarro-Ripoll R.; Lopez-Hernandez A.; Balasa M.; Rivas E.; Martinez-Palli G. Institution (Perdomo-Linares, Lopez-Baamonde, Mellado-Artigas, Garavito-Henao, Arguis, Navarro-Ripoll, Lopez-Hernandez, Rivas, Martinez-Palli) Department of Anesthesiology, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain (Perdomo-Linares, Navarro-Ripoll, Rivas, Martinez-Palli) Departament de Cirurgia i Especialitats Medicoquirurgiques, Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB), Barcelona, Spain (Tort-Merino, Balasa) Department of Neurology, Hospital Clinic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain (Mellado-Artigas, Tort-Merino, Arguis, Navarro-Ripoll, Balasa, Rivas, Martinez-Palli) Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Rivas, Martinez-Palli) CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain (Rivas) Outcomes Research Consortium, Houston, United States Publisher Elsevier Inc. Abstract Background Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery. Exercise-based prehabilitation may enhance functional reserve and reduce vulnerability to perioperative cerebral insults. We hypothesized that multimodal prehabilitation reduces POCD 3 months after cardiac surgery. Methods This prespecified substudy of a single-center randomized controlled trial ( NCT03466606 ) included patients aged >=50 years undergoing elective coronary artery bypass grafting and/or valve surgery. Participants were randomized 1:1 to 4-6 weeks of multimodal prehabilitation (exercise training, nutritional support, and psychological support) or standard preoperative care. Cognitive function was assessed at baseline and 3 months postoperatively using an age- and education-adjusted neuropsychological battery. POCD was defined as performance >=1.5 standard deviations below normative values in at least 2 cognitive tests, excluding the Mini-Mental State Examination. Logistic regression analyses were performed to evaluate factors associated with POCD. Results Of 160 participants screened from the parent trial, 134 met eligibility criteria for the substudy and were randomized; 116 completed 3-month follow-up (prehabilitation n = 53; control n = 63). POCD occurred in 29 patients (25%), including 15/53 (28%) in the prehabilitation group and 14/63 (22%) in controls (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.54-3.50, P = 0.52). In multivariable analysis, preoperative cognitive impairment was independently associated with POCD (OR 13.28, 95% CI 4.06-43.41, P < 0.001), whereas prehabilitation was not (OR 1.09, 95% CI 0.35-3.45, P = 0.877). Higher physical activity levels at 3 months were associated with lower odds of POCD (OR 0.97, 95% CI 0.95-1.00, P = 0.047). Conclusions In this randomized controlled trial, a 4-6-week multimodal prehabilitation program did not reduce postoperative cognitive dysfunction 3 months after cardiac surgery. Although the intervention did not achieve measurable cognitive protection, the observed association between postoperative physical activity levels and postoperative cognitive dysfunction warrants further investigation. Copyright © 2026 Elsevier Inc. <82> Accession Number 649349079 Title Risk factors for postoperative acute kidney injury in major non-cardiac surgery: Systematic review with meta-analysis. Source Journal of perioperative practice. 36(9) (pp 489-497), 2026. Date of Publication: 01 Sep 2026. Author Castro-Crisostomo D.; Caballero-Alvarado J.; Vasquez-Paredes G.; Rodriguez-Angulo A.; Sarmiento-Falen J.; Zavaleta-Corvera C. Institution (Castro-Crisostomo, Caballero-Alvarado, Vasquez-Paredes, Rodriguez-Angulo, Sarmiento-Falen) Faculty of Medicine, Antenor Orrego Private University, Trujillo, Peru (Caballero-Alvarado) Department of Surgery, Regional Hospital of Trujillo, Trujillo, Peru (Zavaleta-Corvera) Faculty of Medicine, Universidad Cientifica del Sur, Lima, Peru Abstract INTRODUCTION: Identifying risk factors for acute kidney injury (AKI) following major non-cardiac surgery is challenging due to heterogeneous findings and variable relevance across published studies. This complexity hinders the development of a standardised prognostic model. METHOD(S): A systematic review and meta-analysis were conducted based on an extensive literature search (2002-2022) in PubMed, Scopus, Web of Science, Cochrane Central, LILACS, and Dart Europe. Studies were independently screened and selected, with extraction of relevant preoperative and intraoperative variables. Meta-analysis was performed using RevMan 5.4. RESULT(S): Out of 533 studies, ten met inclusion criteria. Significant risk factors for postoperative AKI included diabetes mellitus (OR: 1.65, CI: 1.20-2.27), hypertension (OR: 1.86, CI: 1.36-2.54), ACE inhibitors or ARBs use (OR: 1.76, CI: 1.48-2.09), ischaemic heart disease (OR: 1.93, CI: 1.55-2.41), and male sex (OR: 1.28, CI: 1.07-1.53). Protective factors were female sex (OR: 0.72, CI: 0.54-0.96) and higher preoperative haemoglobin (MD: -0.41, CI: -0.52 to -0.30). Trends without statistical significance were noted for older age, low glomerular filtration rate, prolonged operative time, and higher serum creatinine. CONCLUSION(S): Comorbidities and certain pharmacological treatments significantly elevate postoperative AKI risk. These findings underscore the need for vigilant preoperative risk stratification.PROSPERO registration:CRD420251111455. <83> Accession Number 2048351858 Title Differential association of hypothyroidism with cardiovascular events and cardiovascular mortality: a systematic review and meta-analysis. Source Endocrine. 91(1) (no pagination), 2026. Article Number: 277. Date of Publication: 01 Dec 2026. Author Gatta E.; Delbarba A.; Vizzardi E.; Rotondi M.; Cappelli C. Institution (Gatta, Delbarba, Cappelli) Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili, Brescia, Italy (Gatta, Cappelli) Centro per la Diagnosi e Cura delle Neoplasie Endocrine e delle Malattie della Tiroide, University of Brescia, Brescia, Italy (Vizzardi) Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy (Rotondi) Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy (Rotondi) Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy Publisher Springer Abstract Purpose: The cardiovascular impact of hypothyroidism remains controversial, particularly regarding the distinction between cardiovascular disease occurrence and cardiovascular prognosis. We performed a systematic review and meta-analysis to separately evaluate the association between hypothyroidism and incident cardiovascular events and cardiovascular mortality. Method(s): PubMed/MEDLINE, Scopus, and Web of Science were systematically searched for studies published between January 2014 and April 2026 evaluating cardiovascular outcomes in adult patients with overt or subclinical hypothyroidism compared with euthyroid controls. Separate random-effects meta-analyses were performed for cardiovascular events and cardiovascular mortality using pooled odds ratios (ORs) with 95% confidence intervals (CIs). Study quality was assessed using the QUIPS tool. Result(s): Nine studies involving 9,662 patients were included. Six studies evaluating cardiovascular events (5,795 participants) showed no significant association between hypothyroidism and incident cardiovascular events (OR 0.92, 95% CI 0.78-1.09; p = 0.35), with low-to-moderate heterogeneity (I2 = 24.6%). By contrast, eight studies evaluating cardiovascular mortality (7,526 participants) demonstrated a significantly increased mortality risk among hypothyroid patients (OR 2.73, 95% CI 2.16-3.43; p < 0.0001), with low heterogeneity (I2 = 9.7%). Leave-one-out sensitivity analyses confirmed the robustness and stability of the mortality findings. Qualitative synthesis consistently showed worse outcomes in acute and high-risk cardiovascular settings, including acute coronary syndromes, acute heart failure, spontaneous coronary artery dissection, and coronary artery bypass grafting. Conclusion(s): Hypothyroidism was more consistently associated with cardiovascular mortality than with incident cardiovascular events. However, the lack of a statistically significant association with cardiovascular events should not be interpreted as evidence of absence of effect. These findings are consistent with the hypothesis that thyroid dysfunction may be more closely associated with adverse cardiovascular outcomes after disease onset than with incident cardiovascular events. Copyright © The Author(s) 2026. <84> Accession Number 2040589241 Title Methoxyflurane Instead of Morphine in Acute Coronary Syndrome Patients: Results of the Randomized Controlled METHANE-SIRIO 4 Study. Source Thrombosis and Haemostasis. 126(8) (pp 822-831), 2026. Date of Publication: 01 Aug 2026. Author Niezgoda P.; Podhajski P.; Kasprzak M.; Baranska M.; Rakotoarison O.; Karolko B.; Pietrzykowski L.; Michalski P.; Kosobucka A.; Sikora A.; Chalupka J.; Marszall M.; Kuliczkowski W.; Kubica A.; Kubica J. Institution (Niezgoda, Podhajski, Kasprzak, Baranska, Kubica) Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (Rakotoarison, Karolko, Kuliczkowski) Institute for Heart Diseases, Wroclaw Medical University, Wroclaw, Poland (Pietrzykowski, Michalski, Kosobucka, Kubica) Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (Sikora, Chalupka, Marszall) The Department of Medicinal Chemistry, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (Sikora, Chalupka) Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland Publisher Georg Thieme Verlag Abstract Aim Morphine is known to negatively influence the pharmacokinetics (PK) and the antiplatelet effect of oral P2Y12 receptor inhibitors administered due to an acute coronary syndrome. Worldwide studies of the potential approaches to overcome the undesired morphine effect have been only partially successful. The aim of the METHANE-SIRIO 4 study was to evaluate the PK and pharmacodynamics of ticagrelor and its active metabolite in unstable angina (UA) patients treated with morphine or methoxyflurane. Methods and Results Consecutive patients diagnosed with UA, randomized into the study arms, underwent the assessment of platelet reactivity using the Multiplate analyzer at nine predefined study time points. Serum concentrations of ticagrelor and its active metabolite, AR-C124910XX, were measured for each study participant. Median platelet reactivity was significantly lower in patients who received ticagrelor and methoxyflurane versus ticagrelor alone at 30 minutes postticagrelor loading dose. A trend toward lower reactivity was observed at 45 and 240 minutes. Significant differences in median serum concentrations of ticagrelor and its active metabolite were most pronounced between patients treated with ticagrelor and methoxyflurane versus ticagrelor and morphine. Conclusion Co-Administration of methoxyflurane in acute coronary syndrome patients allows for the avoidance of negative effects of morphine and has the additional effect of inhibiting platelet reactivity. Further randomized studies would be recommended to support these findings. Copyright © 2026 Georg Thieme Verlag. All rights reserved. <85> Accession Number 651470566 Title Perioperative hyperoxia versus normoxia during cardiopulmonary bypass in adult cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 10 Jun 2026. Author AlSejari N.Y.; Aljaber B.H.; Alyahya S.A.; Alharran A.M.; Abdul-Hafez H.A.; Alsubaiei A.A. Institution (AlSejari, Aljaber, Alyahya, Alsubaiei) Kuwait CityKuwait (Alharran) College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain (Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine Abstract BACKGROUND: While hyperoxia has conventionally been the standard during cardiopulmonary bypass (CPB) to prevent hypoxemia, recent concerns regarding oxygen-induced oxidative stress have sparked debate over whether a normoxic strategy provides a safer clinical alternative. METHOD(S): A comprehensive search of PubMed, Web of Science, CENTRAL, and Scopus was conducted to identify randomized controlled trials (RCTs) through December 2025. Primary outcomes included short-term and long-term mortality, and acute kidney injury (AKI). Secondary outcomes included assessment of clinical complications and healthcare resource utilization. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. RESULT(S): Twelve RCTs involving 2,732 patients were included. The analysis found no significant difference between hyperoxia and normoxia in short-term mortality (RR: 1.23, 95% CI [0.60, 2.54]; p = 0.57), long-term mortality (RR: 1.10, 95% CI [0.84, 1.43]; p = 0.48), or the incidence of AKI (RR: 0.94, 95% CI [0.82, 1.07]; p = 0.32). Similarly, no significant differences were observed in secondary clinical outcomes, including myocardial infarction, stroke, arrhythmia, or surgical site infections. Hospital resource utilization was comparable, with no significant differences in mechanical ventilation duration (p = 0.06), ICU stay (p = 0.32), or length of hospital stay (p = 0.08). CONCLUSION(S): This meta-analysis detected no statistically significant differences between hyperoxic and normoxic strategies during CPB regarding mortality, clinical outcomes, or hospital resource utilization. Still, the current evidence remains uncertain, warranting further research. Copyright © 2026. The Author(s). <86> [Use Link to view the full text] Accession Number 2046235989 Title Comparison of the effect of intravenous acetaminophen and oral acetaminophen in the prevention of delirium in the elderly after heart surgery: a randomized controlled trial. Source International Journal of Surgery Open. 64(3) (pp 158-164), 2026. Date of Publication: 01 Jun 2026. Author Nikzad-Jamnani A.; Taziki J.; Sabaghi M.; Boskabadi S.J.; Kargar-Soleimanabad S.; Khazaee M. Institution (Nikzad-Jamnani) Department of Anesthesiology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Iran, Islamic Republic of (Taziki) Department of Anesthesiology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Sabaghi, Kargar-Soleimanabad, Khazaee) Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Boskabadi) Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of Publisher Lippincott Williams and Wilkins Abstract Background: - Pain is one of the important causes of delirium. Recent studies have reported some evidence of the appropriate effect of acetaminophen in delirium. Therefore, this study aimed to determine the effect of intravenous (IV) acetaminophen with oral acetaminophen on the incidence of delirium after cardiac surgery. Method(s): - This study was a double-blind randomized clinical trial. Patients with available inclusion criteria were randomly allocated into either the oral or IV acetaminophen groups. In the IV group, 1 gram of acetaminophen was administered every 8 hours after the cardiac surgery, and continued until the first 48 hours. In the oral group, 500 mg of acetaminophen was administered every 6 hours for 48 hours. In addition, both groups received morphine (PRN) for pain, and the dosage and repetition were recorded. The primary outcome was the incidence of delirium based on the Richmond Agitation Sedation Scale scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Result(s): - There was no significant difference in pain level between the two groups (P > 0.05). The mean dose of morphine was higher in the oral acetaminophen group, but no significant difference was observed between the two groups (P > 0.05). There was no significant difference between the two groups in terms of delirium incidence and ICU length of stay (P > 0.05). Conclusion(s): - According to the results of the present study, it seems that the administration of IV and oral acetaminophen does not statistically significant effect in terms of pain intensity, surgical complications, and delirium. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. <87> Accession Number 2048255441 Title Comparison of Ciprofol and Propofol on Postoperative Quality of Recovery and Intraoperative Cerebral Oxygen Saturation in Patients Undergoing Thoracoscopic Thoracic Surgery: A Randomized, Double-Blind, Non-Inferiority Trial. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 625833. Date of Publication: 2026. Author Guo L.; Cai L.; Ni B.; Shi S.; Huang C.; Lai H.; Li Q.; Mo P. Institution (Guo, Cai, Ni, Shi, Huang, Lai, Li, Mo) Department of Anesthesiology, School of Medicine, The Sixth Affiliated Hospital of South China University of Technology (Nanhai District People's Hospital of Foshan), Guangdong, Foshan, China (Guo, Mo) South China University of Technology, Guangdong, Guangzhou, China Publisher Dove Medical Press Ltd Abstract Purpose: Ciprofol provides more stable induction, though its impact on patients' quality of recovery (QoR) and brain oxygenation requires clarification. This trial assessed whether propofol anesthesia is non-inferior to ciprofol regarding postoperative recovery quality, while additionally comparing their effects on intraoperative cerebral oxygenation. Patients and Methods: This single-center, randomized, double-blind, non-inferiority study involved 94 patients scheduled for elective surgery, randomized equally to receive ciprofol (Group C) or propofol (Group P). The primary outcome was the global QoR-15 score measured 24 hours after surgery, with a non-inferiority threshold set at -6.0. Secondary outcomes included 48-hour QoR-15 scores, injection pain frequency, vasopressor requirements, and regional cerebral oxygen saturation (rScO<inf>2</inf>). Result(s): Eighty- eight patients completed the study (Group C: 44; Group P: 44). In ITT analysis, the mean QoR-15 score at 24 hours for Group C was non-inferior to Group P (P<inf>non-inferiority</inf> < 0.001), with consistent findings in the PP analysis. Similar non-inferiority was observed at 48 hours. However, Group C experienced a notably lower rate of injection pain (4.5% vs 59.0%, P < 0.001) and required less phenylephrine (P = 0.009). Although Group P had higher heart rates after induction of anesthesia (P < 0.05), its average arterial pressure was notably reduced (P < 0.05). Notably, rScO<inf>2</inf> in group C was higher than that in group P after induction of anesthesia (P = 0.046) and during the anesthesia maintenance phase (P < 0.05). Conclusion(s): Ciprofol is non-inferior to propofol regarding early postoperative recovery quality. Furthermore, ciprofol mitigates injection pain, reduces vasoconstrictor requirements, and better maintains cerebral oxygenation. Copyright © 2026 Guo et al. <88> Accession Number 2047579319 Title Quality Improvement and Quality Indicator-Related Interventions in Cardiac Rehabilitation: A Systematic Review of Economic Evidence Studies. Source Heart Lung and Circulation. 35(8) (pp 1041-1066), 2026. Date of Publication: 01 Aug 2026. Author Ahmed M.; Kankanamge S.W.; Candelaria D.; Padilla S.R.; Redfern J.; Clark R.A.; Briffa T.; Hyun K.; Figtree G.A.; Cartledge S.; Gallagher R.; Cunich M. Institution (Ahmed, Padilla, Redfern, Cunich) Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Kankanamge, Candelaria, Gallagher) Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Redfern) Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, QLD, Australia (Clark) Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia (Briffa) School of Population and Global Health, University of Western Australia, Crawley, WA, Australia (Hyun) School of Health Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Figtree) Kolling Institute of Medical Research, The University of Sydney, St Leonards, NSW, Australia (Figtree) Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia (Figtree) Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Figtree, Cunich) Cardiovascular Initiative, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia (Cartledge) School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia (Cunich) Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, NSW, Australia (Cunich) Sydney Local Health District, Sydney, NSW, Australia Publisher Elsevier Ltd Abstract Background: Cost-effectiveness evidence on quality improvement (QI) and quality indicator-related interventions in cardiac rehabilitation is crucial for informing scalability; however, the evidence has not been systematically synthesised. We aimed to identify value measures, including costs, health outcomes and efficiency, assess reporting/methodological quality, and evaluate economic impacts of cardiac rehabilitation quality indicator-related interventions. Method(s): Eight electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, NHS Economic Evaluation Database, Health Technology Assessments Database, Scopus, EconLit) were searched to retrieve studies published January 2000-July 2025 (7,639 studies identified, 4,573 screened after removing duplicates). Full and partial economic evaluations of QI and quality indicator-related interventions were included. Reporting quality of the full economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022. Result(s): Thirteen studies were identified, including eight full and five partial economic evaluations. Cost-effectiveness was demonstrated for QI-related interventions utilising shared-care models (incremental cost-effectiveness ratio: Danish krone 125,000/quality-adjusted life year), digital therapeutics (Chinese yuan 39,663.5/quality-adjusted life year), and internet-based case management (cost savings of United States dollar 738-965/patient). Interventions utilising learning and coping strategies were not cost-effective; however, there were cost-saving associated with the heart failure subgroup (Euro 12,399). Regarding quality, six of the full economic evaluations fulfilled >80% of the Consolidated Health Economic Evaluation Reporting Standards. Common gaps were lack of health economic analysis plans and subgroup analyses. Conclusion(s): Evaluations should report on site-specific factors for QI achieved and use a standardised economic evaluation plan to guide additional QI implementation. To achieve this, greater investment is needed to better engage the diverse health leadership and jointly develop solutions integrating innovation and research. Copyright © 2026 The Authors <89> Accession Number 2048248025 Title Surgical outcomes, medical management, accessibility to pediatric cardiac care, and survival in Indian tertiary centers: A Systematic review. Source International Journal of Life Sciences Biotechnology and Pharma Research. 15(8) (pp 186-201), 2026. Date of Publication: 01 Aug 2026. Author Arora V.; Kumar S.; Duggal M. Institution (Arora, Kumar, Duggal) Department of Pediatrics, Kalpana Chawla Government Medical College, Karnal, India Publisher International Journal of Life Sciences Biotechnology and Pharma Research Abstract Background: Congenital heart disease (CHD) remains the most common congenital anomaly worldwide and is a leading contributor to childhood morbidity and mortality. India accounts for one of the largest global burdens of pediatric CHD due to its high birth rate, delayed diagnosis, unequal healthcare distribution, and limited accessibility to specialized cardiac centers. Although remarkable advances in pediatric cardiac surgery have significantly improved survival, disparities in healthcare infrastructure, socioeconomic factors, and delayed referrals continue to adversely affect outcomes. Medical management remains an important component of patient stabilization and long-term care; however, evidence comparing its effectiveness with definitive surgical intervention within the Indian healthcare system remains fragmented. Objective(s): To systematically evaluate the available evidence on surgical and medical management outcomes, accessibility to pediatric cardiac care, and survival among children with congenital heart disease treated in Indian tertiary healthcare centers. Method(s): A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Published studies evaluating pediatric congenital heart disease managed in Indian tertiary-care hospitals were reviewed. Data relating to surgical outcomes, perioperative and medical management, mortality, survival, healthcare accessibility, referral pathways, socioeconomic determinants, and healthcare infrastructure were extracted and synthesized qualitatively. Evidence from multicenter studies, systematic reviews, observational cohorts, and institutional experiences was critically appraised to identify common determinants influencing clinical outcomes. Result(s): The available literature consistently demonstrated that surgical correction remains the definitive treatment for the majority of congenital heart defects, producing substantial improvements in survival and long-term quality of life. Contemporary Indian data report an overall pooled in-hospital surgical mortality of approximately 5.6%, with lesion-specific mortality varying according to disease complexity. Mortality was consistently influenced by delayed diagnosis, advanced disease at presentation, malnutrition, pulmonary vascular disease, postoperative complications, and limited access to specialized pediatric cardiac services. Medical management primarily served as a supportive strategy for hemodynamic stabilization, heart failure control, infection management, and perioperative optimization rather than definitive therapy. Significant disparities in healthcare accessibility persisted between urban and rural populations owing to financial constraints, inadequate referral systems, shortage of trained pediatric cardiac specialists, and unequal geographic distribution of tertiary cardiac centers. Government-funded health insurance schemes and structured referral programs have improved access to surgery in selected regions but remain insufficient to meet the national demand. Conclusion(s): Despite substantial progress in pediatric cardiac surgery across India, survival outcomes continue to be influenced by delayed diagnosis, inequitable healthcare accessibility, and socioeconomic disparities rather than surgical expertise alone. Strengthening early screening programs, expanding pediatric cardiac centers, improving referral networks, enhancing multidisciplinary perioperative care, and establishing comprehensive national outcome registries are essential to further reduce mortality and improve long-term survival among Indian children with congenital heart disease. Copyright ©2026 Int. J. Life Sci. Biotechnol. Pharma. Res. <90> Accession Number 2048293659 Title Antithrombotic strategy according to age in patients with atrial fibrillation and drug-eluting stents: a post hoc analysis of the ADAPT AF-DES randomised trial. Source Age and Ageing. 55(8) (no pagination), 2026. Article Number: afag224. Date of Publication: 01 Aug 2026. Author Lee S.-H.; Kim S.-J.; Her A.-Y.; Cho B.-R.; Kim G.-S.; Kwon T.-G.; Lim S.-W.; Shim J.; Jang J.-Y.; Lee Y.-J.; Lee S.-J.; Yu H.T.; Hong S.-J.; Ahn C.-M.; Kim B.-K.; Ko Y.-G.; Choi D.; Hong M.-K.; Jang Y.; Pak H.-N.; Kim J.-S.; Heo J.H. Institution (Lee, Lee, Lee, Yu, Hong, Ahn, Kim, Ko, Choi, Hong, Jang, Pak, Kim) Division of Cardiology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea (Kim, Heo) Kosin University Gospel Hospital, Division of Cardiology, Busan, South Korea (Her, Cho) Kangwon National University Hospital, Division of Cardiology, Gangwon-do, Chuncheon-si, South Korea (Kim) Inje University Sanggye Paik Hospital, Division of Cardiology, Nowon-gu, Seoul, South Korea (Kwon) Chungbuk National University Hospital, Division of Cardiology, Chungcheongbuk-do, Cheongju-si, South Korea (Lim) Division of Cardiology, CHA University Bundang Medical Center, Chungcheongbuk-do, Cheongju-si, South Korea (Shim) Division of Cardiology, Korea University Anam Hospital, Seoul, South Korea (Jang) Division of Cardiology, National Health Insurance Service Ilsan Hospital, Chungcheongbuk-do, Goyang-si, South Korea Publisher Oxford University Press Abstract Background: Evidence for non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy for older patients with atrial fibrillation (AF) and drug-eluting stents is lacking. Objective(s): We aimed to evaluate the safety and efficacy of NOAC monotherapy in older AF patients with drug-eluting stents. Method(s): This is a secondary analysis of the ADAPT AF-DES randomised trial comparing NOAC monotherapy with combination therapy with NOAC plus clopidogrel in patients with AF and drug-eluting stents. Patients were stratified by age (>=75 years and <75 years). Apixaban or rivaroxaban was used as the NOAC. The primary endpoint was a net adverse clinical event at 1 year after randomisation, defined as a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism or major or clinically relevant non-major bleeding defined by the International Society on Thrombosis and Haemostasis criteria. Result(s): Among 960 patients included in the ADAPT AF-DES trial, 376 (39.2%) patients were aged >=75 years. In patients aged >=75 years, the incidence of the primary endpoint was lower in the NOAC monotherapy group (9.8% vs. 22.3%; adjusted hazard ratio, 0.37; 95% confidence interval, 0.21-0.66; P < .001) than in the combination therapy group. In contrast, the incidences did not differ between treatment strategies in patients aged <75 years. The interaction between age groups and strategy groups did not reach statistical significance (P for interaction = .095). The reduction in major or clinically relevant non-major bleeding with NOAC monotherapy was consistent across age groups. In contrast, the benefit of NOAC monotherapy in major adverse cardiac and cerebrovascular events was more pronounced in patients aged >=75 years, with a statistically significant interaction. Conclusion(s): In this post hoc analysis, NOAC monotherapy was associated with a lower risk of net adverse clinical events, specifically within the older age subgroup. Tailored approach regarding age and individual ischaemic risk may be needed. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <91> 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 <92> Accession Number 2048168169 Title Multimodal opioid-free anesthesia containing esketamine versus opioid-based anesthesia: a systematic review and meta-analysis. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 471. Date of Publication: 01 Dec 2026. Author Fang Y.; Gao M.; Wang X.; Zheng B.; He M.; Zeng X.; Shi Y.; Li L.; Zhang B.; Xu Y.; Gong X. Institution (Fang, Zheng, He, Zeng, Shi, Li, Zhang, Xu) Department of Pain, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, 5 Lu men Avenue, Xiang Zhou District, Hubei Province, Xiangyang City, China (Gao) Department of Anesthesiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Wang, Gong) Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, 5 Lu men Avenue, Xiang Zhou District, Hubei Province, Xiangyang City, China Publisher BioMed Central Ltd Abstract Introduction: The paradigm shift toward opioid-free anesthesia (OFA) is gaining traction, yet evidence regarding specific viable alternatives remains fragmented. This meta-analysis comprehensively evaluates the efficacy and safety of multimodal OFA regimens containing esketamine compared to traditional opioid-based anesthesia (OBA). Method(s): This study conducted a systematic review and meta-analysis by searching the electronic databases PubMed, The Cochrane Library, Web of Science, and Embase, including randomized controlled trials published from inception to September 20, 2024. The included studies had to feature at least one OFA group (defined as a multimodal regimen containing esketamine), where opioids were not used during the preoperative phase, anesthetic induction, intraoperative maintenance, or before anesthesia recovery. Result(s): A total of 14 RCTs (1,703 patients) were analyzed. Regarding the primary outcomes, postoperative pain scores at 24 h (MD = -0.07; 95% CI: -0.27, 0.13; moderate certainty) and 48 h (MD = 0.00; 95% CI: -0.29, 0.30; moderate certainty) showed no statistically significant differences between the groups. However, multimodal OFA regimens containing esketamine demonstrated a reduced risk of chronic postoperative pain based exclusively on data from only two thoracic surgery trials (RR = 0.64; 95% CI: 0.44, 0.92; low certainty). Regarding secondary outcomes, the OFA group showed a significantly lower incidence of intraoperative hypotension (RR = 0.29; 95% CI: 0.17, 0.49; high certainty) and postoperative nausea and vomiting (PONV) (RR = 0.47; 95% CI: 0.27, 0.79; high certainty). No statistically significant differences were detected in extubation time, PACU length of stay, rescue analgesia requirements, or the incidence of nightmares or hallucinations. Notably, substantial statistical heterogeneity was observed across several outcomes, including pain scores, PONV, extubation time, and PACU length of stay. Conclusion(s): Multimodal OFA regimens containing esketamine provide comparable postoperative analgesia to opioid-based anesthesia while reducing PONV and intraoperative hypotension. However, these findings represent combined multimodal effects across heterogeneous settings, and potential benefits for chronic pain prevention should be viewed strictly as hypothesis-generating. Trial registration: PROSPERO ID: CRD42024588900 Copyright © The Author(s) 2026. <93> Accession Number 2048229916 Title Interventions for Silent Brain Infarction and Perioperative Neurocognitive Disorders in Cardiovascular Surgery (INSPIRE): study protocol for a multicentre randomised controlled trial. Source BMJ Open. 16(6) (no pagination), 2026. Article Number: e116246. Date of Publication: 01 Jun 2026. Author Wang L.; Li S.; Devereaux P.J.; Lv H.; Li T.; Zhang L.; An Y.; Chen J.; Wei C.; Zhao L.; Peng Y.; Shi J. Institution (Wang, Lv, Li, Zhang, Shi) Department of Anaesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Li, Peng) Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Li, Peng) Outcomes Research Consortium, Houston, Texas, United States (Devereaux) World Health Research, Population Health Research Institute, Departments of Health Research Methods, Evidence and Impact, and Medicine, McMaster University, Hamilton, ON, Canada (An, Zhao) Department of Anaesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China (Chen) Department of Anaesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Wei) Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China Publisher BMJ Publishing Group Abstract Introduction: The incidence of silent brain infarction (SBI) and perioperative neurocognitive disorders (PND) is higher in cardiac surgery. However, standard preventive strategies remain unknown due to limited evidence. Methods and analysis: This multicentre, prospective, randomised controlled clinical trial with a 1-year follow-up includes patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). 912 participants are randomly assigned 1:1 into either the intervention group with neuroprotective anaesthesia targets (mean arterial pressure 65-90 mm Hg, bispectral index 40-60, bilateral regional cerebral oxygen saturation >=60%, arterial inflow temperature <37 and rewarming rate <0.5/min after exceeding 30 during CPB) or the control group maintained by anaesthetists according to routine care. The primary outcome is the 7-day incidence of new-onset SBI. The key secondary outcome is the 30-day incidence of PND. The secondary outcomes include the 5-day incidence of postoperative delirium, the 30-day incidence of new-onset overt stroke, the 1-year incidence of new-onset overt stroke, the 30-day incidence of transient ischaemic attack (TIA), the 1-year incidence of TIA, the 1-year incidence of PND, the 30-day and 1-year composite incidence of major adverse events (renal insufficiency, myocardial infarction, pulmonary embolism, seizure, all-cause mortality), length of stay (LOS) in intensive care unit, LOS in hospital and hospitalisation cost. Ethics and dissemination: The trial was approved by the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital (Approval No. 2024-2445) and all participating centres. We will disseminate the trial findings in peer-reviewed journals and present the results at national or international conferences. Trial registration number: NCT07048002. 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/. <94> 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. <95> Accession Number 2048100780 Title Esketamine improves postoperative sleep quality in thoracic surgery patients with preoperative sleep disturbance: a randomized controlled trial. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1843977. Date of Publication: 01 Jun 2026. Author Wang X.; Wang H.; Luo H. Institution (Wang, Wang, Luo) Xiangyang NO.1 People's Hospital, Hubei University of Medicine, Xiangyang, China Publisher Frontiers Media SA Abstract Objective - To investigate the effect of multiple intraoperative subanesthetic doses of esketamine on postoperative sleep quality in non-cardiac thoracic surgery patients with preoperative sleep disturbance. Methods - This was a prospective single-center, double-blind placebo-randomized controlled trial of 100 patients undergoing elective non-cardiac thoracic surgery under general anesthesia with preoperative sleep disturbance who were given 0.25 mg/kg esketamine at induction of anesthesia and cutaneous suture compared with placebo to prevent the occurrence of postoperative sleep disturbance. Primary outcomes were the incidence of postoperative sleep disturbance on postoperative day 1, as assessed by Numeric Rating Scale, Athens Insomnia Scale and RCSQ. Secondary outcomes included the incidence of postoperative sleep disturbance on postoperative day 3 and 5, sleep duration, proportion of deep sleep, proportion of rapid eye movement sleep, postoperative pain score, postoperative anxiety score and depression score, intraoperative hemodynamic parameters and blood biomarkers (IL-6, IL-10, and brain-derived neurotrophic factor). Result - A total of 100 patients were randomized to the control group and the esketamine group. The incidence of postoperative sleep disturbance in the esketamine group was significantly lower than in the control group on POD 1 (50%vs 82%; odds ratio [OR], 0.2 [95% CI, 0.1-0.5]; P = 0.001) and POD 3 (22%vs 42%; OR, 0.4 [95% CI, 0.2-0.9]; P = 0.032). And there were significant differences in sleep duration, proportion of deep sleep and proportion of REM sleep (Based on exploratory Fitbit-derived estimates) on postoperative day 1 and 3. By POD 5, the difference was no longer statistically significant. Postoperative pain scores at rest and during movement were significantly lower in the esketamine group immediately after surgery and on postoperative day 1 compared with the control group, with no significant differences on postoperative days 3 and 5. Anxiety and depression scores (HADS) were significantly lower in the esketamine group on postoperative days 1, 3, and 5. Intraoperative hemodynamic parameters demonstrated higher systolic and mean arterial pressures in the esketamine group during anesthesia induction (T2) and lower pressures and heart rate during extubation (T6), indicating attenuated hypotension at induction and blunted stress response at extubation. Intraoperative sufentanil consumption was significantly lower in the esketamine group. Compared with preoperative levels, serum IL-6 concentrations increased in both groups on POD 1, 3, and 5; however, the esketamine group exhibited lower IL-6 levels than the control group on POD one and POD 3, with the difference attenuating by POD 5. Serum IL-10 levels were elevated on POD 1, 3, and five in the esketamine group and were significantly higher than those in the control group at all three time points. Serum BDNF concentrations were increased relative to baseline on POD 1, 3, and five in both groups, and were consistently higher in the esketamine group than in the control group across all postoperative assessments. Subgroup analyses demonstrated that intraoperative esketamine consistently reduced the incidence of postoperative sleep disturbance across predefined subgroups stratified by age, sex, PSQI score, and ASA classification, with no significant interaction effects observed. Conclusion - Multiple intraoperative infusion of 0.25 mg/kg esketamine can effectively improve the postoperative sleep quality of non-cardiac thoracic surgery patients with preoperative sleep disturbance, reduce the incidence of postoperative sleep disturbance, reduce the use of opioids, reduce the occurrence of intraoperative hypotension events, reduce the stress response during extubation, maintain the stability of intraoperative hemodynamics, reduce postoperative pain, and relieve adverse emotions. Moreover, esketamine decreased the level of the pro-inflammatory cytokine IL-6, increased the level of the anti-inflammatory cytokine IL-10, attenuated the postoperative inflammatory response, and promoted the release of BDNF. Clinical Trial Registration - https://www.chictr.org.cn/bin/project/edit?pid=248681, identifier ChiCTR2500096036. Copyright © 2026 Wang, Wang and Luo. <96> 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. <97> [Use Link to view the full text] Accession Number 626484353 Title Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe Ischemic Mitral Regurgitation: A Randomized Clinical Trial From the Cardiothoracic Surgical Trials Network. Source Circulation. Cardiovascular quality and outcomes. 11(11) (pp e004466), 2018. Date of Publication: 14 Nov 2018. Author Ferket B.S.; Ailawadi G.; Gelijns A.C.; Acker M.; Hohmann S.F.; Chang H.L.; Bouchard, D.; Meltzer D.O.; Michler R.E.; Moquete E.G.; Voisine P.; Mullen J.C.; Lala A.; Mack M.J.; Gillinov A.M.; Thourani V.H.; Miller M.A.; Gammie J.S.; Parides M.K.; Bagiella E.; Smith R.L.; Smith P.K.; Hung J.W.; Gupta L.N.; Rose E.A.; O'Gara P.T.; Moskowitz A.J.; Cardiothoracic Surgical Trials Network (CTSN) Investigators Publisher NLM (Medline) Abstract BACKGROUND: The CTSN (Cardiothoracic Surgical Trials Network) recently reported no difference in left ventricular end-systolic volume index or in survival at 2 years between patients with severe ischemic mitral regurgitation (MR) randomized to mitral valve repair or replacement. However, replacement provided more durable correction of MR and fewer cardiovascular readmissions. Yet, costeffectiveness outcomes have not been addressed. METHODS AND RESULTS: We conducted a cost-effectiveness analysis of the surgical treatment of ischemic MR based on the CTSN trial (n=126 for repair; n=125 for replacement). Patient-level data on readmissions, survival, qualityof- life, and US hospital costs were used to estimate costs and quality-adjusted life years per patient over the trial duration and a 10-year time horizon. We performed microsimulation for extrapolation of outcomes beyond the 2 years of trial data. Bootstrap and deterministic sensitivity analyses were done to address parameter uncertainty. In-hospital cost estimates were $78 216 for replacement versus $72 761 for repair (difference: $5455; 95% uncertainty interval [UI]: -7784-21 193) while 2-year costs were $97 427 versus $96 261 (difference: $1166; 95% UI: -16 253-17 172), respectively. Quality-adjusted life years at 2 years were 1.18 for replacement versus 1.23 for repair (difference: -0.05; 95% UI: -0.17 to 0.07). Over 5 and 10 years, the benefits of reduction in cardiovascular readmission rates with replacement increased, and survival minimally improved compared with repair. At 5 years, cumulative costs and quality-adjusted life years showed no difference on average, but by 10 years, there was a small, uncertain benefit for replacement: $118 023 versus $119 837 (difference: -$1814; 95% UI: -27 144 to 22 602) and qualityadjusted life years: 4.06 versus 3.97 (difference: 0.09; 95% UI: -0.87 to 1.08). After 10 years, the incremental cost-effectiveness of replacement continued to improve. CONCLUSION(S): Our cost-effectiveness analysis predicts potential savings in cost and gains in quality-adjusted survival at 10 years when mitral valve replacement is compared with repair for severe ischemic MR. These projected benefits, however, were small and subject to variability. Efforts to further delineate predictors of long-term outcomes in patients with severe ischemic MR are needed to optimize surgical decisions for individual patients, which should yield more cost-effective care. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00807040. Copyright 2018 American Heart Association, Inc. <98> Accession Number 2047726204 Title Use of argatroban as a heparin alternative in cardiac surgery-a rapid review of case reports and series. Source Journal of Thrombosis and Haemostasis. 24(9) (pp 3201-3212), 2026. Date of Publication: 01 Sep 2026. Author Bouvette S.; Butt A.L.; Clifton S.C.; Stewart K.E.; Boylan P.M.; Mazzeffi M.A.; Tanaka K.A. Institution (Bouvette, Butt, Tanaka) Department of Anesthesiology, University of Oklahoma Health, Oklahoma City, OK, United States (Clifton) Reference & Instructional Services, Robert M. Bird Health Sciences Library, University of Oklahoma Health, Oklahoma City, OK, United States (Stewart) Department of Surgery, University of Oklahoma Health, Oklahoma City, OK, United States (Boylan) College of Pharmacy, University of Oklahoma Health, Oklahoma City, OK, United States (Mazzeffi) Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States Publisher Elsevier B.V. Abstract Background Argatroban has been used as an alternative anticoagulant for cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia (HIT) or heparin allergy. Its mechanism of action differs from heparin, and concerns regarding dosing, monitoring, and circuit thrombosis risk remain insufficiently characterized. Objectives This study systematically reviewed published cases of argatroban anticoagulation during CPB for dosing patterns, activated clotting time (ACT) responses, thrombotic and bleeding events, and transfusions. Methods A rapid review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Rapid Reviews guidance. Searches of MEDLINE, Embase, and other index databases identified clinical reports involving argatroban use during CPB. Two investigators independently screened studies, extracted data, and assessed risk of bias. Results Twenty-nine publications describing 30 patients (24 adult and 6 pediatric cases) met inclusion criteria. The median initial argatroban bolus was 0.1 mg/kg, but it was doubled to achieve ACTs of >=400 seconds. Median infusion rate (25th-75th percentile) was 6.8 (4.6-9.7) mug/kg/min. ACT responses were nonlinear, with fluctuations of >100 seconds occurring in 70% of cases. Despite ACTs of >=400 seconds, circuit thrombosis occurred in 40% of cases, most commonly in the reservoir or oxygenator. Recovery to ACT of <200 seconds required a median of 7 hours after discontinuing drug infusion. Perioperative transfusion occurred in 80% of cases. Conclusion Published experience demonstrates major limitations of argatroban as a heparin substitute for CPB, including unpredictable ACT responses and frequently documented circuit thromboses. The reported complication rates should be interpreted as an upper bound given the descriptive nature of case-level evidence and the likelihood of publication bias. Copyright © 2026 International Society on Thrombosis and Haemostasis. <99> Accession Number 2046519188 Title Management of anticoagulation in patients with heparin-induced thrombocytopenia requiring cardiac surgery with cardiopulmonary bypass: guidance from the ISTH SSC on Perioperative and Critical Care Haemostasis and Thrombosis. Source Journal of Thrombosis and Haemostasis. 24(9) (pp 3369-3391), 2026. Date of Publication: 01 Sep 2026. Author Pishko A.M.; Frere C.; Maier C.L.; Levy J.H.; Connors J.M. Institution (Pishko) Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Frere) Department of Hematology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris, Sorbonne Universite, INSERM UMR_S 1166, Paris, France (Maier) Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States (Levy) Department of Anesthesiology, Critical Care and Surgery, Duke University School of Medicine, Durham, NC, United States (Connors) Hematology Division, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States Publisher Elsevier B.V. Abstract Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction characterized by thrombocytopenia and a high risk of thrombosis. Patients with HIT and a need for cardiac surgery with cardiopulmonary bypass represent a challenging group, as anticoagulation with unfractionated heparin (UFH) is the primary treatment choice. We conducted a systematic review evaluating intraoperative anticoagulation strategies for patients with a history of HIT who required cardiac surgery with cardiopulmonary bypass. Guidance statements were generated through consensus of the writing group. Of 1732 screened articles, 30 studies were included. Strategies evaluated were (1) direct thrombin inhibitors; (2) UFH after preoperative or intraoperative therapeutic plasma exchange (TPE); (3) UFH in combination with a potent antiplatelet agent; and (4) heparin reexposure in patients with negative functional assays. Of these, bivalirudin has the strongest supporting data and appears effective; still, its association with increased bleeding and practical limitations, including a lack of a reversal agent, limit its use. TPE with or without intravenous immunoglobulin reduces antiplatelet factor 4/heparin antibody titers and allows for intraoperative UFH use, although protocols are heterogeneous. Use of potent antiplatelet agents with UFH reexposure show promise but carry risks of bleeding and hypotension. Thus, alternative strategies of using UFH in combination with TPE or potent antiplatelet agents may be considered on a case-by-case basis. For patients with negative functional assays, evidence suggests that limited intraoperative UFH reexposure carries a low risk of HIT recurrence, provided postoperative monitoring is performed. These guidance statements provide a framework for multidisciplinary decision making in a complex clinical scenario. Copyright © 2026. Published by Elsevier Inc. <100> 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. <101> Accession Number 2048312872 Title Meta-Analysis of Cardiorespiratory Fitness Impairment in Pediatric Heart Transplant Recipients. Source Clinical Transplantation. 40(8) (no pagination), 2026. Article Number: e70646. Date of Publication: 01 Aug 2026. Author Wu N.; Foulkes S.J.; Weeldreyer N.R.; Kruger C.; Tomczak C.R.; Khoury M.; Conway J.L.; Haykowsky M.J. Institution (Wu, Foulkes, Weeldreyer, Kruger, Haykowsky) Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada (Foulkes) Heart, Exercise and Research Trials Lab, St Vincent's Institute of Medical Research, Fitzroy, VIC, Australia (Foulkes) Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia (Tomczak) College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada (Khoury, Conway) Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada (Haykowsky) Hochgebirgsklinik Davos, Medicine Campus Davos, Davos, Switzerland Publisher John Wiley and Sons Inc Abstract Pediatric heart transplant (PHTR) recipients have reduced cardiorespiratory fitness (VO<inf>2</inf>peak); however, the magnitude of this impairment and its underlying central hemodynamic mechanisms remain poorly characterized. This systematic review and meta-analysis quantified differences in VO<inf>2</inf>peak and peak exercise central hemodynamics between PHTR recipients and age-matched healthy controls (CON). MEDLINE (PubMed) was searched for studies comparing VO<inf>2</inf>peak in PHTR recipients and CON. Pooled effect sizes were expressed as weighted mean differences (WMD) using a DerSimonian-Laird random-effects model, and weighted least-squares meta-regression assessed the moderating effects of age and time post-transplant. Seven unique studies (PHTR n = 90; CON n = 118) reported VO<inf>2</inf>peak and peak HR. PHTR had significantly lower VO<inf>2</inf>peak (WMD = -9.5 mL/kg/min), peak HR (WMD: -30 bpm), and CO (n = 3 studies, WMD: -2.5 L/min), with no difference in peak SBP (n = 3 studies). Meta-regression revealed no significant moderating effect of age or time post-transplant on the VO<inf>2</inf>peak deficit. The markedly reduced VO<inf>2</inf>peak in PHTR recipients is driven primarily by impaired peak CO and persistent chronotropic incompetence, consistent with cardiac allograft sympathetic denervation. Copyright © 2026 The Author(s). Clinical Transplantation published by John Wiley & Sons Ltd. <102> [Use Link to view the full text] Accession Number 2045858145 Title Acute Kidney Injury and Risk of Adverse Neurocognitive Outcomes: A Systematic Review and Meta-Analysis. Source Neurology. 106(11) (no pagination), 2026. Article Number: e218031. Date of Publication: 09 Jun 2026. Author Kelly D.M.; Kelleher E.M.; Rothwell P.M. Institution (Kelly, Rothwell) Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; (Kelly) Division of Critical Care, Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States (Kelleher) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, United States (Kelleher) Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Publisher Lippincott Williams and Wilkins Abstract Background and Objectives - Chronic kidney disease is a recognized risk factor for adverse neurocognitive outcomes, but the effect of acute kidney injury (AKI) on brain health remains less well defined. We conducted a systematic review and meta-analysis to evaluate associations between AKI and subsequent risk of stroke, delirium, and dementia. Methods - Eligible studies were identified by searching Ovid MEDLINE and Embase from inception (Ovid: January 1946; Embase: January 1970) until April 2025. Studies were included if they reported quantitative estimates with measures of precision for the association between AKI and delirium, stroke, or dementia in adult populations. Two reviewers independently screened and extracted data, and study quality was assessed using standardized criteria. Study characteristics, participant demographics, and adjusted effect estimates (hazard ratios [HRs] or odds ratios [ORs]) with 95% CIs were extracted. Pooled HRs and ORs with 95% CIs were calculated using random-effects models. Heterogeneity was evaluated with the chi2 test and I2 statistic, and sources of heterogeneity were explored through prespecified subgroup analyses and meta-regression. Results - We identified 49 studies comprising 11, 253, 825 participants with 1, 279, 145 events. Individuals with AKI were at increased risk of stroke (pooled adjusted HR 1.35, 95% CI 1.20-1.52), delirium (pooled adjusted OR 1.76; 1.42-2.17), and dementia (pooled adjusted HR 1.64, 1.41-1.89). A gradient of risk across increasing AKI stages was demonstrated for stroke (stage 1: HR 1.11; 1.00-1.23; combined stages 2 and 3: HR 1.57; 1.35-1.81). AKI was also associated with higher in-hospital and 90-day mortality poststroke (pooled HR 2.13, 1.56-2.90, and 4.81, 2.55-9.08, respectively) and with 90-day disability (pooled adjusted OR 1.47, 1.22-1.76). Associations between AKI and all outcomes were directionally consistent across sensitivity analyses and pooled propensity score-matched studies. Discussion - In this systematic review and meta-analysis, AKI was consistently associated with increased short-term and long-term neurocognitive risk, including stroke, delirium, and dementia. These findings suggest that AKI may identify individuals vulnerable to both acute and chronic brain injury. Further studies are needed to clarify mechanisms linking AKI to brain injury and to identify strategies to mitigate neurocognitive risk in this high-risk population. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. <103> Accession Number 2048263937 Title Sepsis and atrial fibrillation: the role of amiodarone, alternative strategies and metabolic therapy. A systematic review. Source Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 19(4) (pp 44-50), 2026. Date of Publication: 2026. Author Simutis I.S.; Semigolovskii N.Y.; Zelenaya E.A.; Danilov M.S. Institution (Simutis, Semigolovskii, Zelenaya, Danilov) Sokolov North West Regional Scientific and Clinical Center of the Federal Medical and Biological Agency, Saint Petersburg, Russian Federation (Semigolovskii) Saint Petersburg State University, Saint Petersburg, Russian Federation (Simutis, Danilov) North Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation Publisher Media Sphera Publishing Group Abstract Objective. To analyze the role of amiodarone, alternative rhythm and rate control strategies, and metabolic therapy in sepsis-associated atrial fibrillation (AF). Methods. A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, and RSCI up to January 2026. Randomized controlled trials (RCTs), prospective and retrospective cohort studies (n>=30), and controlled experimental studies in adults with sepsis/septic shock and supraventricular tachyarrhythmias were included. Additionally, RCTs of succinate-containing and metabolic therapies in other critical conditions (acute myocardial infarction, cardiac surgery, stroke, severe traumatic brain injury) evaluating arrhythmic or mechanistically relevant endpoints were considered. Results. New-onset AF in sepsis is associated with a 2- to 3-fold increase in mortality. Amiodarone effectively controls rhythm and rate but does not improve survival in septic shock and carries risks of negative inotropy, hypotension, torsade de pointes, and organ toxicity. In an RCT, propafenone provided faster cardioversion and fewer AF recurrences compared to amiodarone with similar mortality; a survival benefit was observed in patients without significant left atrial dilatation. Short-acting beta1-blockers (esmolol, landiolol) safely control heart rate in hyperdynamic shock. Simultaneous correction of hypokalemia and hypomagnesemia increases the likelihood of spontaneous cardioversion. Succinate-containing infusions (Reamberin) and Cytoflavin in RCTs for critical illness reduce reperfusion arrhythmias and improve left ventricular systolic function. Discussion. Evidence supporting propafenone and beta-blockers is derived from a limited number of RCTs with heterogeneous inclusion criteria. Data on metabolic therapy in sepsis-associated AF are extrapolated from studies in other critical conditions (AMI, COVID-19). Direct multicenter RCTs of succinate-based therapies with arrhythmic endpoints in sepsis are lacking. Conclusion. In sepsis-associated AF, amiodarone should be reserved for patients with significant structural heart disease and left atrial dilatation. Propafenone and short-acting beta1-blockers are preferable alternatives in patients without substantial myocardial remodeling. Succinate-containing and metabolic therapy is pathogenetically justified as an organ-protective adjuvant but requires dedicated RCTs in the sepsis population. Copyright © I.S. Simutis, N.Yu. Semigolovskii, E.A. Zelenaya, M.S. Danilov <104> 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. <105> Accession Number 2043346969 Title Invasive and medical management approaches to non-acute myocardial ischaemic syndromes. Source Nature Reviews Cardiology. 23(9) (pp 661-677), 2026. Date of Publication: 01 Sep 2026. Author Chiu N.; Bhatt D.L.; De Caterina R.; Doenst T.; Kirov H.; Dayan V.; Faxon D.P.; Kaul S.; Perera D.; Puskas J.D.; Steg P.G.; Boden W.E. Institution (Chiu, Faxon) Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, United States (Bhatt) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States (De Caterina) Cardiovascular Division, Pisa University Hospital - University of Pisa, Pisa, Italy (Doenst, Kirov) Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany (Dayan) Centro Cardiovascular Universitario, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay (Kaul) Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States (Perera) British Heart Foundation Centre for Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King's College, London, United Kingdom (Puskas) Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, GA, United States (Steg) Universite Paris-Cite, Assistance Publique - Hopitaux de Paris, INSERM U1148 and FACT (French Alliance of Cardiovascular Trials), Paris, France (Boden) VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States Publisher Nature Research Abstract Over the past two decades, approaches to managing patients with coronary artery disease have improved substantially with advances in percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, pharmacological secondary prevention, anti-anginal agents and lifestyle interventions. Accordingly, clinical management choices in non-acute myocardial ischaemic syndromes (NAMIS) remain a timely and important topic. The risks and benefits of an invasive strategy combined with optimal medical therapy (OMT) versus a conservative strategy of OMT alone should be discussed with patients to facilitate shared clinical decision making. The findings from high-quality, randomized, controlled trials in the era of modern OMT form an essential platform for these informed conversations. In totality, the evidence from randomized, controlled trials supports OMT as the first-line therapeutic approach in patients with NAMIS, whereas selected patients at high anatomical risk or those with persistent anginal symptoms despite initial OMT often derive further symptom relief from invasive therapy with PCI. In patients with high-risk NAMIS, including those with multivessel disease and diabetes mellitus, CABG surgery improves survival, whereas the benefit is less clear for PCI. In this Review, we discuss the findings from contemporary trials evaluating outcomes in patients with NAMIS treated invasively or conservatively with OMT alone, and we conclude with proposed management pathways. Copyright © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2026. <106> Accession Number 2047614441 Title The possible impact of levosimendan infusions on clinical course of heart failure: the results of the LEIA-HF study. Source ESC Heart Failure. 13(1) (no pagination), 2026. Article Number: xvag021. Date of Publication: 01 Feb 2026. Author Kazimierczyk E.; Kazimierczyk R.; Imiela A.M.; Poludniewska D.; Rogalska E.; Szyszkowska A.; Mickiewicz K.; Kuklinski F.; Fernandez-Moreno T.; Gierlotka M.; Straburzynska-Migaj E.; Nessler J.M.; Pawlak A.; Gasior M.; Kubica J.; Jaguszewski M.; Kasprzak J.D.; Bielecka-Dabrowa A.; Wojakowski W.; Leszek P.; Szarpak L.; Tycinska A. Institution (Kazimierczyk, Kazimierczyk, Poludniewska, Rogalska, Szyszkowska, Mickiewicz, Tycinska) Department of Cardiology and Internal Medicine with Cardiac Intensive Care Unit, Medical University of Bialystok, Bialystok, Poland (Imiela) Department of Internal Disease and Cardiology, Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland (Kuklinski, Fernandez-Moreno, Tycinska) Department of Intensive Cardiac Care, Medical University of Bialystok, Bialystok, Poland (Gierlotka) Department of Cardiology, Institute of Medical Sciences, University of Opole, Opole, Poland (Straburzynska-Migaj) First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland (Nessler) Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (Pawlak) Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, Warszawa, Poland (Gasior) 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland (Kubica) Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland (Jaguszewski) First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland (Kasprzak) First Department of Cardiology, Medical University of Lodz, Lodz, Poland (Bielecka-Dabrowa) Department of Cardiology and Adult Congenital Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland (Bielecka-Dabrowa) Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland (Wojakowski) Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (Leszek) Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland (Szarpak) Institute of Medical Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland (Szarpak) Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland Publisher Oxford University Press Abstract Introduction: Intermittent administration of levosimendan has recently been introduced for long-term use in patients with advanced heart failure (HF). However, the impact of this therapy on survival remains inconclusive. Method(s): Levosimendan in ambulatory HF patients was a multicentre, randomized, double-blind, placebo-controlled, Phase IV clinical trial of intermittent levosimendan administration in patients with ambulatory stable advanced HF [left ventricular ejection fraction <=35%, New York Heart Association Classes III and IV]. The primary clinical endpoint of the study was composed of death from any cause or unplanned hospitalization for HF, whichever occurred first in a 12-month follow-up period. Infusion started at a dose of 0.05 mug/kg/min and lasted ~24 h (up to a maximum dose of 12.5 mg) every 4 weeks. The study was conducted in nine centres around Poland. The study was prematurely terminated due to excess of deaths in the active treatment group. Finally, 64 (out of 350 planned) patients were recruited to the study. Result(s): Sixty-four patients with advanced HF [age-64.2 +/- 13.1 years, 57 (89%) men] were enrolled into the study. At baseline visit 34 (53%) patients were randomly assigned to the levosimendan group (study group) and 30 (47%) to the placebo group. Study drug administration resulted in a significant decrease in N-terminal pro-B-type natriuretic peptide concentrations [5084 pg/ml (306-23.203) vs 2027 pg/ml (872-2174), P = .02) and left ventricular ejection fraction improvement (20.9 +/- 5.9% vs 29.27 +/- 5.23%, P = .015) in the study group. These patients also had clinical endpoint numerically more often than patients in the placebo group [22 (64.71%) vs 14 (46.67%); P = .14], including significantly higher deaths [7 (100%) vs 0, P = .02]. Conclusion(s): In a selected group of stable ambulatory advanced HF (left ventricular ejection fraction <=35%, New York Heart Association Classes III and IV) patients, repetitive levosimendan 24 h infusion might be an additional therapeutic option but observed deaths may raise its safety issue. 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. <107> Accession Number 2046698022 Title 2026 American Association for Thoracic Surgery Expert Consensus Document: Diagnosis and management of heparin-induced thrombocytopenia in patients who undergo cardiac surgery. Source Journal of Thoracic and Cardiovascular Surgery. 172(3) (pp 487-509.e3), 2026. Date of Publication: 01 Sep 2026. Author Chatterjee S.; Girardi N.I.; Crow J.; Wieruszewski P.M.; Grant M.C.; Cuker A.; Warkentin T.E.; Mims M.P.; Arora R.C.; Martin M.; Moon M.R.; Cangut B.; Sultan I.S.; Parker A.; Holler J.F.; Balsam L.B.; Engelman D.T. Institution (Chatterjee, Moon) Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex, United States (Chatterjee, Moon) Department of Cardiovascular Surgery, The Texas Heart Institute, Baylor College of Medicine, Houston, Tex, United States (Girardi) Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States (Crow) Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Md, United States (Wieruszewski) Department of Pharmacy, Department of Anesthesiology, Mayo Clinic, Rochester, Minn, United States (Grant) Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Md, United States (Cuker) Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, United States (Warkentin) Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada (Mims) Department of Medicine, Baylor College of Medicine, Houston, Tex, United States (Arora) Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill, United States (Martin) Redline Perfusion & Consulting, LLC, Gainesville, Fla, United States (Cangut) Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Sultan) Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Parker) Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada (Holler) Department of Congenital Perfusion, Atrium Health Levine Children's Hospital, Charlotte, NC, United States (Balsam) Department of Surgery, UMass Chan Medical School, Worcester, Mass, United States (Engelman) Department of Surgery, Baystate Medical Center, University of Massachusetts Chan Medical School-Baystate, Springfield, Mass, United States Publisher Elsevier Inc. Abstract Background: Heparin-induced thrombocytopenia (HIT) in patients who undergo cardiac surgery presents unique diagnostic and management challenges due to universal perioperative heparin exposure, postoperative platelet kinetics, and the high prevalence of critical illness in this population. Current guidelines do not fully address these cardiac surgery-specific features, leading to practice variation in screening, diagnosis, anticoagulation management, and perioperative planning. Consolidated, practical, and evidence-based recommendations are needed that are tailored to cardiac surgery and to temporary mechanical circulatory support after cardiac surgery. Method(s): The American Association for Thoracic Surgery Clinical Practice Standards Committee convened a multidisciplinary panel of 16 experts in cardiac surgery, hematology, critical care, anesthesiology, perfusion, and pharmacology. A comprehensive literature review was performed with medical librarian support. Using a modified Delphi methodology, the panel evaluated the evidence, developed clinical statements, and assigned a class of recommendation and a level of evidence to each recommendation. Result(s): Consensus was achieved for 32 recommendations across 5 domains: epidemiology and natural history of HIT after cardiac surgery; diagnostic evaluation, including appropriate Thrombocytopenia, Timing, Thrombosis, oTher cause (4Ts) score use, time-dependent platelet count patterns, and integration of immunoassay and functional testing; therapeutic management with nonheparin anticoagulants, including the selection of direct thrombin inhibitors, factor Xa inhibitors, and adjunctive therapies; perioperative management of patients with HIT who require cardiac surgery, including the timing of surgery, intraoperative anticoagulation strategy, and adjunctive therapies; and screening, testing, and anticoagulation strategies for patients supported by extracorporeal membrane oxygenation or temporary mechanical circulatory support after cardiac surgery. Additional best practices are included for cardiopulmonary bypass circuit management for patients with HIT. Conclusion(s): This American Association for Thoracic Surgery Expert Consensus Document provides practical, cardiac surgery-specific guidance for the diagnosis and management of HIT across the continuum of cardiac surgical care. By addressing the complexities unique to cardiac surgery, high-risk anticoagulation environments, and extracorporeal and temporary mechanical circulatory support, these recommendations aim to improve diagnostic accuracy, standardize care, reduce complications, and support safe heparin re-exposure or alternative anticoagulation strategies when surgery is required. Copyright © 2026 The American Association for Thoracic Surgery <108> Accession Number 2046605961 Title Comparison Between Artificial Intelligence-Based Models and Traditional Risk Scores for Predicting Risks in Adult Cardiothoracic Surgery: A Systematic Review. Source Journal of Surgical Research. 325 (pp 64-72), 2026. Date of Publication: 01 Sep 2026. Author Fuchs T.K.; Jones C.; Breiner M. Institution (Fuchs, Jones) Edward Via College of Osteopathic Medicine (VCOM), Clinical Sciences, Blacksburg, VA, United States (Breiner) Department of Surgery, Edward Via College of Osteopathic Medicine (VCOM), Blacksburg, VA, United States Publisher Academic Press Inc. Abstract Introduction: Conventional risk scores like EuroSCORE II and Society of Thoracic Surgeons models, derived from logistic regression, may not fully represent complex interactions within cardiac surgery cohorts. Using nonlinear modeling, machine learning (ML) may improve risk prediction by capturing complex relationships. Objective(s): To conduct a systematic review of studies (2020-2026) that compare ML models with traditional risk scores for predicting perioperative mortality or significant adverse events in adult cardiac surgery. Method(s): Following the PRISMA 2020 guidelines, PubMed, Google Scholar, and Cochrane were searched from January 2020 to January 2026. The protocol was registered in PROSPERO (CRD420261295268; registered January 28, 2026). Inclusion necessitated direct comparisons between ML and traditional scoring methodologies with reported performance metrics, such as the area under the curve (AUC). Prediction model Risk Of Bias ASsessment Tool+ artificial intelligence was utilized for bias risk assessment. Result(s): Thirteen studies were included (N = 308-647,726). Studies originated from China (n = 5), United States (n = 3), United Kingdom (n = 2), Colombia, Saudi Arabia, and Turkey (n = 1 each). Algorithms included extreme gradient boosting, random forest, and ensembles. ML models showed improved or comparable performance, with AUC differences of 0.006-0.42, improved calibration, and reclassification (net reclassification improvement 0.550). Extreme gradient boosting AUC was 0.96 for postoperative infection, and random forest AUC was 0.975 for major adverse events in type A dissection. Prediction model Risk Of Bias ASsessment Tool+ artificial intelligence indicated low risk of bias; external validation was limited, and some analyses raised concerns regarding overfitting. Key methodological limitations included data leakage, overfitting risk, and limited temporal and external validation. Conclusion(s): ML models may improve risk prediction in cardiac surgery relative to traditional scores, especially through ensembles and advanced validation techniques. Prospective multicenter validation and evaluation of clinical integration and algorithmic fairness are needed before widespread implementation, with attention to data leakage prevention, overfitting mitigation, temporal drift, and calibration on independent validation sets. Copyright © 2026 Elsevier Inc. <109> Accession Number 2048361777 Title Efficacy and safety of drinking ice-carbonated water and ice-purified water immediately after extubation in paediatric patients with congenital heart disease: A randomised, controlled three-arm trial. Source Australian Critical Care. 39(5) (no pagination), 2026. Article Number: 101663. Date of Publication: 01 Oct 2026. Author Zhang X.; Chen Y.; Peng Y.; Li S.; Chen L.; Lin Y. Institution (Zhang, Chen) School of Nursing, Fujian Medical University, Fujian, Fuzhou, China (Zhang) Department of Nursing, The Second Affiliated Hospital of Xiamen Medical College, China (Peng, Lin) Department of Nursing, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Li, Chen, Lin) Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Chen) Fujian Provincial Special Reserve Talents Laboratory, Fujian, Fuzhou, China Publisher Elsevier Ireland Ltd Abstract Background: Children who undergo congenital heart disease (CHD) surgery face increased postoperative thirst, which can cause discomfort and lead to serious consequences. There is a lack of effective thirst management strategies for this vulnerable group. Objective(s): The aim of this study was to evaluate the efficacy and safety of ice-carbonated water and ice-purified water in alleviating thirst in children following CHD surgery. Result(s): A generalised estimating equation analysis demonstrated group-by-time interactions for both primary outcomes. At T5, the between-group difference in thirst NRS was -4.71 points (95% confidence interval [CI]: -5.12 to -4.30) for H<inf>2</inf>O-ice-carb group vs. control group and -3.86 points (95% CI: -4.36 to -3.35) for H<inf>2</inf>O-ice group vs. control group (both P < 0.001). The H<inf>2</inf>O-ice-carb group demonstrated greater improvement than the H<inf>2</inf>O-ice group (difference = -0.85; 95% CI: -1.26 to -0.44; P < 0.001), with the difference apparent from T1 (P = 0.009). For oral moisture, the H<inf>2</inf>O-ice-carb group showed the strongest effect (2.51% per hour), followed by the H<inf>2</inf>O-ice group (1.66% per hour; both P < 0.001). No differences in adverse events were found among the three groups (P = 0.364). Conclusion(s): Immediate consumption of ice-carbonated and ice-purified water following extubation effectively and safely alleviates postoperative thirst in children after CHD surgery, with ice-carbonated water showing better results. These findings may inform the development of postoperative fasting and fluid management protocols for paediatric patients. Copyright © 2026 The Author(s) <110> Accession Number 2047676594 Title Systematic reviews of values and preferences: methodological challenges, approaches and implications for clinical guideline development. Source European Journal of Cardiovascular Nursing. 25(4) (pp 858-869), 2026. Date of Publication: 01 May 2026. Author Bulto L.N.; Munn Z.; Stern C.; Pollock D.; Barker T.H. Institution (Bulto, Munn, Stern, Pollock, Barker) Health Evidence Synthesis, Recommendations, and Impact (HESRI), School of Public Health, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia (Bulto) Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia Publisher Oxford University Press Abstract Systematic reviews of values and preferences are essential to ensure that healthcare decision-making and clinical practice guidelines reflect what truly matters to patients, caregivers, policymakers, and other interest-holders. These reviews synthesize evidence on how people value different health outcomes and provide critical information about the trade-offs they are willing to make (e.g. the willingness to accept an intervention's side effects to gain a meaningful benefit for a more highly valued outcome). The importance of these reviews in developing trustworthy guidelines is evident, yet limited methodological guidance exists. The process of conducting these reviews presents unique methodological challenges. This paper addresses these challenges by providing a systematic, step-by-step guide for planning and conducting value and preference reviews. We detail key considerations for each stage, from formulating the review question to assessing the certainty of evidence and illustrate these methodological approaches with examples from published reviews to enhance practical understanding. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. <111> Accession Number 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. <112> Accession Number 651457687 Title The impact of leaflet resection versus leaflet preservation on left ventricular reverse remodelling after mitral valve repair: insights from the UK mini mitral trial. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 09 Jun 2026. Author Rao E.; Bayliss C.D.; Wagnild J.M.; Graham R.; Maier R.; Akowuah E. Institution (Rao) Newcastle University Medical School, Newcastle Upon Tyne, United Kingdom (Bayliss, Graham, Akowuah) Department of Cardiac Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom (Wagnild) Department of Anthropology, Durham University, South Road, Durham, United Kingdom (Maier, Akowuah) Academic Cardiovascular Unit, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom (Maier) Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (Akowuah) Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom Abstract OBJECTIVES: Mitral valve repair (MVr) promotes left ventricular (LV) reverse remodelling, and subsequent reduction in LV diameters and volumes. The effectiveness of different MVr techniques, Resect (leaflet resection) and Respect (leaflet preservation) remains debated. This study aimed to investigate the impact of 'Resect' and 'Respect' techniques on LV reverse remodelling, primarily assessed by changes in indexed LV end-systolic diameter (ILVESD) post-MVr. METHOD(S): Data were drawn from the UK Mini Mitral Trial, which randomised 330 patients to MVr via mini-thoracotomy or median-sternotomy. This subanalysis included patients with isolated posterior leaflet prolapse, who had undergone MVr via Resect or Respect techniques. Transthoracic echocardiography was performed pre-operatively and at 12 and 52 weeks post-operatively, with all studies analysed by a core laboratory. Linear mixed-effects models compared changes in indexed LV measurements between groups. RESULT(S): This subanalysis included 175 patients (36 Resect and 139 Respect). Annuloplasty was performed in all but one repair. We found no significant difference between groups in recurrent MR severity at 52 weeks postoperatively (p = 0.31). Both groups had significant improvement in ILVESD by 52 weeks (mean change from baseline - 5.6%, p < 0.001), with no difference between groups (p = 0.24). Both techniques led to significant improvements in indexed end-diastolic LV volumes and diameters, decreasing from baseline to 12 and 52 weeks. However, LV end-systolic volumes and diameters increased at 12 weeks before decreasing by 52 weeks postoperatively. CONCLUSION(S): No significant differences in LV reverse remodelling between Resect and Respect techniques. Both can be recommended to surgeons. Longer follow-up is needed. Copyright © 2026. The Author(s). <113> Accession Number 2046590760 Title Effect of remote ischaemic preconditioning on acute kidney injury after heart transplantation (RIPCAT): A randomised controlled feasibility trial. Source European Journal of Anaesthesiology. 43(9) (pp 785-789), 2026. Date of Publication: 01 Sep 2026. Author M'Pembele R.; Jagdfeld J.D.; Henning L.S.; Huhn R.; Lurati Buse G.; Boeken U.; Roth S. Institution (M'Pembele, Jagdfeld, Henning, Huhn, Lurati Buse, Roth) From the Department of Anaesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany (Huhn) Department of Anaesthesiology, Kerckhoff Heart and Lung Centre, Bad Nauheim, Germany (Boeken) Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany Publisher Lippincott Williams and Wilkins <114> Accession Number 651399775 Title Perineural dexamethasone as an adjuvant to erector spinae plane block for acute and chronic pain after cardiac surgery. Source Scientific reports. 16(1) (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Linares L.A.R.; Martinez R.C.R.; Carvalho V.H.; Navarro E Lima L.H.; Zeferino S.P.; Carneiro J.O.; Galas F.R.B.G. Institution (Linares) University of Sao Paulo School of Medicine, Sao Paulo, Brazil (Linares) InCor, Sao Paulo, Brazil (Martinez) Hospital Sirio-Libanes, Sao Paulo, Brazil (Martinez) IPq-FMUSP, Sao Paulo, Brazil (Carvalho) UNICAMP, Campinas, Brazil (Navarro E Lima) University of Manitoba, Winnipeg, MB, Canada (Zeferino, Carneiro, Galas) University of Sao Paulo School of Medicine, Sao Paulo, Brazil (Zeferino, Galas) InCor, Sao Paulo, Brazil Abstract Pain control after cardiac surgery remains suboptimal. The erector spinae plane (ESP) block offers a safer regional alternative to neuraxial techniques, but its duration is limited. We tested whether perineural dexamethasone added to bilateral ESP blocks reduces acute postoperative pain intensity and attenuates chronic post surgical pain (CPSP) after coronary artery bypass grafting (CABG). In this randomized, double-blind trial (NCT04313959), 43 patients undergoing elective CABG received bilateral ESP blocks with 0.2% ropivacaine alone (control, n = 21) or ropivacaine plus 8 mg perineural dexamethasone (dexamethasone, n = 22). Primary Outcome: pain intensity at rest on postoperative day 1, measured using the numerical rating scale (NRS). Pre-specified secondary outcomes were mechanical ventilation duration, 48-hour opioid consumption, and pain interference at 30, 60, and 90 days measured using the Brief Pain Inventory (BPI). The primary outcome was not significantly different between groups: NRS pain at rest on day 1 was 1.35 +/- 1.95 (control) vs. 1.57 +/- 2.27 (dexamethasone), p = 0.781 (Fig. 1). Acute pain scores and 48-hour opioid consumption were comparable (Fig. 3). Mechanical ventilation was shorter in the dexamethasone group (median 11.6 vs. 14.7 h; p = 0.041; Table 2). At 30 days, no significant between-group differences were found in any BPI domain (all p > 0.05; Table 3). At 60 days, pain intensity scores were lower in the dexamethasone group (composite score 0.47 +/- 0.88 vs. 1.21 +/- 1.28; p = 0.019; Table 3; Fig. 2). By 90 days, all outcomes were comparable (all p > 0.05). One procedure-related adverse event occurred (pneumothorax, control group). Addition of dexamethasone to ropivacaine did not add to the reduction of acute pain. The secondary exploratory findings of shorter mechanical ventilation time and lower pain intensity at 60 days are hypothesis-generating and should be evaluated using larger, adequately powered multicenter trials with intraoperative blinding and a systemic comparator arm.Trial registry: NCT04313959. Copyright © 2026. The Author(s). <115> Accession Number 2044957767 Title Ultrasound-guided axillary access outperforms subclavian puncture for cardiac implantable electronic device implantation: A network meta-analysis of 130,831 patients. Source Heart Rhythm O2. 7(7) (pp 1374-1386), 2026. Date of Publication: 01 Jul 2026. Author Almeida M.E.M.; Ribeiro I.R.; Martins C.K.; Barbosa G.A.; Miranda M.C.; da Silva Menezes Junior A. Institution (Almeida, Ribeiro, Martins, Barbosa, Miranda, da Silva Menezes Junior) Medical Department, School of Medical and Life Sciences, Pontifical Catholic University of Goias, Goias, Goiania, Brazil (da Silva Menezes Junior) Medical Department, Medical Faculty, Federal University of Goias, Goias, Goiania, Brazil Publisher Elsevier B.V. Abstract Background The optimal venous access route for cardiac implantable electronic device implantation remains debated. Objective We compared the efficacy and safety of subclavian vein puncture (SVP), cephalic vein cutdown (CVP), and axillary vein puncture guided by fluoroscopy (FL-AVP) and ultrasound (US-AVP). Methods A systematic search of PubMed, Embase, Cochrane Central, and Web of Science (until September 24, 2025) identified randomized and observational studies comparing >=2 venous access techniques for cardiac implantable electronic device implantation in adults. A frequentist random-effects network meta-analysis estimated odds ratios (ORs) or standardized mean differences with 95% confidence intervals. Heterogeneity, network consistency, and ranking probabilities were assessed using P scores. Results Of the 4316 records screened, 25 studies (130,831 patients) were included. CVP was significantly less successful than FL-AVP (OR 0.18), SVP (OR 0.14), and US-AVP (OR 0.17). SVP carried a higher risk of overall complications than US-AVP (OR 2.21). Procedure time was longer for CVP than for FL-AVP or US-AVP. FL-AVP entailed greater fluoroscopy time and radiation exposure than US-AVP. Pneumothorax occurred less frequently with CVP and FL-AVP than with SVP, whereas lead dislodgement and pericardial effusion were less common with CVP than with SVP. Network ranking favored SVP for procedural success and US-AVP for safety and radiation reduction. Conclusion Axillary (ultrasound- or fluoroscopy-guided) and cephalic approaches outperform subclavian puncture in risk-benefit. US-AVP is considered the first-line technique, FL-AVP is a valid alternative when ultrasound is unavailable, and CVP is preferred for selected anatomies. In contrast, SVP should be reserved for bailout cases. PROSPERO CRD420251017329. Copyright © 2026 Heart Rhythm Society. <116> 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. <117> Accession Number 2045611576 Title Combination antibiotic therapy in Staphylococcus aureus endocarditis: evidence, controversies, and future directions. Source Infection. 54(4) (pp 1787-1801), 2026. Date of Publication: 01 Aug 2026. Author Meena D.S.; Kumar D.; Bohra G.K. Institution (Meena, Kumar, Bohra) Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India Publisher Springer Science and Business Media Deutschland GmbH Abstract Staphylococcus aureus is now the leading cause of infective endocarditis (IE) worldwide and is associated with high mortality and frequent complications. Combination antimicrobial therapy has long been proposed to enhance bactericidal activity, improve biofilm penetration, and limit resistance; however, its true clinical value remains uncertain. This narrative review examines the experimental and clinical evidence for combination regimens in Staphylococcus aureus infective endocarditis (S. aureus IE). We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library through September 2025 for randomised trials, comparative observational studies, major guidelines, and key experimental reports. Evidence is synthesised across methicillin-susceptible and methicillin-resistant strains, and across native and prosthetic valve disease. We summarise the biological rationale, potential benefits, and stewardship impact of combination therapy. We also highlight the practical implications for when to consider, avoid, or de-escalate combination therapy, and outline priorities for future research. We find that evidence for combination therapy in S. aureus endocarditis remains limited and largely observational. Adjunctive rifampin and aminoglycosides have not shown consistent clinical benefit and are associated with increased toxicity. Beta-lactam combinations with vancomycin or daptomycin may reduce the bacteremia duration, but this has not translated into improved survival. Emerging regimens, particularly daptomycin combined with ceftaroline show promise in persistent bacteremia, although evidence remains observational. Overall, current data do not support routine use of combination therapy and favour a selective, case-based approach. High-quality multicentre studies integrating microbiological, pharmacodynamic, and clinical endpoints are urgently needed to define optimal combination strategies. Copyright © Springer-Verlag GmbH Germany, part of Springer Nature 2026. <118> Accession Number 652013523 Title Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis. Source Journal of cardiology. (no pagination), 2026. Date of Publication: 20 Aug 2026. Author Abomohsen M.; Elboliney A.; Mohamed A.E.; Mahgoub I.; Sayed R.S.; Almakadma A.H.; Gadelmawla A.F.; Awashra A.; Gunsburg M.; Chadow H.L. Institution (Abomohsen) Department of Internal Medicine, Brookdale University Hospital & Medical Center, Brooklyn, NY, United States (Elboliney) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Mohamed, Almakadma) Department of Internal Medicine, Brookdale University Hospital & Medical Center, Brooklyn, NY, United States (Mahgoub) St. Joseph's University Medical Center, Paterson, NJ, United States (Sayed) NYC Health & Hospitals/South Brooklyn Health, Brooklyn, NY, United States (Gadelmawla) Faculty of Medicine, Menoufia University, Egypt (Awashra) Department of Medicine, An Najah National University, Nablus, Palestine (Gunsburg, Chadow) Division of Cardiology, One Brooklyn Health, Brooklyn, NY, United States Abstract BACKGROUND: Stroke prevention after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation remains clinically challenging because thromboembolic risk must be balanced against substantial bleeding vulnerability. Left atrial appendage occlusion (LAAO) has been proposed as a nonpharmacologic alternative to long-term anticoagulation in selected patients, but its comparative role in the TAVR population remains insufficiently defined. METHOD(S): We performed a systematic review and meta-analysis of comparative studies evaluating TAVR plus LAAO versus TAVR plus medical therapy in patients with atrial fibrillation. Randomized trials and observational comparative cohorts were eligible. The primary outcome was stroke, transient ischemic attack, or systemic embolism. Secondary outcomes were major bleeding and all-cause mortality. Random-effects odds ratios (ORs) with 95% confidence intervals (CIs) were pooled. RESULT(S): Four studies comprising 652 patients were included, of whom 289 underwent TAVR plus LAAO and 363 received TAVR plus medical therapy. The evidence base included two randomized trials and two observational studies, with LAAO performed either concomitantly with TAVR or in a staged manner shortly thereafter. TAVR plus LAAO was not associated with a significant reduction in stroke/transient ischemic attack/systemic embolism compared with medical therapy (OR 0.83, 95% CI 0.40-1.74). There were also no significant differences in major bleeding (OR 1.10, 95% CI 0.68-1.77) or all-cause mortality (OR 0.93, 95% CI 0.62-1.40). CONCLUSION(S): In the currently available comparative evidence, adding LAAO to TAVR was associated with similar thromboembolic, bleeding, and mortality outcomes compared with medical therapy. These findings do not support routine LAAO for all patients with atrial fibrillation undergoing TAVR, but they leave room for selective use in carefully chosen patients in whom long-term anticoagulation is undesirable. Copyright © 2026. Published by Elsevier Ltd. <119> Accession Number 652014357 Title Etomidate and Ciprofol for Induction in CABG Under Cardiopulmonary Bypass: Mechanistic Rationale, Evidence Gaps, and Future Trial Design. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 29 Jul 2026. Author Li Y.-N.; Yang Q.; He L.-X.; Li L.; Huang X.-J.; Yang B.-C.; Yang K. Institution (Li) Department of Anesthesiology, Dali University, Dali, Yunnan, China; Department of Anesthesiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, Yunnan, China (Yang, He, Li, Huang, Yang, Yang) Department of Anesthesiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, Yunnan, China Abstract Patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) are exposed to substantial perioperative stress, inflammation, and perfusion vulnerability, which may increase the risk of postoperative acute kidney injury (AKI) and postoperative delirium (POD). Although anesthesia induction is brief, it can influence blood pressure, vascular responsiveness, vasopressor exposure, cerebral oxygenation, and tissue perfusion. Etomidate is widely used in high-risk patients because of its hemodynamic stability, but it inhibits adrenal 11beta-hydroxylase and attenuates the cortisol stress response. Ciprofol, a newer intravenous anesthetic, has shown favorable induction hemodynamics and less injection pain in some studies; however, current evidence largely comes from propofol comparisons, non-CABG populations, or process outcomes. No randomized evidence directly compares ciprofol with etomidate in adults undergoing CABG with CPB using AKI or POD as core outcomes. Thus, the superiority of either agent for organ outcomes is unproven. This narrative review summarizes the mechanistic rationale and evidence gaps and proposes standardized design considerations for future high-quality clinical trials. Future studies should use standardized Kidney Disease: Improving Global Outcomes AKI criteria and Confusion Assessment Method (CAM) or CAM-intensive care unit delirium assessment while controlling CPB management, transfusion, vasopressor use, sedation, analgesia, and perioperative steroid exposure. This review aims to construct testable clinical hypotheses and provide a rationale for future trials, rather than to determine the absolute clinical superiority of either agent. Copyright © 2026 Elsevier Inc. All rights reserved. <120> Accession Number 645623659 Title Hybrid strategy as an alternative to norwood surgery for hypoplastic left heart syndrome: an updated systematic review and meta-analysis. Source Cardiology in the Young. Conference: 8th World Congress of Pediatric Cardiology and Cardiac Surgery, WCPCCS 2023. Washington, DC United States. 34(Supplement 1) (pp S541-S542), 2024. Date of Publication: 01 May 2024. Author Montana-Jimenez L.P.; Mejia-Quinones V.; Pizarro A.B.; Gempeler A. Institution (Montana-Jimenez, Mejia-Quinones, Pizarro, Gempeler) Fundacion Valle del Lili/ Universidad Icesi, Cali, Valle del Cauca, Colombia Publisher Cambridge University Press Abstract Background: The hybrid procedure (HP) emerged as an alternative for palliation in patients with hypoplastic left heart syndrome (HLHS) with high risk for the Norwood procedure (NP). Existing metanalyses showed better outcomes for NP but did not consider differences in baseline risk in study populations. Studies comparing the two should be synthesized considering baseline confounding and other aspects that determine the certainty of the evidence. Method(s): We performed a systematic review that followed Cochrane guidelines and PRISMA recommendations (PROSPERO registration CRD42021281510). We searched MEDLINE, EMBASE, LILACS, and Central in October 2021 for randomized controlled trials and observational studies comparing NS and HP for HLHS palliation. Outcomes of interest were mortality (in-hospital, stage 1, late), 1-,3-, and 5-year survival. ROBINS-1 tool was used to assess the risk of bias. We followed the GRADE approach for rating the quality of evidence. Result(s): We identified 444 articles; 55 were reviewed in full-text. 30 fulfilled selection criteria and were included for quantitative (25 studies included in metanalyses) or narrative synthesis (five studies). All were observational studies. They had overall low risk of bias and metanalyses had no inconsistency or imprecision, but their observational nature determined moderate certainty on the results. Comparison of HP and NP for hospital mortality (RR=1.19 [0.83-1.71], 8 studies, n=486), stage I mortality (RR=0.97[0.78 - 1.22], 9 studies, n=1014 patients), late death (RR=0.37 [0.11 - 1.28], 4 studies, n=205), 1-year survival (RR=0.99, [0.92- 1.06], 17 studies, n=1828), 3-year survival (RR=1.00 [0.93- 1.09], 12 studies, n=1495) and 5-year survival (RR=0.96 [0.85- 1.08], 6 studies, n=630) yielded estimates suggesting no clinically-important differences between the two procedures. Conclusion(s): HP and NP may be comparable for initial palliation in patients with HLHS regarding intermediate and long-term survival. Certainty is limited by the observational nature although low risk of bias and sufficient precision suggests that clinically important differences in survival are unlikely. Differences in secondary outcomes and additional advantages are to be studied further as they are currently not reported by most of the studies. <121> Accession Number 652012397 Title Post-transplant Epstein-Barr virus-associated lymphoproliferative disorder after cardiac transplantation: a scoping review. Source Transplant immunology. (pp 102447), 2026. Date of Publication: 20 Aug 2026. Author Calpey J.; Beaton R.; Osorio S.V.; Machado C.J.; Knudsen R.; Kalathoor J.; Knecht M.; Sacca L. Institution (Calpey, Beaton, Osorio, Machado, Knudsen, Kalathoor, Knecht, Sacca) Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States Abstract BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication following cardiac transplantation, frequently driven by Epstein-Barr virus (EBV) in the setting of chronic immunosuppression. Despite its clinical significance, data specific to adult cardiac transplant recipients remain fragmented, with variability in reported incidence, risk factors, and outcomes. METHOD(S): A scoping review was conducted using the Arksey and O'Malley framework and Joanna Briggs Institute guidelines. Five databases were searched for studies published between 2000 and 2025 focusing on EBV-associated PTLD in adult heart transplant recipients. Inclusion criteria encompassed observational and experimental studies conducted in the United States and Canada. Data extraction and screening were performed using Covidence, with study characteristics, incidence, risk factors, prevention strategies, and outcomes synthesized qualitatively. RESULT(S): Six studies met inclusion criteria. PTLD incidence ranged from 0.83% to 5.1%, with 43% to 98% of cases associated with EBV. Donor-positive/recipient-negative EBV serologic mismatch and intensity of immunosuppression were the most consistent risk factors. Median time to PTLD diagnosis ranged from 3.6 to 4.4 years, though late-onset cases were reported. Preventive strategies included EBV PCR surveillance and modification of immunosuppressive regimens, particularly conversion to sirolimus-based therapy. Treatment approaches primarily involved reduction of immunosuppression, rituximab-based therapy, and chemotherapy, with variable outcomes and persistent high morbidity and mortality. CONCLUSION(S): EBV-associated PTLD remains a significant complication after cardiac transplantation. Risk stratification based on EBV serostatus and immunosuppression, along with standardized surveillance and tailored therapeutic strategies, is critical to improving outcomes in this high-risk population. Copyright © 2026. Published by Elsevier B.V. <122> Accession Number 652012419 Title Hemodynamic and Perioperative Effects of Remimazolam Versus Propofol in Adult Cardiac Surgery: A Grade-Assessed Systematic Review and Meta-Analysis. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 07 Jul 2026. Author Salameh H.; Khalili H.; Hashem W.; Assi S.; Nazzal Z. Institution (Salameh, Khalili, Hashem, Assi, Nazzal) Department of Medicine, Faculty of Medicine and Allied Sciences, An-Najah National University, Nablus, Palestine Abstract Hemodynamic instability during adult cardiac surgery increases perioperative risk. Propofol is widely used but may cause dose-dependent hypotension and myocardial depression. Remimazolam, an ultra-short-acting benzodiazepine, has emerged as a potentially more hemodynamically stable alternative, although evidence in cardiac surgery remains limited. A PRISMA-compliant systematic review and meta-analysis were conducted to compare remimazolam with propofol in adult cardiac surgery. PubMed, Embase, Web of Science, and Scopus were searched from inception to January 2026. Randomized controlled trials (RCTs) and comparative cohort studies were included. Primary outcomes included study-defined hypotensive events, mean arterial pressure, heart rate, bispectral index, and operative time. Random-effects models were used for pooled analyses, and evidence certainty was assessed using the GRADE approach. Nine studies involving 903 patients were included. Compared with propofol, remimazolam significantly reduced the incidence of intraoperative hypotensive events (risk ratio 0.50, 95% confidence interval 0.31-0.80) with minimal heterogeneity. Mean arterial pressure and heart rate were comparable between groups. Remimazolam was associated with faster emergence, including shorter times to eye opening and extubation, while operative time, anesthetic depth, postoperative nausea and vomiting, delirium, and hospital stay showed no significant differences. Postoperative adverse events were reduced with remimazolam. Evidence certainty ranged from high to low, mainly due to heterogeneity and imprecision. Remimazolam may provide superior hemodynamic stability and faster postoperative recovery compared with propofol in adult cardiac surgery without compromising anesthetic efficacy or safety. Larger multicenter trials are needed to confirm these findings and define their long-term clinical benefits. Copyright © 2026 Elsevier Inc. All rights reserved. <123> [Use Link to view the full text] Accession Number 646742084 Title Immediate versus staged percutaneous coronary intervention of nonculprit lesions in patients with st-elevation myocardial infarction and multivessel disease: a meta-analysis of 4,120 patients. Source Circulation. Conference: American Heart Association's 2024 Scientific Sessions and the American Heart Association's 2024 Resuscitation Science Symposium. Chicago, IL United States. 150(Supplement 1) (no pagination), 2024. Date of Publication: 01 Nov 2024. Author Paulino D.; Arbaiza E.A.; Martinez D.N.; Xiloj S.; Hernandez B.; Garcia-Mena L. Institution (Paulino) Universidad Autonoma Metropolitana, Mexico City, Mexico (Arbaiza) Universidad de El Salvador, San Miguel, El Salvador (Martinez) Indiana University, Indianapolis, IN, United States (Xiloj) Universidad de San Carlos de Guatemala, Guatemala, Guatemala (Hernandez, Garcia-Mena) Universidad Nacional Autonoma de Mexico, Mexico City, Mexico Publisher Lippincott Williams and Wilkins Abstract Introduction: Multivessel coronary artery disease is common in patients with ST-segment elevation myocardial infarction (STEMI). Previous trials have shown that comprehensive revascularization of nonculprit arteries with significant stenosis reduces the risks of cardiovascular death, myocardial infarction, and ischemia-driven revascularization compared to culprit-only revascularization. However, the optimal timing for revascularizing non-culprit lesions-immediate versus staged percutaneous coronary intervention (PCI)-remains unclear. This meta-analysis aims to determine if staged or immediate PCI is associated with fewer major adverse cardiovascular events. Method(s): A meta-analysis was conducted following PRISMA guidelines, with a protocol registered in PROSPERO (CRD42023485163). We included studies from PubMed, Embase, and Cochrane databases until October 10, 2023. Inclusion criteria were: 1) patients over 18 with STEMI and hemodynamically stable multivessel disease; 2) intervention: immediate PCI; 3) comparator: staged PCI; 4) study types: randomized clinical trials (RCTs) and cohort studies. Study quality was assessed using ROBINS-I for observational studies and ROB 2 for RCTs. Result(s): Nine studies met inclusion criteria: 3 RCTs and 6 cohort studies, with a total of 4,120 patients. Staged PCI was significantly associated with reduced cardiovascular death (RR2= 1.77; 95% CI = 1.11- 2.81; p = 0.02, I2= 24%) and all-cause mortality (RR2= 1.83; 95% CI = 1.19-2.79; p = 0.005, I2= 42%). Hazard ratio analysis also favored staged PCI for cardiovascular death (HR2= 4.11; 95% CI = 1.07-5.87; p = 0.04, I2= 12%) and all-cause mortality (HR2= 8.13; 95% CI = 1.01-8.17; p = 0.05, I2= 37%). No significant differences were found for major adverse cardiovascular events (RR2= 0.98; 95% CI = 0.74- 1.28; p = 0.86, I2= 53%) or in major bleeding, stroke, or target vessel revascularization. Conclusion(s): In patients with STEMI and multivessel disease, staged coronary revascularization is associated with a lower risk of major adverse cardiovascular events, cardiovascular death, and all-cause mortality compared to immediate revascularization, without increasing adverse outcomes. Further research is needed to confirm these findings. <124> Accession Number 643014126 Title A systematic review of the evidence supporting the use of surgical aortic and mitral valves: an update from the CORE MD consortium. Source European Heart Journal. Conference: European Society of Cardiology Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no pagination), 2023. Date of Publication: 01 Nov 2023. Author Mcgovern L.; Coughlan J.J.; Siontis G.; Frenk A.; Melvin T.; Mcgauran G.; Geertsma R.; Schnell-Inderst P.; Fraser A.G.; Windecker S.; Byrne R.A. Institution (Mcgovern) Cardiovascular Research Institute (CVRI), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland (Coughlan) Cardiovascular Research Institute (CVRI)/Mater Private, Dublin, Ireland (Siontis, Frenk, Windecker) Bern University Hospital, Bern, Switzerland (Melvin) Trinity College Dublin, Dublin, Ireland (Mcgauran) Health Products Regulatory Authority (HPRA), Dublin, Ireland (Geertsma) RIVM: National Institute for Public Health and the Environment, Utrecht, Netherlands (Schnell-Inderst) UMIT TIROL, Tirol, Austria (Fraser) University Hospital for Wales, Cardiff, United Kingdom (Byrne) Cardiovascular Research Institute (CVRI), Royal College of Surgeons in Ireland (RCSI)/Mater Private, Dublin, Ireland Publisher Oxford University Press Abstract Introduction: The European Union (EU) Medical Device Regulation (MDR) 2017/745 challenges the medical community to engage with regulators, notified bodies and industry to develop transparent, rigorous and proportionate methods to evaluate the clinical safety and efficacy of medical devices and to monitor their performance. As part of the EU Horizon 2020 funded CORE-MD project, we performed a systematic review of the published scientific evidence available for surgical heart valve replacements for native aortic and mitral valve pathologies. Purpose(s): The aim of this analysis is to review the scientific evidence available which supports the use of currently available surgical aortic and mitral valves. Method(s): A systematic literature review was conducted using Ovid, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). We included only surgical aortic and mitral valves that received CE Mark approval from the year 2000 onwards. We included any study of prospective design (randomised or non-randomised clinical trials of any design) in humans, published between 2000 and 2021. We excluded retrospective studies, case reports, reviews, systematic reviews, meta-analyses, and expert opinion documents. Title and abstract screening, full-text review, risk of bias evaluation and data collection were performed by two authors independently, with disagreements resolved by discussion with a third author. Result(s): A total of 17 surgical aortic valves and 4 surgical mitral valves were identified based on the CE mark criterion (Figure 1). The initial literature search identified 4901 and 3696 potentially eligible papers in the aortic and mitral valve categories, respectively. Finally, 39 aortic and 3 mitral valve studies were included (Figure 2). The majority of included studies (90%) had a non-randomised, prospective, observational design, with 68% receiving industry funding. The median number of patients included was 295 [interquartile range (IQR): 153, 689] with a median maximum follow up of 24 months [IQR: 12, 60]. Only 50% of the identified studies had a pre-specified registered study protocol and only 5% included a power calculation to estimate the required study size. No study reported patient involvement in the study design and only 15% of studies had a comparator group. Using the ROBINS I AND II assessment tools, 90% of the included studies were classified as having a high or serious risk of bias. Conclusion(s): The evidence available for currently used surgical aortic and mitral replacement heart valves is largely from small, industry funded, non-randomised controlled trials. The median duration of maximum follow up was only 24 months, the majority of studies were classed as having a high/serious risk of bias and only half had a pre-registered study protocol. These results highlight the limitations of the available scientific evidence supporting the surgical aortic and mitral valves used in current clinical practice. (Table Presented). <125> Accession Number 646878300 Title Does Heparin Rebound lead to Postoperative Blood Loss in Patients undergoing Cardiac Surgery with Cardiopulmonary Bypass. Source Anesthesia and Analgesia. Conference: 18th World Congress of Anaesthesiologists. Singapore Singapore. 139(6 Supplement 2) (pp 383-385), 2024. Date of Publication: 01 Dec 2024. Author Rijpkema M.; Vlot E.A.; Stehouwer M.C.; Bruins P. Institution (Rijpkema) Medical Centre Leeuwarden, Leeuwarden, Netherlands (Rijpkema, Vlot, Bruins) St. Antonius Hospital, Nieuwegein, Netherlands (Stehouwer) Perfusion Department, St. Antonius Hospital, Nieuwegein, Netherlands Publisher Lippincott Williams and Wilkins Abstract Background and Objectives: Heparin rebound is a common observed phenomenon after cardiac surgery with CPB and is associated with increased postoperative blood loss. However, the administration of extra protamine may lead to increased blood loss as well. Therefore, we want to investigate the relation between heparin rebound and postoperative blood loss and the necessity to provide extra protamine to reverse heparin rebound. Method(s): We searched PubMed, Cochrane, EMBASE, Google Scholar and Web of Science to review the question: ?Does heparin rebound lead to postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass.? Combination of search words were framed within four major categories: heparin rebound, blood loss, cardiac surgery and cardiopulmonary bypass. All studies that met our question were included. Quality assessment was performed using the Cochrane risk of bias (RoB2) tool for randomized controlled trials and the risk of bias in non-randomized studies of intervention (ROBINS-I) for non-randomised trials. Result(s): 4 randomized (Kaul TK et al., 1979; Martin et al., 1992; Pardanani et al., 1970; Purandare et al., 1979) and 17 non-randomized (Abuelkasem et al., 2019; Ellison et al., 1974; Esposito et al., 1983; Galeone et al., 2013; Gollub S, 1967; Gravlee et al., 1992; Ichikawa et al., 2014; Kesteven et al., 1986; Kuitunen et al., 1991; Pifarre et al., 1989; Radulovic V et al., 2015; Shore- Lesserson et al., 1998; Subramaniam et al., 1995; Taneja et al., 2009; Teoh et al., 1993, 2004; Umlas et al., 1983) studies were included. The mean incidence of heparin rebound was 40%. The postoperative heparin levels, due to heparin rebound, were often below or equal to 0.2 IU/mL. We could not demonstrate an association between heparin rebound and postoperative blood loss or transfusion requirements. However the quality of evidence was poor due to a broad variety of definitions of heparin rebound, measured by various coagulation tests and studies with small sample sizes. Discussion and Conclusion(s): The influence of heparin rebound on postoperative bleeding seems to be negligible, but might get significant in conjunction with incomplete heparin reversal or other coagulopathies. For that reason, it might be useful to get a picture of the entire coagulation spectrum after cardiac surgery, as can be done by the use of a viscoelastic test in conjunction with an aggregometry test. <126> Accession Number 643013511 Title Impact of carotid artery stenosis on outcomes of transcatheter aortic valve replacement: a systematic review and meta-analysis. Source European Heart Journal. Conference: European Society of Cardiology Congress, ESC 2023. Amsterdam Netherlands. 44(Supplement 2) (no pagination), 2023. Date of Publication: 01 Nov 2023. Author Gibicoski T.B.; Caetano L.; Silva E.P.; Rodriguez F.A.; Scabello I.; Iplinski B. Institution (Gibicoski, Rodriguez) Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (Caetano) Federal University of Paraiba, Joao Pessoa, Brazil (Silva) Santo Amaro Hospital, Recife, Brazil (Scabello) Joao Pessoa University Center, Joao Pessoa, Brazil (Iplinski) Santa Casa de Misericordia Hospital, Porto Alegre, Brazil Publisher Oxford University Press Abstract Background/Introduction: Carotid Artery Stenosis (CAS) is common in elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR). However, the impact of CAS on the outcomes of TAVR is unclear. Purpose(s): This systematic review and meta-analysis aimed to compare the clinical and periprocedural outcomes in patients with and without CAS undergoing TAVR. Method(s): PubMed, Embase, and Cochrane databases were searched up to February 2023. We included studies that performed a direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data were extracted from published reports and the ROBINS-I tool was utilised for quality assessment. Review Manager 5.1 was adopted for statistical analysis. A random-effects model was used to calculate a pooled effect size and 95% confidence interval. Result(s): Five observational studies and 111,915 patients were included. Follow-up ranged from 30 days to 1 year. The mean age was 80.7 +/- 8.2 years and 46.3% were female. The risk of stroke or transient ischaemic attack was elevated in the group of patients with CAS (OR 1.44; 95% CI 1.05-1.99; p=0.02; Figure 1A). Similarly, there was an increased risk of myocardial infarction in the CAS group (OR 1.25; 95% CI 1.06-1.47; p= 0.008; Figure 1B). In contrast, all-cause mortality (OR 0.99; 95% CI 0.71-1.37; p=0.94; Figure 2A) and major bleeding (OR 1.14; 95% CI 0.98-1.32; p=0.08; Figure 2B) were not significantly different between CAS and non-CAS groups. There was also no significant difference in acute kidney injury (OR 0.99; 95% CI 0.79-1.23; p=0.99) and new pacemaker implantation (OR 0.95; 95% CI 0.70-1.30; p=0.76) between patients with and without CAS. Conclusion(s): Our findings suggest that CAS is significantly associated with cerebrovascular events and myocardial infarction in patients who undergo TAVR, without a significant impact on all-cause mortality. Further prospective studies are needed for a more granular assessment of additional determinants of this association, such as unilateral vs. bilateral involvement and whether there is a threshold of CAS severity for increased risk. <127> Accession Number 652011280 Title Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Circulation. Arrhythmia and electrophysiology. (pp e015245), 2026. Date of Publication: 21 Aug 2026. Author Rao A.; Ravi V.; Murthi M.; Chikatimalla R.; Talla V.; Nagaraj N.; Dhar G.; Jolly N.; Vij A. Institution (Rao) Department of Internal Medicine, Guthrie Robert Packer Hospital, PA (A.R.), Sayre, United States (Ravi) Division of Electrophysiology, Heart and Vascular Institute, Saint Francis Health System, Tulsa, United States (Murthi, Vij) Division of Cardiology, Cook County Health, Chicago, Mexico (Chikatimalla) Department of Cardiology, University of Miami Miller School of Medicine, FL (R.C.) (Talla) Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India (Nagaraj) Jagadguru Jayadeva Murugarajendra Medical College, Davanagere, India (Dhar, Jolly, Vij) Division of Cardiology, Rush University Medical Center, Chicago, N.J, Mexico Abstract BACKGROUND: Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation, but randomized controlled trials have primarily focused on composite end points, potentially obscuring differences in individual clinical outcomes. We compared the efficacy and safety of LAAC versus OAC with an emphasis on individual clinical outcomes. METHOD(S): A systematic review and meta-analysis of randomized controlled trials comparing LAAC with OAC in adults with atrial fibrillation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from January 2000 to March 2026. The primary efficacy end point was any stroke, and the primary safety end point was major bleeding. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model. RESULT(S): Six randomized controlled trials comprising 7004 patients (3681 LAAC; 3323 OAC) were included. LAAC was associated with a higher risk of ischemic stroke (RR, 1.41 [95% CI, 1.04-1.91]; P=0.03; 3.2% versus 2.1%), without a significant difference in any stroke (RR, 1.08 [95% CI, 0.82-1.42]; P=0.60) or the composite of stroke, systemic embolism, or death (RR, 0.99 [95% CI, 0.77-1.29]; P=0.96). Cardiovascular mortality (RR, 0.88; P=0.40) and all-cause mortality (RR, 0.92; P=0.36) were similar between groups. Major bleeding, including procedural events, did not differ significantly (RR, 0.93; P=0.40), although LAAC was associated with a significantly lower risk of nonprocedural major bleeding (RR, 0.57 [95% CI, 0.43-0.77]; P<0.01; 6.2% versus 10.7%). CONCLUSION(S): In patients with atrial fibrillation, LAAC is associated with a higher risk of ischemic stroke, but lower risk of nonprocedural major bleeding compared with OAC, with no significant differences in composite thromboembolic outcomes or mortality, underscoring the importance of individualized risk-benefit assessment in stroke prevention strategies. <128> Accession Number 2048643146 Title Organ Transplantation: Current Challenges and Emerging Innovations across Preservation, Immunology and Xenotransplantation. Source International Journal of Pharmacy Research and Technology. 16(2) (pp 3290-3299), 2026. Date of Publication: 01 Jul 2026. Author Sundresh N.J.; Kaviya; Velan K. Institution (Sundresh, Kaviya, Velan) Department of General Surgery, Government Medical College and Hospital, Cuddalore, India Publisher Advanced Scientific Research Abstract Background: Organ transplantation has evolved from a life-saving surgical intervention into a multidisciplinary field integrating immunology, bioengineering, and data science. Despite major advances in donor management, perioperative care, and immunosuppression, long-term outcomes remain constrained by a persistent global shortage of transplantable organs, ischemia-reperfusion injury, chronic rejection, and the toxicity of lifelong immunosuppression. Objective(s): To synthesize contemporary evidence on the principal challenges facing organ transplantation and the innovations being deployed against them, spanning organ donation and allocation policy, ex vivo machine perfusion, immune monitoring and tolerance induction, and xenotransplantation. Method(s): A structured narrative review of the literature indexed in PubMed, Embase, and Scopus was performed, prioritizing randomized controlled trials, prospective multicenter registries, and current (2023-2026) systematic reviews and position papers, including recent International Xenotransplantation Association consensus statements and Lancet Commission publications. Domains reviewed included donation after circulatory death (DCD) and allocation policy, hypothermic and normothermic machine perfusion across liver, kidney, and heart transplantation, donor-derived cell-free DNA (dd-cfDNA) as a rejection biomarker, precision immunomodulation and tolerance-induction strategies, and clinical xenotransplantation. Result(s): DCD donors accounted for approximately 23% of deceased donors globally in 2022, with markedly higher and rapidly rising utilization in the United States, Spain, and Belgium, and DCD recovery has risen across every major organ type in recent US national data. Machine perfusion trials show a consistent pattern: hypothermic oxygenated perfusion has most reliably improved clinically relevant outcomes such as delayed graft function and biliary complications, while normothermic perfusion, despite improving logistics, organ utilization, and early graft injury markers in liver transplantation (a 300-patient multicenter RCT), has not consistently translated into improved graft or patient survival, and a UK kidney RCT (n=338) found no reduction in delayed graft function with a brief period of normothermic perfusion. Donor-derived cell-free DNA has emerged as a validated, non-invasive rejection biomarker, achieving an AUC of 0.789 for biopsy-proven acute rejection in a multicenter kidney registry of 1,743 recipients, though performance varies by organ, timing, and surveillance versus for-cause context, and sensitivity in some surveillance settings has been reported as low as 0%. Precision immunomodulation strategies-regulatory T-cell therapy, tolerogenic dendritic cells, gene-edited cellular platforms, and biomarker-guided minimization-remain in early clinical development, with successful immunosuppression weaning reported only in small cohorts. Xenotransplantation has progressed rapidly since the first genetically modified pig heart transplant in January 2022: as of late 2025, at least six pig kidney, two pig heart, and one pig liver compassionate-use or early-phase clinical cases have been reported, with the longest pig-to-human kidney survival now standing at 271 days under a regulated multicenter trial, alongside the initiation of the first formal multi-patient xenotransplantation clinical trials following FDA clearance in 2024-2025. Conclusion(s): Organ transplantation is being reshaped simultaneously along four fronts-expanded donation strategies, ex vivo organ reconditioning, non-invasive immune monitoring, and xenotransplantation-each addressing a distinct facet of the field's core constraints of organ scarcity and immune-mediated graft loss. Machine perfusion and dd-cfDNA monitoring are approaching mainstream clinical adoption, while tolerance-induction strategies and xenotransplantation remain earlier-stage but are advancing at a pace substantially faster than historical precedent. Continued progress will depend on larger randomized trials with hard clinical endpoints, standardized biomarker validation, and carefully governed expansion of xenotransplantation and DCD programs within evolving regulatory and ethical frameworks. Copyright © 2026, Advanced Scientific Research. All rights reserved. <129> Accession Number 2038756056 Title Outcomes of Endovascular Repair Confined to the Ascending Thoracic Aorta: A Systematic Review and Meta-Analysis. Source Journal of Vascular Surgery. Conference: ESVS Annual Meeting 2025. Istanbul Turkey. 81(6) (pp 1529), 2025. Date of Publication: 01 Jun 2025. Author de Kort J.F.; Mandigers T.J.; Bissacco D.; Domanin M.; Piffaretti G.; Twine C.P.; Wanhainen A.; van Herwaarden J.A.; Trimarchi S.; de Vincentiis C. Publisher Elsevier Inc. Abstract Objective: High risk, inoperable patients with ascending aortic disease are increasingly managed with thoracic endovascular aortic repair (TEVAR). The aim of this study was to assess the available literature on TEVAR confined to the ascending aorta (a-TEVAR), describing study and patient characteristics, procedural and stent graft details, and outcomes. Data sources: This was a systematic review and meta-analysis. MEDLINE, Web of Science, and Scopus were systematically searched for eligible studies reporting on outcomes after a-TEVAR (PROSPERO ID: CRD42023440826). Eligible studies reported outcomes after a-TEVAR without adjunctive supra-aortic vessel treatment. Review Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The ROBINS-I and Joanna Briggs Institute Critical Appraisal Checklist were used as quality assessment tools. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence certainty analysis was performed for the main outcomes. The main outcome was death. A proportional meta-analysis was performed with a mean and 95% confidence interval (CI) for the main outcomes. All articles were included up to 1 January 2024. Result(s): Ninety four studies were included (19 cohort studies, 75 case reports or series), reporting on 259 patients (57.8% male). The mean age was 69.1 (95% CI 65.0 - 73.1) years and mean follow up 19.6 (95% CI 14.5 - 24.6) months. The most common comorbidity was prior cardiac or thoracic surgery (n = 191). The most frequent indications for a-TEVAR (52.1% urgent a-TEVAR) were type A aortic dissection (43.6%) and pseudoaneurysm (38.6%). The most commonly deployed stent grafts were Gore (44.5%), Cook (23.5%), and Medtronic (17.0%). The in hospital mortality rate was 7.3% (95% CI 4.7 - 11.2%), 30 day mortality rate 7.7% (95% CI 5.1 - 11.6%), and overall mortality rate 17.0% (95% CI 12.9 - 22.0%) during follow up. GRADE showed very low evidence certainty for all outcomes. Eighty eight complications were reported and there was a re-operation rate of 13.1% (95% CI 9.5 - 17.8%). In hospital and 30 day mortality rates for type A dissection were 12.4% (95% CI 7.5 - 19.7%) (n = 14) and 13.3% (95% CI 8.2 - 20.8%) (n = 15), respectively, and for pseudoaneurysm 4.0% (95% CI 1.6 - 9.8%) (n = 4) and 4.0% (95% CI 1.6 - 9.8) (n = 4), respectively. Conclusion(s): Despite heterogeneous literature and very low GRADE evidence certainty, a-TEVAR seems technically feasible in high risk patients. In addition, there is need for a consensus on when and how to use a-TEVAR and a need for a specific endograft for use in the ascending aorta. <130> Accession Number 2038440130 Title Left atrial appendage closure with the AnchorMan or Watchman devices: 12-month results of the SAFE-PROTECT randomised trial. Source EuroIntervention. 22(13) (pp e720-e729), 2026. Date of Publication: 06 Jul 2026. Author Wang B.; Cai H.; Wu Y.; Chen M.; Wang C.; Jiang X.; Tao S.; Zhong Z.; Zeng J.; Wang F.; Ning Z.; Yuan Z.; He J.; Francese D.P.; Lansky A.J.; He B.; Chu H. Institution (Wang, Chu) Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, China (Cai) Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China (Wu) Department of Cardiology, Second Affiliated Hospital of Nanchang, Nanchang, China (Chen) Department of Cardiology, Central Hospital of Wuhan, Wuhan, China (Wang) Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Jiang) Department of Cardiology, Zhuhai People's Hospital, Zhuhai, China (Tao) Department of Cardiology, Second People's Hospital of Yunnan Province, Kunming, China (Zhong) Department of Cardiology, Meizhou People's Hospital, Meizhou, China (Zeng) Department of Cardiology, Sichuan Provincial People's Hospital, Chengdu, China (Wang) Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China (Ning) Department of Cardiology, Shanghai Pudong New District Zhoupu Hospital, Shanghai, China (Yuan) Department of Cardiology, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China (He) Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (Francese, Lansky) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States (He) Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China Publisher Europa Group Abstract BACKGROUND: Percutaneous closure of the left atrial appendage (LAA) is an alternative to chronic oral anticoagulation to reduce stroke risk in patients with non-valvular atrial fibrillation (AF). AIMS: The SAFE-PROTECT trial was designed to evaluate the safety and efficacy of the AnchorMan, a novel LAA closure device, compared with the Watchman 2.5 device for patients with AF at high risk of ischaemic stroke. METHOD(S): SAFE-PROTECT was a multicentre, open-label, non-inferiority trial of patients with non-valvular AF at high risk of ischaemic stroke, randomised 1:1 to LAA closure with the AnchorMan or the Watchman device. The 12-month primary endpoint was clinical success (freedom from ischaemic/haemorrhagic stroke, systemic embolism, cardiovascular or unexplained death); the secondary efficacy endpoint was echocardiography-defined LAA occlusion (peridevice leak 0.99; difference -0.3; 95% confidence interval [CI]: -3.9 to 3.5; pnon-inferiority=0.0004) and the powered secondary efficacy endpoint of LAA closure (100% vs 100%; difference 0%; 95% CI: -3.60 to 3.50; pnon-inferiority=not applicable). The rates of all-cause death, stroke, major bleeding, and device-related complications were low and similar between groups. CONCLUSION(S): Among patients with non-valvular AF at high risk of ischaemic stroke, the AnchorMan device met its prespecified non-inferiority primary clinical success and secondary LAA occlusion endpoints compared with the Watchman 2.5 device. ClinicalTrials.gov: NCT04479722. Copyright © Europa Group 2026. All rights reserved. <131> Accession Number 2048441588 Title Multivessel coronary artery bypass grafting via small thoracotomy versus sternotomy (MIST): an investigator-initiated, international, open-label, randomised controlled trial. Source The Lancet. 408(10556) (pp 711-720), 2026. Date of Publication: 22 Aug 2026. Author Ruel M.; Nambala S.; Guo M.H.; Verevkin A.; Rabindranauth P.; Kikuchi K.; Davierwala P.M.; Lemma M.; Ponnambalam M.; Sheikh A.; Black A.; Borger M.A.; Whitlock R.P.; Zhang Y.; Wells G.A. Institution (Ruel, Guo, Sheikh, Black, Zhang) Department of Surgery, University of Ottawa, Ottawa, ON, Canada (Nambala) Department of Surgery, Apollo Hospitals, Bengaluru, India (Verevkin, Borger) University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany (Rabindranauth) Department of Cardiothoracic Surgery, Gundersen Health System, La Crosse, WI, United States (Kikuchi) Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (Davierwala) Department of Surgery, University of Toronto, Toronto, ON, Canada (Lemma) Department of Surgery, Jilin Heart Hospital, Changchun, China (Ponnambalam) Department of Surgery, University of British Columbia, Vancouver, BC, Canada (Whitlock) Department of Surgery, McMaster University, Hamilton, ON, Canada (Wells) School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Publisher Elsevier B.V. Abstract Background Coronary artery bypass grafting (CABG) is a common but invasive operation traditionally performed through a median sternotomy. Minimally invasive cardiac surgery (MICS) CABG via small thoracotomy might improve postoperative recovery, but randomised evidence has been scarce. We aimed to compare patient-reported recovery after MICS CABG versus sternotomy CABG in patients with multivessel coronary artery disease and to describe clinical and safety outcomes. Methods MIST was an investigator-initiated, international, open-label, randomised controlled trial done at seven centres (four academic hospitals and three community hospitals) in Canada, India, China, Germany, the USA, and Japan. Patients referred to participating surgeons for CABG were eligible if they were aged 18 years or older; had angiographically confirmed multivessel coronary artery disease, defined as lesions of at least 70% stenosis in at least two major epicardial vessels and at least two separate coronary artery territories (left anterior descending artery, left circumflex artery, or right coronary artery) or left main coronary stenosis of 50% or more; and were suitable for coronary surgery both with sternotomy CABG and MICS CABG. Patients who were haemodynamically compromised, had contraindications to either approach, had had previous cardiac surgery, or required concomitant procedures were excluded. Eligible patients were randomly assigned (1:1) to MICS CABG or sternotomy CABG by a central, web-based system, stratified by centre, with block sizes of four and six. The primary endpoint was patient-reported physical recovery at 1 month, assessed by the 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS) score. The primary analysis was by intention to treat; safety analyses were done according to treatment received. Missing 1-month questionnaire data were handled by multiple imputation. The trial was registered with ClinicalTrials.gov ( NCT03447938 ), and is closed to recruitment. Findings Between Aug 24, 2018, and Nov 26, 2024, 176 patients were enrolled, 170 of whom were randomly assigned to MICS CABG (n=86) or sternotomy CABG (n=84). The median age of patients was 67.0 years (IQR 61.0-72.0), 154 (91%) patients were male, and 16 (9%) were female. At 1 month after surgery, SF-36 PCS scores were significantly higher in the MICS CABG group than in the sternotomy CABG group (mean 45.1 [SD 8.0] vs 42.2 [9.1]; mean difference 2.9 [95% CI 0.3-5.5]; p=0.031). Clinical and safety follow-up at 1 month was complete in all patients; 12-month clinical and safety follow-up was complete in all except three patients in the sternotomy CABG group. Up to 12 months after surgery, there were no deaths or strokes in either group; one major adverse cardiac or cerebrovascular event occurred in the MICS CABG group before 1 month and none in the sternotomy CABG group. Interpretation For selected patients with multivessel coronary artery disease, MICS CABG performed by experienced teams improved patient-reported physical recovery at 1 month compared with sternotomy CABG, with no apparent safety penalty through to 12 months. These findings support consideration of MICS CABG in appropriately selected patients treated by experienced teams, and further studies of implementation, recovery pathways, and long-term outcomes. Funding Medtronic. Copyright © 2026 Elsevier Ltd. <132> Accession Number 2048368739 Title Risk factors for diaphragmatic dysfunction in mechanically ventilated patients: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1828707. Date of Publication: 2026. Author Che R.; Pan S.; Han J.; Ma Q.; Xue A. Institution (Che, Xue) Qinghai University, Xining, China (Pan, Han, Ma) Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining, China Publisher Frontiers Media SA Abstract Objective - To systematically identify and evaluate the risk factors for diaphragmatic dysfunction (DD) in mechanically ventilated patients. Methods - A comprehensive search of PubMed, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM was conducted from database inception through July 2025. Case-control, cohort, and cross-sectional studies reporting risk factors for DD in mechanically ventilated patients were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias. Meta-analyses were performed using Review Manager 5.4. Results - Eleven studies comprising 5, 272 mechanically ventilated patients were included (7 cohort, 1 case-control, 3 cross-sectional). Meta-analysed risk factors: infection/sepsis (OR = 2.65, 95% CI: 1.32-5.34, p = 0.006), higher APACHE II score (OR = 1.19, 95% CI: 1.09-1.30, p < 0.0001), older age (OR = 1.02, 95% CI: 1.00-1.04, p = 0.02), and higher BMI (OR = 1.03, 95% CI: 1.01-1.06, p = 0.02) were each independently associated with increased DD risk. Meta-analysed protective factors: higher serum albumin (OR = 0.88, 95% CI: 0.79-0.98, p = 0.018) and greater grip strength (OR = 0.70, 95% CI: 0.62-0.78, p < 0.0001) were protective. Narrative-only findings: MV-related exposures could not be pooled owing to incompatible operationalisations across five studies; surgery-related factors (CABG, valve replacement, CPB duration) yielded inconclusive results due to extreme inter-study heterogeneity (I 2 = 88-95%). Conclusion - Sepsis/infection, disease severity, advanced age, and elevated BMI are independent risk factors for DD in mechanically ventilated patients, whereas adequate nutritional status and preserved muscle strength are protective. Early identification of high-risk patients, nutritional optimisation, and infection control may reduce DD incidence. Systematic review registration - The publicly accessible registration URL is: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261302793, this systematic review was registered with PROSPERO under the unique identifier CRD420261302793. Copyright © 2026 Che, Pan, Han, Ma and Xue. <133> Accession Number 652001759 Title Intravenous iron to treat anaemia before cardiac surgery (ITACS): international, double blind, placebo controlled randomised trial. Source BMJ (Clinical research ed.). 394 (pp e100407), 2026. Date of Publication: 19 Aug 2026. Author Myles P.S.; Klein A.A.; Smith J.A.; Wallace S.; Forbes A.; Zavarsek S.; Symons J.A.; Baker R.A.; Wood E.M.; McQuilten Z.; McGiffin D.; Christie-Taylor G.; Soon C.K.; Chan M.T.V.; Martin C.; Richards T. Institution (Myles, Wallace, Symons, McQuilten, McGiffin) Alfred Hospital, Melbourne, VIC, Australia (Myles, Smith, Wallace, Forbes, Wood, McQuilten, Martin) Monash University, Melbourne, VIC, Australia (Klein) Royal Papworth Hospital, Cambridge, United Kingdom (Smith, Wood) Monash Health, Clayton, VIC, Australia (Zavarsek) Deakin University, Burwood, VIC, Australia (Symons) University of Melbourne, Melbourne, VIC, Australia (Baker) Flinders Medical Centre and Flinders University, Adelaide, SA, Australia (Christie-Taylor) Royal Adelaide Hospital, Adelaide, SA, Australia (Soon) Institut Jantung Negara, Kuala Lumpur, Malaysia (Chan) Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (Richards) School of Health, Sport & Bioscience, University of East London, London, United Kingdom Abstract OBJECTIVE: To evaluate the effects of intravenous iron on red cell transfusion and recovery after cardiac surgery. DESIGN: International, multicentre, double blind, placebo controlled randomised trial (ITACS). SETTING: 33 hospitals across 10 countries. Participants were enrolled between July 2016 and December 2023. PARTICIPANTS: 955 adults with anaemia undergoing elective cardiac surgery. Exclusion criteria included haemoglobinopathy or iron storage disorder, renal dialysis, and erythropoietin or intravenous iron given in the previous four weeks. INTERVENTION: A computer generated program randomised participants to intravenous iron 1000 mg or placebo 1-26 weeks before surgery. Participants, clinicians, and data collectors were masked to the intervention. MAIN OUTCOME MEASURES: The number of days alive and at home up to 90 days after surgery (primary outcome), red cell transfusion requirements and complications (secondary outcomes). RESULT(S): Of 2993 screened participants, 955 were enrolled and 921 of the eligible 939 modified intention-to-treat participants were assessed for the primary outcome. The median number of days alive and at home up to 90 days after surgery was 81.1 (interquartile range 74.8-83.7) in patients assigned to intravenous iron and 80.0 (69.5-83.6) in those receiving placebo (adjusted median difference 1.0 day, 95.4% confidence interval 0.0 to 2.1 days, P=0.041). Red cell transfusions were given to 262 patients (61.1%) in the iron group and 302 (68.2%) in the placebo group during their hospital stay (relative risk 0.90, 95% confidence interval 0.82 to 0.99, P=0.027). No differences were observed for major complications or length of hospital stay. CONCLUSION(S): Among patients with anaemia undergoing elective cardiac surgery, preoperative intravenous iron was associated with a reduction in red cell transfusion and a small improvement in the number of days alive and at home in the first 90 days after surgery. Intravenous iron is an effective component of patient blood management in this setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT02632760. Copyright © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. <134> Accession Number 2038531596 Title Safety of exercise after pulmonary endarterectomy: a systematic review. Source ERJ Open Research. 12(4) (no pagination), 2026. Article Number: 01449-2025. Date of Publication: 01 Jul 2026. Author Page A.; Mares K.; McCormack C. Institution (Page) Department of Physiotherapy, Royal Papworth Hospital, Cambridge, United Kingdom (Mares) School of Health Sciences, University of East Anglia, Norwich, United Kingdom (McCormack) Department of Sport Science and Nutrition, Faculty of Science and Engineering, Maynooth University, Kildare, Ireland (McCormack) National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland Publisher European Respiratory Society Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism, leading to high pulmonary arterial pressures. Pulmonary endarterectomy (PEA) surgery is the gold standard treatment for CTEPH, significantly improving patient outcomes. Post-operative cardiac remodelling is an important consideration, highlighting the need to balance early exercise with potential impacts on cardiac recovery. The objective of the present study was to investigate the safety and feasibility of early exercise interventions following PEA surgery for CTEPH, and to review the existing literature on early exercise interventions post-PEA. Methods A systematic review was conducted using the AMED, CINAHL, Embase and MEDLINE databases. Search terms included "pulmonary endarterectomy", "chronic thromboembolic pulmonary hypertension", "exercise", "exercise training", "mobility" and "rehabilitation". Studies were included if they involved adult patients with CTEPH who underwent PEA and participated in post-operative exercise interventions. Results The review identified studies with small, heterogeneous patient cohorts engaging in early post-operative exercise following PEA. Interventions included walking, cycling, dumbbell exercises and respiratory training. Safety measures, such as continuous monitoring of oxygen levels and heart rate, were implemented and no adverse events were reported. Improvements in exercise capacity and right heart measurements were observed, suggesting that early exercise is both safe and beneficial. Conclusion Early exercise interventions following PEA surgery appear safe and feasible, with potential benefits for exercise capacity and cardiac remodelling. Future research should include randomised controlled trials and qualitative studies to confirm these findings and assess impacts on patient quality of life. Copyright © The authors 2026. <135> Accession Number 2038523441 Title Comparative study of intravenous clonidine versus fentanyl in attenuating hemodynamic response to laryngoscopy and tracheal intubation. Source Asian Journal of Medical Sciences. 17(8) (pp 17-22), 2026. Date of Publication: 02 Aug 2026. Author Tiwari A.K.; Dutta P.; Maurya P.; Rathour P.; Singh S. Institution (Tiwari) Department of Anaesthesia and Operation Theatre Technology, Atal Bihari Vajpayee Medical University, Uttar Pradesh, Lucknow, India (Dutta) Department of Physiology, PES University Institute of Medical Sciences and Research, Karnataka, Bengaluru, India (Maurya) Department of Anaesthesia and Operation Theatre Technology, DIT University, Uttarakhand, Dehradun, India (Rathour) Department of Anaesthesia and Operation Theatre Technology, Government Institute of Medical Sciences, Uttar Pradesh, Greater Noida, India (Singh) Department of Anaesthesia and Operation Theatre Technology, Gopal Narayan Singh University, Bihar, Jamuhar, India Publisher Manipal Pokhara College of Medical Science Abstract Background: Laryngoscopy and tracheal intubation trigger a transient sympathetic surge causing tachycardia and hypertension, which can be harmful in patients with comorbidities. Clonidine and fentanyl are used to attenuate this response, but comparative evidence on their effectiveness is limited. Aims and Objectives: The aim of the study is to evaluate and compare the effectiveness of intravenous (IV) clonidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. Material(s) and Method(s): A prospective, randomized study was conducted over 6 months involving 80 adult patients (American Society of Anaesthesiologists physical status I and II), aged 18-65 years, scheduled for non-cardiovascular elective surgeries under general anesthesia. Patients were randomly assigned to two groups: Group C received IV clonidine (4 mug/kg) and Group F received IV fentanyl (2 mug/kg) approximately 5 min before intubation. Hemodynamic parameters - systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO<inf>2</inf>) - were recorded at baseline, pre-intubation, during intubation, and at 1, 3, and 5 min post-intubation. Statistical analysis was performed using independent t-tests and one-way analysis of variance. Result(s): Both groups exhibited attenuation of hemodynamic responses. SBP at 5-min post-intubation was significantly lower in the fentanyl group (P=0.037). However, inter-group differences in DBP, MAP, HR and SpO<inf>2</inf> were not statistically significant. Intra-group analysis revealed transient fluctuations in SBP, DBP, and MAP post-intubation, with HR and SpO<inf>2</inf> remaining stable. Conclusion(s): Both IV clonidine and fentanyl are effective in blunting the hemodynamic response to laryngoscopy and intubation. The choice between the two may be guided by patient profile, comorbidities, and anesthetic context. Copyright © 2026 Asian Journal of Medical Sciences. <136> Accession Number 2048164040 Title Coronary artery bypass grafting in women: optimizing operative outcomes. Source Current Opinion in Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Constantakis S.; Lamarche-Silmser K.; Reed E.; Clarizia N.A.; Ruel M.; Sozzi F.B. Institution (Constantakis) Faculty of Medicine, University of Ottawa, United States (Constantakis, Lamarche-Silmser) Division of Cardiac Surgery, Ottawa Heart Institute Research Corporation, United States (Reed, Clarizia, Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada (Sozzi) Department of Cardio-Thoracic-Vascular Diseases, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Women undergoing coronary artery bypass grafting (CABG) continue to experience worse perioperative and long-term outcomes than men despite advances in surgical techniques and perioperative care. This review summarizes contemporary evidence on sex-related differences in coronary artery disease (CAD), surgical outcomes, and secondary prevention. Gaps in the current evidence are identified and priorities for optimizing outcomes and informing sex-specific clinical practice are highlighted. Recent findings - Women present with distinct patterns of CAD, including higher prevalence of microvascular dysfunction and nonobstructive disease, contributing to delayed diagnosis and referral for surgical revascularization. Women are less likely to receive guideline-recommended revascularization strategies, including multiple arterial grafting. Women also experience higher rates of graft failure, mortality, and stroke after CABG. Emerging observational evidence suggests that off-pump and minimally invasive CABG approaches may reduce the disparities in female patients, although randomized sex-specific data remains limited. Secondary prevention remains suboptimal, with persistent gaps in implementation of guideline-directed therapies. Summary - Significant disparities persist across the continuum of care for women undergoing CABG, from diagnosis through long-term secondary prevention. Improving equitable implementation of evidence-based surgical strategies, increasing representation of women in randomized clinical trials, and developing sex-specific evidence are essential to optimize outcomes and inform future clinical guidelines. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <137> Accession Number 2048497603 Title Deep versus moderate hypothermia in pediatric cardiac surgery: Systematic review and meta-analysis of early postoperative outcomes. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Zoupas I.; Covell J.M.; Cruz Naranjo J.; Podgorsek B.; Chen P.C.; LaPar D.J.; Greenleaf C.E. Institution (Zoupas, Covell, Cruz Naranjo, Chen, LaPar, Greenleaf) Division of Pediatric and Congenital Cardiac Surgery, Department of Cardiothoracic and Vascular Surgery, Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX, United States (Podgorsek) Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX, United States Publisher SAGE Publications Ltd Abstract Introduction: Deep hypothermia (DH) has been widely adopted for cerebral and visceral protection during pediatric cardiac surgery, but concerns about perioperative complications remain. This meta-analysis aims to evaluate the impact of DH compared to moderate hypothermia (MH) on outcomes in pediatric cardiac surgery patients. Method(s): Following a PRISMA-compliant systematic search in PubMed, Cochrane, and Embase, eligible studies comparing DH (<22degreeC) with MH (22-30degreeC) in pediatric cardiac surgery were assessed. Risk of bias was evaluated using the ROBINS-I tool. Result(s): Five comparative studies with 448 patients (250 in the MH group and 198 in the DH group) were included. Baseline characteristics were similar between groups, with the majority of patients undergoing aortic arch repairs. Perioperative variables were also similar, except for cross-clamp time, which was significantly longer in the DH group (p = 0.02), and circulatory arrest was more frequently used in DH patients (p = 0.01). No significant differences were found in overall postoperative complication rates, acute kidney injury, 24-h chest drainage volume, or in-hospital mortality. However, the incidence of early postoperative neurological complications was significantly higher in the DH group (p < 0.001). Conclusion(s): Moderate hypothermia may be associated with a significantly lower incidence of postoperative neurological complications compared to deep hypothermia, while overall in-hospital mortality and morbidity rates remained similar between the two groups. Taken together, these findings support moderate hypothermia with regional perfusion as a clinically feasible and well-tolerated alternative to deep hypothermia in pediatric cardiac surgery. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <138> Accession Number 652003351 Title Clopidogrel Versus Dual-Antiplatelet Therapy for Long-Term Maintenance After Coronary Stenting in Ischemic and Bleeding Birisk Patients With Acute Coronary Syndromes and Diabetes: A Prespecified Subgroup Analysis of the OPT-BIRISK Trial. Source Journal of the American Heart Association. (pp e049178), 2026. Date of Publication: 20 Aug 2026. Author Zhang D.; Li Y.; Qiu M.; Zhou Y.; Chen S.; Pei H.; Liu J.; Xu B.; Han Y.; Stone G.W. Institution (Zhang, Li, Qiu, Han) State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology General Hospital of Northern Theater Command, Cardiovascular Research Institute Shenyang China, China (Zhou, Liu) Beijing Anzhen Hospital, Capital Medical University Beijing China, China (Chen) Nanjing First Hospital, Nanjing Medical University Nanjing China, China (Pei) First Affiliated Hospital of Baotou Medical College Baotou China, China (Xu) Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University Nanjing China, China (Stone) Icahn School of Medicine at Mount Sinai New York NY Abstract BACKGROUND: Among patients with acute coronary syndromes at both high bleeding and ischemic risk (birisk), extended clopidogrel monotherapy after 9 to 12 months of dual-antiplatelet therapy reduces bleeding without increasing ischemia. Whether this benefit extends to birisk patients with diabetes is unknown. METHOD(S): This prespecified subgroup analysis of the OPT-BIRISK (Optimal Antiplatelet Therapy for High Bleeding and Ischemic Risk Patients) trial included birisk patients with acute coronary syndrome who had completed 9 to 12 months of dual-antiplatelet therapy after percutaneous coronary intervention. Patients were then randomized 1:1 to 9 months of clopidogrel plus placebo versus clopidogrel plus aspirin. Outcomes were compared by diabetes status. The primary end point was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding at 9 months after randomization. The key secondary end point was major adverse cardiac and cerebral events, defined as a composite outcome of all-cause death, myocardial infarction, stroke, or clinically driven revascularization. RESULT(S): Of 7758 patients, 4072 (52.5%) had diabetes. Clopidogrel monotherapy decreased Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (2.1% versus 3.2%; hazard ratio [HR], 0.66 [95% CI, 0.45-0.97]) with no increase in major adverse cardiac and cerebral events (2.9% versus 3.6%; HR, 0.79 [95% CI, 0.56-1.12]) compared with clopidogrel plus aspirin in patients with diabetes. Outcomes were consistent in patients without diabetes, with no significant interactions by diabetes status. CONCLUSION(S): In birisk patients with acute coronary syndrome who were stable on dual-antiplatelet therapy with clopidogrel plus aspirin for 9 to 12 months after percutaneous coronary intervention, clopidogrel monotherapy for an additional 9 months reduced clinically relevant bleeding without increasing ischemic events compared with continued dual-antiplatelet therapy, irrespective of diabetes status. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT03431142. <139> [Use Link to view the full text] Accession Number 652000868 Title Hypotension Prediction Index versus Mean Arterial Pressure Alarm for Preventing Intraoperative Hypotension in Elective Non-Cardiac Surgery: A Randomized Controlled Trial. Source Anesthesiology. (no pagination), 2026. Date of Publication: 19 Aug 2026. Author Florax A.A.; Mulder M.P.; van Ieperen R.P.; Fresiello L.; Donker D.W.; Potters J.-W. Institution (Florax) Department of Anesthesiology, Medisch Spectrum Twente, Netherlands & Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Technical physician, Enschede, Netherlands (Mulder) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Technical physician, Enschede, Netherlands (van Ieperen) Department of Anesthesiology, Medisch Spectrum Twente, Anesthesiologist, Enschede, Netherlands (Fresiello) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Biomedical engineer, Enschede, Netherlands (Donker) Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Netherlands & Intensive Care Center, University Medical Center Utrecht, Enschede, Utrecht, Netherlands (Potters) Department of Anesthesiology, Medisch Spectrum Twente, Netherlands & Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Anesthesiologist, Enschede, Netherlands Abstract BACKGROUND: Intraoperative hypotension is common during surgery and has been retrospectively associated with acute kidney injury, myocardial injury, and increased mortality. The Hypotension Prediction Index was developed to support proactive blood pressure management, but shows a strong correlation with mean arterial pressure. Observational data suggest that a mean arterial pressure alarm set at 72 mmHg may perform similarly to the default Hypotension Prediction Index alarm (>85). We hypothesized that a 72 mmHg mean arterial pressure alarm is non-inferior to the Hypotension Prediction Index in preventing intraoperative hypotension. METHOD(S): In this single-center, blinded, randomized controlled trial, adults undergoing moderate- or high-risk elective non-cardiac surgery with continuous arterial pressure monitoring were assigned to either a mean arterial pressure alarm (<72 mmHg) or a Hypotension Prediction Index alarm (>85). The primary outcome was the area under the threshold for mean arterial pressure <65 mmHg. Secondary outcomes included the incidence and severity of hypo- and hypertension, duration of active alarms, incidence of acute kidney and myocardial injury, 30-day mortality, hospital length of stay, and cumulative dosages of vasoactive medication and fluids. RESULT(S): 143 participants were included in the final analysis. The median area under the hypotension threshold was 3.75 [0.00-22.62] mmHgmin in the mean arterial pressure group and 4.00 [0.00-19.00] mmHgmin in the Hypotension Prediction Index group. After log-transformation, the mean difference was 0.03 (95% CI: -0.24 to 0.29), with the lower bound remaining above the predefined non-inferiority margin (-0.4). No differences were observed in secondary hemodynamic metrics, alarm characteristics, patient outcomes, or administered medications and fluids. CONCLUSION(S): A mean arterial pressure alarm of 72 mmHg is non-inferior to the Hypotension Prediction Index >85 in preventing intraoperative hypotension. Given its simplicity and broad availability, a MAP alarm of 72 mmHg represents a pragmatic and cost-effective alternative for proactive blood pressure management. Copyright © 2026 American Society of Anesthesiologists. All Rights Reserved. <140> Accession Number 2048511792 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. 302 (no pagination), 2026. Article Number: 107544. Date of Publication: 01 Dec 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, Conen, Van Reekum, Bangdiwala, Balasubramanian, Bashir, Rangarajan, Agapay, Yusuf) Population Health Research Institute, Hamilton, ON, Canada (Wong, Conen, Doumouras, Van Reekum, Bangdiwala, Anvari, Yusuf) Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada (Doumouras, Anvari) Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada (Piche, Pettigrew, Poirier) Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, 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, Hospital Nove 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, Saint-Charles-Borromee, 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) Department of Medicine, Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Research Institute, Barcelona, Spain Publisher Elsevier Inc. 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. Methods BRAVE is an investigator-initiated, multi-center, open-label RCT with blinded endpoint adjudication comparing MBS vs 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, behavioral, 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. Results 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. Conclusions BRAVE is the first large RCT evaluating whether MBS safely reduces major cardiovascular events compared with medical therapy in high-risk patients with obesity. Trial Registration ClinicalTrials.gov Identifier: NCT05531474. Copyright © 2026 Elsevier Inc. <141> Accession Number 2038546462 Title Frailty and intraoperative hypotension as interrelated predictors of postoperative outcomes. Source International Journal of Medical Anesthesiology. 9(8) (pp 9-14), 2026. Date of Publication: 01 Aug 2026. Author Anshul Institution (Anshul) Postgraduate Institute of Medical Sciences, PGIMS, Haryana, Rohtak, India Publisher AkiNik Publications Abstract This article examines the relationship between frailty and intraoperative hypotension in the context of postoperative outcomes among non-cardiac surgical patients. The study was conducted as a systematic review of scientific publications followed by an analytical synthesis of evidence regarding patient physiological vulnerability, intraoperative hemodynamic instability, and the most significant postoperative complications. Particular attention is paid not to individual risk factors but to their interaction. A comparative analysis of contemporary approaches to frailty assessment, the characteristics of intraoperative hypotension, and their associations with delirium, acute kidney injury, myocardial injury, prolonged hospitalization, hospital readmissions, and mortality was performed. It was found that reduced physiological reserves are associated with increased sensitivity to intraoperative hemodynamic disturbances. At the same time, clinical significance is determined not only by the absolute level of arterial blood pressure. Equally important is the patient's ability to tolerate periods of relative tissue hypoperfusion. An original conceptual model is proposed that integrates frailty, intraoperative hypotension, and postoperative complications within a unified pathophysiological framework. The model considers intraoperative hypotension as an intermediate mechanism through which the risk associated with diminished physiological reserves is realized. The findings expand current understanding of the mechanisms underlying postoperative outcomes and may be of interest to specialists in anesthesiology, perioperative medicine, and gerontology. Copyright © 2026, AkiNik Publications. All rights reserved. <142> Accession Number 2048511036 Title Bivalirudin as an Alternative to Heparin in Pediatric Cardiac Procedures: Evidence, Challenges, and Future Directions. Source Sage Open Pediatrics. 13 (no pagination), 2026. Article Number: 30502225261479091. Date of Publication: 01 Jan 2026. Author Basit A.; Khaliq S.; Ahmed S.; Khan S.; Naeem H.; Haq M. Institution (Basit, Khaliq, Ahmed) Department of Pediatrics, King Edward Medical College, Punjab, Lahore, Pakistan (Khan) Department of Pediatrics, Bolan Medical College, Balochistan, Quetta, Pakistan (Naeem) Department of Pediatrics, SUNY Downstate Medical Center, NY, United States (Haq) Department of Pediatrics, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh Publisher SAGE Publications Ltd Abstract Unfractionated heparin remains the standard anticoagulant for pediatric cardiac procedures, but its drawbacks in children are hard to ignore. Because it works through antithrombin, its effect is unpredictable, dosing is difficult to titrate, and it carries the risk of heparin-induced thrombocytopenia (HIT). Bivalirudin, a direct thrombin inhibitor, inhibits thrombin without needing antithrombin. The pediatric evidence, though, is thin. Beyond one cardiac surgery trial and a few catheterization studies, most work comes from ECMO, along with growing use in pediatric ventricular assist device (VAD) support, where direct thrombin inhibitors have replaced heparin and now feature in society guidance. These studies show bivalirudin is feasible and predictable, but not that it consistently beats heparin. For now, its clearest role is in children who cannot tolerate heparin or whose anticoagulation is unstable. The field needs multicenter randomized trials, agreed-upon protocols, and monitoring built for children. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). <143> Accession Number 652005461 Title Redo-Transcatheter Aortic Valve Implantation Versus Surgical Explantation in Patients With Previous Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Source Journal of the American Heart Association. (pp e048885), 2026. Date of Publication: 20 Aug 2026. Author Ktenopoulos N.; Apostolos A.; Terentes-Printzios D.; Drakopoulou M.; Synetos A.; Latsios G.; Xaplanteris P.; Panoulas V.; Baumbach A.; Tsioufis K.; Toutouzas K. Institution (Ktenopoulos, Apostolos, Terentes-Printzios, Drakopoulou, Synetos, Latsios, Tsioufis, Toutouzas) First Department of Cardiology, Hippokration General Hospital of Athens National and Kapodistrian University of Athens Athens Greece, Greece (Ktenopoulos, Apostolos, Drakopoulou, Synetos, Latsios, Tsioufis, Toutouzas) Unit of Structural Heart Diseases, First Department of Cardiology, Medical School, Hippocration General Hospital of Athens National and Kapodistrian University of Athens Athens Greece, Greece (Apostolos, Panoulas) Royal Brompton and Harefield Hospitals Guy's and St Thomas' NHS Foundation Trust London United Kingdom, United Kingdom (Apostolos) Faculty of Medicine, Imperial College London London United Kingdom, United Kingdom (Xaplanteris) Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre Universite Libre de Bruxelles Brussels Belgium, Belgium (Panoulas) National Heart and Lung Institute Imperial College London London United Kingdom, United Kingdom (Baumbach) Center for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London and Barts Heart Center London United Kingdom, United Kingdom (Baumbach) Cleveland Clinic London United Kingdom, United Kingdom Abstract BACKGROUND: As transcatheter aortic valve implantation (TAVI) expands to younger and lower-risk populations, failed transcatheter heart valves are increasingly encountered, yet the optimal reintervention strategy remains uncertain. This meta-analysis aimed to compare the outcomes of redo-TAVI (TAVI-in-TAVI) versus surgical transcatheter heart valve explantation with surgical aortic valve replacement (TAVI-explantation) after transcatheter heart valve failure. METHOD(S): PubMed/Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched from inception to September 10, 2025 for comparative studies. The primary outcome was all-cause mortality (in-hospital, 30-day, and 1-year). Secondary outcomes included cerebrovascular events, major adverse cardiac events, permanent pacemaker implantation, greater-than-mild paravalvular leak, major bleeding, length of stay, and 30-day readmission. As the primary analysis, reconstructed individual patient-level data were analyzed using Firth penalized logistic regression adjusting for study, and complementary random-effects meta-analyses were also used. RESULT(S): Eight observational studies including 6166 patients (3743 redo-TAVI; 2425 TAVI-explantation) were analyzed. Compared with TAVI-explantation, redo-TAVI was associated with lower in-hospital mortality (odds ratio [OR], 0.20 [95% CI, 0.11-0.35]; P<0.0001), 30-day mortality (OR, 0.28 [95% CI, 0.23-0.34]; P<0.0001), and 1-year mortality (OR, 0.70 [95% CI, 0.62-0.80]; P<0.0001). No significant differences were observed in cerebrovascular events or permanent pacemaker implantation rates. Redo-TAVI was associated with lower major bleeding (OR, 0.35 [95% CI, 0.24-0.50]; P<0.0001), fewer 30-day readmissions (OR, 0.53 [95% CI, 0.30-0.92]; P=0.023), and shorter hospitalization (Mean Difference -6.29 days [95% CI, -8.66 to -3.93), but a higher risk of greater-than-mild paravalvular leak (OR, 80.12 [95% CI, 11.30-10 153]; P<0.0001). CONCLUSION(S): Redo-TAVI was associated with lower early and 1-year mortality, reduced bleeding, and shorter hospitalization compared with TAVI-explantation, with similar cerebrovascular event and permanent pacemaker implantation rates but higher paravalvular leak risk. These findings support redo-TAVI as the preferred reintervention strategy in anatomically suitable patients, whereas randomized trials and longer-term follow-up are needed to refine lifetime management strategies after transcatheter heart valve failure. <144> Accession Number 2048491938 Title Impact of Genetic Testing Among Patients With Familial Hypercholesterolemia on Adverse Cardiovascular Events - The Hokuriku-Plus Familial Hypercholesterolemia Registry Study -. Source Circulation Journal. 90(8) (pp 1100-1106), 2026. Date of Publication: 01 Aug 2026. Author Tada H.; Takeji Y.; Goten C.; Okada H.; Yoshida S.; Shimojima M.; Nomura A.; Mori M.; Takashima S.-I.; Kato T.; Usui S.; Sakata K.; Hayashi K.; Fujino N.; Nagase K.; Kawashiri M.-A.; Takamura M. Institution (Tada, Takeji, Goten, Okada, Yoshida, Shimojima, Nomura, Mori, Takashima, Kato, Usui, Sakata, Hayashi, Fujino, Takamura) Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan (Nagase) Innovative Clinical Research Center, Kanazawa University, Ishikawa, Japan (Kawashiri) Department of Internal Medicine, Kaga Medical Center, Ishikawa, Japan Publisher Japanese Circulation Society Abstract Background: We aimed to clarify the impact of genetic testing on major adverse cardiovascular events (MACE) among patients with heterozygous familial hypercholesterolemia (HeFH) using data from the Hokuriku-plus FH Registry (UMIN000038210). Methods and Results: In all, 431 patients were enrolled in the study, with a median follow-up of 3.9 years. The primary outcome was time to first MACE, defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, or non-fatal stroke. Using Cox proportional hazards regression models, we examined whether undergoing genetic testing was associated with a reduced risk of MACE. Among the 431 patients, sufficient data were available for 386 with HeFH, of whom 202 (52.3%) underwent genetic testing. Low-density lipoprotein cholesterol (LDL-C) levels at follow-up were significantly lower in group that underwent genetic testing than in the group that did not (median 102 vs. 130mg/dL, respectively; P<0.001). During follow-up, 23 MACE occurred (18 in the non-testing group and 5 in the genetic testing group). Notably, undergoing genetic testing was significantly associated with a reduced risk of MACE, even after adjusting for LDL-C levels (hazard ratio 0.66; 95% confidence interval 0.20-0.92; P=0.033). Conclusion(s): Genetic testing in patients with HeFH was associated with a reduced risk of MACE independent of LDL-C. Randomized controlled trials will be needed to clarify whether providing genetic testing can reduce MACE among patients with HeFH. Copyright © (2026), All rights are reserved to the Japanese Circulation Society. For permissions, please email: cj@j-circ.or.jp <145> Accession Number 2048490375 Title Effects of FiO2 adjustment on hyperoxia biomarkers and postoperative complications using oxygen reserve index during one-lung ventilation. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 514. Date of Publication: 01 Dec 2026. Author Aykenar B.; Ayhan A.; Issi S.; Kilic M.D.; Zeyneloglu P. Institution (Aykenar) Department of Intensive Care, Faculty of Medicine, Gazi University, Mevlana street, Ankara, Turkey (Ayhan, Zeyneloglu) Department of Anesthesia and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey (Issi, Kilic) Department of Thoracic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey Publisher BioMed Central Ltd Abstract Background: One-lung ventilation (OLV) is commonly used in thoracic surgery but increases the risk of intraoperative hypoxemia. To prevent hypoxia, high fractions of inspired oxygen (FiO2) are frequently administered; however, excessive oxygen exposure may lead to hyperoxia and oxidative tissue injury. The Oxygen Reserve Index (ORi) is a non-invasive monitoring parameter that provides real-time information on moderate hyperoxia. This study aimed to evaluate whether ORi-guided oxygen titration reduces intraoperative FiO2 exposure and influences oxidative stress biomarkers and postoperative outcomes in patients undergoing OLV. Method(s): In this prospective, randomized controlled trial, 60 patients undergoing elective thoracic surgery requiring OLV were allocated to either an ORi-guided group or a conventional oxygen management group. In the ORi group, FiO2 was adjusted according to predefined ORi thresholds, whereas in the control group oxygen management was guided solely by pulse oximetry. The primary outcome was the mean intraoperative FiO2 administered during OLV and throughout the entire surgery. Secondary outcomes included serum and tracheal aspirate levels of interleukin-6 (IL-6), superoxide dismutase (SOD), and malondialdehyde (MDA), postoperative pulmonary complications, and surgical site infections. Result(s): Mean intraoperative FiO2 was significantly lower in the ORi group compared with the control group during OLV and across total surgery duration (p < 0.001). Oxygen saturation and ventilatory parameters were comparable between groups. Biomarker levels showed significant time-dependent changes; however, no significant differences were observed between groups, and no significant group x time interaction was detected. The incidence of postoperative pulmonary complications and surgical site infections did not differ between groups. Conclusion(s): ORi-guided oxygen titration during OLV enables safe reduction of intraoperative FiO2 while maintaining adequate oxygenation. Although this strategy did not translate into measurable differences in oxidative stress biomarkers or postoperative complications, these findings provide important clinical evidence regarding the physiological impact of moderate hyperoxia in thoracic surgery. Trial registration: ClinicalTrials.gov identifier NCT07359833. First submission date: 17.01.2026 Retrospectively registered on 21.1.2026. Copyright © The Author(s) 2026. <146> Accession Number 2048574854 Title The effects of animation-based education provided to older patients scheduled for coronary artery bypass graft surgery on patients' pain, fear, anxiety, and self-care management: A randomized controlled trial. Source Geriatric Nursing. 73 (no pagination), 2026. Article Number: 104257. Date of Publication: 01 Oct 2026. Author Yavuz A.S.P.I.R.G.A.I.P.; Karaman Ozlu Z. Institution (Yavuz) Ataturk University Research Hospital, Department of Cardiovascular Surgery, Erzurum, Turkey (Karaman Ozlu) Ataturk University, Nursing Faculty, Department of Surgical Nursing, Erzurum, Turkey Publisher Elsevier Inc. Abstract The present research was performed to evaluate the effects of animation-based education provided to older patients scheduled for coronary artery bypass graft surgery on patients' pain, fear, anxiety, and self-care management. The research was carried out using a randomized controlled experimental design, with the intervention group receiving animation-based education and the control group participating in the preoperative clinical routine practice. The research data were collected from patients aged 65 and older who were scheduled for coronary artery bypass graft surgery between April 2023 and January 2025. The study was completed with 72 patients undergoing coronary artery bypass graft surgery, including 35 in the intervention group and 37 in the control group. The intervention group had significantly lower mean scores on the Visual Analog Scale, Surgical Fear Questionnaire, and Hospital Anxiety and Depression Scale compared with the control group (p ' 0.05). In contrast, the intervention group demonstrated significantly higher scores on the Self-Care Management in Chronic Diseases Scale and its subscales than the control group (p ' 0.05). The findings indicate that animation-based education provided before coronary artery bypass graft surgery effectively reduced postoperative pain, fear, anxiety, and depression levels while improving self-care management among older adults. Therefore, animation-based education may be considered an effective nursing intervention to support perioperative care and postoperative recovery in older patients undergoing CABG surgery. Copyright © 2026 Elsevier Inc. <147> Accession Number 2048536144 Title Intrawound Vancomycin Powder in Surgical Site Infection Prophylaxis: A Comprehensive Review of Mechanisms, Efficacy, Safety, and Clinical Controversies. Source Advances in Therapy. (no pagination), 2026. Date of Publication: 2026. Author Abd-Elsayed A.; Troka M.P.; Ortega J.L.; Riad A.I.; Bianco G.L.; Kaye A.D.; Reilly M.J. Institution (Abd-Elsayed, Troka, Ortega, Reilly) Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, B6/319 CSC, Madison, WI, United States (Riad) Department of Biology, The Ohio State University, Columbus, OH, United States (Bianco) Responsabile U.O. Analgesia E Chirurgia Percutanea, Fondazione Istituto G. Giglio, Sicily, Cefalu, Italy (Kaye) Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA, United States Publisher Adis Abstract Surgical site infections (SSIs) remain a critical postoperative complication that causes significant morbidity, mortality, and healthcare costs. To mitigate these risks, intrawound vancomycin powder has been increasingly adopted as a prophylactic option, particularly for high-risk procedures such as spine, orthopedic trauma, and cardiothoracic surgeries. However, the decision ultimately remains at the surgeon's discretion. This comprehensive review evaluates the mechanisms, clinical efficacy, and controversies surrounding the application of topical vancomycin. The current literature shows that intrawound vancomycin powder effectively reduces Gram-positive SSIs, overcomes ischemic barriers to early biofilm formation, and maintains a safe systemic profile while remaining highly cost-effective. However, serious clinical concerns remain about its widespread use, including higher rates of sterile wound dehiscence, possible localized cellular toxicity that may impair bone fusion, changes in pathogen profiles, and the growing threat of antimicrobial resistance. The absence of a US Food and Drug Administration (FDA) approval, lack of standardized dosing regimens, and warnings from major health organizations complicate its true clinical utility. Ultimately, the available literature suggests a shift away from universal application and toward tightly controlled, targeted interventions guided by strict antimicrobial stewardship. However, it remains for surgeons to evaluate risks versus benefits when administering vancomycin powder into incisions. Ongoing large-scale randomized controlled trials and emerging translational approaches, such as extended-release carrier systems and personalized bacteriological profiling, are essential for establishing definitive, evidence-based clinical guidelines. Copyright © The Author(s) 2026. <148> Accession Number 2048485029 Title Comparable survival over an extended follow-up after on-pump versus off-pump coronary artery bypass grafting: a propensity score-matched cohort. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 731. Date of Publication: 01 Dec 2026. Author Pikkujamsa A.; Rinne P.; Wistbacka J.-O.; Hilska M. Institution (Pikkujamsa) Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland (Pikkujamsa) Medical Research Center, Research Unit of Translational Medicine, University of Oulu, Oulu, Finland (Rinne) Department of Surgery, Vaasa Central Hospital, Vaasa, Finland (Wistbacka, Hilska) Department of Anaesthesiology and Intensive Care, Vaasa Central Hospital, Vaasa, Finland (Hilska) Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Faculty of Medicine, University of Turku, Turku, Finland Publisher BioMed Central Ltd Abstract Background: Long-term survival following off-pump coronary artery bypass grafting (OPCAB) compared with conventional on-pump coronary artery bypass grafting (ONCAB) remains uncertain. Randomised trials and meta-analyses up to 5-10 years after procedures have demonstrated either no significant differences or modest disadvantages of OPCAB, particularly regarding completeness of revascularisation and late mortality. However, comparative data extending up to 20 years after procedure are scarce. Thus, very-long-term outcomes after ONCAB versus OPCAB in a propensity score-matched cohort were evaluated. Method(s): Consecutive adults undergoing isolated primary coronary artery bypass grafting between 1999 and 2016 at a single cardiac surgery centre were retrospectively identified. Patients undergoing isolated OPCAB or ONCAB procedures were included and matched in a 1:2 ratio using clinically relevant preoperative variables. The primary outcome was overall survival in the matched cohort analysed using Cox proportional hazards regression. Result(s): During the study period, 2,935 patients underwent isolated primary coronary artery bypass grafting (CABG), of whom 2,496 (85.0%) underwent ONCAB and 439 (15.0%) OPCAB procedures. Median survival time was 13.7 years (95% CI 13.2-14.2) and median follow-up was 12.3 years (interquartile range 8.0-17.1, maximum 23.9 years). The matched cohort consisted of 402 OPCAB patients matched to 804 ONCAB patients. Median survival time was 12.4 years (95% CI 11.9-13.2) in ONCAB and 12.6 years (95% CI 11.5-13.8) in OPCAB patients. Overall survival did not differ significantly between the groups (HR 0.95, 95% CI 0.82-1.11; ONCAB as reference). No significant differences were observed in the cumulative incidence of cardiovascular mortality. Conclusion(s): In this propensity score-matched cohort with follow-up extending up to 20 years, ONCAB and OPCAB were associated with comparable long-term survival and cardiovascular mortality. These findings support an individualised approach to operative technique selection based on patient characteristics and surgical expertise. Copyright © The Author(s) 2026. <149> Accession Number 652004684 Title Prophylactic Surgical Left Atrial Appendage Closure in Bioprosthetic Aortic Valve Replacement: Short-Term Outcomes of Randomized Controlled LAA-CLOSURE Trial. Source Journal of the American Heart Association. (pp e046654), 2026. Date of Publication: 20 Aug 2026. Author Kiviniemi T.; Halfwerk F.; Bustamante Munguira J.; Zindovic I.; Malmberg M.; Olsson C.; Perrotta S.; van Schaagen F.; Suwalski P.; Hartikainen J.; Hanke T.; Reyes Copa G.; Speekenbrink R.G.H.; Bustamante E.; Erixon C.; Gunn J.; Bjurbom M.; Jeppsson A.; Oei F.; Wietsma N.E.; Dahlberg S.; Lip G.; Lehto J.; Vasankari T.; Airaksinen J.; van Putte B. Institution (Kiviniemi, Malmberg, Gunn, Lehto, Vasankari, Airaksinen) Turku University Hospital and University of Turku Finland, Finland (Halfwerk, Speekenbrink, Wietsma) Medisch Spectrum Twente, Netherlands (Halfwerk, Speekenbrink, Wietsma) University of Twente, TechMed Centre Enschede The Netherlands, Netherlands (Bustamante Munguira, Bustamante) Hospital Clinico Universitario de Valladolid Valladolid Spain, Spain (Zindovic, Erixon, Dahlberg) Department of Clinical Sciences, Department of Cardiothoracic Surgery, Skane University Hospital Lund University Lund Sweden, Lund, Norway (Olsson, Bjurbom) Karolinska University Hospital and the Karolinska Institutet Stockholm Sweden, Sweden (Perrotta, Jeppsson) Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden, Sweden (Perrotta, Jeppsson) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden, Sweden (van Schaagen, Oei) University Medical Center Rotterdam Rotterdam the Netherlands, Netherlands (Suwalski) National Medical Institute of the Ministry of Interior and Administration Center of Postgraduate Medical Education Warsaw Poland, Poland (Hartikainen) Kuopio University Hospital, University of Eastern Finland Kuopio Finland, Finland (Hanke) Asklepios Klinik Harburg Hamburg Germany, Germany (Reyes Copa) Hospital Universitario La Princesa Madrid Spain, Spain (Lip) Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK (van Putte) St. Antonius ziekenhuis Nieuwegein the Netherlands, Netherlands Abstract BACKGROUND: Surgical closure of the left atrial appendage (LAA) reduces stroke risk in patients with atrial fibrillation (AF) undergoing cardiac surgery. We evaluated the safety and efficacy of prophylactic LAA closure during bioprosthetic surgical aortic valve replacement in patients without prior AF. METHOD(S): In this investigator-initiated, academic, randomized, open-label, multicenter LAA-CLOSURE (Left Atrial Appendage CLOSURE for the Prevention of Thromboembolisms in Patients Undergoing Aortic Bioprosthesis Surgery) trial, 921 patients without prior AF undergoing bioprosthetic surgical aortic valve replacement with or without concomitant surgery were randomized and 904 patients included in the modified intention-to-treat analysis (prophylactic LAA closure, n=445; or usual care, n=459). Median age was 73 years (interquartile range, 69-76), 34.8% were women, and 49% had concomitant coronary artery disease. The primary end point was a composite of cardiovascular death, stroke, or systemic embolism at 30 days. RESULT(S): The primary end point occurred in 10 of 434 (2.2%) patients in the LAA closure group and 14 of 452 (3.1%) patients in the control group; however, the treatment effect changed direction at =7 days. In the time-split Cox regression model, hazard ratios were 2.4 (95% CI, 0.62-9.4; P=0.20) between 0 and 7 days and 0.29 (95% CI, 0.080-1.0; P=0.056) between 7 and 30 days. No closure-related serious complications or differences in bleeding were observed. Postoperative AF occurred in 205 of 445 (46.1%) versus 184 of 459 (40.1%) patients (relative risk, 1.1 [95% CI, 0.99-1.3]; P=0.07), and AF at discharge in 40 of 445 (9.2%) versus 34 of 459 (7.7%) patients (relative risk, 1.2 [95% CI, 0.77-1.8]; P=0.44), in the closure and control groups, respectively. CONCLUSION(S): Prophylactic LAA closure during bioprosthetic surgical aortic valve replacement was safe and did not increase bleeding. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT02321137. <150> Accession Number 2048543291 Title Effect of Classical Hand Massage on Pain in Patients Undergoing Coronary Artery Bypass Graft Surgery: Randomized Controlled Trial. Source Journal of Integrative and Complementary Medicine. (no pagination), 2026. Date of Publication: 2026. Author Kara O.; Oztekin S.D.; Yapici N. Institution (Kara) Department of Surgical Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey (Oztekin) School of Health Sciences, Department of Nursing, Dogus University, Istanbul, Turkey (Yapici) Department of Anesthesiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Publisher SAGE Publications Ltd Abstract Introduction: Coronary artery bypass grafting (CABG) is one of the most common major surgical procedures, and patients often experience severe postoperative pain. Effective, safe, and nonpharmacological strategies are needed to support pain management and physiological stability after CABG. This study aimed to evaluate the effect of classical hand massage on postoperative pain and physiological parameters in patients undergoing CABG surgery. Method(s): This single-blind randomized controlled trial study was conducted with 80 patients in the cardiovascular surgery intensive care unit. The intervention group received 30 min of classic hand massage (15 min per hand) in addition to routine care, while the control group received routine care alone. The primary outcome was postoperative pain intensity measured using the Visual Analog Scale (VAS). Secondary outcomes included systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, and oxygen saturation. These outcomes were assessed before the intervention (T<inf>0</inf>) and at 5, 30, 60, 90, and 120 min thereafter (T<inf>1</inf>-T<inf>5</inf>), and between-group differences were evaluated at a significance level of p < 0.05. Result(s): Classic hand massage significantly reduced sternotomy pain at all follow-up times (2.30-3.50 vs. 5.37-6.20; p < 0.001). Drain pain was also lower at 5 min (2.07 +/- 0.64 vs. 3.94 +/- 1.25) and 30 min (2.07 +/- 0.64 vs. 4.11 +/- 1.32) (p < 0.001). Back and leg-incision pain showed no between-group differences (p > 0.05). Systolic blood pressure was lower at 30 and 60 min (p = 0.012; p = 0.037), and diastolic blood pressure at 5 and 30 min (p = 0.015; p = 0.018). Respiratory rate decreased and oxygen saturation increased at all times (p < 0.001). Pulse rate did not differ (p > 0.05). No patient requested analgesics. No adverse events or intervention-related harms were observed during the study period. Conclusion(s): Hand massage was associated with lower pain scores and favorable physiological responses in patients undergoing CABG surgery. Nevertheless, further multicenter studies with larger sample sizes are needed to strengthen the evidence base and support the generalizability of these findings. Copyright © 2026, © The Author(s) <151> Accession Number 652003313 Title Residual Atherosclerotic Cardiovascular Disease Risk in Statin Users: A Systematic Review and Meta-Analysis. Source Journal of the American Heart Association. (pp e044840), 2026. Date of Publication: 20 Aug 2026. Author Watanabe A.H.; Bash L.D.; Westley T.; Garcia A.; Aiello E.; Bradbury J.; Garg J.; Telukuntla V.; Nanna M.G. Institution (Watanabe, Bash) Merck & Co, Inc Rahway NJ (Westley, Aiello, Bradbury) Lumanity Sheffield UK (Garcia) Lumanity Utrecht the Netherlands (Garg, Telukuntla) Lumanity Gurugram India (Nanna) Section of Cardiovascular Medicine Yale School of Medicine New Haven CT Abstract BACKGROUND: Statins are the cornerstone of lipid-lowering therapy, reducing low-density lipoprotein cholesterol in adults. However, residual atherosclerotic cardiovascular disease (ASCVD) risk among statin users remains unclear. This study estimated residual ASCVD risk in statin users in practice. METHOD(S): We conducted a systematic literature review and meta-analyses following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including observational studies published January 1, 2013, to August 1, 2023, that reported ASCVD risk in adult statin users. Five outcomes were assessed: composite risk (major adverse cardiovascular events or all-cause death), myocardial infarction, ischemic stroke, cardiovascular-related death, and coronary revascularization. Meta-analysis methods were used to synthesize individual study estimates. For each outcome, forest plots present study-level estimates and the pooled incidence rate per 1000 person-years (PPY). RESULT(S): The meta-analysis of residual composite risk (major adverse cardiovascular events or all-cause death) in the overall population was 12.3 PPY (range, 0.2-72.0). Rates were lower in adults at risk of ASCVD (6.4 PPY [range, 3.7-9.8 PPY]) and higher in adults with prior ASCVD (15.8 PPY [range, 0.2-72.0 PPY]). Meta-analysis for myocardial infarction showed 8.23 PPY (range, 1.1-88.82 PPY) in the overall patient population, and a lower rate of ischemic stroke with a rate of 6.0 PPY (range, 1.4-18.8 PPY). A rate of 4.3 PPY (range, 0.4-22.9 PPY) was estimated for cardiovascular-related death, and 7.4 PPY for coronary revascularization (range, 3.1-27.6 PPY). CONCLUSION(S): Despite substantial between-study variability, this real-world meta-analysis indicates meaningful residual ASCVD risk among statin users, underscoring persistent treatment gaps and need for comprehensive, optimized risk management. <152> Accession Number 2048555615 Title Are Homografts Superior to Prosthetic Valves in Destructive Aortic Endocarditis? A Systematic Review and Pairwise Meta-Analysis of Early-Midterm Outcomes. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 8734329. Date of Publication: 2026. Author Cubas W.S.; Gundelach J.; Arimura S.; Alfabeto A.; Kawaguchi Y.; Hong J.; Guo L.-R.; Chu M.W.A. Institution (Cubas, Arimura, Alfabeto, Kawaguchi, Hong, Guo, Chu) Department of Surgery, Division of Cardiac Surgery, Western University, London, ON, Canada (Gundelach) Department of Cardiac Surgery, Las Higueras Hospital, Talcahuano, Chile Publisher John Wiley and Sons Inc Abstract Background: Destructive aortic endocarditis (DAE) requires complex surgery. Homografts are traditional gold standards, but emerging evidence questions their superiority over prosthetic valves. This systematic review and pairwise meta-analysis compare early-midterm outcomes. Method(s): A comprehensive search of PubMed, Embase, Scopus, and Cochrane (1990-2025) identified studies comparing homografts, mechanical, and bioprosthetic valves for DAE. Outcomes included mortality, reoperation, stroke, reinfection, and midterm survival. Pairwise meta-analysis and Pearson's correlation were applied. Result(s): Sixteen studies (9948 patients) were included (homograft n = 1359; mechanical n = 2717; biological n = 5872). The mean age was 53.5 years, and 74.9% were male. No significant differences were observed in 30-day mortality (homograft vs mechanical: OR 1.31, 95% CI 0.99-1.72; vs biological: OR 1.15, 95% CI 0.73-1.81), midterm survival (RR 1.00, 95% CI 0.92-1.09; RR 1.06, 95% CI 0.88-1.28), or reinfection (homograft vs mechanical: RR 0.99, 95% CI 0.82-1.19; vs biological: RR 0.77, 95% CI 0.44-1.36). Reoperation was significantly higher with homografts versus mechanical (OR 1.58, 95% CI 1.17-2.14) and biological valves (OR 1.45, 95% CI 1.22-1.72), with no heterogeneity (I2 = 0%). Stroke risk was comparable across all comparisons, with nonsignificant numerical trends favoring homografts: homograft vs mechanical (OR 0.86, 95% CI 0.37-1.20), homograft vs biological (OR 0.65, 95% CI 0.30-1.41), and mechanical vs biological (OR 0.99, 95% CI 0.80-1.23). Unadjusted pooled proportions suggested higher early mortality with homografts (19.1%) compared to mechanical (16.8%) and biological (15.1%) valves, though these differences were not statistically significant in adjusted pairwise meta-analyses. Conclusion(s): Homografts do not demonstrate definitive superiority for DAE. While nonsignificant numerical trends toward lower stroke rates were observed with homografts, no statistically significant benefits were confirmed for mortality, reinfection, or midterm survival. Homografts were associated with significantly higher reoperation rates without a survival advantage. Valve selection requires patient-tailored balancing of infection control, durability, and procedural risk. Copyright © 2026 W. Samir Cubas et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <153> Accession Number 2048325957 Title Elevated Cardiopulmonary Bypass Flow for Renal Protection in Cardiac Surgery: A Randomized Trial. Source Anesthesia and Analgesia. (no pagination), 2026. Date of Publication: 2026. Author Wijk J.; Corderfeldt-Keiller A.; Redfors B.; Lannemyr L. Institution (Wijk, Redfors, Lannemyr) From the Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Section of Cardiothoracic Anaesthesia and Intensive Care, Sweden (Corderfeldt-Keiller) Department of Perfusion, Sahlgrenska University Hospital, Gothenburg, Sweden (Corderfeldt-Keiller) Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Acute kidney injury (AKI) is a common and severe complication after cardiac surgery with cardiopulmonary bypass (CPB). Experimental data suggest that increasing CPB flow beyond standard targets may improve renal oxygenation, but clinical evidence is limited. We hypothesized that increasing CPB flow would attenuate renal injury and improve organ perfusion. METHOD(S): - In this single-center, randomized controlled trial, 89 adults undergoing elective cardiac surgery were allocated to either high-flow (2.9 L.min.m-2) or standard-flow (2.4 L.min.m-2) during CPB. Mean arterial pressure (MAP) was maintained at 60 to 80 mm Hg by use of norepinephrine. Primary outcomes were urine biomarkers of renal injury; N-acetyl-beta-d-glucoseaminidase (NAG) and tissue inhibitor of metalloproteinase-2 x insulin-like growth factor binding protein-7 [TIMP-2 x IGFBP-7] levels at 60 minutes post-CPB. Additional outcomes included serum creatinine changes, AKI incidence, perioperative norepinephrine dose, and fluid balance. RESULT(S): - High-flow significantly reduced renal injury biomarkers compared to standard-flow, geometric mean ratio for NAG: 0.43; 95% confidence interval (CI), 0.26 to 0.70, P < .001, and [TIMP-2 x IGFBP-7]: 0.46; 95% CI, 0.30 to 0.73; P < .001. Median S-creatinine remained below baseline for the first three postoperative days in the high-flow group, and above baseline in the standard-flow group. AKI incidence was 16% (7/45) in the high-flow group vs 25% (11/44) in the standard-flow group, odds ratio 1.90; 95% CI, 0.64 to 5.60, P = .248. Norepinephrine doses were significantly reduced in the high-flow-group, both intraoperatively and up until 4 hours after CPB. There were no significant differences in fluid balance, bleeding, or adverse events. CONCLUSION(S): - Increasing CPB flow by 20% reduced renal injury biomarkers and postoperative creatinine and improved early hemodynamic stability. Further large-scale, multicenter trials are required to validate these findings and determine patient subgroups most likely to benefit. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the International Anesthesia Research Society. <154> Accession Number 2048512290 Title Treatment of antibody-mediated rejection in heart transplantation: from empirical combination to multi-target precision intervention. Source Frontiers in Immunology. 17 (no pagination), 2026. Article Number: 1902286. Date of Publication: 2026. Author Xu N.; Dong Y.; Yue Y.; Zhou L. Institution (Xu, Dong, Zhou) Department of General Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China (Yue) Department of Infectious Disease, Shaoyang Central Hospital, Shaoyang, China Publisher Frontiers Media SA Abstract Antibody-mediated rejection (AMR) is the primary immunological obstacle limiting long-term survival in heart transplant recipients. Driven by donor-specific antibodies (DSA), AMR damages graft microvasculature through multiple pathways, including complement activation, antibody-dependent cellular cytotoxicity, and sustained endothelial activation. It may present as acute hemodynamic collapse or progress insidiously in a subclinical manner, ultimately culminating in cardiac allograft vasculopathy (CAV) and graft failure. Over the past two decades, with successive updates to the ISHLT pathological diagnostic system, AMR has evolved from a vague clinical concept into a distinct entity defined by explicit histopathological and immunopathological criteria. However, therapeutic advances have markedly lagged behind the deepening understanding of its diagnosis. For a long time, the first-line regimen has consisted of plasma exchange combined with intravenous immunoglobulin (IVIG). Nevertheless, its mechanism-clearance of circulating antibodies plus broad-spectrum immunomodulation-neither targets the source of antibody production (long-lived plasma cells) nor selectively blocks terminal effector pathways. Approximately 30-50% of refractory AMR cases respond poorly to this regimen. Over the past decade, agents targeting plasma cells (proteasome inhibitor bortezomib), the terminal complement component (C5 monoclonal antibody eculizumab), the IL-6 pathway (tocilizumab, clazakizumab), and the more recent anti-CD38 monoclonal antibody (daratumumab) have entered clinical practice, shifting AMR treatment from having no actionable targets to enabling multi-node intervention. This review delineates the rationale underlying this evolution: the treatment paradigm is transitioning from empirical combination therapy to biomarker-driven, multi-target precision intervention covering the entire sequence of "production-circulation-effector pathways." However, the field remains in a distinct transitional phase characterized by "weapons available but tactics lacking"-the vast majority of evidence derives from single-center, retrospective, small-sample observational studies, with no randomized controlled trial (RCT) specifically designed for AMR in heart transplantation. Consensus is lacking on how to select, combine, and sequence these agents based on individual immune phenotypes. Stratified therapy, dynamic biomarker monitoring, and rational multi-target combination will be the core directions for solving this challenge in the coming decade. Copyright © 2026 Xu, Dong, Yue and Zhou. <155> Accession Number 2048488583 Title Systematic Review of Acute Coronary Artery Revascularization During Pregnancy. Source American Journal of Cardiology. 275 (pp 51-57), 2026. Date of Publication: 15 Sep 2026. Author Basala T.R.; Mutlu D.; Romano E.; Wanar A.; Carvalho P.E.P.; Rangan B.V.; Sandoval Y.; Sharkey S.W.; Saxena R.; Brilakis E.S. Institution (Basala, Mutlu, Carvalho, Rangan, Sandoval, Brilakis) The Center for Coronary Artery Disease, Minneapolis Heart Institution Foundation and Minneapolis Heart Institute, Minneapolis, MN, United States (Basala, Romano, Wanar) The University of Michigan Medical School, Ann Arbor, MI, United States (Sharkey, Saxena) The Penny Anderson Women's Cardiovascular Center, Minneapolis Heart Institution Foundation and Minneapolis Heart Institute, Minneapolis, MN, United States Publisher Elsevier Inc. 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 are reserved, including those for text and data mining, AI training, and similar technologies. <156> Accession Number 651989165 Title Cold and Room-Temperature Platelets in Cardiac Surgery: The CHIPS Randomized Clinical Trial. Source JAMA. (no pagination), 2026. Date of Publication: 17 Aug 2026. Author Spinella P.C.; Zantek N.D.; VanBuren J.M.; Nicolson S.C.; Khanna A.K.; Klompas A.M.; Boisen M.L.; Williams T.M.; Monteleone M.; Bashir D.A.; Pavey W.; Smith B.B.; Ahmed M.I.; Niebler R.A.; Jeng E.; Flynn B.C.; Joshi R.V.; Preuss J.F.; Goswami D.; Yamada C.; Lewis C.; Cohn C.S.; Tint H.; Kwak J.; Sodha N.; Simon E.R.; Van P.Y.; Greilich P.E.; Booth F.V.M.; Carter C.P.; Keegan A.; Cap A.P.; Matuk J.; McGlothlin A.; Berry N.S.; Lewis R.J.; Steiner M.E. Institution (Spinella) Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States (Zantek, Cohn) Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, University of Minnesota, Minneapolis, United States (VanBuren, Carter) Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, United States (Nicolson) Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States (Khanna) Department of Anesthesiology, Division of Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States (Khanna) Outcomes Research Consortium, Houston, TX, United States (Klompas) Departments of Anesthesiology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States (Boisen) Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Pittsburgh, Pittsburgh, PA, United States (Williams) Department of Anesthesiology & Perioperative Medicine, Division of Cardiothoracic Anesthesiology, UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States (Monteleone) Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Bashir) Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, United States (Pavey) Department of Anaesthesia and Perioperative Medicine, Division of Cardiothoracic Anaesthesia, Fiona Stanley Hospital, Perth, WA, Australia (Smith) Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ, United States (Ahmed) Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, United States (Niebler) Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Milwaukee, United States (Jeng) Department of Surgery, Division of Cardiovascular Surgery, University of Florida, Gainesville, United States (Flynn) Department of Anesthesiology, Division of Critical Care, University of Kansas Medical Center, Kansas City, United States (Joshi, Greilich) Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, William P. Clements Jr University Hospital, Dallas, United States (Preuss) Department of Anesthesia, University of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia (Goswami) Department of Anesthesia and Critical Care Medicine, Division of Pediatric Cardiac Critical Care and Anesthesia, Johns Hopkins Medical Center, Baltimore, MD, Liberia (Yamada) Department of Pathology, Division of Transfusion Medicine, University of Michigan, Ann Arbor, United States (Lewis) Department of Anesthesiology and Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States (Tint) Department of Pathology and Laboratory Medicine, Hemotherapy & Transfusion Medicine, University of Texas Health Science Center, Memorial Hermann Health System, Houston, United States (Kwak) Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Loyola University Medical Center, Maywood, IL, United States (Sodha) Department of Surgery, Division of Cardiac Surgery, Rhode Island Hospital, Providence, United States (Simon) Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesia, University of Wisconsin School of Medicine and Public Health, Madison, United States (Van) Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, Jamaica (Booth) Independent Safety Consultant, Houston, TX, United States (Keegan) Department of Hematology, King Edward Memorial Hospital, PathWest Laboratory Medicine, Perth, WA, Australia (Cap) Department of Medicine, Uniformed Services University, Bethesda, MD, Liberia (Matuk) School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States (McGlothlin, Berry, Lewis) Berry Consultants, Austin, TX, United States (Lewis) Senior Statistical Editor, JAMA, Slovenia (Steiner) Department of Pediatrics, University of Minnesota, Minneapolis, United States Abstract Importance: Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 degreeC) for up to 5 to 7 days; however, cold storage (1-6 degreeC) may allow for increased storage duration without loss of hemostatic function. Objective(s): To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass. Design, Setting, and Participant(s): A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration-ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025. Intervention(s): Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage. Main Outcomes and Measures: The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output. Result(s): Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, -0.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL/kg [5.2-15.4] for CSPs vs 8.4 mL/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, -1.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group. Conclusions and Relevance: For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs. Trial Registration: ClinicalTrials.gov Identifier: NCT04834414. <157> Accession Number 2048440086 Title Early Versus Later Bicavopulmonary Connection in Infants: A Systematic Review and Meta-Analysis. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 8599819. Date of Publication: 2026. Author Almehandi A.; Altarkait A.; Ali Y.; Alhajri M.; Shandala A.; Al-Naseem A.O.; Kindi H.A.; thani S.A. Institution (Almehandi) Department of Cardiovascular Science, University College London, London, United Kingdom (Altarkait, Ali) Department of General Surgery, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Surra, Kuwait (Alhajri) Department of Surgery, Al-Adan Hospital, Kuwait City, Kuwait (Shandala) Department of Surgery, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, United Kingdom (Al-Naseem) Department of Surgery, McGill University, Montreal, Canada (Kindi) Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Seeb, Oman (thani) Department of Pediatric Intensive Care Unit, The Royal Hospital, Muscat, Oman Publisher John Wiley and Sons Inc Abstract Background: The bicavopulmonary connection (BCPC) is a crucial palliation for single-ventricle physiology, improving haemodynamics by alleviating ventricular volume overload. While traditionally performed at 4-6 months, the optimal timing is debated, with a trend toward earlier intervention to reduce interstage mortality. This meta-analysis compares outcomes of early versus late BCPC. Method(s): A systematic search of PubMed, EMBASE and Cochrane Central identified studies comparing early (< 6 months) and late (>= 6 months) stage 2 palliation. Primary outcomes were early, late and interstage mortality. Secondary outcomes included operative parameters, ICU/hospital stay, duration of mechanical ventilation, Fontan completion rates, postoperative haemodynamics and complications. Pooled risk ratios (RR), odds ratios (OR), or mean differences (MD) with 95% confidence intervals were calculated using random-effects models. Result(s): Ten studies (2220 patients: 841 early, 1379 late) were included. The incidence of early mortality was significantly greater in the early BCPC group (RR = 2.28, CI = 1.29-4.05, p = 0.005), though late and interstage mortality were similar. Operative parameters and haemodynamics (atrial pressure, SVC pressure, oxygen saturation) were comparable. However, the early group had significantly longer hospital stay (MD = 5.21 days, p = 0.02), ICU stay (MD = 2.03 days, p = 0.02) and duration of mechanical ventilation (MD = 36.19 h, p < 0.0001). Time to Fontan, age at Fontan, Fontan completion rates and complications were indifferent. Conclusion(s): Early BCPC is associated with a higher risk of short-term mortality, with similar interstage and long-term survival. Postoperative recovery is prolonged with earlier intervention. Fontan completion and postoperative complications are otherwise comparable. Future randomised multicentre studies are needed to establish optimal timing for BCPC surgery. Copyright © 2026 Abdullah Almehandi et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <158> Accession Number 2048461042 Title Invited Review: Are the Floodgates Opening? New Indications for Transcatheter Aortic Valve Implantation for Asymptomatic Severe and Moderate Aortic Stenosis. Source Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Fontana G.P.; Ganapathi A.M. Institution (Fontana, Ganapathi) Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, CA, United States Publisher W.B. Saunders 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 2 populations as well as explore the future directions of TAVI use in these patients. Copyright © 2026 Published by Elsevier Inc. <159> Accession Number 2048440054 Title Comparative Efficacy and Safety of Ivabradine vs. Beta Blockers in Heart Transplant Patients: A Systematic Review and Meta-Analysis. Source Health Science Reports. 9(8) (no pagination), 2026. Article Number: e73068. Date of Publication: 01 Aug 2026. Author Hassan A.; Amir M.; Naeem M.; Ali E.F.; Ullah U.; Jahangir M.A.; Hassaan M.U.; Aman R.; Rifat H.R.; Nazir M.F.; Awais M.N.; Alizai A.; Gul S.; Asif A. Institution (Hassan, Amir, Naeem, Ullah, Jahangir, Hassaan) King Edward Medical University, Mayo Hospital, Punjab, Lahore, Pakistan (Ali) Sargodha Medical College, Faisal Masood Teaching Hospital, Punjab, Sargoadha, Pakistan (Aman, Rifat, Alizai, Gul) Gomal Medical College, KMU Peshawar, DHQ hospital DIKhan, Pakistan (Nazir) Rawalpindi Medical University, Holy Family Hospital, Rawalpindi, Pakistan (Awais) Shaheed Ziaur Rahman Medical College & Hospital, Bogura, Bangladesh (Asif) Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan Publisher John Wiley and Sons Inc Abstract Background and Aims: Elevated resting heart rate in heart transplant (HTx) recipients due to graft denervation is associated with adverse outcomes. Ivabradine and beta blockers are commonly used for heart rate control post-HTx, but their comparative effectiveness and safety remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of ivabradine versus beta blockers in heart transplant recipients. Method(s): Following PRISMA guidelines, a comprehensive literature search was conducted in April 2025 across PubMed, Cochrane, Embase, and Google Scholar. Original studies, including cohort studies and randomized controlled trials (RCTs) comparing ivabradine to beta blockers in heart transplant patients were considered eligible. The primary outcome was mean heart rate. Secondary outcomes were left ventricular mass, left ventricular mass index, and ejection fraction; adverse events (phosphenes, dizziness, fatigue, sepsis); and mortality and survival. Risk of bias was assessed using Cochrane RoB 2 for the randomized trial and ROBINS-I for the non-randomized studies, and statistical analyses were performed using Review Manager 5.4. Result(s): Four studies, including one RCT and three cohort studies, met the inclusion criteria. Ivabradine demonstrated a statistically significant reduction in left ventricular mass index at 24 months (MD -8.82; 95% CI -14.05 to -3.59; p = 0.001) and heart rate at 24 months (MD -11.70; 95% CI -23.36 to -0.05; p = 0.05). Other efficacy parameters, including left ventricular mass, ejection fraction, and heart rate at 12 months, showed no significant differences. Adverse effects and survival outcomes were similar between groups. Sensitivity analysis revealed reduced heterogeneity when one high-bias study was excluded. Conclusion(s): Ivabradine may offer improved heart rate control and favourable changes in left ventricular mass index compared with beta blockers in heart transplant recipients, with a comparable safety and mortality profile. Given the small evidence base, the predominance of observational studies, and the substantial heterogeneity observed across several outcomes, these findings should be regarded as exploratory and hypothesis-generating. Further large-scale RCTs are warranted to confirm these findings and guide clinical decision-making. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <160> Accession Number 2048488556 Title Comment on "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. 70 (no pagination), 2026. Article Number: 100855. Date of Publication: 01 Oct 2026. Author Rohtagi R.; Ratnakar P.J.; Sati D.M.; Srinivasan H. Institution (Rohtagi) Sharda University School of Medical Sciences and Research, India (Ratnakar) Dr D Y Patil Vidyapeeth (Deemed to be University), India (Sati) Graphic Era Deemed to be University, India (Srinivasan) SIMATS Deemed University Saveetha Medical College and Hospital, India Publisher Elsevier Inc. <161> Accession Number 651990072 Title Bempedoic Acid and First and Recurrent Limb Outcomes in Statin-Intolerant Patients With Peripheral Artery Disease: Insights From the CLEAR Outcomes Trial. Source Circulation. (no pagination), 2026. Date of Publication: 18 Aug 2026. Author Bonaca M.P.; Canonico M.E.; Li N.; Sasiela W.J.; Nissen S.E.; Lincoff A.M.; Nicholls S.J. Institution (Bonaca, Canonico) PC Clinical Research, University of Colorado School of Medicine (Bonaca, Canonico) Department of Medicine, University of Colorado (Li, Sasiela) Esperion Therapeutics, Inc, Ann Arbor, United States (Nissen, Lincoff) Department of Cardiovascular Medicine and Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland Clinic (Nicholls) Victorian Heart Institute, Monash University, Melbourne, VIC, United Kingdom Abstract BACKGROUND: Patients with peripheral artery disease (PAD) are at high risk of major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs). Recently, bempedoic acid was shown to reduce MACEs in primary and secondary prevention patients. Whether bempedoic acid reduces the risk of MALE in patients with PAD is unknown. METHOD(S): CLEAR Outcomes (Cholesterol Lowering via Bempedoic Acid [ETC1002], an ACL-Inhibiting Regimen) randomized 13 970 patients to bempedoic acid 180 mg or placebo from December 22, 2016, to August 14, 2019. The trial primary end point was MACE-4, defined as death resulting from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. A clinical history of PAD was reported by investigators at baseline. Two blinded vascular medicine specialists independently adjudicated MALEs, including adverse events indicating worsening PAD symptoms leading to revascularization, chronic limb-threatening ischemia, and acute limb ischemia. Outcomes were assessed as time to first event and total (including recurrent) events with a negative binomial approach. RESULT(S): A total of 1624 of the enrolled patients (mean+/-SD age, 63.9+/-9.9 years; 915 [56.3%] female) had PAD at baseline. In patients with PAD in the placebo group, 69 (8.3%) had MALEs over a median of 40.6 months, with rate of recurrent events of 4.0%/y. Bempedoic acid reduced the risk of MALEs by 36% (hazard ratio, 0.64 [95% CI, 0.44-0.93]; P=0.018) Bempedoic acid reduced total MALEs by 45% (relative risk, 0.55 [95% CI, 0.35-0.85]; P=0.007). First MACE-4 or MALE was reduced overall by 13% (hazard ratio, 0.87 [95% CI, 0.80-0.95]) with consistent effects with PAD (hazard ratio, 0.82 [95% CI, 0.64-1.04]) and without PAD (hazard ratio, 0.87 [95% CI, 0.79-0.86]; Pinteraction=NS) but not statistically significant within the PAD subgroup alone. Total MACE-4 or MALE was reduced (relative risk, 0.81 [95% CI, 0.73-0.90]) overall with consistent effects in PAD (relative risk, 0.71 [95% CI, 0.54-0.95]) and without PAD (relative risk, 0.82 [95% CI, 0.73-0.92]; Pinteraction=NS). CONCLUSION(S): Patients with PAD are at high risk of MALEs and MACEs. Bempedoic acid reduces both MACEs and MALEs in patients with atherosclerotic vascular disease, with notable absolute benefits in patients with PAD. These findings support (1) the importance of lowering low-density lipoprotein cholesterol in patients with PAD to reduce overall vascular risk and (2) the benefits of bempedoic acid in this population. <162> Accession Number 651979805 Title COMPARING ROBOTIC-ASSISTED CORONARY ARTERY BYPASS GRAFTING USING THE DA VINCI SURGICAL SYSTEM TO A NONROBOTIC APPROACH: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS. Source Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access Through Patient-Centered Collaboration. Glasgow, Scotland United Kingdom. 28(12 Supplement 1) (pp S483-S484), 2025. Date of Publication: 01 Dec 2025. Author Patel N.; Yankovsky A.; Kreaden U. Institution (Patel, Yankovsky) Intuitive Surgical, Sunnyvale, CA, United States (Kreaden) Biostatistics,Accessand Evidence, Intuitive Surgical, Sunnyvale, CA, United States Publisher Elsevier Ltd Abstract Objectives: To compare the perioperative clinical outcomes of robotic-assisted (rCABG) to non-robotic coronary artery bypass grafting (non-rCABG). Method(s): A PRISMA-guided literature review of studies from Pubmed, Scopus and Embase was conducted for publications between 01/01/2010 and 01/11/2024 (Prospero #CRD420250652462). Included studies reported on adults with coronary artery disease requiring revascularization, comparative studies including rCABG and nonrobotic CABG, in the form of RCT, large database, prospective, and retrospective cohort studies with a sample size greater than 20 subjects in each arm and quantifiableperioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects. Result(s): The search identified31 eligible studies (27 retrospective, 3 database, and 1 prospective),Including 20,935 rCABG and 970,305 non-rCABG patients. Operative time was comparable between both groups. rCABG patients also experienced an 18% higher likelihood of reoperation due to bleeding (OR:1.18, [1.04, 1.34] p<0.01). Compared to non-rCABG, patients undergoing rCABG were 71% less likely to receive a postoperative blood transfusion (OR:0.29, [0.22, 0.39] p<0.01), had shorter ICU stay by 0.84 days (p<0.01), shorter hospital stay by 1.98 days ( p<0.01), were 39% less likely to have postoperative atrial fibrillation(OR: 0.61, [0.51, 0.73] p<0.01), 43% less likely to experience a stroke (OR: 0.57, [0.48, 0.69] p<0.01), and had less short term mortality (OR:0.68 [0.58, 0.78], p<0.01). Both groups had comparable rates of postoperative myocardial infarction and revascularization postsurgery. Conclusion(s): This meta-analysis demonstrates that rCABG is safe and effective with numerous patient benefitsover non-rCABG, but highlights gaps in high level evidence comparing rCABG to non-rCABG. These results nevertheless may be useful for decision-making by payors, policymakers, and Health Technology Assessment bodies. <163> Accession Number 2048435679 Title Invasive and echocardiographic gradients of self- and balloon-expandable valves in failing aortic bioprostheses. Source Netherlands Heart Journal. (no pagination), 2026. Date of Publication: 2026. Author Chatterjee S.; van den Dorpel M.; Adrichem R.; Ren C.B.; Kardys I.; Nuis R.-J.; Daemen J.; Hirsch A.; Geleijnse M.L.; Van Mieghem N.M. Institution (Chatterjee, van den Dorpel, Adrichem, Ren, Kardys, Nuis, Daemen, Hirsch, Geleijnse, Van Mieghem) Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, Netherlands (Hirsch) Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (Van Mieghem) Interventional Cardiology, Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands Publisher Bohn Stafleu van Loghum Abstract Background: Transcatheter aortic valve implantation (TAVI) is an established treatment for a failing aortic bioprosthesis. The hemodynamics of TAVI in degenerated transcatheter or surgical aortic valves (TAV-in-TAV or TAV-in-SAV) are unknown. We aimed to investigate hemodynamic differences between self- and balloon-expandable TAV-in-TAV and TAV-in-SAV groups, and transthoracic echocardiography-derived (TTE) versus invasive transaortic pressure gradients. Method(s): Patients >= 18 years with a self-expanding EVOLUT (SEV) or balloon-expandable SAPIEN3 (BEV) valve for TAV-in-TAV or TAV-in-SAV were included. Transaortic gradients were determined invasively and by TTE within 48 h post-intervention. Result(s): We identified 56 patients with SEV (n = 36) or BEV (n = 20) TAV in a failing aortic bioprosthesis. Fourteen cases involved failing transcatheter valves and 42 surgical bioprostheses. Invasive mean gradients were similar after BEV and SEV (median (25th-75th percentile): 6.0 (1.5-6.5) vs 7.0 (2.0-10.0) mm Hg, p = 0.109). Mean gradients by TTE were higher for BEV than SEV at discharge (16.0 (10.8-19.8) versus 10.0 (7.0-12.0) mm Hg, p = 0.003) and 12-month follow-up (13.0 (11.0-15.5) versus 9.0 (7.0-12.3) mm Hg, p = 0.025). The discrepancy between TTE and invasive mean gradients was significantly larger for BEV than SEV (13.0 (6.3-14.0) vs 3.0 (1.5-8.3) mm Hg, p = 0.001) and most pronounced in TAV-in-SAV (BEV 13.0 (6.3-17.0) vs SEV 3.0 (1.0-8.5) mm Hg, p = 0.004). Conclusion(s): Mean gradient after TAV in a failing bioprosthesis is similar for BEV and SEV, when measured invasively, but higher with BEV than SEV by TTE. The discordance between invasive and TTE-derived mean gradients is the largest in BEV. Copyright © The Author(s) 2026. <164> [Use Link to view the full text] Accession Number 2048359897 Title Determining when patients with thyroid illnesses should be cleared for surgery. Source Current Opinion in Endocrinology, Diabetes and Obesity. (no pagination), 2026. Date of Publication: 2026. Author Paul A.; Abraham A.A.; George T. Institution (Paul, Abraham, George) Department of General Medicine, Christian Medical College and Hospital, Tamil Nadu, Vellore, India Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Thyroid dysfunction often delays surgery during preoperative evaluation, though evidence on perioperative risk and biochemical optimization is limited. This review explores recent literature on perioperative outcomes in hypothyroidism and hyperthyroidism, focusing on surgery delays, rapid optimization strategies, and areas of uncertainty. Recent findings - Observational studies and meta-analyses link subclinical hypothyroidism with adverse cardiovascular outcomes in cardiac surgeries, but evidence for non-cardiac surgeries is limited. Overt hypothyroidism is associated with complications like impaired wound healing, prolonged ventilation, and cardiovascular issues, making euthyroid state preferable before surgery, despite retrospective, heterogeneous data. For hyperthyroid patients undergoing total thyroidectomy, recent literature questions the need for biochemical euthyroid state; evidence for non-thyroid surgeries is sparse and extrapolated from thyroid surgeries. Selective use of liothyronine and therapeutic plasma exchange in severe or urgent cases shows promise, but evidence is limited and low quality. Summary - Current management of thyroid dysfunction is largely consensus-driven and based on limited evidence. Routine elective surgery optimization is advised for overt thyroid disease; however, in urgent cases, surgery after starting appropriate therapy and multidisciplinary planning is often reasonable. Future research should focus on prospective outcome data, rapid correction strategies, and the role of modern care pathways in reducing endocrine-related surgical risks. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <165> Accession Number 651979918 Title A SYSTEMATIC LITERATURE REVIEW AND METAANALYSIS COMPARING ROBOTIC-ASSISTED MITRAL VALVE REPAIR USING THE DA VINCI SURGICAL SYSTEM TO OPEN MITRAL VALVE REPAIR. Source Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access Through Patient-Centered Collaboration. Glasgow, Scotland United Kingdom. 28(12 Supplement 1) (pp S41), 2025. Date of Publication: 01 Dec 2025. Author Yankovsky A.; Patel N.; Kreaden U. Institution (Yankovsky, Patel) Intuitive Surgical, Sunnyvale, CA, United States (Kreaden) Biostatistics,Accessand Evidence,Intuitive Surgical, Sunnyvale, CA, United States Publisher Elsevier Ltd Abstract Objectives: This systematic literature review and meta-analysis compares the perioperative clinical outcomes of robotic-assisted (rMVR), open (oMVR) and minithoracotomy (mini-MVR) mitral valve repair. Method(s): A PRISMA-guided literature review was conducted using Pubmed, Scopus, and Embase covering 01/01/2010 to 01/11/2024 (Prospero #CRD420250652462). Inclusion criteria consisted of publications involving adults with mitral valve disease requiring repair of the mitral valve, in the form of RCTs, large database, prospective, and retrospective cohort studies with a sample size greater than 20 in each arm and quantifiable perioperative safety and effectiveness outcomes. Data were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effects or random-effects (heterogeneity significant). Result(s): The search identified 25 eligible studies (17 retrospective, 5 database, 2 prospective, and 1 RCT), including 12,133 rMVR, 8,496 mini-MVR, and 9,685 oMVR patients. Mini-MVR and rMVR were comparable with respect to outcomes of safety and effectiveness. Compared to oMVR, rMVR operative time was 43.5 minutes longer (p<0.01). Additionally, patients undergoing rMVR were 48% less likely to receive a blood transfusion postoperatively (OR:0.52, [0.31, 0.88] p=0.01), had shorter ICU stay by 0.4 days (p=0.03), had shorter hospital stay by 1.3 days ( p<0.01), were 28% less likely to experience postoperative atrial fibrillation (OR: 0.72, [0.62, 0.84] p<0.01) and 47% less likely to experience short-term mortality (OR: 0.53, [0.31, 0.92] p=0.03) compared to oMVR patients. Conclusion(s): Current evidence demonstrates that rMVR is comparable to mini-MVR repair and offers numerous benefits over oMVR. While further prospective comparative studies are warranted, rMVR is a safe and effective choice over oMVR. This information may be helpful for payers, policymakers, and Health Technology Agencies. <166> Accession Number 2048376817 Title Effect of driving pressure-guided individualized PEEP in children undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass on postoperative atelectasis and oxygenation: a randomized controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 496. Date of Publication: 01 Dec 2026. Author Chen X.; Song H.; Zang M.; Zhou J.; Liu Y.; Ren Y. Institution (Chen, Zang) Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China (Song, Zhou, Liu, Ren) Department of Anesthesiology, The Affiliated Women and Children's Hospital of Qingdao University, Qingdao, China Publisher BioMed Central Ltd Abstract Background: Right lateral thoracotomy cardiac surgery induces postoperative atelectasis due to cardiopulmonary bypass (CPB), patient positioning, and mechanical ventilation. Fixed positive end-expiratory pressure (PEEP) may fail to meet pediatric ventilation requirements. This study aims to investigate the effects of driving pressure-guided individualised PEEP on postoperative atelectasis and oxygenation. Method(s): Children aged 6 months to 5 years undergoing right lateral thoracotomy cardiac surgery with CPB were randomly assigned to two groups. Group C received conventional protective ventilation with fixed PEEP of 5 cmH<inf>2</inf>O in the lateral decubitus position until the end of ventilation. Group D had driving pressure-guided individualized PEEP titration following both the lateral decubitus position and the CPB, with ventilation maintained at the titrated PEEP. Both groups received lung recruitment maneuvers. Observations were conducted at the following time points: after intubation (T<inf>0</inf>), after lateral positioning (T<inf>1</inf>), before CPB (T<inf>2</inf>), after CPB (T<inf>3</inf>), at the end of surgery (T<inf>4</inf>), before leaving the operating room (T<inf>5</inf>), after admission to the ICU (T<inf>6</inf>), and 1 h after extubation (T<inf>7</inf>). Lung ultrasonography was performed for each patient at T<inf>0</inf> and T<inf>5</inf>. The primary outcomes were the incidence of postoperative atelectasis and lung ultrasound scores (LUS). Secondary outcomes included PaO<inf>2</inf>/FiO<inf>2</inf> ratio (P: F ratio), incidence of post-CPB hypoxemia and postoperative pulmonary complications (PPCs) within 3 days, peak airway pressure (P<inf>peak</inf>), dynamic pulmonary compliance (Cdyn), PEEP, driving pressure, extubation time, length of ICU stay, length of hospital stay, heart rate and mean arterial pressure. Result(s): At T<inf>5</inf>, the incidence of atelectasis and LUS were lower in Group D than in Group C (P < 0.05). P: F ratio in Group D was higher than in Group C at T<inf>2</inf>, T<inf>4</inf>, and T<inf>6</inf> (P < 0.05). The incidence of post-CPB hypoxemia and extubation time were lower in Group D (P < 0.05). Group D showed superior intraoperative respiratory mechanics parameters. However, there were no significant differences in the incidence of PPCs within 3 days, intraoperative hemodynamics, ICU length of stay, or hospital length of stay between the two groups (P > 0.05). Conclusion(s): Driving pressure-guided individualized PEEP ventilation reduces the incidence of postoperative atelectasis in children undergoing right lateral thoracotomy cardiac surgery with CPB. It also improves oxygenation and intraoperative respiratory mechanics. However, there was no significant difference in the incidence of PPCs within 3 days. Trial registration: ChiCTR, ChiCTR2500098036. Registered on February 28, 2025, www.chictr.org.cn. Copyright © The Author(s) 2026. <167> Accession Number 651981668 Title COST-UTILITY ANALYSIS OF THE ALLOMAP TEST FOR THE MONITORING OF PATIENTS AFTER HEART TRANSPLANTATION: ECONOMIC EVALUATION ALONGSIDE THE CUPIDON TRIAL. Source Value in Health. Conference: ISPOR Europe 2025: Powering Value and Access Through Patient-Centered Collaboration. Glasgow, Scotland United Kingdom. 28(12 Supplement 1) (pp S164), 2025. Date of Publication: 01 Dec 2025. Author Serrier H.; Huot L.; Hanser M.; Lelong B.; Epailly E.; Boignard A.; Dorent R.; Battistella P.; Coutance G.; Guitard J.; Pattier S.; Nafeh-Bizet C.; Nubret K.; Baudry G.; Radosavljevic M.; Sebbag L. Institution (Serrier, Huot) Hopitaux de Lyon, Lyon, France (Hanser, Baudry) Hospices Civils de Lyon, Lyon, France (Lelong) Rennes university Hospital, Rennes, France (Epailly) Strasbourg University Hospitals, Strasbourg, France (Boignard) Grenoble University Hospital, Grenoble, France (Dorent, Coutance) Assistance Publique Hopitaux de Paris URCEco, Paris, France (Battistella) Reunion University Hospital, Saint Denis, France (Guitard) Toulouse University Hospital, Toulouse, France (Pattier) Nantes University Hospital, Nantes, France (Nafeh-Bizet) Rouen university Hospital, Rouen, France (Nubret) Hopitaux Universitaires de Bordeaux, Bordeaux, France (Radosavljevic) New Civil Hospital, Strasbourg, France (Sebbag) Hopitaux de Lyon, France Publisher Elsevier Ltd Abstract Objectives: AlloMap is a non-invasive blood test that can identify patients with low probability of moderate to severe acute cellular transplant rejection. The International Society of Heart and Lung Transplantation recommends its use for the monitoring of patients between 6 months and 5 years after heart transplantation. This test could be an alternative to systematic biopsies but is expensive and not covered by French health insurance. Our objective was to perform an economic evaluation of the AlloMap test for the monitoring of patients after heart transplantation. Method(s): Economic evaluation was conducted alongside the CUPIDON multicenter randomized controlled trial which enrolled patients between 2016 and 2020 in either the AlloMap or Biopsies strategy. The evaluation was conducted from a healthcare system perspective over a 30-month period. Costs were estimated using actual hospital stay data and QALYs were estimated using the EQ5D-5L questionnaire and preference scores validated in the French population. Uncertainty was handled using the nonparametric bootstrap and univariate analysis. Result(s): 190 patients were randomized and included in the cost-utility analysis. Initial characteristics of the populations were comparable. In the main analysis, the AlloMap strategy represented an additional cost of around 15,380 compared with the Biopsies strategy. The average cost per patient was estimated at 39,069 for the AlloMap strategy and 23,689 for the Biopsies strategy. The average QALY per patient was estimated at 1.87 for the AlloMap strategy and 1.92 for the Biopsies strategy but the difference was not significant. Further analysis showed that the Biopsies strategy became more costly than the AlloMap strategy when the price of the test fell below 799. Conclusion(s): The AlloMap test is expected to be cost effective for a price below 799 in a French setting. According to these results, there is a need to reflect on the optimal follow-up for heart transplantation patients. <168> [Use Link to view the full text] Accession Number 2029388567 Title 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Source Circulation. 149(1) (pp E1-E156), 2024. Date of Publication: 02 Jan 2024. Author Joglar J.A.; Chung M.K.; Armbruster A.L.; Benjamin E.J.; Chyou J.Y.; Cronin E.M.; Deswal A.; Eckhardt L.L.; Goldberger Z.D.; Gopinathannair R.; Gorenek B.; Hess P.L.; Hlatky M.; Hogan G.; Ibeh C.; Indik J.H.; Kido K.; Kusumoto F.; Link M.S.; Linta K.T.; Marcus G.M.; McCarthy P.M.; Patel N.; Patton K.K.; Perez M.V.; Piccini J.P.; Russo A.M.; Sanders P.; Streur M.M.; Thomas K.L.; Times S.; Tisdale J.E.; Marie Valente A.; Van Wagoner D.R. Publisher Lippincott Williams and Wilkins Abstract AIM: The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHOD(S): A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. Copyright © 2023 by the American College of Cardiology Foundation and the American Heart Association, Inc. <169> Accession Number 2048404777 Title Perioperative continuous vs. interrupted oral anticoagulation in TAVR: a systematic review and meta-analysis. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 711. Date of Publication: 01 Dec 2026. Author Gan X.; Lang Z.; Meng X.; Su Y.; Zhu Y.; Zhao J.; Bai M. Institution (Gan) Office of Graduate Education, The First Hospital of Lanzhou University, Gansu, Lanzhou, China (Lang, Meng, Su, Zhu, Zhao, Bai) The First School of Clinical Medicine of Lanzhou University, Gansu, Lanzhou, China (Lang, Meng, Su, Zhu, Zhao, Bai) Department of Cardiology, The First Hospital of Lanzhou University, Gansu, Lanzhou, China (Lang, Meng, Su, Zhu, Zhao, Bai) Gansu Province Clinical Research Center for Cardiovascular Diseases, Gansu, Lanzhou, China Publisher BioMed Central Ltd Abstract Objectives: To evaluate the clinical outcomes associated with continuous versus interrupted oral anticoagulation strategies during the perioperative period of transcatheter aortic valve replacement, with a focus on balancing thromboembolic and bleeding risks. Method(s): We searched PubMed, Web of Science, Cochrane Library, Scopus, Ovid and Embase up to February 2026. All studies compared continuous oral anticoagulation versus interruption of oral anticoagulation for TAVI. The primary outcomes were major bleeding, major vascular complications, and stroke. Data synthesis was performed by calculating risk ratios (RRs) or standardized mean differences (SMDs), each accompanied by 95% confidence intervals (CIs). The study was prospectively registered with PROSPERO (CRD420251070176). Result(s): A total of five studies comprising 3,316 patients were included. Compared with interrupted anticoagulation, continued OAC was not associated with a statistically significant increase in major bleeding or major vascular complications. Continued OAC showed a borderline association with a lower risk of stroke, together with lower red blood cell transfusion and higher device success rates. However, given the limited number of studies, the predominance of retrospective evidence, and the trial sequential analysis findings, these results should be interpreted cautiously. Conclusion(s): Continuation of OAC during TAVR appears feasible and was not associated with an increased risk of major bleeding or major vascular complications in the currently available evidence. Although continued OAC showed a possible association with lower stroke and transfusion risks, the evidence remains limited and statistically fragile. Larger randomized trials are needed before definitive clinical recommendations can be made. Copyright © The Author(s) 2026. <170> Accession Number 2048533247 Title The 2026 American Association for Thoracic Surgery (AATS) expert consensus document: Surgical management of primary chest wall malignancies. Source Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Raymond D.P.; Abdelsattar Z.M.; Brown L.M.; Campbell S.R.; Guerra J.J.; Mangla A.; Meguid R.A.; Mesko N.W.; Moran S.L.; Rocco G.; Shen K.R.; Towe C.W.; Tong B.C.; Walsh G.L.; Donington J.S. Institution (Raymond) Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Center for Chest Wall Disease, Cleveland Clinic, Cleveland, OH, United States (Abdelsattar) Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Loyola University Medical Center and Edward Hines Veterans Affairs Hospital, Maywood, IL, United States (Brown) Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, CA, United States (Campbell) Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, United States (Guerra, Walsh) Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States (Mangla) Division of Sarcoma and Cutaneous Oncology, Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, United States (Meguid) Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States (Mesko) Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States (Moran) Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, United States (Rocco) Department of Surgery, Thoracic Service, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY, United States (Shen) Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States (Towe) Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve School of Medicine, University Hospitals, Cleveland, OH, United States (Tong) Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, United States (Donington) Section of Thoracic Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, United States Publisher Elsevier Inc. Abstract Objective: The management of chest wall primary malignancies is challenging for thoracic surgeons because of the rarity and diversity of disease processes requiring nuanced knowledge. This document reviews the existing literature and provides multidisciplinary consensus recommendations for evaluation and treatment of chest wall primary malignancies. Method(s): The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international, multidisciplinary panel of medical oncologists, radiation oncologists, orthopedic surgeons, plastic and reconstructive surgeons, and thoracic surgeons with significant expertise in the management of chest wall malignancies. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with a class of recommendations and level of evidence for 6 themes: (1) diagnosis and staging, (2) tumors treated with primary resection, (3) tumors treated with resection after induction therapy, (4) tumors not treated with primary surgical resection, (5) technical surgical principles, and (6) postoperative management. Result(s): Consensus was achieved on 34 statements on the basis of extensive literature review and current clinical experience spanning 11 high-volume institutions. These statements provide a standard for initial evaluation of a suspected chest wall neoplasm, histology directed management of a diverse group of malignancies, surgical management principles, and postoperative management. Conclusion(s): This multidisciplinary expert consensus document provides a framework upon which thoracic surgeons can approach the management of primary chest wall malignancies. Accurate diagnosis and staging, multidisciplinary treatment planning, and careful attention to surgical techniques to achieve an R0 (microscopically negative margin) resection are all vital elements. Furthermore, multi-institutional efforts are required to advance our understanding of chest wall malignancies. Copyright © 2026 The Authors <171> Accession Number 2048291707 Title Reperfusion Strategies in Donation After Circulatory Death Heart Transplantation: An Up-to-Date Narrative Review. Source Journal of Clinical Medicine. 15(15) (no pagination), 2026. Article Number: 5947. Date of Publication: 01 Aug 2026. Author Galeone A.; Luciani G.B.; Onorati F. Institution (Galeone, Luciani) Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Verona, Italy (Onorati) Cardiac Surgery Unit, Ospedale Santa Chiara, University of Trento, Trento, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Donation after circulatory death has emerged worldwide as a safe and effective alternative pathway to increase the donor pool. However, organs undergo a variable period of warm ischemia during the agonal phase and the cardiac arrest before graft procurement, and the heart is particularly vulnerable to injury provoked by warm ischemia and subsequent reperfusion. Several reperfusion strategies are currently available for the recovery and assessment of heart function in these donors, with promising early and long-term results. Nevertheless, each technique implies specific financial, logistical and ethical challenges, translating into a heterogeneous landscape of protocols across European and non-European countries. Additionally, no randomized clinical trials have been published to assess the superiority of one technique over the other, and current clinical evidence is based on retrospective registry data and single-center observational studies. Copyright © 2026 by the authors. <172> Accession Number 2047300168 Title Extracorporeal Membrane Oxygenation as a Preoperative Bridge for Infective Endocarditis: A Case Report and Review. Source ASAIO Journal. (no pagination), 2026. Article Number: 10.1097/MAT.0000000000002767. Date of Publication: 2026. Author Chen Y.; Liang S.; Xu S.; Huang J.; Hao J.; Li C. Institution (Chen, Liang, Xu, Huang, Li) From the Department of Critical Care Medicine, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China (Hao) Department of Emergency Medicine, Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen, China Publisher Lippincott Williams and Wilkins Abstract Infective endocarditis (IE) complicated by refractory cardiopulmonary failure carries high mortality, and standardized protocols for extracorporeal membrane oxygenation (ECMO) are lacking. We report a 31 year old male with fulminant IE, severe aortic regurgitation, acute respiratory distress syndrome (ARDS), and refractory cardiogenic shock who was initially supported with venovenous (VV) ECMO for isolated respiratory failure. Due to progressive hemodynamic deterioration, configuration was converted to veno-arterial (VA) ECMO, followed by emergency aortic valve replacement and targeted antimicrobial therapy. The patient achieved successful decannulation and discharge. To contextualize this case, we conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying 21 additional cases (2000-2025), forming a 22-patient cohort. Pooled analysis demonstrated an overall in-hospital survival rate of 81.8% (18/22) with ECMO bridging. Surgical treatment significantly improved survival compared with conservative management (94.4% vs. 25%). These findings suggest that ECMO is a feasible bridge-to-surgery strategy for IE with refractory cardiopulmonary failure. However, given the significant risk of publication bias inherent to case report data, we propose a hypothesis-generating management algorithm emphasizing individualized mode selection and early surgical source control, rather than definitive clinical guidelines. Large-scale prospective studies are required for validation. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO. <173> Accession Number 2048222845 Title Effect of general anesthesia on postoperative outcomes of transcatheter aortic valve implantation in patients: a systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1714689. Date of Publication: 16 Jul 2026. Author Li G.; He J.; Yang Y.; Deng J.; Zeng C.; Zhao G.; Zhong M. Institution (Li, He, Yang, Deng, Zeng, Zhao, Zhong) Department of Anesthesiology, Guangdong Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China Publisher Frontiers Media SA Abstract Objective - The optimal mode of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery has been controversial recently, especially with the popularization of TAVI in young and low-risk patients and reduced dependence on transesophageal echocardiography (TEE). Beyond general anesthesia (GA), there are more than one type of anesthetic methods such as regional anesthesia (RA), local anesthesia (LA), monitored anesthesia care (MAC), deep sedation (DS), conscious sedation (CS) et al. used on TAVI. The aim of this systematic review and meta-analysis was to evaluate the effects of general anesthesia on the prognosis of patients undergoing TAVI. Methods - The Cochrane Library, PubMed, Embase, and Medline databases were searched from their inception to May 2025. Literature was selected according to the inclusion and exclusion criteria, and the meta-analysis was completed using RevMan 5.3. Results - A total of eligible 38 literatures were enrolled, including 23, 848 patients. The results of the meta-analysis showed that compared with the non-GA groups, the in-hospital mortality (RR = 1.99, 95%CI, 1.19-3.30, P = 0.008), incidence of postoperative pneumonia (RR = 2.39, 95%CI, 1.43-4.00, P = 0.0009), procedure time (MD = 20.22, 95%CI, 15.37-25.07, P < 0.00001), length of hospital stay (MD = 1.43, 95%CI, 1.10-1.76, P < 0.00001), and ICU stay (SMD = 1.91, 95%CI, 1.40-2.42, P < 0.00001) were all increased in the GA group. There were no significant differences between the groups in 30-day mortality (RR = 1.19, 95%CI, 0.97-1.47, P = 0.09), postoperative acute kidney injury (RR = 1.16, 95%CI, 0.90-1.50, P = 0.26), postoperative stroke (RR = 0.99, 95%CI, 0.80-1.22, P = 0.90), postoperative vascular complication (RR = 1.10, 95%CI, 0.92-1.33, P = 0.30), and postoperative myocardial infarction (RR = 1.12, 95%CI, 0.72-1.73, P = 0.61). Conclusion - GA not only increases in-hospital mortality and the incidence of postoperative pulmonary infections in patients undergoing TAVI but also prolongs the length of hospitalization and ICU stay. However, GA did not increase the incidence of postoperative acute kidney injury, stroke, myocardial infarction, or vascular complications, nor did it increase the 30-day postoperative mortality rate and long-term quality of life in patients. The choice of anesthesia for TAVI should be evaluated according to the patient's condition and surgical approaches to minimize adverse complications and mortality. Further RCTs are required to verify the most likely anesthetic choices for TAVI. Copyright © 2026 Li, He, Yang, Deng, Zeng, Zhao and Zhong. <174> Accession Number 2048354937 Title Coronary computed tomographic angiography for detection of coronary artery disease in patients presenting to the emergency department with chest pain: a meta-analysis of randomized clinical trials. Source European Heart Journal Cardiovascular Imaging. 14(8) (pp 782-789), 2013. Date of Publication: 01 Aug 2013. Author D'Ascenzo F.; Cerrato E.; Biondi-Zoccai G.; Omede P.; Sciuto F.; Presutti D.G.; Quadri G.; Raff G.L.; Goldstein J.A.; Litt H.; Frati G.; Reed M.J.; Moretti C.; Gaita F. Institution (D'Ascenzo, Cerrato, Omede, Sciuto, Presutti, Quadri, Moretti, Gaita) Division of Cardiology, University of Turin, Torin, Italy (D'Ascenzo, Biondi-Zoccai, Moretti) Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Ospedaletti, Italy (Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and Biotechnologies Sapienza, University of Rome, Rome, Italy (Raff, Goldstein) Division of Cardiology, William Beaumont Hospital, Royal Oak, MI, United States (Litt) Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, United States (Reed) Emergency Medicine Research Group Edinburgh (EMeRGE), Edinburgh, United Kingdom Publisher Oxford University Press Abstract Background: Assessment of chest pain patients remains a clinical challenge in the emergency department (ED). Several randomized controlled trials (RCTs) have shown the additive value of coronary computed tomographic angiography (CCTA) compared with standard care. Not all of them, however, had enough power to detect differences in clinical outcomes like revascularization. Therefore, we performed a meta-analysis to test the safety and efficacy of this non-invasive diagnostic approach in low- and intermediate-risk chest pain patients. Method(s): MEDLINE/PubMed was systematically screened for RCTs comparing CCTA and non-CCTA approaches for ED patients presenting with chest pain. Baseline features, diagnostic strategies, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. Result(s): A total of four RCT studies including 2567 patients were identified, with similar inclusion and exclusion criteria. Patients in the CCTA group were more likely to undergo percutaneous or surgical revascularization during their index visit, with an odd ratio of 1.88 (1.21-2.92). Time to diagnosis was reduced with CCTA (-7.68 h;-12.70 to 2.66) along with costs of care in the ED (-$680; -1.060 to -270: all CI 95%). Conclusion(s): The present meta-analysis shows that a strategy with CCTA used as first imaging test for low- and intermediate-risk patients presenting to the ED with chest pain appears safe and seems not to increase subsequent invasive coronary angiographies. The approach is cost-effective although limited data and incomplete cost analyses have been performed. CCTA increases coronary revascularizations, with still an unknown effect on prognosis, especially in the long term. Copyright Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2012. For permissions please email: journals.permissions@oup.com <175> Accession Number 651967778 Title National survey results: Midline laparotomy closure technique among surgical specialities across the UK, including gynaecological oncology. Source BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S14), 2026. Date of Publication: 01 Jun 2026. Author Ahmed S.; Newton C. Institution (Ahmed, Newton) St Michael's Hospital, University Hospitals of Bristol and Weston, Bristol, United Kingdom Publisher John Wiley and Sons Inc Abstract Background: Midline laparotomy closure technique remains an ongoing debate. The European and American Hernia Societies (2022) published the updated guidelines for closure of abdominal wall incisions in virgin abdomens and recommended the small-bite technique. Although RCTs suggested potential benefit with small-bite, concerns remain regarding applicability to high-risk cohorts such as gynaecological oncology patients. Objective(s): This study aimed to evaluate current national practice in midline laparotomy closure techniques across surgeons. Method(s): A national cross-speciality survey was conducted (2024-2026). Consultants and trainees in gynaecological oncology, gynaecology, colorectal, vascular, cardiothoracic and general surgery were invited to participate. Result(s): Out of 100 responses, 64 came from gynaecology. Among respondents, 51% use the small-bites technique (54% of gynaecologists). Only 44% apply it to virgin abdomens. Only 75 (75%) surgeons were aware that the small-bite technique is recommended for closure of virgin abdomens. 45 (45%) of surgeons change their technique for abdominal closure based on risk factors, most commonly BMI. Other risk factors included smoking, diabetes, previous laparotomy, and length of surgery. 79% are open to adopt or recommend small-bite, with 5 respondents seeking more evidence. Five users are satisfied with the small-bite technique, but stress the need for proper application of the method. Conclusion(s): The small-bite technique is used by over half of the participants. Encouraging units that adopted small-bite to apply it as recommended on virgin abdomens, follow the steps, and conduct audits on gynaecological oncology patients is a necessary change. Further speciality-specific observational data and RCT are required to inform standardisation of practice. �

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