EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 118 Results Generated From: Embase <1980 to 2026 Week 19> Embase Weekly Updates (updates since 2026-05-01) - (118 records) <1> Accession Number 2041918030 Title The Limit of Detection in the Emergency Department Trial (LEGEND): A Stepped-Wedge Cluster Randomized Trial to Rule Out Acute Myocardial Infarction and Reduce Hospital Length of Stay for Patients Presenting to the Emergency Department. Source Annals of Emergency Medicine. 87(4) (pp 424-434), 2026. Date of Publication: 01 Apr 2026. Author Greenslade J.; Parsonage W.; Stephensen L.; Parsons R.; Perez S.; Starmer K.; Starmer G.; Gaikwad N.; McPhail S.M.; Hall E.; Brownlee E.; McCormick E.; Cullen L. Institution (Greenslade, Stephensen, Brownlee, McCormick, Cullen) Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia (Greenslade, Parsonage, Stephensen, Parsons, McPhail, Cullen) the Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia (Parsonage) the Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia (Perez) Emergency Department, Logan Hospital, Brisbane, Australia (Starmer) Emergency Department, Cairns Hospital, Cairns, Australia (Starmer) Department of Cardiology, Cairns Hospital, Cairns, Australia (Gaikwad) the Department of Cardiology, the Prince Charles Hospital, Brisbane, Australia (Gaikwad) Faculty of Medicine, the University of Queensland, Brisbane, Australia (Hall) the Emergency Department, the Prince Charles Hospital, Brisbane, Australia (Hall) the Emergency Department, Gold Coast University Hospital, Gold Coast, Australia Publisher Elsevier Inc. Abstract Study objectives The Limit of Detection in the Emergency Department (LEGEND) rule-out strategy integrates high-sensitivity cardiac troponin assay concentrations with shared decision making to rapidly assess emergency patients with suspected acute coronary syndrome (ACS). We hypothesized that the LEGEND rule-out strategy would reduce length of stay (LOS), increase the proportion of patients safely discharged within 4 hours, reduce cardiac testing, and decrease hospital representations, while maintaining patient safety. Methods We conducted a stepped-wedge cluster randomized controlled trial in 4 Australian emergency departments from August 2019 to July 2020. We included adult patients presenting with suspected ACS. We randomized sites to implement the LEGEND strategy. The primary outcome was LOS. Secondary outcomes included discharge from hospital within 4 hours, cardiovascular tests, representations, index, and 30-day events. Results The study included 9,944 patients, 5,347 in the standard care and 4,597 in the intervention arm. For patients in the LEGEND cohort (presentation troponin <=2 ng/L), the mean LOS was 3.6 hours shorter in the intervention arm than the standard care arm (95% confidence interval [CI] 2.5 to 4.6 hours). The proportion of patients safely discharged within 4 hours increased by 22.9% (95% CI 19.5% to 26.3%), and cardiac testing decreased by 7.8% (95% CI 4.6% to 11.1%). There were no differences in representations, index events, or 30-day events. Conclusion The LEGEND rule-out strategy safely ruled out acute myocardial infarction, reduced hospital LOS, increased the proportion of patients discharged within 4 hours, and reduced cardiac testing. Copyright © 2025 American College of Emergency Physicians. <2> Accession Number 650215836 Title Choosing Between CABG and PCI for 3-Vessel Coronary Disease: What's Cost Got to Do With It?. Source Journal of the American College of Cardiology. 87(16) (pp 2160-2162), 2026. Date of Publication: 28 Apr 2026. Author Mark D.B.; Rao S.V. Institution (Mark) Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA (Rao) New York University Grossman School of Medicine, NY, United States <3> [Use Link to view the full text] Accession Number 2043621254 Title Clinical Outcomes of Organ Transplantation Following Donation After Medical Assistance in Dying: A Systematic Review and Meta-Analysis. Source Transplantation. Publish Ahead of Print (no pagination), 2025. Date of Publication: 12 Dec 2025. Author Slagter J.S.; Cappelle M.L.; Polak W.G.; den Hoed C.M.; van de Wetering J.; Hellemons M.E.; Manintveld O.C.; van der Kaaij N.P.; Dor F.J.M.F.; Pengel L.H.M.; Porte R.J.; Minnee R.C. Institution (Slagter, Cappelle, Polak, Dor, Porte, Minnee) Erasmus MC Transplant Institute, Division of HPB/Transplant Surgery, Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands (den Hoed) Erasmus MC Transplant Institute, Department of Gastroenterology/Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands (van de Wetering) Erasmus MC Transplant Institute, Division of Nephrology and Kidney Transplantation, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands (Hellemons) Erasmus MC Transplant Institute, Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, Netherlands (Manintveld) Erasmus MC Transplant Institute, Department of Cardiology, Erasmus Medical Centre, Rotterdam, Netherlands (van der Kaaij) Erasmus MC Transplant Institute, Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, Netherlands (Pengel) Erasmus MC Transplant Institute, Erasmus Medical Centre, Rotterdam, Netherlands Publisher Lippincott Williams and Wilkins Abstract Background. - Organ donation after medical assistance in dying (DCD-V) is becoming increasingly common in the few countries where medical-assistance in dying is legalized. While donor warm ischemia time may be shorter compared with controlled donation after circulatory death, the use of high doses of euthanasic drugs could impact posttransplant outcomes. To assess whether DCD-V is a safe and effective method to expand the organ donor pool, it is important to examine the posttransplant results. This systematic review aims to evaluate the outcomes of DCD-V heart, lung, liver, kidney, and pancreatic islets transplantation. Methods. - A systematic literature search was conducted in the EMBASE, MEDLINE, Web of Science, and Google Scholar databases for studies reporting clinical outcomes following transplantation with DCD-V grafts. The primary outcome was graft survival. Results. - The search identified 550 studies, of which 19 were included for qualitative and 7 for quantitative analysis. Graft survival rates for DCD-V grafts were comparable to those for controlled donation after circulatory death grafts. Conclusions. - The limited data from this review suggests that DCD-V provides acceptable outcomes and appears safe in lung and kidney transplantation, but caution is warranted in liver transplantation. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <4> Accession Number 2043868344 Title Fibrinolysis vs urgent surgery in obstructive prosthetic valve thrombosis: updated evidence from a systematic review and meta-analysis. Source Journal of Thrombosis and Haemostasis. 24(5) (pp 1827-1839), 2026. Date of Publication: 01 May 2026. Author Resende B.; Mata E.; Castro M.; Pinto A.M.; Ribeiro S.; Gameiro J.; Lourenco A.; Ferraz-Costa G.; Goncalves L. Institution (Resende, Gameiro, Ferraz-Costa, Goncalves) Department of Cardiology, Coimbra Local Health Unit, Coimbra, Portugal (Mata, Castro, Pinto, Ribeiro, Lourenco) Department of Cardiology, Alto Ave Local Health Unit, Guimaraes, Portugal (Ferraz-Costa, Goncalves) Faculty of Medicine, University of Coimbra, Coimbra, Portugal (Goncalves) Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal Publisher Elsevier B.V. Abstract Background Obstructive prosthetic valve thrombosis (PVT) is a life-threatening complication. The first-line therapy remains uncertain. While surgery has historically been preferred, advances in low-dose, slow-infusion fibrinolysis protocols have improved outcomes. Objectives To evaluate the efficacy and safety of fibrinolytic therapy versus urgent valve surgery in PVT. Methods Following a systematic search of 5 databases, a meta-analysis compared fibrinolysis with urgent valve surgery for obstructive PVT. The primary outcomes were in-hospital all-cause mortality and complete restoration of valve function. Secondary outcomes included stroke, systemic embolism, major bleeding, recurrent PVT, and all-cause mortality during follow-up. Data were pooled as risk ratio (RR) using random-effects models, with sensitivity and meta-regression analyses. Results Across 12 observational studies and 1 randomized controlled trial, 1300 patients (fibrinolysis/surgery: 714/586) were included. No significant difference was observed in in-hospital mortality (RR: 0.59 [0.27-1.30]; I 2=57.1%). However, fibrinolysis was associated with lower complete restoration of valve function (RR: 0.82 [0.70-0.96]; I 2=71.6%) and higher risks of stroke (RR: 3.19 [1.30-7.85]; I 2=0%), systemic embolism (RR: 3.88 [1.44-10.4]; I 2=0%), and recurrent PVT (RR: 2.44 [1.18-5.05]; I 2=58.3%). No differences were found in major bleeding or all-cause mortality during follow-up. Sensitivity analyses restricted to alteplase-based regimens favored fibrinolysis, showing lower in-hospital mortality (RR: 0.12 [0.05-0.29]; I 2=0%), consistent with meta-regression findings, and efficacy comparable to surgery. Conclusion Our study suggests that surgery offers higher immediate success with fewer embolic or recurrent events. However, contemporary alteplase protocols may be associated with improved safety outcomes relative to surgery, with no apparent loss of efficacy. Given the low certainty of available evidence, treatment should be individualized according to patient risk profile, and institutional resources. Copyright © 2026 International Society on Thrombosis and Haemostasis. <5> Accession Number 2039418464 Title Clinical and health status after permanent pacemaker implantation in patients undergoing transcatheter aortic valve replacement: Insights from the SCOPE I randomized trial. Source Cardiovascular Revascularization Medicine. 85 (pp 12-20), 2026. Date of Publication: 01 Apr 2026. Author Nakase M.; Tomii D.; Lanz J.; Prendergast B.; Heg D.; Thiele H.; Mollmann H.; Kim W.-K.; Burgdorf C.; Linke A.; Redwood S.; Hilker M.; Conradi L.; Kerber S.; Thilo C.; Toggweiler S.; Walther T.; Joner M.; Windecker S.; Pilgrim T. Institution (Nakase, Tomii, Lanz, Windecker, Pilgrim) Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (Heg) Department of Clinical Research, University of Bern, Switzerland (Mollmann) Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany (Kim) Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany (Burgdorf) Heart and Vascular Centre, Bad Bevensen, Germany (Linke) Department of Internal Medicine and Cardiology, Heart Centre Dresden, Technische Universitat Dresden, Dresden, Germany (Prendergast, Redwood) Department of Cardiology, St Thomas' Hospital, London, United Kingdom (Hilker) Department of Cardiothoracic Surgery, University Medical Centre, Regensburg, Germany (Joner) German Heart Centre, Technical University of Munich, Munich, Germany (Thiele) Heart Centre Leipzig, Leipzig, Germany (Conradi) Department of Cardiovascular Surgery, University Heart Centre Hamburg, Hamburg, Germany (Kerber) Department of Cardiology, Cardiovascular Centre Bad Neustadt, Bad Neustadt, Germany (Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim, Germany (Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland (Walther) Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital Frankfurt, Frankfurt, Germany Publisher Elsevier Inc. Abstract Background The impact of new permanent pacemaker (PPM) implantation on prognosis after transcatheter aortic valve replacement (TAVR) is controversial. Objectives To investigate the impact of new PPM implantation on combined outcomes of vital and patient-reported health status after TAVR. Methods Patients in the SCOPE (Safety and Efficacy of the ACURATE Neo/TF Compared to the SAPIEN 3 Bioprosthesis) trial were stratified according to new PPM implantation within 30 days of TAVR. In this trial, clinical endpoints were adjudicated according to the Valve Academic Research Consortium (VARC)-2 definition. The combined outcomes, including general outcomes and clinical efficacy, were retrospectively adjudicated according to the VARC-3 definition at 1 and 3 years of follow-up. Results Among 640 patients without a PPM at baseline (mean age 82.8 +/- 4.1 years, 58.1 % females, mean Society of Thoracic Surgeons predicted risk of mortality 4.2 +/- 2.5), 69 (10.8 %) required PPM implantation within 30 days of TAVR. Patients requiring a PPM had higher rates of right ventricular dysfunction (33 % versus 15 %, P = 0.038) at 1 year. Improvement in patient-health status measures was similar between groups throughout the study period. Patients requiring a new PPM had similar rates of unfavorable clinical outcomes (Risk ratio [RR]<inf>adjusted</inf> 0.89 [95 % CI 0.68-1.16]) and clinical efficacy (RR<inf>adjusted</inf> 0.96 [95 % CI 0.76-1.22]) compared to those who did not require new PPM implantation. Conclusions In the SCOPE I trial, new PPM implantation complicating TAVR had no impact on an integrated endpoint of vital and disease-specific health status throughout 3 years of follow-up. Copyright © 2025 The Authors. <6> Accession Number 650746702 Title Long-Term Mortality After PCI or CABG for Left Main Stem Disease: Updated Meta-Analysis of Randomized Trials Using Reconstructed Individual-Participant Survival Data. Source Journal of the American College of Cardiology. 87(16) (pp 2180-2183), 2026. Date of Publication: 28 Apr 2026. Author Koeckerling D.; Reddy R.K.; Howard J.P.; Bansal R.; Bernstein H.; Lehmann L.; Frey N.; Buszman P.P.; Buszman P.E.; Christiansen E.H.; Park S.-J.; Serruys P.W.; Stone G.W.; Ahmad Y. Institution (Koeckerling, Lehmann, Frey) Department of Cardiology, Angiology and Respiratory Medicine, Heidelberg University Hospital, Heidelberg, Germany (Reddy, Howard) National Heart and Lung Institute, Imperial College London, London, United Kingdom (Bansal) Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom (Bernstein, Ahmad) Division of Cardiology, University of California-San Francisco, San Francisco, CA, United States (Buszman) Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland (Buszman) Jan Dlugosz University, Czestochowa, Poland (Christiansen) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Park) Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Republic of Korea (Serruys) CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland; Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland (Stone) Icahn School of Medicine at Mount Sinai, NY, United States <7> Accession Number 2044830265 Title Plasmalyte versus ringer's lactate for postoperative renal function and acid-base balance in hypertensive patients on ACEI/ARB therapy: A randomized controlled trial. Source Indian Journal of Clinical Anaesthesia. 13(2) (pp 257-263), 2026. Date of Publication: 2026. Author Madigela N.; Sudhamala P.; Patki A.Y.; Yadav M.; Durga P. Institution (Madigela, Sudhamala, Patki, Yadav, Durga) Dept. of Anaesthesiology, Nizam's Institute of Medical Sciences, Telangana, Hyderabad, India Publisher IP Innovative Publication Pvt. Ltd. Abstract Background and Aims: Preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is advised to prevent intraoperative hypotension. However, this withdrawal may reduce renal perfusion and increase the risk of acute kidney injury (AKI). Balanced crystalloids are preferred in such patients. Although Plasmalyte demonstrates advantages over Ringer's Lactate (RL) in surgical populations, its effects in patients on chronic ACEI/ARB therapy remain unclear. This study aimed to compare the effects of Plasmalyte and Ringer's Lactate on postoperative renal function and acid-base balance in hypertensive patients on long-term ACEI/ARB therapy undergoing elective surgery under general anesthesia. Material(s) and Method(s): This prospective, observer-blinded randomized controlled trial was conducted in a tertiary care hospital. Two hundred hypertensive adults (ASA physical status I-II) on ACEI/ARB therapy for at least three months were randomized to receive Plasmalyte (n=100) or Ringer's Lactate (n=100) intraoperatively as the sole intravenous fluid. Estimated glomerular filtration rate (eGFR), pH, standard base excess, serum creatinine, potassium, chloride and lactate were measured preoperatively, one hour and 24 hours postoperatively. Result(s): At 24 hours postoperatively, eGFR was significantly better preserved in the Plasmalyte group compared to the Ringer's Lactate group (71.5+/-7.5 vs. 66.6+/-6.3 mL/min/1.73m2; p=0.024). The Ringer's Lactate group demonstrated a mild, clinically insignificant rise in lactate at one hour (1.96+/-0.50 vs. 1.59+/-0.55 mmol/L; p=0.016) and mild acidosis at one hour (pH 7.36+/-0.07 vs. 7.39+/-0.06; p=0.002) and 24 hours postoperatively (pH 7.33+/-0.08 vs. 7.37+/-0.06; p=0.0001). Serum electrolytes and creatinine values were comparable between the two groups at all time points. Conclusion(s): In ACEI/ARB-treated hypertensive patients undergoing elective non-cardiac surgery, Plasmalyte provides better preservation of eGFR and more stable acid-base status compared to Ringer's Lactate, suggesting a renal and metabolic advantage in this population. Copyright © 2026 The Author(s) <8> Accession Number 2042560529 Title Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery: Systematic Review and Meta-analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(6) (pp 1869-1878), 2026. Date of Publication: 01 Jun 2026. Author Salles M.M.M.; Massoud R.O.; de Carvalho P.L.; Correia J.S.; Melo R.H. Institution (Salles) Department of Medicine, University of Oeste Paulista, Jau, Brazil (Massoud) Department of Medicine, State University of Para, Belem, Brazil (de Carvalho) Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil (Correia) Department of Arts and Science, University of South Florida, Tampa, FL, United States (Melo) Hospital Municipal Gilson de Cassia Marques de Carvalho, Sao Paulo, Brazil (Melo) Hospital Israelita Albert Einstein, Sao Paulo, Brazil Publisher W.B. Saunders Abstract Cardiovascular surgery with cardiopulmonary bypass (CPB) is associated with several potential complications, including the activation of inflammatory and coagulation pathways, which may lead to acute kidney injury (AKI). In this context, the intraoperative use of extracorporeal cytokine adsorbers has been studied for their potential benefits; however, their association with renal outcomes remains unclear. The authors aimed to perform a systematic review and meta-analysis comparing the AKI incidence and the need for renal replacement therapy in patients undergoing cardiovascular surgery with and without intraoperative hemoadsorption (HA). A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to identify observational studies and randomized controlled trials (RCTs) comparing the use of cytokine adsorbers incorporated into the CPB circuit (eg, CytoSorb and Jafron HA series) with standard surgical treatment during cardiac surgery. Statistical analysis was performed using Review Manager, version 5.4. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The authors included 17 studies-7 of which were RCTs-comprising a total of 1,797 patients, 826 of whom underwent HA during CPB. The incidence of AKI was lower with HA in the overall analysis, driven by observational data, whereas RCTs did not show a statistically significant reduction (overall RR, 0.66; 95% CI, 0.49-0.87; p = 0.008). The need for renal replacement therapy did not differ significantly between groups (RR, 0.83; 95% CI, 0.63-1.11; p = 0.19). Intraoperative HA may be associated with a lower AKI incidence in observational studies, but randomized data do not confirm a causal benefit. Larger, standardized trials are required to determine the effect on renal outcomes. Copyright © 2025 Elsevier Inc. <9> Accession Number 2043534722 Title Superficial Parasternal Intercostal Plane Block for Analgesia After Cardiac Surgery: An Updated Meta-analysis of Randomized Controlled Trials With Meta-regression and Trial Sequential Analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(6) (pp 1879-1890), 2026. Date of Publication: 01 Jun 2026. Author Dost B.; Karapinar Y.E.; Turunc E.; Beldagli M.; Turan E.I.; De Cassai A. Institution (Dost, Turunc) Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey (Karapinar) Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa Faculty of Medicine, Istanbul, Turkey (Beldagli) Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun, Turkey (Turan) Department of Anesthesiology and Reanimation, Health Science University, Istanbul Kanuni Sultan Suleyman Education and Training Hospital, Istanbul, Turkey (De Cassai) Department of Medicine (DIMED), University of Padua, Padua, Italy (De Cassai) Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy Publisher W.B. Saunders Abstract Background: Effective postoperative pain control is essential for enhanced recovery after cardiac surgery, yet optimal multimodal strategies continue to evolve. The superficial parasternal intercostal plane (S-PIP) block has been proposed as a simple and safe technique for median sternotomy analgesia; however, current evidence remains fragmented, and its clinical impact is unclear. Method(s): We conducted a systematic review and meta-analysis of randomized controlled trials assessing the analgesic efficacy and safety of the S-PIP block in adult cardiac surgery. PubMed, Embase, CENTRAL, Web of Science, Scopus, ClinicalTrials.gov, and gray literature were searched through September 2025. Trials comparing S-PIP with standard or placebo analgesia were pooled using a random-effects model. The primary outcome was 24-hour opioid use (morphine milligram equivalents). Trial sequential analysis, meta-regression, and Grades of Recommendation, Assessment, Development, and Evaluation were applied to evaluate the robustness and certainty of evidence. Result(s): Twenty-seven randomized controlled trials (1,760 patients) met the inclusion criteria. S-PIP block significantly reduced 24-hour opioid use compared with control (mean difference, -8.53 mg; 95% CI, -14.39 to -2.68), although the reduction was below the minimal clinically important difference and demonstrated substantial heterogeneity (I2 = 98.1%). Trial sequential analysis confirmed statistical significance, but the required sample size was not achieved. The block also lowered early pain scores, reduced rescue analgesic use, and shortened extubation time and intensive care unit stay. No meaningful differences were observed in hospital stay, postoperative nausea and vomiting, or chronic postsurgical pain. The certainty of the evidence ranged from moderate to very low. Conclusion(s): S-PIP provides modest early analgesic benefits after cardiac surgery. Further high-quality multicenter trials are required to clarify its overall clinical value. Copyright © 2026 Elsevier Inc. <10> Accession Number 2045046990 Title Adverse Events of Saffron (Crocus sativus L.): Systematic Review of Current Evidence. Source Health Science Reports. 9(5) (no pagination), 2026. Article Number: e72212. Date of Publication: 01 May 2026. Author Hasheminasab F.S.; Hajimonfarednejad M.; Najibi S.M.; Hashempur M.H. Institution (Hasheminasab) Pharmacology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of (Hasheminasab) Department of Genetic, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of (Hajimonfarednejad, Najibi, Hashempur) Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Hajimonfarednejad) Canadian College of Integrative Medicine (CCIM), Montreal, QC, Canada (Najibi) Department of Health Services Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background: Crocus sativus L., commonly known as saffron, is a widely used spice with a rich history of culinary and medicinal applications. This systematic review aims to compile human data from studies on monopreparations of C. sativus, including stigma powder and other extracts, to evaluate their safety. Method(s): Databases, including the Web of Science, Scopus, and PubMed Central, were searched up to August 2024 using the keywords "saffron" or "Crocus sativus" for clinical trials, case reports, and case series. Result(s): A total of 102 clinical trials and a single case report were included in this review. Nearly 78% of the trials evaluating the monopreparation of C. sativus addressed safety concerns and reported the complications that occurred. Approximately 56% indicated that one or more adverse effects were experienced during the intervention period. The estimated incidence of adverse events related to C. sativus consumption is around 17.5%. The most frequently reported side effects were gastrointestinal problems, which were minor and self-limiting in most cases. Conclusion(s): The findings suggest that C. sativus is generally well tolerated. However, due to some potentially significant adverse events associated with its medicinal use at higher doses or prolonged administration, clinical monitoring should be considered. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <11> [Use Link to view the full text] Accession Number 2040338519 Title Open-lung ventilation and mechanical power in thoracic surgery. Source European Journal of Anaesthesiology. 43(5) (pp 395-404), 2026. Date of Publication: 01 May 2026. Author Zorrilla-Vaca A.; Barbeta E.; Librero J.; Ferrando C. Institution (Zorrilla-Vaca, Barbeta, Librero, Ferrando) From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA (AZV), Department of Anesthesiology, Hospital Universitario Evaristo Garcia, Universidad del Valle, Cali, Colombia (AZV), Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona (EBCF), Red de Investigacion en Servicios de Salud, Navarrabiomed, Complejo Hospitalario de Navarra, Pamplona Spain (JL), Institut D'investigacio August Pi I Sunyer, Barcelona (CF) and CIBER de Enfermedades Respiratorias CIBERES, Instituto de Salud Carlos III, Madrid, Spain Publisher Lippincott Williams and Wilkins Abstract BACKGROUND - Individualisation of positive-end expiratory pressure (PEEP) is an open-lung ventilation strategy associated with better respiratory mechanics. Mechanical power has been associated with lung injury in critical care settings, but the interaction between optimisation of PEEP and mechanical power during one-lung ventilation (OLV) remains poorly understood.OBJECTIVE - This study aimed to determine the effect of individualisation of PEEP on mechanical power during OLV as well as to establish the association between mechanical power and postoperative pulmonary complications after thoracic surgery.DESIGN - This is a post hoc analysis of a multicentre randomised trial.SETTING - Operating rooms.PATIENTS - Thoracic surgery cases requiring OLV.INTERVENTION - Open-lung ventilation strategy (i.e. individualised PEEP titration based on respiratory compliance) versus standard PEEP. Mechanical power and its components were compared between both groups at five different time-points: two-lung ventilation (T0), baseline OLV (T1), 20 min after OLV (T2), end of OLV (T3) and before extubation (T4).MAIN OUTCOME MEASURES - Our primary outcome included a composite of postoperative pulmonary complications within 30 days after surgery. Multivariable mixed-effects logistic regressions were performed to assess associations between various thresholds of mechanical power and postoperative pulmonary complications.RESULTS - A total 1253 patients were included in this analysis, of which 635 received open-lung ventilation, and 618 received conventional ventilation. The median difference in mechanical power was higher in the open-lung ventilation group during OLV than in the control group at T2, T3 and T4: 1.39 [95% confidence interval (CI), 0.91 to 1.86] J min-1, 1.27 (95% CI, 0.79 to 1.75) J min-1 and 2.12 (95% CI, 1.60 to 2.63) J min-1, respectively. While the resistive component of mechanical power was associated with postoperative pulmonary complications [odds ratio (OR), 1.07 (95% CI, 1.01 to 1.13) per J min-1], the static component was protective [OR, 0.91 (95% CI, 0.85 to 0.98) per J min-1].CONCLUSION - Individualisation of PEEP during OLV leads to nonclinically significant higher levels of mechanical power compared with standard PEEP. Each component of mechanical power seems to have different interactions with the occurrence of postoperative pulmonary complications.TRIAL REGISTRATION - NCT03182062 Copyright © 2025 American Heart Association, Inc. <12> Accession Number 2043958550 Title Assessing preoperative bleeding risk using international normalized ratio and activated partial thromboplastin time: a systematic review. Source Journal of Thrombosis and Haemostasis. 24(5) (pp 1627-1642), 2026. Date of Publication: 01 May 2026. Author Rahhal H.; Sampat R.; Tse B.; Liontos L.; Hicks L.K.; Tang G.H.; Sholzberg M. Institution (Rahhal) Departamento de Clinica Medica, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil (Rahhal) Faculdade de Medicina, Universidade de Sao Caetano do Sul, Sao Paulo, Brazil (Sampat, Tse, Tang) Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, ON, Canada (Tse, Sholzberg) Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada (Liontos) Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (Hicks, Sholzberg) Department of Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada Publisher Elsevier B.V. Abstract Background The prothrombin time (PT) and activated partial thromboplastin time (APTT) are often considered routine tests in the assessment of perioperative bleeding risk. Physicians continue to order these tests, and major medical societies guidelines exhibit significant heterogeneity regarding the utility of coagulation tests as a general screening tool, despite many advocating for a risk-stratified approach over routine testing. Objectives This study aimed to assess for association between preoperative coagulation tests and bleeding events around elective surgery. Methods We conducted a systematic review of the literature. Three electronic databases were consulted MEDLINE, EMBASE, and EBM Reviews. Randomized trials and observational studies that assessed the predictive accuracy of preprocedural PT and APTT test results for perioperative bleeding were deemed eligible for inclusion. Outcomes included any bleeding events in the postoperative period. Results In total, 100 studies were included in our qualitative synthesis: otolaryngology ( n = 15), minor surgeries and procedures ( n = 15), neurosurgery ( n = 17), orthopedic surgeries ( n = 6), cardiac surgeries ( n = 16), liver transplantation or hepatectomy ( n = 20), general surgery, and other types of major surgery ( n = 11). Qualitative synthesis demonstrated a weak or inconsistent association between PT or APTT and bleeding events. Associations were more frequently reported in studies involving patients with cirrhosis and/or neoplastic disease of the liver undergoing liver resection, transplantation, or major abdominal cancer debulking surgery. Conclusion Our findings confirm that coagulation testing results are not consistently associated with bleeding in minor surgeries and nearly all major elective surgeries. However, PT results might be associated with bleeding outcomes in patients with advanced liver disease undergoing major abdominal surgeries. Copyright © 2026 International Society on Thrombosis and Haemostasis. <13> Accession Number 2043717395 Title Evaluation of the Effect of Intravenous Lidocaine on the Systemic Inflammatory Response Associated With Cardiopulmonary Bypass in Valvular and/or Coronary Cardiac Surgery: Protocol for a Double-Blind Randomized Clinical Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(6) (pp 1668-1677), 2026. Date of Publication: 01 Jun 2026. Author Fernandez-Martinez A.; Lopez Picado A.; Gonzalez-Garcia J.; Aguado Sevilla M.; Lobato Solores F.; Castroviejo Ibanez B.; de Miguel Fernandez P.; Benito Martinez P.; Valero Gonzalez S.; Galve Marques A.I.; Mainar Gil I.; Boukichou Abdelkader N.; Iniguez Martinez M.; Bermejo Bravo A.; Apinaniz Apinaniz R.; Corral Cardenas E.; Ferreira Laso L. Institution (Fernandez-Martinez) Faculty of Medicine, University of the Basque Country, Bizkaia, Leioa, Spain (Fernandez-Martinez, Aguado Sevilla, Lobato Solores, Castroviejo Ibanez, de Miguel Fernandez, Benito Martinez, Valero Gonzalez, Galve Marques, Ferreira Laso) Anaesthesiology, Resuscitation and Pain Management, Hospital Universitario San Pedro, Logrono, Spain (Lopez Picado) Department of Public Health and Preventive Medicine, University of the Basque Country, Bilbao, Spain (Gonzalez-Garcia) Department of Surgery, Radiology and Physical Medicine, University of the Basque Country, Bilbao, Spain (Gonzalez-Garcia) Anaesthesiology, Resuscitation and Pain Management, Hospital Universitario de Basurto, Bilbao, Spain (Mainar Gil) Intensive Care Medicine, Hospital Universitario San Pedro, Logrono, Spain (Boukichou Abdelkader) Department of Statistics, Data Science Unit, La Rioja Biomedical Research Center (CIBIR), Logrono, Spain (Iniguez Martinez) Department of Infectious Diseases, La Rioja Biomedical Research Center (CIBIR), Logrono, Spain (Bermejo Bravo, Apinaniz Apinaniz) Hospital Pharmacy, Hospital Universitario San Pedro, Logrono, Spain (Corral Cardenas) Hospital Universitario San Pedro, Logrono, Spain Publisher W.B. Saunders Abstract Objectives: To assess whether intravenous lidocaine reduces the systemic inflammatory response associated with cardiopulmonary bypass (CPB) and improves clinical outcomes in adult patients undergoing elective valvular and/or coronary cardiac surgery. Design(s): Single-center, parallel-group, double-blind, randomized clinical trial. Setting(s): San Pedro University Hospital, Logrono, Spain. Participant(s): Ninety adult patients (>=18 years) scheduled for elective valvular and/or coronary surgery with CPB who provide informed consent. Intervention(s): Patients will be randomly assigned to receive either intravenous lidocaine (1.5-mg/kg bolus followed by 1.5-mg/kg/h infusion until sternal closure) or an equivalent volume of saline solution as placebo. For patients with a body mass index greater than 30 kg/m2, the infusion dose will be adjusted according to ideal body weight, calculated as height (in centimeters) - 100 for men and height (in centimeters) - 110 for women. Measurements and Main Results: The primary outcome is the interleukin 6 level at 6 hours postoperatively. Secondary outcomes include trajectories of inflammatory and myocardial injury biomarkers (C-reactive protein, high-sensitivity troponin T, and tumor necrosis factor alpha), postoperative complications related to the systemic inflammatory response (acute kidney injury, transfusion requirements, vasoplegia, respiratory dysfunction, delirium, infection, and multiorgan dysfunction), postoperative pain, intensive care unit length of stay, 30-day mortality, and incidence of post-CPB atrial fibrillation. The analysis will be conducted on an intention-to-treat basis. Conclusion(s): This trial will determine whether intravenous lidocaine attenuates the systemic inflammatory response induced by CPB and improves clinical outcomes in adult patients undergoing elective cardiac surgery. Copyright © 2026 The Author(s) <14> Accession Number 2045047634 Title Long-Term Clinical Outcomes of CABG vs. PCI With DES for Multivessel and Left-Main Coronary Artery Disease: A Systematic Review and Meta-Analysis. Source Journal of Interventional Cardiology. 2026(1) (no pagination), 2026. Article Number: 6698370. Date of Publication: 2026. Author Saleem M.M.; Tariq M.H.; Upadhyay M.; Brar A.; Usman A.; Ahmed R.; Mudassar M.; Ibrahim S.; Bajwa M.S.; Alkotob M.L.; Zaitoun A. Institution (Saleem, Upadhyay, Brar) Michigan State University, Flint, MI, United States (Tariq) Northwest Medical Center, Tucson, AZ, United States (Usman, Alkotob, Zaitoun) Hurley Medical Center, Flint, MI, United States (Ahmed) Yale New Haven Hospital, New Haven, CT, United States (Mudassar) King Edward Medical College, Lahore, Pakistan (Ibrahim) King Edward Medical University, Lahore, Pakistan (Bajwa) JFK University Medical Center, Edison, NJ, United States Publisher John Wiley and Sons Inc Abstract Background: Current guidelines favor Coronary Artery Bypass Graft (CABG) Surgery over Percutaneous Coronary Intervention (PCI) for multivessel (MVD) and left main coronary artery disease (LM-CAD) due to better outcomes. However, the FAME-3 trial suggests similar long-term results between PCI and CABG for triple-vessel disease. To explore this discrepancy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing CABG and PCI with DES, assessing differences in all-cause mortality, target vessel revascularization (TVR), and major adverse cardiovascular and cerebrovascular events (MACCE) over at least 3 years. Method(s): RCTs comparing CABG with PCI, reporting outcomes on at least 3 years (36 months) of follow-up, were included. Using an Intention-to-treat analysis, the primary outcome was assessed as the relative risk of all-cause mortality, while secondary outcomes consisted of TVR and MACCE. We also performed subgroup analysis based on the type of coronary artery disease (LM-CAD or MVD) and SYNTAX scores. Result(s): CABG did not show any significant benefit in terms of all-cause mortality when compared to PCI for either LM-CAD or MVD (RR: 0.90, 95% CI: 0.78, 1.04). It had a lower risk of all-cause mortality in patients with SYNTAX < 23 and a lower risk of MACCE (RR: 0.75, 95% CI: 0.70, 0.81) and TVR (RR: 0.50, 95% CI: 0.38, 0.66) across all subgroups regardless of the SYNTAX score. Conclusion(s): While no major mortality difference was noted between CABG and PCI, the risk of MACCE and TVR was lower with CABG in both LM-CAD and MVCAD across all SYNTAX scores. This should be discussed at length with patients, as it may impact decision-making. Copyright © 2026 Muhammad M. Saleem et al. Journal of Interventional Cardiology published by John Wiley & Sons Ltd. <15> Accession Number 2045312583 Title Does Robot-Assisted Hybrid Coronary Revascularization Matter? Insights From a Single-Center Experience in Patient Quality of Life. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Bafageeh S.W.; Barnawi H.I.; Ashour M.A.; Alsulami M.M.; Aljefri Y.; Zabani I.; Khalil H.; Elamin O.; Jamjoom A.; AlUthman U. Institution (Bafageeh, Barnawi, Ashour, Elamin, Jamjoom, AlUthman) Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Bafageeh) Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia (Alsulami, Aljefri) Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Zabani) Department of Anesthesiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (Khalil) Department of Cardiology, King Fahad General Hospital, Jeddah, Saudi Arabia Publisher SAGE Publications Ltd Abstract Objective: Coronary artery disease (CAD) significantly affects patient quality of life (QoL). Robot-assisted hybrid coronary revascularization (RHCR) emerged as a minimally invasive alternative to conventional coronary artery bypass grafting (CABG), offering enhanced recovery and improved QoL outcomes. This study evaluates the QoL outcomes of RHCR compared with conventional CABG preoperatively and 4 weeks and 6 months postoperatively using the validated 36-Item Short Form (SF-36) questionnaire. Method(s): This prospective study included 96 patients (48 RHCR, 48 CABG) with multivessel CAD treated at King Faisal Specialist Hospital between July 2018 and December 2020. QoL was assessed using the SF-36 questionnaire across 8 domains with scores obtained preoperatively and at 4 weeks and 6 months after surgery. Statistical analyses were conducted to compare changes between groups. Result(s): The RHCR group consistently reported higher scores for physical functioning and role limitations due to physical health, mental health, social functioning, and general health at all time points. At 4 weeks, RHCR patients experienced significantly better scores in physical functioning (75.4 vs 62.6, P < 0.001), social functioning (72.5 vs 64.2, P = 0.003), and bodily pain (76.8 vs 54.0, P < 0.001). At 6 months, RHCR maintained superiority in physical functioning (94.7 vs 88.0, P < 0.001), general health (84.1 vs 78.1, P = 0.020), and mental health (83.5 vs 75.4, P = 0.002). Conclusion(s): RHCR is associated with greater improvements in QoL compared with conventional CABG, particularly in domains related to physical functioning, role limitations due to physical health, and general health perception. Copyright © The Author(s) 2026 <16> Accession Number 2045234975 Title Transcatheter edge-to-edge mitral valve repair versus medical therapy for secondary mitral regurgitation: a meta-analysis of randomized controlled trials. Source Monaldi Archives for Chest Disease. 96(1) (no pagination), 2026. Article Number: 3264. Date of Publication: 2026. Author Mata E.; Garcia B.L.; Tinoco M.; Castro M.; Pinheiro L.; Portugues J.; Ferreira F.; Ribeiro S.; Melica B.; Lourenco A. Institution (Mata, Garcia, Tinoco, Castro, Pinheiro, Portugues, Ferreira, Ribeiro, Lourenco) Department of Cardiology, Local Health Unit of Alto Ave, Guimaraes, Portugal (Melica) Department of Cardiology, Local Health Unit of Gaia and Espinho, Vila Nova de Gaia, Portugal Publisher Page Press Publications Abstract Secondary mitral regurgitation (SMR) is associated with increased hospitalizations and mortality. Clinical trials comparing mitral valve transcatheter edge-to-edge repair (M-TEER) with guideline-directed medical therapy (GDMT) show conflicting results, but the RESHAPE-HF2 trial offers new insights. This study aims to assess the M-TEER effect in addition to GDMT in reducing all-cause mortality, cardiovascular death, and heart failure hospitalizations (HHF) in patients with SMR when compared to GDMT alone. On September 2, 2024, PubMed, Cochrane CENTRAL, Scopus, and Web of Science were searched for randomized controlled trials comparing M-TEER in addition to GDMT with GDMT in SMR patients with heart failure. A study-level random-effects meta-analysis was conducted using trial-reported point estimates. Seven records from three trials (COAPT, MITRA-FR, RESHAPE-HF2) involving 1426 participants were included. At 24 months, M-TEER (using MitraClip) significantly reduced the first HHF [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.45-0.96] and all HHF (HR 0.63, 95% CI 0.49-0.81). However, no significant reduction was observed in all-cause mortality (HR 0.76, 95% CI 0.57-1.01) or cardiovascular death (HR 0.77, 95% CI 0.56-1.06). The intervention group had more patients in the New York Heart Association class I/II at 12 and 24 months, but no significant improvement in 6-minute walk test performance at 12 months. High trial heterogeneity requires careful interpretation of pooled estimates. Differences in medical therapy and patient characteristics likely affected outcomes across trials. While M-TEER demonstrates benefits in reducing HHF, its effectiveness in reducing mortality remains inconclusive. The degree of left ventricular enlargement may have influenced outcomes, underscoring the importance of careful patient selection. © Copyright: the Author(s), 2025. <17> Accession Number 2045124120 Title Economic evaluation of alternative cardiac rehabilitation programmes compared to centre-based cardiac rehabilitation programmes: a systematic review. Source European Journal of Preventive Cardiology. 33(6 Focus Issue on Cardiac Rehabilitation) (pp 958-972), 2026. Date of Publication: 01 Apr 2026. Author Zou Y.; Du J.; Burger H.; Zuidema S.; van der Werf S.; Janus S.; Qu N. Institution (Zou) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Du) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Du) Department of Psychiatry, University of Oxford, Oxford, United Kingdom (Burger) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Zuidema) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (van der Werf) Central Medical Library, University Medical Center Groningen, University of Groningen, Groningen, Netherlands (Janus) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Qu) Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Qu) Academy of Medical Engineering and Translational Medicine, Medical School, Tianjin University, Tianjin, China (Qu) Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China Publisher Oxford University Press Abstract Aims: Traditional centre-based cardiac rehabilitation (CBCR) has several drawbacks, including high costs, limited accessibility, and low utilisation rates. As a result, alternative cardiac rehabilitation programmes (ACRPs), such as home-based rehabilitation and telerehabilitation, have been developed. This systematic review aims to synthesise existing evidence on the economic evaluation of ACRPs compared to CBCR. Methods and Results: We searched databases of MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and EconLit, as well as trials registers of Clinicaltrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register. The last search date was 20 March 2025. We included randomised controlled trials that directly compared ACRP with CBCR in terms of cost and effectiveness. Study quality was assessed using the Cochrane Risk of Bias tool and the Drummond 10-item checklist. Both qualitative and quantitative syntheses were conducted, with random-effects models applied in the meta-analysis. Thirteen studies met the inclusion criteria, comprising 2040 participants. Meta-analysis showed a non-significant trend favouring CBCR over ACRP for EQ-5D (SMD = -0.32; 95% CI: -0.71 to 0.06; I2 = 79%). For QALY, there was no difference between ACRP and CBCR (SMD = -0.02; 95% CI: -0.19 to 0.15; I2 = 0). Ten of the thirteen studies reported lower costs for ACRP compared with traditional CBCR. Three of five economic evaluations found ACRP to be cost-effective. Conclusion(s): ACRPs demonstrate cost-effectiveness comparable to traditional CBCR. This review highlights the potential of ACRPs, such as home-based rehabilitation and telerehabilitation, as solutions for broader implementation in CR practice. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. <18> Accession Number 2045364201 Title Septic arthritis due to Corynebacterium striatum in native joints: a systematic review of published cases. Source Diagnostic Microbiology and Infectious Disease. 116(1) (no pagination), 2026. Article Number: 117440. Date of Publication: 01 Sep 2026. Author Posada S.R.; Zamora P.C.; Lopez L.P.; Dominguez M.G.; Fernandez R.C.; Pardavila H.P.; Garcia P.M.A. Institution (Posada, Zamora, Lopez, Dominguez, Fernandez, Garcia) Department of Clinical Microbiology and Parasitology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain (Pardavila) Department of Infectious Diseases, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain Publisher Elsevier Inc. Abstract Background: Corynebacterium striatum has traditionally been regarded as a skin commensal and is frequently dismissed as a contaminant when isolated from clinical samples. However, it has increasingly been recognized as an opportunistic pathogen in selected clinical settings. Septic arthritis involving native joints remains an exceptionally rare manifestation, and its clinical significance is often difficult to interpret. Method(s): Given the absence of comprehensive analyses in this field, we performed a systematic literature review of published cases of septic arthritis caused by C. striatum involving native joints, in accordance with PRISMA 2020 guidelines. Demographic data, risk factors, clinical presentation, microbiological findings, management strategies, and outcomes were reviewed. A contemporary case was included as part of the overall analysis. Result(s): Twelve cases were identified. Most patients presented with acute monoarticular arthritis affecting large joints, particularly the knee and shoulder. Predisposing factors were present in nearly all cases, including advanced age, immunosuppression, underlying joint disease, or recent joint manipulation. Synovial fluid analysis consistently demonstrated a marked inflammatory profile. Repeated isolation of C. striatum from sterile joint samples supported its etiologic role. Management commonly included surgical irrigation and debridement combined with prolonged antimicrobial therapy, most frequently vancomycin. Overall outcomes were generally favourable, although severe complications were reported in patients with significant comorbidities. These findings identify consistent clinical and therapeutic patterns despite the rarity of the condition. Conclusion(s): Corynebacterium striatum should be considered a potential cause of septic arthritis in native joints, particularly in high-risk patients. Its clinical presentation is largely indistinguishable from that of septic arthritis caused by more common bacterial pathogens, and diagnosis relies on repeated isolation from sterile synovial samples in the context of a markedly inflammatory synovial profile. Early surgical drainage combined with targeted prolonged antimicrobial therapy, most commonly vancomycin with oral linezolid step-down when susceptible, appears to represent the most consistently supported management strategy based on available evidence. Recognition of its pathogenic potential is essential to avoid misclassification as contamination, prevent delayed diagnosis and suboptimal treatment, and ultimately improve clinical outcomes in this emerging clinical entity. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <19> [Use Link to view the full text] Accession Number 2044877673 Title Impaired endotoxin inactivation, rather than gut translocation, is associated with organ injury in cardiac surgery with cardiopulmonary bypass: An ancilliary analysis of a randomised control trial. Source European Journal of Anaesthesiology. Publish Ahead of Print (no pagination), 2026. Date of Publication: 14 Jan 2026. Author Nguyen M.; Alvarez M.; Evezard C.; Ibrahima A.; Huette P.; Mahjoub Y.; Pais-De-Barros J.-P.; Bouhemad B.; Masson D.; Gautier T.; Guinot P.-G.; Abou-Arab O. Institution (Nguyen, Alvarez, Evezard, Ibrahima, Huette, Mahjoub, Pais-De-Barros, Bouhemad, Masson, Gautier, Guinot, Abou-Arab) From the Department of Anesthesiology and Intensive Care, Dijon Universite Hospital (MN, CE, BB, PGG), the Universite Bourgogne Europe, Dijon, France (MN, BB, DM, PPG), the Centre for Translational and Molecular Medicine (CTM), INSERM UMR1231, Lipness Team, Dijon (MN, MA, JPPde B, BB, DM, TG, PGG), the Department of Anesthesiology and Intensive Care, Amiens Universite Hospital (AI, PH, YM, OAA), the Department of Anesthesiology and Intensive Care, Pauchet sante, Clinique Victor Pauchet, the DiviOmics Facility, UMS 58 BioSanD, Universite de Bourgogne (JPPdeB), the Laboratory of Clinical Chemistry, Dijon Universite Hospital, Dijon, France Publisher Lippincott Williams and Wilkins Abstract BACKGROUNDS - In patients with cardiac surgery under cardiopulmonary bypass (CPB), postoperative inflammation is a driver of adverse outcomes. Endotoxaemia is one of the factors thought to trigger this inflammatory response. The mechanism behind high endotoxin activity (increased translocation vs. reduced inactivation capacity) has never been elucidated and may imply different therapeutic candidates. OBJECTIVES - We aimed to evaluate, in patients with cardiac surgery with prolonged CPB, mechanisms and consequences of endotoxaemia and the efficacy of haemo-adsorption to reduce the endotoxin burden. DESIGN - Ancillary analysis of a randomised controlled trial. Patients scheduled for cardiac surgery with prolonged CPB were assigned to receive either intra-operative haemo-adsorption or standard of care. Endotoxin mass and activity were measured before surgery, at the end of CPB, 6, 24 and 48h after the end of surgery. SETTING - Operating room, Amiens University Hospital. PATIENTS - Adults scheduled for cardiac surgery under CPB with an expected CPB time more than 90min. INTERVENTION - Patients were randomised to receive either haemo-adsorption or standard care during CPB. MAIN OUTCOME MEASURES - Endotoxin activity. RESULTS - Two hundred and ninety-five samples from 66 patients were analysed. Following CPB, we observed a reduction in endotoxin mass accompanied by a relative increase in endotoxin activity. High postoperative endotoxin activity was associated with intra-operative dobutamine requirement, increased postoperative inflammatory biomarkers and organ injury. Endotoxin plasma concentration and activity were not lower in patients treated with haemo-adsoprtion. CONCLUSION - The capacity of individuals to inactivate endotoxin rather than raw endotoxin mass (i.e. Quantity) seemed to be a determinant of endotoxin noxious effect in cardiac surgery and CBP. Haemo-adsorption was not associated with a reduction of endotoxin plasma mass or activity in patients with cardiac surgery under CPB. TRIAL REGISTRATION - ClinicalTrials.gov, NCT04201119NCT04201119 Copyright © 2026 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited. <20> Accession Number 2045003578 Title Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Source Echocardiography. 43(5) (no pagination), 2026. Article Number: e70474. Date of Publication: 01 May 2026. Author Zheng E.; Garza A.; Vetter S.; Tan B.E.X.; Cotella J.; Randazzo M.; Slivnick J. Institution (Zheng) University of Massachusetts Chan Medical School, Worcester, MA, United States (Garza, Vetter, Slivnick) Division of Cardiovascular Medicine, The University of Chicago Medicine, Chicago, IL, United States (Tan) Baylor College of Medicine, Houston, TX, United States (Cotella) Cardiologo en Altos de Salta Swiss Medical Group, Tucuman, Argentina (Randazzo) Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States Publisher John Wiley and Sons Inc Abstract Purpose: Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure with overlapping phenotypes, such as aortic stenosis (AS) and hypertrophic cardiomyopathy. The apical sparing ratio (ASR) derived from echocardiographic strain imaging has been widely adopted as a potential screening tool for CA, though performance across clinical contexts remains uncertain. Method(s): We performed a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of ASR for identifying CA among patients with left ventricular hypertrophy (LVH), including a prespecified subgroup of patients with severe AS, in September 2024. Random-effects models incorporating multiple ASR thresholds were used to estimate pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC). Result(s): Among 3501 records screened, 22 studies (n = 4144) met inclusion criteria for primary analysis. An optimal Youden ASR of threshold = 0.83 yielded pooled sensitivity (95% confidence interval) of 73% (66%, 79%) and specificity of 77% (67%, 84%), with an AUC of 0.81 (0.69, 0.89). In the severe AS subgroup (5 studies, n = 911), pooled sensitivity and specificity were 65% (47%, 80%) and 74% (58%, 85%), respectively, with an AUC of 0.79 (0.70, 0.92). Across analyses, high heterogeneity was observed. Sensitivity analyses, excluding high-bias or low-threshold studies, produced similar findings. Conclusion(s): ASR demonstrates only modest diagnostic performance for differentiating CA from hypertrophic phenotypes, with limited sensitivity at conventional thresholds. These findings underscore the limitations of ASR as a standalone screening tool and highlight the need for alternative approaches to improve diagnostic accuracy. Copyright © 2026 Wiley Periodicals LLC. <21> [Use Link to view the full text] Accession Number 2040188669 Title Continuing the Quest to Refine Coronary Risk Stratification. Source Circulation: Cardiovascular Imaging. 18(9) (no pagination), 2025. Article Number: e018896. Date of Publication: 01 Sep 2025. Author Slipczuk L.; Garcia M.J. Institution (Slipczuk, Garcia) Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, United States Publisher Lippincott Williams and Wilkins <22> Accession Number 2044044053 Title Transcatheter aortic valve replacement for mixed aortic valve disease: An updated meta-analysis and systematic review. Source American Journal of the Medical Sciences. 371(5) (pp 434-440), 2026. Date of Publication: 01 May 2026. Author Kidess G.G.; Hamza M.; Basit J.; Alraiyes M.; Alraies M.C. Institution (Kidess) Department of Internal Medicine, The University of Chicago Medical Center, Chicago, IL, United States (Hamza) Department of Hospital Medicine, Gurthrie Cortland Regional Medical Center, Cortland, NY, United States (Basit) Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Alraiyes) Department of Interventional Cardiology Research, Detroit Medical Center/Wayne State University, Detroit, MI, United States (Alraies) Cardiovascular Unit, Detroit Medical Center/Wayne State University, Detroit, MI, United States Publisher Elsevier B.V. Abstract Background: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with mortality rates comparable to pure aortic stenosis (PAS). While most TAVR complications also occur at similar rates between the MAVD and PAS populations, recent studies have shown conflicting results. Method(s): A systematic literature review was conducted on PubMed and Embase for studies on the outcomes of TAVR in MAVD from inception until May 2024. Primary outcomes were short- and long-term mortality. Secondary outcomes were paravalvular regurgitation (PVR), vascular and bleeding complications, pacemaker implantation, and cerebrovascular complications. A random-effects model was used to pool risk ratios (RR) and 95 % confidence intervals (CI). Result(s): Eleven observational studies, including 133,558 patients, were included in the analysis. There were no significant differences in primary endpoints (p > 0.05). MAVD was associated with a higher risk of paravalvular regurgitation (RR: 1.29, 95 % CI: 1.07-1.55) and higher risk of vascular complications (RR: 1.20, 95 % CI: 1.01-1.44). No significant differences were noted in other secondary outcomes (p > 0.05), although there was a nonsignificant trend towards a decreased risk of cerebrovascular complications associated with TAVR in MAVD patients. Conclusion(s): TAVR is an intervention with similar mortality and complication risk in MAVD and PAS patients. Future research is needed to further clarify the outcomes of TAVR in patients with MAVD, especially regarding cerebrovascular complications, long-term mortality, and the association of paravalvular regurgitation with mortality. Copyright © 2026 Southern Society for Clinical Investigation <23> Accession Number 2045238910 Title A Prospective Randomized Controlled Trial to Study the Advantage of Implementation of Enhanced Recovery after Surgery (ERAS) Protocol in Patients Undergoing Elective Coronary Artery Bypass Grafting. Source International Journal of Drug Delivery Technology. 16(24 Supplement) (pp 451-457), 2026. Date of Publication: 2026. Author Satwik M.; Biradar P.A.; Karigar S.L.; Pratibha S.D. Institution (Satwik, Karigar, Pratibha) Department of Anaesthesiology, Shri B.M. Patil Medical College, Hospital and Research Centre and BLDE (Deemed to be University), Karnataka, Vijayapura, India (Biradar) Shri B.M. Patil Medical College, Hospital and Research Centre and BLDE (Deemed to be University), Super Speciality Hospital, Karnataka, Vijayapura, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Objective: To assess the effectiveness of an ERAS protocol in patients undergoing elective CABG (coronary artery bypass grafting) on CPB (Cardiopulmonary bypass) on patient recovery and length of stay. Method(s): This prospective randomized controlled trial was conducted in a tertiary care hospital from July 2024 to November 2025. Adult patients (18-85 years) undergoing elective CABG on CPB were randomly allocated into two groups: Routine Protocol (RP, n = 26) and ERAS Protocol (EP, n = 26). The ERAS group received structured preoperative counselling, prehabiliteration, preoperative carbohydrate loading, multimodal analgesia and strict normothermia while the control group received routine perioperative care. Primary outcomes were time to extubation and postoperative hospital stay. Secondary outcomes included time to ambulation, time to enteral feeding, opioid consumption and postoperative complications. Result(s): Baseline characteristics were comparable between the groups. The ERAS group showed significantly early extubation (4.62 +/- 0.64 Vs 6.85 +/- 0.61 hours; p < 0.0001), shorter postoperative hospital stay (4.04 +/- 0.59 Vs 6.08 +/- 0.56 days; p < 0.0001), earlier ambulation (6.04 +/- 0.77 Vs 8.88 +/- 0.82 hours; p < 0.0001), and early initiation of enteral feeding (7.12 +/- 0.77 Vs 10.88 +/- 1.07 hours; p < 0.0001). Requirement of rescue analgesic doses was significantly less in ERAS group compared to routine group (0.15 +/- 0.37 Vs 1.38 +/- 0.57: p < 0.0001). The incidence of postoperative complications was comparable between groups. Conclusion(s): Implementation of an ERAS protocol in patients undergoing CABG on CPB significantly enhances postoperative recovery, reduces hospital stay, and reduces the dose requirement of postoperative opioid use without increasing complications, supporting its safe and effective adoption in cardiac surgical practice. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <24> Accession Number 2044773260 Title The influence of staged intervention based on Meleis transition theory on the knowledge, attitude, practice and anticoagulation effect of warfarin in patients undergoing cardiac valve surgery. Source Chinese Journal of Practical Nursing. 42(10) (pp 761-767), 2026. Date of Publication: 01 Apr 2026. Author Xing A.; Chen C.; Wu Y.; Bao T.; Hu X. Institution (Xing, Chen, Wu, Bao, Hu) Department of Cardiac Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China Publisher Chinese Medical Journals Publishing House Co.Ltd Abstract Objective To explore the influence of nursing intervention based on Meleis transformation theory on the knowledge, attitude, practice and anticoagulation effect of warfarin in patients after cardiac valve surgery, in order to provide reference for the postoperative management of such patients in clinical practice. Methods A randomized controlled study was conducted. Patients who met the inclusion and exclusion criteria after cardiac valve surgery and were admitted to the First Affiliated Hospital of Wenzhou Medical University from January to October 2024 were selected as the research subjects by convenience sampling. They were divided into the control group and the experimental group using a random number table. The control group received conventional warfarin medication guidance after the operation, while the patients in the experimental group received nursing intervention based on the Meleis transformation theory on the basis of the control group. The effects were evaluated at 1 month and 6 months after the operation by using the self-designed general information questionnaire, warfarin knowledge, attitude and Practice questionnaire, and the compliance rate of the International normalized ratio (INR). Results A total of 90 cases were finally included in the control group, including 42 males and 48 females, with an age of (55.2 +/- 15.6) years. There were 89 cases in the experimental group, including 44 males and 45 females, with an age of (56.1 +/- 16.3) years. The scores of warfarin knowledge dimension, attitude dimension, behavior dimension and total score of the patients in the experimental group one month after the operation were (7.0 +/- 1.2), (31.9 +/- 6.1), (21.5 +/- 5.9) and (60.4 +/- 13.5) respectively. Compared with the scores of (6.4 +/- 1.4), (27.2 +/- 7.3), (18.6 +/- 6.0), and (52.2 +/- 14.9) of the control group, the differences were statistically significant (t values ranged from 3.15 to 4.78, all P<0.05). The scores of warfarin knowledge dimension, attitude dimension, behavior dimension and total score of the patients in the experimental group 6 months after the operation were (8.6 +/- 1.8), (35.6 +/- 8.1), (27.5 +/- 6.7) and (71.7 +/- 16.6) points respectively. Compared with the scores of (7.5 +/- 1.6), (29.8 +/- 6.3), (22.9 +/- 5.8), and (60.2 +/- 13.7) in the control group, the differences were statistically significant (t values ranged from 3.17 to 5.82, all P<0.05). The rates of reaching the INR standard within 6 months after surgery in the experimental group and the control group were (77.8 +/- 12.9) % and (70.4 +/- 14.5) %, respectively. There was a statistically significant difference between the two groups (t=3.67, P<0.05). Conclusions The nursing intervention based on the Meleis transformation theory can improve the knowledge, attitude and practice level of warfarin in patients after cardiac valve surgery, enhance the anticoagulation effect of warfarin, and is worthy of promotion and application in the postoperative nursing of cardiac valves. Copyright 2026, Chinese Medical Association <25> Accession Number 2045124103 Title Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized controlled trial. Source European Journal of Preventive Cardiology. 33(6 Focus Issue on Cardiac Rehabilitation) (pp 815-826), 2026. Date of Publication: 01 Apr 2026. Author Menezes H.J.; Grace S.L.; Padmakumar R.; Babu A.S.; Rao R.R.; Kamath A.; D'Souza S.R.B. Institution (Menezes) Department of Obstetrical and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, Manipal, India (Grace) Faculty of Health, York University, Toronto, Canada (Grace) Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada (Padmakumar) Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India (Babu) Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal, India (Rao) Department of Data Science and Computer Applications, Manipal Institute of Technology, Manipal Academy of Higher Education, Karnataka, Manipal, India (Kamath) Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, Manipal, India (D'Souza) Department of Obstetrical and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, Manipal, India Publisher Oxford University Press Abstract Aims: Women are under-represented in cardiac rehabilitation (CR), especially in lower-income settings. This study tested Technology-bAsed Cardiac rehabilitation Therapy (TaCT) on functional capacity, risk factors, quality of life (QoL; MacNew), heart-health behaviours (e.g. Global Physical Activity Questionnaire), cardiac symptoms (e.g. angina), and morbidity (e.g. hospitalization and procedure) in women. Methods and Results: Single-centre, single-blind, two parallel arms (1:1 SNOSE) randomized superiority trial, undertaken in an Indian outpatient cardiology department, where women with stable cardiac disease and smartphone access were recruited. TaCT was compared with standard care (CR rare), with assessments conducted before the intervention, and 6 months later. The 6-month comprehensive intervention was delivered via several technologies. Exercise prescriptions were based on an Incremental Shuttle Walk Test (ISWT; primary outcome). Analyses were based on intention-to-treat. Fifty women were randomized to intervention, and 50 to control (n = 89; 89.0% retained). There were few tobacco users. Results for the following outcomes favoured intervention: functional capacity [ISWT effect size = 0.3 (95% confidence interval = 1.0 to -0.2), P = 0.002; Duke Activity Status Index P < 0.001; Sit-to-Stand P = 0.003], QoL (global and all subscale P's < 0.001), and heart-health behaviours (exercise P < 0.001; medication adherence P = 0.02), and anxiety (P = 0.002). There were no significant differences in blood pressure, waist circumference, or cardiac symptoms. Three participants in the intervention group experienced morbidity and 1 suffered mortality and 9 in controls experienced morbidity only. Conclusion(s): The TaCT program significantly improved functional capacity, QoL, heart-health behaviours and anxiety in women with cardiovascular disease in a middle-income country, demonstrating the potential of technology-based CR tailored for women in these settings. Registration: CTRI/2021/07/035197 URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=51810&EncHid=79231 .15408&modid=1&compid=19. Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. <26> Accession Number 2042353720 Title Left atrial appendage closure in patients with hereditary hemorrhagic telangiectasia and atrial fibrillation: a prospective study and systematic review. Source European Journal of Internal Medicine. 147 (no pagination), 2026. Article Number: 106695. Date of Publication: 01 May 2026. Author Torres-Iglesias R.; Teruel L.; Sanchez-Corral M.A.; Cerda P.; Villanueva B.; Gamundi E.; Pelaez P.; Moreno-Lopes S.; Iriarte A.; Alba E.; Portillo A.; Gomez-Lara J.; Ribas J.; Riera-Mestre A. Institution (Torres-Iglesias, Sanchez-Corral, Cerda, Villanueva, Pelaez, Moreno-Lopes, Iriarte, Alba, Portillo, Ribas, Riera-Mestre) HHT Unit. Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain (Torres-Iglesias, Cerda, Villanueva, Pelaez, Moreno-Lopes, Iriarte, Riera-Mestre) Internal Medicine Department. Hospital Universitari Bellvitge, Barcelona, Spain (Torres-Iglesias, Cerda, Villanueva, Iriarte, Portillo, Ribas, Riera-Mestre) Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain (Torres-Iglesias, Riera-Mestre) Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain (Teruel, Sanchez-Corral, Gomez-Lara) Cardiology Department. Hospital Universitari de Bellvitge, Barcelona, Spain (Gamundi) Cytology and Hematology Laboratory, Anatomic Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain (Alba) Angioradiology Unit, Radiology Department. Hospital Universitari de Bellvitge, Barcelona, Spain (Portillo) Otorhinolaringology Department. Hospital Universitari Bellvitge, Barcelona, Spain (Ribas) Pneumology Department. Hospital Universitari de Bellvitge, Barcelona, Spain Publisher Elsevier B.V. Abstract Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disease with a high risk of iron deficiency anemia secondary to epistaxis and gastrointestinal bleeding. Atrial fibrillation (AF) is associated with a high risk of ischemic stroke and oral anticoagulation therapy is indicated for its prevention. Percutaneous left atrial appendage closure (LAAC) is recommended to prevent stroke in patients with AF and high risk of bleeding such as HHT patients. However, double antiplatelet therapy at first, followed by long-term single antiplatelet therapy, is also recommended after the procedure to prevent device-related thrombus (DRT), which most HHT patients cannot tolerate. This prospective observational study describes 36 HHT patients with AF, 23 of whom underwent LAAC. To prevent DRT, simple antiplatelet therapy was indicated for 3 months if tolerated. In addition, a systematic review on LAAC in HHT patients was performed to compare our results with what has been previously reported. A total of 57 HHT patients with AF and LAAC were analysed. Although only 12.3% tolerated long-term simple antiplatelet therapy, none presented DRT during follow-up. Three ischemic events were reported but only one of them appears to be partially related to AF in a patient with significant leakage peri-device. In conclusion, percutaneous LAAC is a safe and potentially effective strategy for preventing ischemic stroke in HHT patients with AF. A simplified and personalized antiplatelet regimen was not associated with DRT or ischemic events. Copyright © 2025. Published by Elsevier B.V. <27> Accession Number 2044962067 Title Effect of Continuous Theta-Burst Stimulation on Postoperative Delirium in Older Patients Who Undergo Cardiac Surgery. Source Neuromodulation. (no pagination), 2026. Date of Publication: 2026. Author Zhang J.; Zhu Y.; Yin Y.; Xiao C.; Zhang Y.; Sun J.; Qi Y.; Wang L. Institution (Zhang, Zhu, Yin, Zhang, Qi, Wang) Department of Anesthesiology, Xuzhou Central Hospital, Southeast University, Jiangsu, Xuzhou, China (Zhang, Zhu, Yin, Zhang, Qi, Wang) Department of Anesthesiology, Xuzhou Central Hospital, Jiangsu, Xuzhou, China (Xiao) Jiangsu Province Key Laboratory of Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, China (Sun) Department of Anesthesiology, Zhongda Hospital, Southeast University, Jiangsu, Nanjing, China Publisher International Neuromodulation Society Abstract Objectives Postoperative delirium (POD) is a common complication after cardiac surgery in older patients, associated with higher mortality and prolonged stays. Continuous theta-burst stimulation (cTBS), a noninvasive neuromodulation technique, has been shown to modulate cortical excitability, offering potential as a treatment for cognitive dysfunction after surgery. The posterior cingulate cortex (PCC) is strongly involved in resource allocation, episodic memory, and executive function. This study aims to investigate the efficacy of cTBS on PCC in reducing POD in older patients having cardiac surgery. Materials and Methods A single-center, randomized, double-blind, placebo-controlled trial was conducted. Older patients receiving cardiac surgery were randomly assigned to either active or sham cTBS groups. cTBS was applied to PCC for five days before and after surgery. The primary outcome was POD incidence during the first five postoperative days. Intention-to-treat analysis was performed in February 2026. Results A total of 78 patients were recruited and randomly assigned to the active cTBS group (39 patients) or the sham cTBS group (39 patients). The active cTBS group showed a significantly lower incidence of POD than did the sham cTBS group (23.1% vs 48.7%). Moreover, the active cTBS group exhibited considerably lower levels of anxiety and pain, and reduced analgesic consumption. However, although the levels of tumor necrosis factor-alpha and interleukin-6 in the active cTBS group showed a downward trend, the changes did not reach statistical significance. Conclusion PCC-targeted cTBS effectively reduces POD in older patients who undergo cardiac surgery, alleviating anxiety, pain, and sleep disturbances. These findings suggest cTBS as a promising nonpharmacologic treatment for POD. Clinical Trial Registration The Clinicaltrials.gov registration number for the study is NCT0557 5583. Copyright © 2026. Published by Elsevier Inc. <28> Accession Number 2041896634 Title Valvular Complications Related to Microaxial Assist Device Use: A Case-Level Systematic Review. Source Artificial Organs. 50(4) (pp 505-510), 2026. Date of Publication: 01 Apr 2026. Author Nolan G.P.; Hammond M.C.; Rahimov D.; Karimanasseri C.; Nasher N.; Macmillan T.R.; Entwistle J.W.; Rajagopal K.; Hoopes C.W.; Tchantchaleishvili V. Institution (Nolan) Drexel University College of Medicine, Philadelphia, PA, United States (Nolan, Hammond, Rahimov, Karimanasseri, Nasher, Macmillan, Entwistle, Rajagopal, Hoopes, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States (Hammond) The Lawrenceville School, Lawrenceville, NJ, United States Publisher John Wiley and Sons Inc Abstract Background: Microaxial devices provide effective short-term hemodynamic support in patients with cardiogenic shock or during high-risk procedures. However, there is a paucity of data regarding device-associated valvular complications. We sought to pool existing data to understand its incidence, management, and outcomes. Method(s): An electronic search was conducted in October 2024 to identify studies reporting microaxial device-associated valvular complications that did not resolve with device explantation. A total of 26 case reports and case series, representing 27 patients, were included. Patient-level data were extracted for analysis. Result(s): The median age was 50 years [IQR 34-65], and 78% (21/27) were male. The indications for microaxial support were cardiogenic shock (85.2%, 23/27), coronary bypass grafting (7.4%, 2/27), and high-risk percutaneous coronary intervention (7.4%, 2/27). The most commonly used devices were the Impella 5.0 (41%, 11/27) and Impella CP (22%, 6/27). Aortic regurgitation (AR) developed in 67% of patients (18/27). Mitral regurgitation (MR) developed in 33% (9/27) of patients, all of which were severe. The median duration of microaxial support was 10 [3-15] days. Overall, 74% (20/27) of patients underwent surgical management, 11% (3/27) underwent transcatheter treatment, and 15% (4/27) were managed nonoperatively. In-hospital/30-day mortality was 11% (3/27), including two deaths among patients with MR (22%) and one in a patient with AR (5.6%) with a pre-existing bioprosthetic aortic valve (p = 0.19). When considering the patients with only native valves and excluding the bioprosthetic aortic valve, mortality was significantly higher among MR patients compared to those with AR (MR: 22%; AR: 0%, p = 0.04). At a median follow-up of 183 [30-365] days, overall survival was 89% (24/27). Conclusion(s): AR was more common than MR; however, all MR cases were severe. MR may be associated with worse outcomes. Surgical management appears to be the most frequently employed strategy for valvular injury. Copyright © 2025 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <29> Accession Number 2045016110 Title The effect of chronic total occlusion on outcomes following transcatheter aortic valve implantation: a systematic review and meta-analysis. Source Future Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Dimitriadis K.; Pyrpyris N.; Beneki E.; Meier D.; Papanikolaou A.; Dris E.; Theofilis P.; Antiochos P.; Fournier S.; Tzimas G.; Aznaouridis K.; Tsioufis K. Institution (Dimitriadis, Pyrpyris, Beneki, Papanikolaou, Dris, Theofilis, Aznaouridis, Tsioufis) First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece (Beneki, Meier, Antiochos, Fournier, Tzimas) Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland Publisher Taylor and Francis Ltd. Abstract Aim: The pre-procedural presence of chronic total occlusions (CTO) in patients undergoing transcatheter aortic valve implantation (TAVI) could be a significant predictor of outcomes. This meta-analysis aims to investigate whether CTO presence significantly alters outcomes in TAVI patients. Method(s): A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After study selection, a random effect meta-analysis was performed. Result(s): Seven studies with a total of 15,162 patients undergoing TAVI were included. There was no significant difference regarding in-hospital [Relative Risk (RR): 1.13; 95% Confidence Interval (95% CI): 0.82-1.55] and 1-year all-cause mortality (RR: 1.58; 95% CI: 0.71-3.50). Patients with CTO exhibited significantly increased rates of myocardial infarction (RR: 1.27, 95% CI: 1.07-1.51) and reduced rates of new pacemaker implantation (RR: 0.88, 95% CI: 0.79-0.98). No differences were found in cardiogenic shock (RR: 1.18, 95% CI: 0.97-1.44), acute kidney injury (RR: 1.06, 95% CI: 0.88-1.28), vascular complications (RR: 1.10, 95% CI: 0.91-1.33), or bleeding (RR: 1.01, 95% CI: 0.89-1.14). Conclusion(s): In TAVI patients, pre-procedural unrevascularized CTO presence is not related to short- or mid-term increased mortality. Further studies are needed to identify predictors of adverse events and phenotypes benefiting from revascularization. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <30> Accession Number 2044514888 Title Percutaneous Coronary Intervention in Frail Patients Undergoing Transcatheter Aortic Valve Replacement. Source JACC: Cardiovascular Interventions. 19(7) (pp 828-839), 2026. Date of Publication: 13 Apr 2026. Author Ratcovich H.; Holmvang L.; Sadjadieh G.; Jabbari R.; Glinge C.; Sabbah M.; Veien K.T.; Niemela M.; Freeman P.; Linder R.; Sorensen R.; Ioanes D.; Terkelsen C.J.; Ellert-Gregersen J.; Christiansen E.; Eftekhari A.; Piuhola J.; Kajander O.; Koul S.; Savontaus M.; Karjalainen P.; Ruck A.; Angeras O.; Bieliauskas G.; Jorgensen T.H.; Sondergaard L.; De Backer O.; Engstrom T.; Lonborg J. Institution (Ratcovich, Holmvang, Sadjadieh, Jabbari, Glinge, Sabbah, Sorensen, Bieliauskas, Jorgensen, De Backer, Engstrom, Lonborg) Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (Veien, Ellert-Gregersen) Department of Cardiology, Odense University Hospital, Odense, Denmark (Niemela, Piuhola) Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland (Freeman, Eftekhari) Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (Linder, Ruck) Department of Medicine, Karolinska Institute, Stockholm, Sweden (Linder, Ruck) Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden (Ioanes, Angeras) Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Terkelsen, Christiansen) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (Terkelsen) The Danish Heart Foundation, Copenhagen, Denmark (Kajander) Heart Hospital, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland (Kajander) The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (Koul) Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden (Savontaus) Heart Center, Turku University Hospital, Turku, Finland (Karjalainen) Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland (Angeras) Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden (Sondergaard) Abbott Cardiovascular, Santa Clara, CA, United States (De Backer) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Publisher Elsevier Inc. Abstract Background Frailty is an important predictor of outcomes in patients with coronary artery disease (CAD) and following transcatheter aortic valve replacement (TAVR). The NOTION-3 (Third Nordic Aortic Valve Intervention) trial demonstrated that performing percutaneous coronary intervention (PCI) in addition to TAVR reduced the risk for major adverse cardiac events (MACE). Whether this benefit applies to frail patients remains uncertain. Objectives The aim of this study was to evaluate efficacy and safety of PCI in frail TAVR patients with CAD. Methods NOTION-3 was an international, open-label, randomized superiority trial enrolling patients with CAD and severe aortic stenosis undergoing TAVR. Patients were randomized 1:1 to PCI or conservative treatment. Frailty was assessed post hoc using a calculated frailty score derived from baseline data on symptom-related limitations, daily function, and quality of life. Primary endpoint was a composite of all-cause mortality, myocardial infarction (MI), and urgent coronary revascularization. Safety endpoints included bleeding and acute kidney injury. Results Frailty data were available for 407 patients (90%), of whom 130 (32%) were frail. During median follow-up of 2 years (Q1-Q3: 1-4 years), PCI reduced MACE in nonfrail patients (15% vs 33%; HR: 0.42; 95% CI: 0.25-0.69; P < 0.001), as well as death of any cause (P = 0.019), MI (P = 0.004), and urgent revascularization (P = 0.005). No differences were observed in frail patients. In contrast, frail patients undergoing PCI had more bleeding events (HR: 2.51; 95% CI: 1.23-5.11; P = 0.011). Conclusions In nonfrail patients with CAD undergoing TAVR, PCI lowered the risk for MACE, all-cause mortality, and MI compared to conservative treatment. In frail patients, PCI increased bleeding without clinical benefit. These findings require confirmation in larger prospective studies. Copyright © 2026 American College of Cardiology Foundation. <31> Accession Number 2044266655 Title Meta-Analysis: Prevalence and Incidence of Gastroparesis Following Lung or Heart Transplantation. Source Alimentary Pharmacology and Therapeutics. 63(10) (pp 1348-1359), 2026. Date of Publication: 01 May 2026. Author Eldesouki M.H.; Marey M.M.; Ali M.A.; Genidy A.M.; Gamal M.H.; Othman A.M.; Mohamed A.N.; Al Qady A.; Amaris M.A.; Sharma A. Institution (Eldesouki) Department of Internal Medicine, New York Medical College, St Michael Medical Center, Newark, NJ, United States (Marey) Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt (Ali) Qena Faculty of Medicine, Qena University, Qena, Egypt (Genidy, Gamal) Faculty of medicine, Tanta University, Tanta, Egypt (Othman) Department of Internal Medicine, Faculty of Medicine, Kafr El-Sheik University, Kafr El-Sheik, Egypt (Mohamed) Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, United States (Al Qady, Amaris) Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Florida, Gainesville, FL, United States (Sharma) Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, United States Publisher John Wiley and Sons Inc Abstract Background: Gastroparesis is a recognized complication after thoracic organ transplantation that impairs nutrition, medication absorption, and graft outcomes. Aim(s): This study aimed to quantify the risk of gastroparesis following lung (LT) and combined heart-lung transplantation (HLT). Method(s): A systematic search of PubMed, Embase, Scopus, and Web of Science from inception to January 2025 identified studies reporting gastroparesis after LT or HLT in adult cohorts with objective diagnostic testing. Random-effects meta-analysis was used to pool prevalence and incidence, with subgroup analyses by transplant type, and diagnostic modality, and meta-regression asessing the effects of age and sex. Result(s): Twenty-one studies, including 2888 patients, met the inclusion criteria. The pooled prevalence of gastroparesis was 31.87% (95% CI: 19.88-46.87). Subgroup analysis revealed a higher prevalence of gastroparesis in combined HLT recipients (44.89%, 95% CI: 17.05-76.35) compared to LT only (26.95%, 95% CI: 15.46-42.68), though this difference was not statistically significant (p = 0.31). The overall incidence was 25.67% (95% CI: 15.07-40.41), with HLT recipients showing a higher incidence (35.79%, 95% CI: 20.73-54.29) than LT only (19.38%, 95% CI: 8.3-38.9). Conclusion(s): Gastroparesis affects nearly one-third of thoracic transplant recipients, with a numerically higher burden after HLT transplantation. There was no association between age and gender and the prevalence of post-transplant gastroparesis. Copyright © 2026 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. <32> Accession Number 2037949959 Title Baseline characteristics in the TransitionCHF study: asymptomatic patients with heart failure and reduced ejection fraction. Source ESC Heart Failure. 13(1) (no pagination), 2026. Article Number: xvag012. Date of Publication: 01 Feb 2026. Author Muller-Kozarez I.; Sandek A.; Edelmann F.; Gertler C.; Placzek M.; Friede T.; Licka M.; Rieth A.; Schunkert H.; Akin I.; Arnold N.; Stork S.; Feuerstein A.; Hasenfuss C.H.-L.G.; Wachter R. Institution (Muller-Kozarez, Wachter) Department of Cardiology, University Hospital Leipzig, Liebigstrase 20, Leipzig, Germany (Sandek, Gertler, Hasenfus, Wachter) Clinic for Cardiology and Pneumology, University of Gottingen, Gottingen, Germany (Sandek, Gertler, Hasenfus, Wachter) Charite-University Medicine Berlin, Berlin, Germany (Edelmann, Feuerstein) German Center for Cardiovascular Research (DZHK), partner Site Berlin, Berlin, Germany (Placzek, Friede) Department of Medical Statistics, University Medical Center Gottingen, Gottingen, Germany (Licka) Department of Internal Medicine III cardiology, Angiology and Respiratory Medicine, Heidelberg University, Heidelberg, Germany (Rieth) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (Schunkert) Department of Cardiology, Deutsches Herzzentrum Munchen, TUM Universitatsklinikum, Munich, Germany (Schunkert) German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (Akin) First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany (Arnold) University Medical Center Hamburg-Eppendorf, Department of cardiology, University Heart and Vascular center Hamburg, Hamburg, Germany (Stork) Department of Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany (Stork) Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Wurzburg, Wurzburg, Germany Publisher Oxford University Press Abstract Introduction The majority of clinical studies investigating patients with heart failure and a reduced ejection fraction (HFrEF) exclusively included patients with symptomatic heart failure. There is a paucity of information concerning the clinical characteristics, progression to symptomatic heart failure, heart failure hospitalization rates and survival in patients with asymptomatic systolic left ventricular dysfunction (ASLVD). We address this knowledge gap by describing the baseline characteristics of participants in the prospective observational TransitionCHF study of patients with reduced left ventricular Function in New York Heart Association (NYHA) functional Class I and comparing them to those of other recent trials in HFrEF. Methods In total, 1005 individuals with ASLVD NYHA I with an ejection fraction <= 40% were recruited. Patient characteristics were compared with other studies involving patients with symptomatic heart failure. Multivariable linear regression and Pearson coefficients were used to determine the association between quality of life, mental health, markers of organ function, Nterminal prohormone of brain natriuretic peptide (NT-proBNP) plasma levels, and exercise performance Results The mean age of participants was 60 +/- 14 years and 18% were women. The mean ejection fraction was 36% and the mean left ventricular end-diastolic diameter was 59 mm. When compared with studies involving patients with symptomatic heart failure, the age was = 5 years younger and the frequency of comorbidities was lower. The Short Form Health Survey-36 physical functioning score was moderately correlated with the Maastricht Vital Exhaustion Questionnaire (MQ; r = -0.44 and weakly with 6-min walking distance (r = 0.32), peak VO<inf>2</inf> at ergospirometry (r = 0.28), and Heart Focus Anxiety (HAF17; r = -0.34). NT-proBNP levels showed a weak association with peak VO<inf>2</inf> (r = -0.29) and the 6-min walk distance (r = -0.21). Conclusions Patients included in the TransitionCHF study are younger and suffer from fewer comorbidities as compared with symptomatic heart failure patients. Associations between NT-proBNP levels and markers of exercise performance were weak. Copyright © The Author(s) 2026. <33> Accession Number 2044803800 Title Digital health interventions for lipid management in atherosclerotic cardiovascular disease: a systematic review and meta-analysis of randomised controlled trials. Source eClinicalMedicine. 94 (no pagination), 2026. Article Number: 103886. Date of Publication: 01 Apr 2026. Author Schut Y.; Buhler D.G.B.; Snaterse-Zuidam M.; Malekzadeh A.; Somsen G.A.; Martens M.A.C.; Winter M.M. Institution (Schut, Buhler, Snaterse-Zuidam, Martens, Winter) Department of Cardiology, Heart Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands (Schut, Somsen, Winter) Department of Cardiology, Cardiology Centres of the Netherlands, Netherlands (Malekzadeh) Medical Library, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, Netherlands Publisher Elsevier Ltd Abstract Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality worldwide. Lipid management is a key component of secondary prevention, but the majority of patients fail to achieve low-density lipoprotein cholesterol (LDL-c) goals. Digital health may serve as an innovative and cost-effective approach to improve lipid control, but a systematic quantitative synthesis is lacking. This study aimed to evaluate the effect of digital health interventions on LDL-c reduction and lipid target attainment in patients with ASCVD. Method(s): A systematic search was performed in Medline, Embase, CINAHL, and CENTRAL from inception to May 27, 2025. Randomised controlled trials (RCTs) evaluating the effect of digital health interventions in patients with ASCVD and reporting lipid outcomes were included. The primary outcomes were change in mean LDL-c and achievement of lipid control (LDL-c < 1.8 mmol/L). Pooled estimates were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, and publication bias was assessed by visual inspection of a funnel plot and Egger's test. The Cochrane Risk of Bias 2 was used to evaluate risk of bias. The protocol was registered with PROSPERO (CRD42024575196). Finding(s): Of the 4997 records identified, 18 RCTs from 11 regions (n = 12,970) were included in the systematic review. Risk of bias was scored as high across all included trials. Overall, digital health was associated with greater reductions in LDL-c compared with usual care [mean difference (MD) = -0.10 mmol/L (95% CI -0.17 to -0.04); p = 0.003; I2 = 74%]. No evidence of publication bias was detected. Lipid control was also improved [risk ratio (RR) = 1.15 (95% CI 1.03-1.28); p = 0.02; I2 = 57%]. In subgroup analyses, multi-component interventions showed the greatest reduction in LDL-c [MD = -0.22 mmol/L (-0.38 to -0.07); I2 = 78%], compared to SMS-only interventions [MD = -0.03 mmol/L (-0.14 to 0.08); I2 = 70%], SMS combined with supportive material [MD = -0.05 mmol/L (-0.14 to 0.03); I2 = 36%], and smartphone applications [MD = -0.07 mmol/L (-0.21 to 0.06); I2 = 47%], although differences between delivery modes were not statistically significant (p = 0.21). Self-reported medication adherence was slightly improved in the digital health group compared with controls [RR = 1.08 (1.00-1.16); p = 0.04; I2 = 88%]. In addition, digital health was associated with a reduced risk of hospitalisation [RR = 0.64 (0.50-0.81); p < 0.001; I2 = 18%]. Interpretation(s): Our findings suggest that digital health interventions can support LDL-c reduction and lipid control in patients with ASCVD. Multi-component interventions were most effective, particularly when combined with high-frequency delivery, bidirectional communication, and telemonitoring. High heterogeneity and high risk of bias were observed across studies, and LDL-c reduction was not a primary outcome in most trials, warranting careful interpretation. Nevertheless, digital health shows potential for integration in lipid management, and warrants future research to optimise effectiveness and support implementation in clinical practice. Funding(s): Innovative Health Initiative Joint Undertaking. Copyright © 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <34> Accession Number 2044962384 Title Economic evaluation of outpatient specialized models of care versus usual care for venous thromboembolism management- A systematic review. Source Thrombosis Update. 23 (no pagination), 2026. Article Number: 100237. Date of Publication: 01 Jun 2026. Author Mpinganzima R.; Lee T.; Nguyen H.; Bonsu K.; Young S. Institution (Mpinganzima, Lee, Nguyen, Bonsu, Young) School of Pharmacy, Memorial University, 300 Prince Philip Drive, St John's, NL, Canada (Lee, Young) Pharmacy Program, Newfoundland and Labrador Health Services, 300 Prince Philip Drive, St John's, NL, Canada Publisher Elsevier B.V. Abstract Background Venous thromboembolism (VTE) is a major cause of cardiovascular-related mortality and morbidity worldwide. The clinical and economic burden of the disease remains substantial. We conducted a systematic review (SR) to identify and consolidate economic evaluation studies which compared specialized outpatient thrombosis and anticoagulation care models to usual care for the management of VTE. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and PRISMA literature search extension (PRISMA-S) guidelines were followed. A comprehensive search of PubMed, Embase, Cochrane Library, and CINAHL from inception to March 22, 2025 was completed. Two reviewers independently screened titles and abstracts assessed full text articles for inclusion, and performed data extraction. Discrepancies were resolved through team discussion. A quality assessment was performed using the Quality of Health Economic Studies checklist. Findings were then summarized using narrative synthesis methods. Results Twenty-five articles met the inclusion criteria, including 10 full economic evaluations (four high quality studies, four moderate quality studies, and two low quality studies) and 15 partial economic evaluation studies (four moderate quality studies and 11 low quality studies). Compared to usual care, specialized outpatient thrombosis and anticoagulation care models were associated with healthcare cost savings (ranging from 1374 CAD to 2,760,118 CAD), had similar or improved clinical outcomes, and were deemed cost-effective (ICER of -4 CAD per % TTR, 21,602 CAD per QALY, and 29,466 CAD). Conclusion There is a paucity of high-quality economic evaluation studies that compare specialized outpatient thrombosis and anticoagulation care models to usual care for patients with VTE. Further research based on current clinical practice, which includes comprehensive, specialized thrombosis and anticoagulation care that incorporate contemporary treatments is needed. Copyright © 2026 The Authors. <35> Accession Number 2041797594 Title Self-expanding or balloon-expandable transcatheter aortic valve replacement in patients with small aortic annulus: A systematic review and meta-analysis. Source Indian Heart Journal. 78(2) (pp 79-88), 2026. Date of Publication: 01 Mar 2026. Author Attachaipanich T.; Kaewboot K.; Attachaipanich S. Institution (Attachaipanich) Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States (Kaewboot) Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Attachaipanich) Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan Publisher Elsevier B.V. Abstract Background: A small aortic annulus presents unique hemodynamic challenges during transcatheter aortic valve replacement (TAVR), increasing the risk of prosthesis-patient mismatch (PPM) and suboptimal valve performance. This study aimed to compare the efficacy and safety of self-expanding valves (SEVs) versus balloon-expandable valves (BEVs) in patients with a small aortic annulus. Method(s): A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to June 1, 2025. Studies comparing clinical outcomes of SEVs and BEVs in patients with a small aortic annulus were included. Result(s): Thirty-eight studies involving 19,421 participants were included. No significant difference in all-cause mortality was observed between SEVs and BEVs from in-hospital to 5-year follow-up. SEVs were associated with a significantly lower risk of PPM at discharge (OR 0.34, 95 % CI 0.28-0.42), 30 days (OR 0.31, 95 % CI 0.21-0.47), and 1 year (OR 0.25, 95 % CI 0.15-0.42). However, SEVs were associated with a higher risk of in-hospital paravalvular leakage (PVL) (OR 1.95, 95 % CI 1.39-2.74), moderate-to-severe PVL (OR 2.48, 95 % CI 1.91-3.22), and permanent pacemaker implantation (PPI) both in-hospital and at 30 days. These findings remained consistent across sensitivity analyses limited to new-generation valves and propensity score-matched or randomized studies. Conclusion(s): SEVs offer favorable hemodynamic advantages and lower risks of PPM and valve dysfunction compared to BEVs, with no difference in survival. However, these benefits must be weighed against the increased risks of PVL and PPI. Individualized valve selection remains essential to optimizing outcomes in TAVR patients. Copyright © 2025 Cardiological Society of India <36> Accession Number 2044628236 Title Streamlining postprocedural care after transcatheter edge-to-edge repair. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 295. Date of Publication: 01 Dec 2026. Author Voran J.C.; Baucks J.; Catania V.; Bramlage P.; Frank D.; Kreidel F. Institution (Voran, Baucks, Frank, Kreidel) Department of Internal Medicine III, Cardiology and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Kiel, Germany (Voran, Baucks, Kreidel) DZHK (German Centre for Cardiovascular Research), Partner site Hamburg/Kiel/Lubeck, Potsdamer Strasse 58, Berlin, Germany (Catania, Bramlage) Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, Cloppenburg, Germany Publisher BioMed Central Ltd Abstract Background: Patients undergoing transcatheter edge-to-edge repair (TEER) of the mitral or tricuspid valve are predominantly elderly and exhibit high rates of frailty. The procedure regularly involves general anaesthesia, necessitating the monitoring of patients on an intensive or intermediate care unit (ICU/ImCU). This study aimed to investigate the outcome of patients being admitted to a general ward as opposed to an ICU/ImCU for postprocedural care after TEER. Method(s): This is a retrospective study analysing the course of 209 patients that underwent TEER at a university hospital centre in Germany from January 2022 to February 2024. Patients were assigned to either intended postprocedural care at ICU/ImCU (n = 113) or streamlined care (n = 95) based on a cut-off date unrelated to this study. Result(s): In comparison to the ICU/ImCU group, patients in the streamlined group exhibited a significantly reduced total hospital stay (median 4 [IQR 3, 9] vs. 3 [IQR 3, 5] days, p = 0.009) and a reduced postprocedural length of stay without an elevated rate of unplanned ICU/ImCU admissions. Postprocedural care in the streamlined group was not associated with a higher rate of complications nor a higher mortality rate at 30 days (0.9% vs. 2.2%, p = 0.6), six months (10.1% vs. 4.7%, p = 0.2) or 12 months (16.0% vs. 12.0%, p = 0.4). Conclusion(s): The transition of postprocedural care from the ICU/ImCU to a general ward was found to be safe, reduced length of hospital stay and spared the utilization of ICU/ImCU resources. This encourages for randomised clinical trials to further advance the streamlined care of these patients. Copyright © The Author(s) 2026. <37> Accession Number 2044351608 Title Hemolysis and Acute Kidney Injury Following Cardiac Surgery With Cardiopulmonary Bypass in Patients With Preexisting Renal Dysfunction. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(6) (pp 1740-1748), 2026. Date of Publication: 01 Jun 2026. Author Volleman C.; Phelp P.G.; Dubelaar D.P.C.; Tuip-de Boer A.M.; Hollander R.V.G.; Nieuwland R.; Vlaar A.P.J.; van den Brom C.E. Institution (Volleman, Phelp, Dubelaar, Tuip-de Boer, Vlaar, van den Brom) Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Volleman, Phelp, Dubelaar, Tuip-de Boer, Hollander, Vlaar, van den Brom) Laboratory for Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Volleman, van den Brom) Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, Netherlands (Nieuwland) Amsterdam Vesicle Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Nieuwland) Laboratory of Experimental Clinical Chemistry, Department of Laboratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands Publisher W.B. Saunders Abstract Objectives: Acute kidney injury (AKI) is a common complication following cardiac surgery with cardiopulmonary bypass (CPB). This study investigated whether cell-free hemoglobin (CFHb) levels after CPB are associated with endothelial damage and postoperative AKI in patients with preexisting renal dysfunction. Design(s): A substudy of a randomized controlled trial. Setting(s): Secondary referral and tertiary hospital. Participant(s): Adult patients undergoing cardiac surgery with CPB and an estimated glomerular filtration rate (eGFR) <50 mL/min/1.73 m2 or diabetes mellitus with an eGFR of <60 mL/min/1.73 m2. Intervention(s): Clinical data and plasma samples were collected after induction of anesthesia, within 1 hour at the intensive care unit, and 24 and 48 hours postoperatively. Measurements and Main Results: Of the 89 patients included, 21% developed AKI. CFHb peaked at 1 hour postoperatively (22.5 v 5.4 mg/dL, p < 0.001), and lactate dehydrogenase rose until 48 hours postoperatively (119 v 339 U/L, p < 0.001). Tumor necrosis factor alpha and intercellular adhesion molecule 1 increased following surgery (7.06 v 9.21 ng/mL, p = 0.020; 247 v 388 ng/mL, p < 0.001). Angiopoietin-2 rose until 48 hours postoperatively and was higher in patients with AKI at 24 hours (4,162 v 3,374 pg/mL, p = 0.027). Similarly, neutrophil gelatinase-associated lipocalin increased in patients with AKI (43.1 v 88.0 ng/mL, p < 0.001). CFHb at 1 hour postoperatively was not associated with angiopoietin-2 at 24 or 48 hours. Adding CFHb to a prediction model of AKI did not improve model fit (p = 0.28) or discrimination (p = 0.32). Conclusion(s): This study demonstrates that CPB induces hemolysis and endothelial activation and damage in patients with preexisting renal dysfunction. Although CFHb concentrations were higher in those developing AKI, CFHb did not predict AKI or correlate with markers of endothelial damage. Copyright © 2026 The Author(s) <38> Accession Number 2038028035 Title No antithrombotic therapy versus single antiplatelet therapy after percutaneous left atrial appendage closure in non-valvular atrial fibrillation: rationale and design of the multicentre, randomised, non-inferiority NAPT-LAAC trial. Source EuroIntervention. 22(8) (pp e455-e462), 2026. Date of Publication: 2026. Author Otsuka T.; Yamamoto M.; Asami M.; Naganuma T.; Ohno Y.; Tani T.; Nakazawa G.; Izumo M.; Saji M.; Hachinohe D.; Ueno H.; Sugiura A.; Shimura T.; Okazaki S.; Morikawa T.; Izumi Y.; Nakashima M.; Kubo S.; Shirai S.; Watanabe Y.; Hayashida K. Institution (Otsuka) Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (Otsuka) Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (Yamamoto) Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (Asami) Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (Naganuma) Department of Cardiology, New Tokyo Hospital, Chiba, Japan (Ohno) Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan (Tani) Department of Cardiology, Sapporo East Tokushukai Hospital, Sapporo, Japan (Nakazawa) Division of Cardiology, Department of Medicine, Kindai University, Faculty of Medicine, Osaka, Japan (Izumo) Department of Cardiology, St. Marianna University, School of Medicine, Kawasaki, Japan (Saji) Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan (Hachinohe) Department of Cardiology, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan (Ueno) Department of Cardiology, Toyama University Hospital, Toyama, Japan (Sugiura) Department of Cardiology, Nagoya Heart Center, Nagoya, Japan (Shimura) Department of Cardiology, Gifu Heart Center, Gifu, Japan (Okazaki) Department of Cardiology, Juntendo University Hospital, Tokyo, Japan (Morikawa) Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan (Izumi) Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (Nakashima) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan (Kubo) Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan (Shirai) Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (Watanabe) Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Hayashida) Department of Cardiology, Keio University School of Medicine, Tokyo, Japan Publisher Europa Group Abstract The current standard regimen for antithrombotic therapy after percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) recommends long-term use of antiplatelet agents. However, this recommendation is not supported by sufficient clinical evidence. Since LAAC is a treatment option for managing patients at high risk of bleeding, it is necessary to clarify whether long-term antiplatelet therapy is truly required after LAAC. The Non-Antithrombotic Versus. Single antiPlatelet Therapy Following Left Atrial Appendage Closure (NAPT-LAAC) trial, a prospective, randomised, controlled, open-label, blinded-endpoint multicentre study, will be conducted in Japan. It was designed to evaluate whether non-antithrombotic therapy is non-inferior to antiplatelet monotherapy after 45 days of oral anticoagulant (OAC) monotherapy following LAAC, with respect to the incidence of thrombotic and bleeding composite events in patients with NVAF and high bleeding risk. Patients with NVAF with a CHA<inf>2</inf> DS<inf>2</inf>-VA score >=2 and who successfully undergo LAAC are eligible for inclusion. A total of 500 patients undergoing LAAC will be randomised (1:1) to aspirin monotherapy versus non-antithrombotic therapy for the 45 days following OAC monotherapy. The primary outcome is a composite of all-cause mortality, myocardial infarction, stroke, systemic embolism, major bleeding, and clinically relevant non-fatal bleeding during a maximum of 4 years of follow-up. Major bleeding or clinically relevant non-fatal bleeding is defined as Type 2, 3, or 5 bleeding, according to the Bleeding Academic Research Consortium definition. The NAPT-LAAC trial will determine the probable non-inferiority of long-term non-antithrombotic therapy to aspirin monotherapy in patients with NVAF who undergo LAAC. (ClinicalTrials.gov: NCT07125417; jRCTs031250110). Copyright © 2026, The Authors. <39> Accession Number 2044976948 Title Outcomes of Drug-Coated Balloon Versus Drug-Eluting Stent for In-Stent Restenosis and De-Novo Lesions: A Meta-Analysis of Randomized Controlled Trials. Source Health Science Reports. 9(5) (no pagination), 2026. Article Number: e72061. Date of Publication: 01 May 2026. Author Moghadam A.S.; Kazemian S.; Shojaei S.; Moghadam S.S.; Dolama R.H.; Ebrahimi R.; Shirmard F.O.; Pourfaraji S.M.A.; Najafi M.S.; Hobaby S.; Soleimani H.; Tajdini M.; Tehrani B.; Kolte D.; Elgendy I.; Basavarajaiah S.; Latib A.; Sattar Y.; Chadi Alraies M.; Hosseini K. Institution (Moghadam, Kazemian, Shojaei, Moghadam, Dolama, Ebrahimi, Shirmard, Pourfaraji, Najafi, Hobaby, Soleimani, Tajdini, Hosseini) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of (Tajdini) Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States (Tehrani) Inova Heart and Vascular Institute, Falls Church, VA, United States (Kolte) Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States (Elgendy) Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, United States (Basavarajaiah) Department of Cardiology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom (Latib) Division of Cardiology, Montefiore Medical Center, The Bronx, NY, United States (Sattar) Department of Cardiology, West Virginia University, Morgantown, WV, United States (Chadi Alraies) Department of Cardiology, Detroit Medical Center, Detroit, MI, United States (Hosseini) Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark Publisher John Wiley and Sons Inc Abstract Background and Aims: Drug-coated balloons (DCBs) and drug-eluting stents (DESs) are commonly used in percutaneous coronary interventions (PCI), but their long-term comparative effectiveness remains unclear. This meta-analysis aimed to compare the clinical and angiographic outcomes of DCB versus DES in patients with in-stent restenosis (ISR) and de novo lesions, including ST-elevation myocardial infarction (STEMI) and small vessel disease (SVD). Method(s): A systematic search identified randomized controlled trials (RCTs) comparing DCBs and DESs. The primary outcome was target lesion revascularization (TLR), with secondary outcomes including all-cause mortality, cardiovascular mortality, myocardial infarction, stent/lesion thrombosis, and late lumen loss (LLL). The frequentist network meta-analysis and binary random-effect analysis were used to compare DCB versus. DES. Result(s): A total of 21 RCTs with 4244 patients were included. In ISR patients, the risk of TLR was comparable between DCB vs. DES at 1-year (OR: 1.36, 95% CI: 0.86-2.14) and beyond 1-year (OR: 1.23, 95% CI: 0.79-1.93). DCB and DES showed no significant difference in other secondary outcomes at 1-year and beyond. In STEMI and SVD patients, DCB and DES demonstrated similar outcomes, except for a lower LLL after DCB in patients with SVD (SMD: -0.38, 95% CI: -0.53 to -0.22). Conclusion(s): DCB and DES were associated with a similar risk of TLR in patients with ISR, STEMI, and SVD. The results were consistent at 1-year and beyond time intervals. Furthermore, DCB was associated with a lower LLL compared to DES in patients with SVD. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <40> Accession Number 2031785493 Title Digital tools in cardiac reperfusion pathways: A systematic review. Source Future Healthcare Journal. 11(1) (no pagination), 2024. Article Number: 100128. Date of Publication: 01 Mar 2024. Author Chhatwal K.; Deighton A.; Dhir A.; Kumar V.V.; Titus-Glover S.; Shah D.; Holt L. Institution (Chhatwal) Medical student, Imperial College London, London, United Kingdom (Deighton) Foundation year 1 doctor, Homerton Healthcare NHS Foundation Trust, London, United Kingdom (Dhir) Foundation year 1 doctor, North Devon Healthcare NHS Foundation Trust, Exeter, United Kingdom (Kumar, Titus-Glover, Shah, Holt) Medical student, Barts and the London School of Medicine and Dentistry, London, United Kingdom Publisher Elsevier B.V. Abstract With health and surgery increasingly aided by digital technologies, there exists a growing impetus to understand how such tools must integrate into existing clinical pathways to ensure a positive impact on patient and organisational outcomes. Consequently, this study sought to collate evidence on the use of digital technology in cardiac reperfusion surgeries. We systematically searched three scientific databases for relevant articles. In total, 1,092 articles were retrieved, with 126 screened using inclusion/exclusion criteria, and 21 selected for analysis. Articles reported on the use of virtual reality, mHealth and telehealth in cardiovascular reperfusion procedures, ranging from surgical training regimens to postoperative rehabilitation. Here, despite clinical advantages, limitations were highlighted, including cost, ineffective interfaces and extensive training needed to operate novel digital tools. Nevertheless with further development and input from patient stakeholders, many limitations look set to dematerialise and provide tangible improvements to the benefit of patients and hard-pressed health institutions. Copyright © 2024 <41> Accession Number 2044614954 Title Transcatheter aortic valve implantation in centers without a cardiac surgery department: a meta-analysis of contemporary evidence. Source Postepy w Kardiologii Interwencyjnej. 22(1) (pp 58-69), 2026. Date of Publication: 2026. Author de Almeida A.R.; Viana R.; Fernandes R.; Bento A.; Bras D.; Congo K.; Patricio L. Institution (de Almeida, Viana, Fernandes, Bento, Bras, Congo, Patricio) Hospital Espirito Santo de Evora, Portugal Publisher Termedia Publishing House Ltd. Abstract Introduction: The prevalence of aortic stenosis (AS) is increasing, resulting in a growing demand for aortic valve interventions. Current guidelines recommend transcatheter aortic valve implantation (TAVI) only in centers with on-site cardiac surgery (CS) backup. However, procedural advancements have reduced the need for emergent cardiac surgery (ECS), prompting a debate about the necessity of backup for this procedure. This meta-analysis evaluated the safety of TAVI performed in centers without CS backup. Material(s) and Method(s): The study was conducted in accordance with the MOOSE guidelines. The protocol was registered at PROSPERO (CRD420251044095). PubMed, CENTRAL, and Scopus were systematically searched up to November 2025. Studies comparing outcomes of TAVI performed with and without on-site CS or reporting outcomes of TAVI in non-CS centers were included. The outcomes were in-hospital mortality, 30-day death, need for ECS, and stroke. Meta-analyses of comparative studies and pooled proportions were performed using random-effects models. Risk of bias was evaluated using the ROBINS-I tool. Result(s): Eight observational studies were analyzed, including 22,203 patients (19,373 with and 2830 without on-site CS). No significant difference in in-hospital mortality was observed between groups (relative risk [RR] = 1.1, 95% CI: 0.6-1.9, p = 0.8). Thirty-day mortality was also similar (RR = 1.2, 95% CI: 0.5-2.6, p = 0.72). ECS did not occur (0%; 95% CI: 0-1), with an RR of 0.8 (95% CI: 0.2-2.4, p = 0.7). Stroke rates did not differ (RR = 1.1, 95% CI: 0.8-1.5). Pooled in-hospital mortality in non-surgical centers was 3% (95% CI: 1-4%), and 30-day mortality was 4% (95% CI: 2-6%). Sensitivity analyses in propensity score-matched populations confirmed findings with reduced heterogeneity and consistent results. Conclusion(s): TAVI performed in centers without on-site cardiac surgery demonstrated comparable outcomes to those with surgical backup, suggesting that selected programs may safely operate under this model. These findings support reconsidering current guideline restrictions to enhance access and equity in TAVI delivery. Copyright © Termedia Sp. z o. o. <42> Accession Number 2044999306 Title Perinatal Management and Appropriate Time of Delivery in Monochorionic Monoamniotic Twins When One Twin has Transposition of the Great Arteries. A Case Report and Systematic Review of the Literature. Source Pediatric Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Montoya J.; Tapasco L.; Mulinari L.; Ruano R.; Alkon J. Institution (Montoya, Tapasco, Alkon) Department of Pediatrics, Division of Pediatric Cardiology, Miller School of Medicine, University of Miami, Miami, United States (Mulinari) Department of Surgery, Division of Pediatric Cardiac Surgery, Miller School of Medicine, University of Miami, Miami, United States (Ruano) Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Miller School of Medicine, University of Miami, Miami, United States Publisher Springer Abstract Monochorionic monoamniotic (MCMA) twin pregnancies are typically delivered at 32-34 weeks of gestation to reduce the risk of intrauterine demise, but this practice may compromise outcomes for a growth-restricted or very-low-birth-weight twin requiring complex cardiac surgery. We conducted a literature review in Cochrane Central Register of Controlled Trials, EMBASE and PubMed from inception to October 26, 2025. We included reports of MCMA twin pregnancies with one fetus with TGA describing perinatal outcomes, cord complications, and cardiac surgery in very-low-birth-weight neonates. Of 388 records identified, 302 abstracts were screened, 54 full texts reviewed, and 8 studies were included. Only five published cases of MCMA with one twin affected by transposition of the great arteries were identified: two in conjoined twins, one with postmortem diagnosis after extreme prematurity, and two operated cases, of whom just one survived. We describe to our knowledge the third non-conjoined MCMA twin pregnancy with TGA and only the second postoperative survivor, delivered at 34 weeks. Systematic reviews have suggested that, in otherwise stable MCMA pregnancies with TGA, prolonging gestation to at least 33 weeks is considered safe, and based on our experience we suggest that prolonging pregnancy to 34 weeks may still be beneficial, but multicenter data is needed to reach this conclusion. Copyright © The Author(s) 2026. <43> Accession Number 2044612875 Title Cost-utility of point-of-care viscoelastic hemostatic assays in the management of bleeding during cardiac surgery: A single-blinded prospective multicenter stepped wedge cluster randomized trial in French context. Source Anaesthesia Critical Care and Pain Medicine. 45(3) (no pagination), 2026. Article Number: 101704. Date of Publication: 01 May 2026. Author Vourc'h M.; Boissier E.; Lakhal K.; Grosjean S.; Labaste F.; Robin E.; Bougle A.; Mattei M.; Morel J.; Wurtz V.; Mertes P.-M.; Zlotnik D.; Lagier D.; Beurton A.; Rineau E.; Fischer M.-O.; May M.-A.; Medard A.; Guimbretiere G.; Durand-Zaleski I.; Pere M.; Rozec B.; Rigal J.-C. Institution (Vourc'h, Lakhal, Rozec, Rigal) Anesthesie et reanimation chirurgicale, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Vourc'h) INSERM CIC 0004 Immunologie et infectiologie, Nantes Universite, France (Boissier) Laboratoire d'hematologie, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Grosjean) Departement d'Anesthesie-Reanimation, Centre Hospitalier Universitaire de Dijon, LNC UMR1231, Universite Bourgogne Franche Comte, Dijon, France (Labaste) Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire de Toulouse; Inserm U1048, I2MC-Institut des Maladies Metaboliques & Cardiovasculaires, Universite Paul Sabatier, Toulouse, France (Robin) Department of Anesthesia and Reanimation, Centre Hospitalier Universitaire de Lille, Bd du Pr Jules Leclercq, Lille, France (Bougle) Department of Anesthesiology and Critical Care, DMU DREAM, Hopital La Pitie-Salpetriere, APHP 75013 Paris, France. GRC 29 - Groupe de Recherche Clinique en Anesthesie Reanimation medecine Perioperatoire, ARPE, Sorbonne Universite, Paris, France (Mattei) Anesthesie et Reanimation de Chirurgie Cardiaque, Centre Hospitalier Universitaire de Nancy, Nancy, France (Morel) Departement d'anesthesie reanimation, CHU St Etienne, 25 boulevard Pasteur, Saint Etienne, France (Wurtz) Departement d'Anesthesie-Reanimation, Hopital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France (Mertes) Service d'Anesthesie Reanimation, UMR_S 1255, Nouvel Hopital Civil - Centre Hospitalier Universitaire de Strasbourg, 83 rue Himmerich, Strasbourg, France (Zlotnik) Department of Anesthesiology and Intensive Care, Hopital Europeen Georges Pompidou, AP-HP 75015, Paris, France. INSERM UMR-S1140 "Innovations Therapeutiques en Hemostase", Universite Paris Cite, Paris, France (Lagier) Service d'Anesthesie Reanimation - CHU La Timone - APHM, UR 4264 - Centre Europeen de Recherche en Imagerie Medicale - Aix-Marseille Universite, Marseille, France (Beurton) Department of Cardiovascular Anesthesia and Critical Care, Centre Hospitalier Universitaire de Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Universite de Bordeaux, Pessac, France (Rineau) Department of anesthesiology and critical care, Angers University Hospital, Angers, France; Univ Angers, MITOVASC INSERM U1083 - CNRS 6015, Team CARME, Angers, France (Fischer) Institut Aquitain du Coeur, Clinique Saint Augustin, ELSAN 33074 Bordeaux, France. Pole Reanimations Anesthesie, Centre Hospitalier Universitaire de Caen, Caen, France (May) Anesthesie - Reanimation Chirurgicale, Centre Hospitalier Universitaire de Tours, Tours, France (Medard) Pole Anesthesie Reanimation, Chirurgie Cardio-vasculaire, Hopital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France (Guimbretiere) Department of thoracic and cardiovascular Surgery, l'Institut du Thorax, Hopital Laennec, Centre Hospitalier Universitaire de Nantes, Nantes Universite, Nantes, France (Durand-Zaleski) Service d'epidemiologie clinique, URC-Eco AP-HP, Hotel Dieu. CRESS, Inserm, INRAE, universite Paris Cite, 75004 Paris, France; Sante Publique hopital Henri-Mondor, Universite Paris Est Creteil, Creteil, France (Pere) Plateforme de Methodologie et Biostatistique, Direction de la Recherche et de l'Innovation, Centre Hospitalier Universitaire, Nantes, France (Rozec) Nantes Universite, CNRS, INSERM, l'institut du thorax, Nantes, France Publisher Elsevier Masson s.r.l. Abstract Background: The IMOTEC study aims to determine whether a point-of-care viscoelastic hemostatic assay (VHA)-guided algorithm is cost-effective for the management of ongoing bleeding. Method(s): Stepped wedge cluster randomized trial, patient blinded, conducted at 16 French academic cardiac surgery centers from 01/2017 to 02/2020. Adults undergoing elective or urgent cardiac surgery with ongoing bleeding were enrolled during 2 successive inclusion periods: 1) transfusion guided on standard hemostasis tests (control period), and 2) transfusion using a VHA-guided algorithm. The primary objective was to estimate the efficiency of VHA based on the 1-year incremental cost-utility ratio (ICUR, primary outcome). Secondary outcomes included transfusion, postoperative complications, duration of stay in-hospital, reintervention, and mortality. Result(s): 1095 patients were randomized, and 1044 (95.3%) were analyzed. The mean utility was 0.60 (+/-0.30) in the VHA vs. 0.61 (+/-0.30) in the control period, adjusted difference, -0.01 [95% CI, -0.09 to 0.07]. The ICUR did not suggest that the VHA-guided algorithm was cost-effective. One-year mortality was 12.0% for VHA and 10.9% for control, Hazard Ratio, 1.69 [95% CI, 0.98-2.89], P = .06. The frequency of plasma and platelet transfusions was significantly lower in the VHA compared to the control period (respectively, 48.8% vs. 72.4%, P < 0.0001 and 52.3% vs. 74.1%, P = .0002), whereas fibrinogen administration was more frequent in the VHA period (58.4% vs. 47.0%, P = .002). The median in-hospital length of stay was significantly shorter in the VHA vs. control period: 11.0 days (8.0-18.0) vs. 14.0 (9.0-22.0), P = .02. Conclusion(s): The ICUR did not suggest that VHA was cost-effective in cardiac surgery patients with ongoing bleeding, compared with standard tests. Trial registration: Clinical trial submission: November 2, 2016Registry name: Cost-Utility Analysis of Management of Peri Operative Hemorrhage Following Cardiac Surgery With Cardiopulmonary Bypass (IMOTEC)ClinicalTrials. Copyright © 2025 The Author(s). Published by Elsevier Masson SAS on behalf of Societe Francaise d'Anesthesie et de Reanimation (SFAR). This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <44> Accession Number 2041420751 Title Cerebral embolic protection devices in transcatheter aortic valve implantation: An updated meta-analysis of randomized controlled trials. Source Indian Heart Journal. 78(2) (pp 72-78), 2026. Date of Publication: 01 Mar 2026. Author Mansouri E.S.; Queiroga F.; Ghasemi M.; Barbosa L.M.; Pinilla J.; Faizan M.A.; Ardebili S.F.Z.; Jena N.; Gomes W. Institution (Mansouri) Department of Internal Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Queiroga) Department of Medicine, Emory University, Atlanta, United States (Ghasemi) Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Barbosa) Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (Pinilla) CES University, School of Medicine, Medellin, Colombia (Faizan) Gomal Medical College, Khyber Medical University, Peshawar, Pakistan (Ardebili) Charles University, Faculty of Medicine in Hradec Kralove, Czechia (Jena) Department of Interventional Cardiology, Marshall University, Huntington, WV, United States (Gomes) INC Hospital, Department of Interventional Cardiology, Curitiba, Brazil Publisher Elsevier B.V. Abstract Background: Cerebral embolic protection devices (CEPD) have been designed to prevent embolization to the cerebral circulation during transcatheter aortic valve replacement (TAVR). However, the efficacy and safety of CEPD in stroke prevention in TAVR remains uncertain. Method(s): PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing CEPD vs. control for patients undergoing TAVR. Risk ratios (RR) with 95 % confidence intervals (CI) were pooled with a random-effects model. Result(s): Our meta-analysis included eight RCTs with 11,596 patients, of whom 5946 (51 %) were randomized to the CEPD group. There was no significant difference in the incidence of any stroke (3.51 % vs. 3.64 %; RR 0.91; 95 % CI 0.75-1.1; p = 0.33; I2 = 0 %) between groups. Similarly, CEPD did not significantly reduce the incidence of all-cause mortality (0.82 % vs. 0.67 %; RR 1.13; 95 % CI 0.74-1.74; p = 0.57; I2 = 0 %) Conclusion(s): Among patients undergoing TAVR, CEPD did not significantly reduce stroke incidence or all-cause mortality. Copyright © 2025 Cardiological Society of India <45> Accession Number 2044940522 Title Cerebral Embolic Protection Devices (CEPDs) During Transcatheter Aortic Valve Implantation (TAVI): A Meta-Analysis of Randomized Controlled Trials. Source Clinical Cardiology. 49(4) (no pagination), 2026. Article Number: e70309. Date of Publication: 01 Apr 2026. Author Gbreel M.I.; Badran A.S.; Hassan M.; Balata M. Institution (Gbreel) Faculty of Medicine, October 6 University, Giza, Egypt (Badran) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hassan) Theodor Bilharz Research Institute, Giza, Egypt (Balata) Department of Cardiology, University Hospital Rostock, Rostock, Germany Publisher John Wiley and Sons Inc Abstract Aims: Transcatheter aortic valve implantation (TAVI) is associated with procedure-related stroke. Cerebral embolic protection devices (CEPDs) are designed to reduce the risk of embolic debris reaching the brain; however, the evidence supporting their efficacy remains controversial. We aim to evaluate the efficacy and safety of CEPDs in patients undergoing TAVI. Method(s): Major databases were systematically searched up to April 2025. Only randomized controlled trials (RCTs) were included and critically appraised using the Cochrane Risk of Bias (ROB-2) tool. We calculated risk ratios (RRs) with the 95% confidence intervals for the outcomes, and trial sequential analysis (TSA) was conducted to reduce the risk of false-positive results due to random errors. Result(s): Eight RCTs (11,589 patients) were analyzed. No significant difference was observed in overall stroke incidence between CEPD and control groups (0.92 (95% CI: 0.75-1.14; p = 0.40, I2 = 0%), including disabling and non-disabling strokes. Device-specific analyses showed a non-significant reduction in disabling stroke with the Sentinel device. All-cause mortality, transient ischemic attacks, bleeding, acute kidney injury, delirium, and pacemaker implantation rates were similar between groups. CEPD use was linked to a transient improvement in cognitive function (MoCA scores) at 2-5 days post-TAVI, but this effect was not sustained at later follow-ups. TSA indicated that current evidence is insufficient to definitively refute CEPD efficacy. Conclusion(s): CEPDs show no significant reduction in overall, disabling, or non-disabling stroke, nor in all-cause mortality post-TAVI. Trial Registration: This meta-analysis was registered on PROSPERO. No.: CRD420251026208. Copyright © 2026 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC. <46> Accession Number 2042075652 Title Updates in Radial Access for Neurointervention: Feasibility, Innovations, and Future Directions. Source Seminars in Interventional Radiology. 42(6) (pp 646-654), 2025. Date of Publication: 01 Dec 2025. Author Nedelcu S.; Suroop M.; Puri A.S. Institution (Nedelcu) Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States (Suroop) Northeastern University, Boston, MA, United States (Puri) University of Massachusetts Chan Medical School, Worcester, MA, United States Publisher Thieme Medical Publishers, Inc. Abstract Radial access has rapidly gained popularity in the neurointervention world, building on its proven success in cardiovascular procedures. Radial access is currently used for a variety of neurointervention procedures, such as diagnostic cerebral angiography, aneurysm embolization, and mechanical thrombectomy due to a proven strong safety profile, patient-preferred alternative to traditional femoral access, faster ambulation, and fewer access-site complications. Additionally, the radial approach has proven effective for navigating particularly challenging arches not suitable for the femoral approach, posterior circulation interventions, and select acute ischemic stroke thrombectomy cases. Advances in the radial access technique, such as the distal radial access approach in the anatomical snuffbox, development of specialized access catheters, long radial sheaths to mitigate spasm, and refined hemostasis techniques have improved its feasibility, broadened its applicability to be routinely used in neurointervention procedures, and increased its utilization in cases with challenging aortic arch anatomy. Meta-analyses have reported high technical success (around 97%) with low crossover (approximately 5%) and minimal complications. This review highlights the latest evidence on radial access in neurointervention, focusing on technical tips, appropriate patient selection, clinical applications, as well as complication management. Copyright © 2025. Thieme. All rights reserved. <47> Accession Number 2044899501 Title Incidence and outcomes of major bleeding among first-time oral factor Xa inhibitor users: multinational observational cohort studies. Source Research and Practice in Thrombosis and Haemostasis. 10(2) (no pagination), 2026. Article Number: 103351. Date of Publication: 01 Feb 2026. Author Cohen A.T.; Welsh R.C.; Leentjens J.; Canbay A.; Choudhuri S.; Er C.; Chai-Adisaksopha C.; Dover D.C.; Smits E.; Mamza J.B.; Gao H.; Zhang R.; Randhawa A.K.; Beekman W.; Scherg F.; Palacios B.; Godfrey G.; Lang E.; Arenillas J.; Coleman C.I. Institution (Cohen) Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom (Welsh) University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, AB, Canada (Leentjens) Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands (Canbay) Department of Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany (Choudhuri) Northern Care Alliance National Health Services (NHS) Foundation Trust, Salford, United Kingdom (Er) Department of General Medicine, Woodlands Health, Singapore, Singapore (Chai-Adisaksopha) Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand (Dover) Canadian VIGOUR (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research) Centre, University of Alberta, Edmonton, AB, Canada (Smits) PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands (Mamza, Gao, Zhang) AstraZeneca, Medical and Scientific Affairs, BioPharmaceuticals Medical, London, United Kingdom (Randhawa) AstraZeneca, Medical and Scientific Affairs, Mississauga, ON, Canada (Beekman) AstraZeneca, Medical Evidence, Den Haag, Netherlands (Scherg) AstraZeneca, Medical Evidence, BioPharmaceuticals Business Unit, Hamburg, Germany (Palacios) AstraZeneca, Medical Evidence, Madrid, Spain (Godfrey) AstraZeneca, BioPharmaceuticals Medical, Europe and Canada, Zug, Switzerland (Lang) Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada (Arenillas) Hospital Clinico Universitario and Department of Medicine, University of Valladolid, Valladolid, Spain (Coleman) Department of Pharmacy Practice, University of Connecticut, Storrs, CT, United States Publisher Elsevier B.V. Abstract Background: Despite the favorable risk-benefit profile of factor (F)Xa inhibitors (FXai) vs vitamin K antagonists, major bleeding remains a concern. Objective(s): This study sought to describe the incidence and mortality rates of major bleeding in FXai-treated patients using large national registries. Method(s): This multinational, retrospective cohort study analyzed electronic health records and administrative claims data across Canada and 4 European countries. Adults initiated on FXai for atrial fibrillation, venous thromboembolism, nonmechanical cardiac valve replacement, and other indications were included. Major bleeding was defined as bleeding at critical sites or leading to hospitalization or fatality. Pooled incidence rates of major bleeding, case fatality rates, and associated all-cause mortality up to <=3 years after the index bleeding event were calculated across countries. Result(s): This study included 358,143 new FXai users, of whom 23,418 experienced major bleeding. The pooled incidence rate of major bleeding was 11.0 per 100 person-years (95% CI, 6.1-15.9) at 3 months, 8.2 (95% CI, 4.5-11.8) at 1 year, and 6.7 (95% CI, 3.7-9.7) at 3 years, and the case fatality rate was 9.0%, 8.9%, and 9.0%, respectively. Gastrointestinal bleeds were the most common major bleed observed, but intracranial hemorrhage had the highest case fatality rate. In patients with major bleeding, all-cause mortality incidence was 57.5 per 100 person-years (95% CI, 29.1-85.8) at 3 months and 28.9 (95% CI, 17.6-40.3) at 1 year. Conclusion(s): Results of this large-scale study indicate that the incidence of major bleeding remains elevated during the first 3 years after initiating FXai treatment and that these bleeding events seemed to be associated with significant mortality. 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/ <48> Accession Number 2029384105 Title Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis. Source Journal of Endovascular Therapy. 32(6) (pp 1906-1919), 2025. Date of Publication: 01 Dec 2025. Author de Liyis B.G.; Kosasih A.M.; Jagannatha G.N.P.; Dewangga M.S.Y. Institution (de Liyis, Kosasih, Jagannatha) Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia (Dewangga) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia Publisher SAGE Publications Inc. Abstract Introduction: The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. Method(s): Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. Result(s): Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). Conclusion(s): Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. Clinical Impact This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies. Copyright © The Author(s) 2024 <49> Accession Number 2045008030 Title Cardiovascular Benefit and Gastrointestinal Risk of Colchicine in Secondary Prevention: Risk Associated with Dose and Treatment Duration. Source American Journal of Cardiovascular Drugs. (no pagination), 2026. Date of Publication: 2026. Author Bian C.; Shen Q.; Liu X.-X.; Zhou M.; Ren Z.; Dong Z.; Jin X.; Song B.; Li B. Institution (Bian, Shen, Ren) School of Clinical Medicine, Shandong Second Medical University, Weifang, Weifang, China (Liu) Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China (Zhou) Department of Cardiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Shandong, Binzhou, China (Bian, Song, Li) Department of Cardiology, Zibo Central Hospital, No.10, South Shanghai Road, Zibo, China (Dong) Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Jin) Department of Geriatrics, Zibo Central Hospital, No. 10, South Shanghai Road, Zibo, China Publisher Adis Abstract Aims: This meta-analysis aims to evaluate the efficacy and safety of colchicine for the secondary prevention of cardiovascular and cerebrovascular diseases, and examines how dose and treatment duration modify its risk-benefit profile. Method(s): A meta-analysis comparing colchicine to placebo or standard care was performed. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. The secondary endpoint was expanded MACE (eMACE), defined as MACE plus ischemia-driven coronary revascularization. Result(s): Colchicine significantly reduced the risk of MACE (relative risk [RR] 0.83, 95% confidence interval [CI] 0.72-0.96) and eMACE (RR 0.78, 95% CI 0.64-0.96), with benefits driven by reductions in non-fatal MI and ischemia-driven coronary revascularization. No significant effect was observed on cardiovascular or all-cause mortality. Colchicine increased gastrointestinal adverse reactions (RR 1.90, 95% CI 1.41-2.55) and drug-related adverse event (DAE)-related colchicine discontinuation (RR 1.54, 95% CI 1.06-2.25). Sensitivity analyses revealed that the guideline-recommended dosage (0.5 mg once daily) for > 6 months maintained cardiovascular benefit (MACE RR 0.77, 95% CI 0.62-0.96), while gastrointestinal risk (RR 1.51, 95% CI 0.97-2.33) and DAE-related colchicine discontinuation risk (RR 1.42, 95% CI 0.80-2.51) became non-significant. Conclusion(s): Colchicine provides lasting benefit for patients with cardiovascular and cerebrovascular diseases. Gastrointestinal risk is dose and time dependent, and higher early in treatment. Tolerating and maintaining long-term standard-dose therapy improves the benefit-risk balance. These findings highlight the early treatment phase as a period of higher gastrointestinal risk, suggesting that strategies to support adherence during this period warrant further investigation. Registration: PROSPERO registration number CRD42024623329. Copyright © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026. <50> Accession Number 2045122393 Title Clinical applicability of anti-Xa measurements to monitor unfractionated heparin activity during arterial procedures: a scoping review. Source Journal of Thrombosis and Haemostasis. (no pagination), 2026. Date of Publication: 2026. Author Hoebink M.; Steunenberg T.A.H.; Smit S.; Hamer H.M.; Wiersema A.M.; Yeung K.K.; Jongkind V. Institution (Hoebink, Steunenberg, Smit, Wiersema, Yeung, Jongkind) Amsterdam UMC location Vrije Universiteit, department of Vascular Surgery, Amsterdam, Netherlands (Hoebink, Steunenberg, Wiersema, Jongkind) Dijklander Ziekenhuis, Department of Vascular Surgery, Hoorn, Netherlands (Hoebink, Steunenberg, Wiersema, Yeung, Jongkind) Amsterdam Cardiovascular Sciences, Atherosclerosis and Aortic Diseases, Amsterdam, Netherlands (Hamer) Amsterdam UMC, location AMC, Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine, Amsterdam, Netherlands Publisher Elsevier B.V. Abstract The anti-Xa test is regarded as the standard assay to measure unfractionated heparin activity in a laboratory setting, but its use during arterial procedures has not been established. The objectives of this systematic review, designed as a scoping review, were to structure the existing body of evidence, identify possible research gaps, and provide guidance for future research on the applicability of anti-Xa to measure the heparin activity during arterial procedures. Literature search resulted in 55 included reports (cardiac procedures: 44 reports; noncardiac procedures: 9 reports; cardiac and noncardiac procedures: 2 reports). During arterial procedures, anti-Xa is widely used as reference laboratory test to validate heparin point-of-care assays, compare different heparinization strategies and measure residual heparin activity at the end of the procedure or after heparin reversal using protamine. There is considerable heterogeneity among included reports, which hampers the ability to draw firm conclusions. The available literature is insufficient to define optimal periprocedural heparin activity measured by anti-Xa. Currently, anti-Xa is not used as a primary heparin monitoring assay during arterial procedures. The impact of alterations in periprocedural anti-Xa activity on clinical outcomes has been rarely investigated. Anti-Xa measurements appear to be reproducible compared with point-of-care heparin activity essays but require standardization. In conclusion, anti-Xa is useful as a reference test to evaluate point-of-care heparin testing and compare heparin strategies during arterial procedures, but there is a high need for studies to investigate correlation of anti-Xa levels with clinical outcomes and to determine optimal anti-Xa levels for arterial procedures. Copyright © 2026 The Author(s). <51> Accession Number 651052120 Title Effectiveness of doppler renal resistive index in early detection of postoperative acute kidney injury in prolonged cardiopulmonary bypass cardiac surgeries. Source Minerva anestesiologica. (no pagination), 2026. Date of Publication: 29 Apr 2026. Author Ucar M.H.; Yilmaz C.; Ata F.; Karasu D.; Balk Ucar S.; Kurtarangil Dogan A.; Kat N.K.; Gamli M. Institution (Ucar) Istanbul Kanuni Sultan Suleyman Training and Education Hospital, University of Health Sciences Turkiye (Yilmaz) Department of Anesthesiology and Reanimation, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey (Ata, Karasu, Gamli) Department of Anesthesiology and Reanimation, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey (Balk Ucar) Department of Anesthesiology and Reanimation, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey (Kurtarangil Dogan) Clinic of Anesthesiology and Reanimation, Kutahya City Hospital, Kutahya (Kat) Department of Radiology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey Abstract BACKGROUND: The aim of this study is to investigate the value of renal Doppler ultrasonography-derived Renal Resistive Index (RRI) for early prediction of cardiac surgery-associated acute kidney injury (CSA-AKI) in patients undergoing prolonged cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, and to assess perioperative risk factors, length of stay, and short-term outcomes. METHOD(S): Ninety adult patients (>18 years) scheduled for elective cardiac surgery under general anesthesia, with CPB >70 minutes and ACC >60 minutes, without preexisting acute or chronic renal failure. Patients were stratified according to KDIGO criteria as Group 1 (no CSA-AKI, N.=64) and Group 2 (CSA-AKI, N.=26). Preoperative and postoperative (first hour) RRI measurements were performed by a single radiologist. Demographic, intraoperative, and postoperative parameters including transfusion, urine output, fluid balance, vasoactive/inotropic agent and diuretic use, serum creatinine, and hematocrit levels were collected. RESULT(S): The postoperative RRI cutoff of 0.70 predicted CSA-AKI with 76.9% sensitivity and 73.4% specificity (P<0.001). Group 2 had significantly lower hematocrit levels during CPB rewarming (P=0.04). On postoperative days 2 and 3, urine output and fluid balance differed significantly between groups (P: 0.004-0.005 and P<0.001 - P<0.001, respectively). Inotropic/vasopressor requirements were higher in Group 2 on day 3 (P=0.003). Stage 1 AKI was most common (80.8%), predominantly on postoperative day 2. Group 2 demonstrated longer mechanical ventilation, prolonged ICU stay, and higher 30-day mortality (P=0.016, P=0.012, and P=0.006). CONCLUSION(S): Routine postoperative assessment of RRI in high-risk cardiac surgeries may enable earlier detection of CSA-AKI compared with KDIGO criteria, allowing earlier initiation of renal-protective strategies and potentially improving patient outcomes. <52> Accession Number 2045302518 Title A pilot randomized controlled trial to test the feasibility of a mobile health (mHealth) self-help intervention for adults after cardiac surgery. Source European Journal of Cardiovascular Nursing. 25(2) (pp 354-363), 2026. Date of Publication: 01 Mar 2026. Author Wynne R.; Nolte J.; Angel J.; Moore A.; Campbell T.; Ferguson C. Institution (Wynne) Centre for Quality & Patient Safety, Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Australia (Wynne) Western Health-Deakin Partnership, Western Centre for Research & Education, Majorca Street, St Albans, VIC, Australia (Nolte) Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia (Angel) Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia (Moore) Healthily Pty Ltd, St Kilda Road, Melbourne, VIC, Australia (Campbell) Healthily Pty Ltd, St Kilda Road, Melbourne, VIC, Australia (Ferguson) School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia Publisher Oxford University Press Abstract Aims: To determine feasibility, acceptability and test protocol integrity, for testing a mobile health (mHealth) intervention focused on enhancing self-management after adult cardiac surgery. Secondary aims were to assess the effect of the intervention on 30-day readmission, quality of life, and knowledge, skill and confidence for self-help. Methods and Results: A parallel-group, pilot randomized controlled trial was conducted in a major metropolitan publicly funded health service. Adult elective cardiac surgery patients discharged home within 30-days, able to understand spoken English, and use a smartphone, tablet or computer were eligible for inclusion. The mHealth intervention comprised patient narrative videos, and on-line resources focused on diagnosis, preparing for surgery, and immediate, and ongoing recovery. From August 2021 until the 23rd of December 2022, there were 341/516 elective cardiac surgery cases. Of 70 (20.5%) eligible patients, 61 (87.1%) participated. The mHealth intervention was accessed by 27 (84.4%) participants. When accessed, the intervention was feasible and acceptable for patients, there were no protocol violations. There was high viewing of content related to diagnosis, surgery and looking forward, compared with programmes related to rehabilitation. Readmission rates did not differ between groups. Participants taking action to manage their health in the intervention group incrementally increased from baseline to 90-day follow-up. Conclusion(s): The effect of patient narratives on patient activation warrants testing in an adequately powered randomized controlled trial. While the uptake of the mHealth intervention was modest, trends in actions for self-help and rate of 30-day readmission imply the intervention is potentially effective in improving self-help management. Registration: The Australian and New Zealand Clinical Trials Registry: ACTRN12621000082808. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. <53> [Use Link to view the full text] Accession Number 2044547082 Title GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS DO NOT DECREASE THE RISK FOR CORONARY REVASCULARIZATION IN PATIENTS WITH TYPE 2 DIABETES: A META-ANALYSIS OF CARDIOVASCULAR OUTCOME TRIALS. Source Journal of Hypertension. Conference: Megaron Athens International Conference Center. Athens Greece. 40(Supplement 1) (pp e164), 2022. Date of Publication: 01 Jun 2022. Author Patoulias D.; Katsimardou A.; Imprialos K.; Stavropoulos K.; Siskos F.; Kassimis G.; Petidis K.; Papadopoulos C.; Karagiannis A.; Doumas M. Institution (Patoulias, Katsimardou, Imprialos, Stavropoulos, Siskos, Petidis, Papadopoulos, Karagiannis, Doumas) Aristotle University of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece (Kassimis) Aristotle University of Thessaloniki, Second Department of Cardiology, Thessaloniki, Greece Aristotle University of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece Publisher Lippincott Williams and Wilkins Abstract Objective: - Cardiovascular disease (CVD) is common among subjects with type 2 diabetes mellitus (T2DM), while it represents the main cause of death, accounting for half of deaths in this population. Prevalence of coronary artery disease (CAD) among diabetic subjects is relatively high, more than 20%. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of antidiabetics with established cardiovascular benefits for patients with T2DM, have been shown to decrease the risk for major adverse cardiovascular events, cardiovascular and all-cause mortality, while they have been shown to decrease the risk for fatal or non-fatal myocardial infarction; therefore they have been suggested as second-line treatment option for patients with T2DM and established atherosclerotic cardiovascular disease.Design and method: - We searched PubMed from inception to September 1st, 2021, for the relevant cardiovascular outcome trials with GLP-1RAs in patients with T2DM, to pool data concerning coronary revascularization. We searched both published reports and supplementary appendices. We evaluated the surrogate outcome of coronary revascularization with GLP-1RAs versus placebo. Result(s): - We pooled data from 5 trials in a total of 41, 355 subjects with T2DM. GLP-1RA treatment compared to placebo did not have a significant effect on the risk for coronary revascularization (risk ratio = 0.95, 95% CI; 0.81 - 1.11, I2 = 77%, p = 0.51). No significant differences were observed during various subgroup analyses. Conclusion(s): - Despite their established cardioprotective effects in high-risk patients with T2DM, GLP-1RAs do not seem to confer a significant risk reduction in terms of coronary revascularization. Additional analyses according to the type of revascularization procedure might provide interesting insights. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. <54> Accession Number 651054904 Title Efficacy of intranasal insulin in preventing postoperative delirium and its impact on insulin resistance in elderly non-cardiac surgical patients: a systematic review and meta-analysis. Source Minerva anestesiologica. (no pagination), 2026. Date of Publication: 29 Apr 2026. Author Qin J.; Zhou W.; Chen S.; Cheng M.; Shen X.; Ma J. Institution (Qin, Zhou, Chen, Cheng, Shen) Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China (Ma) Department of Anesthesiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China Abstract BACKGROUND: Postoperative delirium (POD) is a common and serious complication in elderly patients and has been established to be associated with insulin resistance (IR), a key marker of dysregulated glucose metabolism. Therefore, this study aims to systematically evaluate the efficacy of intranasal insulin in preventing POD in elderly non-cardiac surgery patients and to further investigate whether its mechanism of action is related to the improvement of IR. METHOD(S): A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journals Database and Chinese Biomedical Literature Database from inception to October 19, 2025, to identify randomized controlled trials that compared elderly patients who were administered intranasal insulin during the perioperative period with those who were not. The primary outcomes of this study were the incidence of POD and the efficacy of different insulin dosing regimens. The secondary outcome was the change in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) values before and after surgery. Data from eligible trials were pooled to calculate the combined risk ratio (RR) or standardized mean difference (SMD). RESULT(S): Analysis of seven trials involving 778 elderly patients showed that, compared to placebo, intranasal insulin significantly reduced POD incidence on day one (RR: 0.33; 95%CI: 0.22 to 0.47; P<0.001) and its cumulative incidence over three days (RR: 0.31; 95%CI: 0.22 to 0.44; P<0.001) and five days (RR: 0.32; 95%CI 0.18 to 0.56; P<0.001). In contrast, the change in HOMA-IR across the surgery period did not differ significantly between the two groups (SMD: -0.27; 95%CI: -0.77 to 0.23; P=0.290). CONCLUSION(S): Intranasal insulin is effective in reducing the incidence of POD. This benefit is likely mediated through central nervous system glucose metabolism, rather than by reversing peripheral IR, a premise that requires validation in future trials. <55> Accession Number 2045086734 Title Effect of maternal voice on sleep quality in children following cardiac surgery: protocol for a randomized controlled trial. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1760057. Date of Publication: 2026. Author Shi S.; Wang X.; Wang R.; Du F.; Wang H.; Yu Y.; Shen B. Institution (Shi, Wang) Department of Cardiothoracic Surgery, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (Shi, Wang) School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Wang) Department of Pediatrics, Suzhou Xiangcheng People's Hospital, Suzhou, China (Du) Department of Nursing, Suzhou Xiangcheng People's Hospital, Suzhou, China (Yu) Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China (Shen) Department of Nursing, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China Publisher Frontiers Media SA Abstract Background - Children with congenital heart disease (CHD) frequently experience postoperative sleep disturbances, which can adversely affect recovery and overall postoperative outcomes. Maternal voice has been suggested as a soothing auditory stimulus with the potential to improve sleep quality in children. This study aims to evaluate the effect of auditory intervention centered on the maternal voice on sleep quality in children undergoing cardiac surgery. Methods - This prospective, randomized controlled trial will enroll 132 children with CHD undergoing open-heart surgery. Participants will be randomly assigned to either the control group or the maternal voice-based intervention group. The primary outcome is the overall sleep efficiency across the night of surgery, postoperative Day 1, and postoperative Day 2. Secondary outcomes include additional sleep parameters, pain scores, sedation scores, delirium scores, B-type natriuretic peptide (BNP) levels, cardiac troponin I (cTnI) levels, dosages of dexmedetomidine and sufentanil, cardiac intensive care unit (CICU) length of stay, total hospital length of stay, and parental satisfaction. Discussion - This trial aims to provide high-quality evidence on maternal voice to improve postoperative sleep quality in children with CHD. Trial registration numbers - Chinese Clinical Trial Registry (https://www.chictr.org.cn) ChiCTR2500111004. Copyright © 2026 Shi, Wang, Wang, Du, Wang, Yu and Shen. <56> Accession Number 2045301602 Title Association of the prognostic nutritional index and geriatric nutritional risk index with clinical outcomes in patients undergoing coronary artery bypass surgery: a systematic review and meta-analysis. Source Journal of Thoracic Disease. 18(4) (no pagination), 2026. Article Number: 319. Date of Publication: 30 Apr 2026. Author Gao Y.; Hou W.; Ma Y.; Xu Z. Institution (Gao, Hou, Ma, Xu) Department of Cardiothoracic Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, China Publisher AME Publishing Company Abstract Background: The association between preoperative prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) and clinical outcomes in patients receiving coronary artery bypass surgery (CABG) remains unclear now. This study aimed to clarify the associations of the PNI and the GNRI with clinical outcomes among patients who underwent CABG. Method(s): The PubMed, Embase, and Web of Science databases were searched up to July 11, 2025. Studies that investigated the relationships between the PNI and GNRI and clinical outcomes, such as long-term and short-term mortality and postoperative complications, were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were combined. Result(s): Twenty-one observational cohort studies involving 14,523 patients undergoing CABG were included in this meta-analysis. Most studies were retrospective in design, and follow-up periods ranged from in-hospital outcomes to long-term mortality. For PNI, the pooled results demonstrated that a lower PNI was related to an increased risk of long-term mortality (OR =0.91, P<0.001), short-term mortality (OR =0.88, P=0.01), acute kidney injury (AKI) (OR =0.73, P=0.009), major adverse cardiac and cerebrovascular events (OR =0.774, P<0.001), atrial fibrillation (OR =0.92, P=0.02), neurologic complications (OR =0.61, P=0.041), hemorrhage (OR =0.123, P=0.025), hospital-acquired infection (OR =0.472, P<0.001), and intra-aortic balloon pump use (OR =0.372, P<0.001), but the PNI was not associated with the risk of postoperative overall complications (P=0.13) or pulmonary complications (P=0.663). Only three studies evaluated GNRI. The GNRI was only associated with the risk of short-term mortality (OR =0.91; P=0.03), and no significant relationship between the GNRI and AKI (P=0.42) or major adverse cardiac or cerebrovascular events (OR =0.195) was observed. Conclusion(s): Based on the current evidence, the PNI was associated with clinical outcomes in patients who underwent CABG, and lower PNI indicated increased risk of postoperative mortality and complications. Copyright © AME Publishing Company. <57> Accession Number 2045329071 Title Effectiveness of non-pharmacological and pharmacological interventions in preventing delirium in older adults: a systematic review and meta-analysis of randomised controlled trials. Source Age and Ageing. 55(3) (no pagination), 2026. Date of Publication: 01 Mar 2026. Author Sanchez A.; Sawant-Uttekar P.; Heinen D.; Pribadi A.N.; Thomas C.; von Arnim C.; Kuhnle J.; Kreisel S.H.; Hewer W.; Fath B.; Sadlonova M.; Rapp M.; Deeken F. Institution (Sanchez) Department of Social and Preventive Medicine, University of Potsdam, Brandenburg, Potsdam, Germany (Sawant-Uttekar) Klinik fur Geriatrie, Marien Hospital Stuttgart, Baden-Wurttemberg, Stuttgart, Germany (Heinen) Department of Social and Preventive Medicine, University of Potsdam, Brandenburg, Potsdam, Germany (Pribadi) Department of Social and Preventive Medicine, University of Potsdam, Brandenburg, Potsdam, Germany (Thomas) Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Baden-Wurttemberg, Stuttgart, Germany (Thomas) Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Baden-Wurttemberg, Freiburg, Germany (Thomas) Department of Anaesthesiology, Klinikum Stuttgart, Baden-Wurttemberg, Stuttgart, Germany (von Arnim) Department of Geriatrics, University Medical Center Gottingen, Lower Saxony, Gottingen, Germany (Kuhnle) Department of Geriatrics, University Medical Center Gottingen, Lower Saxony, Gottingen, Germany (Kuhnle) Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Baden-Wurttemberg, Stuttgart, Germany (Kuhnle) German Center for Cardiovascular Research (DZHK), Lower Saxony, Gottingen, Germany (Kreisel) Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy Bethel, Evangelisches Krankenhaus Bielefeld, North Rhine-Westphalia, Bielefeld, Germany (Hewer) Clinic for Geriatric Psychiatry, Klinikum Christophsbad, Baden-Wurttemberg, Goppingen, Germany (Fath) Department of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Baden-Wurttemberg, Stuttgart, Germany (Fath) Clinic for Geriatric Psychiatry, Klinikum Christophsbad, Baden-Wurttemberg, Goppingen, Germany (Sadlonova) Department of Geriatrics, University Medical Center Gottingen, Lower Saxony, Gottingen, Germany (Sadlonova) German Center for Cardiovascular Research (DZHK), Lower Saxony, Gottingen, Germany (Sadlonova) Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Goettingen, Lower Saxony, Goettingen, Germany (Sadlonova) Department of Cardiac, University Medical Center Goettingen, Lower Saxony, Germany (Sadlonova) Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States (Rapp) Department of Social and Preventive Medicine, University of Potsdam, Brandenburg, Potsdam, Germany (Rapp) German Center for Mental Health (DZPG), Brandenburg, Potsdam, Germany (Deeken) Department of Social and Preventive Medicine, University of Potsdam, Brandenburg, Potsdam, Germany Publisher Oxford University Press Abstract Background: Delirium is a serious neuropsychiatric condition common among older adults, associated with prolonged hospital stays, increased morbidity and mortality. Although guidelines emphasise prevention, identifying most effective measures is crucial. Objective(s): To evaluate the efficacy of non-pharmacological and pharmacological interventions in preventing delirium in older adults (>=65 years). Method(s): We conducted a systematic review and meta-analysis of randomised controlled trials across settings, excluding ICU-only studies. MEDLINE, Cochrane, Web of Science and PsycINFO were searched through October 2024. Comparators included standard care, placebo, or other drugs. Random-effects models estimated pooled risk ratios. Risk of bias was assessed using RoB 2.0. Subgroup analyses were performed by setting and drug type. PROSPERO: CRD42024500387. Result(s): Eighty-seven trials (19,289 randomised patients) were included. Non-pharmacological multicomponent interventions (k = 17) significantly reduced delirium occurrence (risk ratio [RR] = 0.56, 95% CI 0.45-0.72; I2 = 63%) versus usual care, although certainty of evidence was very low. Effects were significant in non-cardiovascular surgical and medical patients. Single-component non-pharmacological interventions (k = 9) showed mixed or inconclusive findings. Among pharmacological trials (k = 53), dexmedetomidine reduced delirium risk (RR = 0.49; 95% CI 0.43-0.57; low-certainty) in non-cardiovascular surgical patients. Corticosteroids and intranasal insulin showed significant effects (high-certainty), based on a small number of trials. Mixed strategies, such as haemodynamic or cerebral oxygen-guided approaches, suggested potential benefit but were heterogeneous. Conclusion(s): Non-pharmacological multicomponent interventions reduce delirium occurrence and should be prioritised. Dexmedetomidine showed benefit in non-cardiac surgical populations, while evidence for other drugs remains inconclusive. Overall, certainty was low to very low, highlighting the need for further high-quality randomised trials to ensure generalisability. 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. <58> Accession Number 2045301653 Title Vasopressor requirements and hemodynamic stability during anesthesia using remimazolam and sevoflurane in patients undergoing minimally invasive aortic valve replacement surgery: a prospective randomized controlled study. Source Journal of Thoracic Disease. 18(4) (no pagination), 2026. Article Number: 342. Date of Publication: 30 Apr 2026. Author Lee J.; Shin S.-W.; Yoon J.-U.; Kim H.-J.; Yoon J.-P.; Shon H.-S.; Lee D.E.; Kim H.Y. Institution (Lee, Yoon, Kim, Yoon, Shon, Lee) Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea (Lee, Yoon, Kim, Yoon, Shon, Lee) Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea (Lee, Yoon, Kim, Yoon, Shon) Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, South Korea (Shin) Department of Anesthesia and Pain Medicine, Haeundae Bumin Hospital, Busan, South Korea (Kim) Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Beomeo-ri, Mulgeumeup, Yangsan, South Korea (Kim) Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Beomeo-ri, Mulgeumeup, Yangsan, South Korea (Kim) Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea, 20 Geumo-ro, Beomeo-ri, Mulgeumeup, Yangsan, South Korea Publisher AME Publishing Company Abstract Background: Anesthetic agents can cause hypotension, and patients with severe aortic stenosis (AS) require special attention. This study compared the effects of remimazolam versus sevoflurane anesthesia on hemodynamics in patients with severe AS undergoing minimally invasive aortic valve replacement (AVR). Method(s): Patients were assigned to the remimazolam (R) or sevoflurane (S) group. Group R received remimazolam 6 mg/kg/h for induction and 1-2 mg/kg/h for maintenance with remifentanil. Group S received 1% propofol at 1-2 mg/kg for induction and sevoflurane with remifentanil for maintenance. Vasopressor requirement and hypotensive events were compared. Result(s): Sixty-four patients were enrolled, and one patient was excluded from the study. The infusion rate of norepinephrine was lower in group R during post-cardiopulmonary bypass (CPB) (0.040+/-0.051 vs. 0.085+/-0.080 mcg/kg/min, P=0.03). The proportion of hypotension was lower in group R during post-CPB (80.2%+/-21.5% vs. 91.9%+/-25.2%, P=0.04), and the entire duration of anesthesia (66.5%+/-16.9% vs. 76.0%+/-16.2%, P=0.03). Conclusion(s): Compared to conventional sevoflurane anesthesia, remimazolam-based total intravenous anesthesia was associated with more stable hemodynamics and reduced vasopressor requirement during pre-CPB, and post-CPB in patients with severe AS undergoing minimally invasive AVR. Trial Registration: The clinical research was registered at ClinicalTrials.gov (Ref: NCT05864625). Copyright © AME Publishing Company. <59> Accession Number 2045327940 Title Oral step-down vs full-course intravenous antibiotic therapy for infective endocarditis: Protocol for a systematic review and meta-analysis. Source PLOS ONE. 21(4 April) (no pagination), 2026. Article Number: e0348084. Date of Publication: 01 Apr 2026. Author Cruz-Cuevas J.D.; Amador Bedoya J.A.; Mendez Gaitan M.P.; Ramirez M.C.; Quiroga J.G.; Rodriguez Villegas A.; Reyes A.S. Institution (Cruz-Cuevas, Amador Bedoya, Mendez Gaitan, Ramirez, Quiroga, Rodriguez Villegas, Reyes) Fundacion Cardioinfantil, Instituto de Cardiologia, Bogota, Colombia (Cruz-Cuevas, Amador Bedoya, Ramirez, Quiroga, Rodriguez Villegas) School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia (Mendez Gaitan) School of Medicine, Universidad El Bosque, Bogota, Colombia (Reyes) School of Medicine, Universidad de La Sabana, Bogota, Colombia Publisher Public Library of Science Abstract Background Infective endocarditis (IE) is a life-threatening condition traditionally managed with prolonged intravenous (IV) antibiotic therapy. However, sequential oral antibiotic therapy has emerged as a promising alternative in selected patients, potentially reducing hospital stay, adverse events, and healthcare costs. While the POET trial demonstrated non-inferiority of oral step-down therapy in a narrow subset of patients with left-sided IE, broader applicability remains uncertain. Observational studies and recent meta-analyses have yielded heterogeneous and inconclusive results, underscoring the need for a comprehensive synthesis of current evidence. Methods This protocol outlines the methodology for a systematic review and meta-analysis comparing the effectiveness and safety of sequential oral antibiotic therapy versus full-course IV therapy in adult patients with bacterial IE. We will include randomized controlled trials and observational comparative studies enrolling adults diagnosed with IE by Duke criteria, clinical judgment, or histopathological confirmation. The primary outcomes are all-cause mortality and clinical cure; secondary outcomes include relapse, unplanned cardiac surgery, embolic events, hospital length of stay, and adverse events. Searches will be conducted in MEDLINE, Embase, CENTRAL, and LILACS, with no restrictions on publication date or language. Risk of bias will be assessed using RoB 2 and ROBINS-I tools. Data synthesis will follow Cochrane guidelines, and certainty of evidence will be evaluated using the GRADE approach. Discussion This review will provide a rigorous and up-to-date synthesis of the evidence on oral step-down therapy in IE, addressing populations underrepresented in prior trials. The findings will inform clinical decision-making, guideline development, and future research on optimizing antibiotic strategies for IE. Copyright © 2026 Cruz-Cuevas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. <60> Accession Number 2045301957 Title Clinical research advances in thoracic surgery and thoracic oncology in 2025: a panoramic narrative review. Source Journal of Thoracic Disease. 18(4) (no pagination), 2026. Article Number: 424. Date of Publication: 30 Apr 2026. Author Sun Z.; Li X.; Hao Z.; Zhang H.; Ou D.; Zhou W.; Liang H.; Cui F. Institution (Sun, Li, Hao, Zhang) Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China (Ou, Zhou) Nanshan School, Guangzhou Medical University, Guangzhou, China (Liang, Cui) Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, China Publisher AME Publishing Company Abstract Background and Objective: The year 2025 brought important refinements in thoracic surgery and thoracic oncology, particularly in risk-adapted screening, biomarker-guided perioperative therapy, minimally invasive surgery, and perioperative recovery. This narrative review summarizes clinically relevant evidence reported in 2025 and discusses how these updates may influence multidisciplinary practice. Method(s): We conducted a narrative review of literature and conference reports published or presented between January 1 and December 31, 2025. PubMed, Google Scholar, and the official abstract proceedings/ websites of the American Society of Clinical Oncology (ASCO), the World Conference on Lung Cancer (WCLC), and the European Society for Medical Oncology (ESMO) were searched using combinations of disease-, treatment-, and surgery-related . Earlier pivotal trials were cited selectively to provide background context where needed. Key Content and Findings: The National Comprehensive Cancer Network (NCCN) updated lung cancer screening criteria toward broader risk inclusion. In resectable non-small cell lung cancer (NSCLC), 2025 data further refined perioperative strategies for molecularly selected and driver-negative populations, including long-term outcomes from immunotherapy trials and phase III evidence for neoadjuvant targeted therapy. Robot-assisted thoracic surgery (RATS) continued to show advantages in selected complex settings, especially after induction treatment. Progress in mesothelioma, esophageal cancer, perioperative rehabilitation, and digital symptom monitoring also underscored the increasing importance of whole-patient care. However, several emerging tools, including circulating tumor DNA (ctDNA) and artificial intelligence (AI)-assisted models, still require prospective validation, standardization, and broader accessibility before routine implementation. Conclusion(s): Recent advances in thoracic oncology increasingly support a more precise, multidisciplinary, and patient-centered model of care. The most meaningful progress in 2025 lay not only in new treatments, but also in better integration of molecular stratification, surgical decision-making, and perioperative management. Copyright © AME Publishing Company. <61> Accession Number 2045301348 Title Evaluation of the utility of slow mode for pulmonary vessel resection using a surgical stapler in anatomical pulmonary resection: a prospective randomized controlled trial protocol. Source Journal of Thoracic Disease. 18(4) (no pagination), 2026. Article Number: 425. Date of Publication: 30 Apr 2026. Author Karita R.; Inage T.; Takahashi K.; Sugawara T.; Suzuki H. Institution (Karita, Inage, Suzuki) Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan (Takahashi) Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan (Sugawara) Clinical Research Center, Chiba University Graduate School of Medicine, Chiba, Japan Publisher AME Publishing Company Abstract Background: Intraoperative bleeding from the pulmonary vessel stumps is a well-known complication of anatomical lung resection performed with surgical staplers. While advancements in stapling devices have improved safety, staple line bleeding (SLB) remains a serious concern as it can prolong operative time and increase complications risk. The SigniaTM stapling system features both adaptive firing technology plus mode (AFTM) and manual slow mode (MSM), allowing for adjustable staple firing speed. A retrospective study has suggested that MSM could minimize SLB risk; however, these findings lack confirmation from prospective studies. This study is aimed to investigate the utility of MSM for SLB prospectively. Method(s): A total of 140 patients will be randomized into two groups. One group will undergo pulmonary vessel resection using AFTM and the other using MSM. The primary endpoint is intraoperative observation of SLB on pulmonary vessel stumps. Data analysis is scheduled for the period from 2025 to 2027. Discussion(s): This trial investigates whether MSM lowers the risk of SLB from pulmonary vessels and reduce the need for additional hemostatic procedures. If a slower firing speed is proven to minimize intraoperative SLB, selecting MSM could significantly improve the safety and efficiency of thoracic surgery. This could reduce complications, decrease the need for additional hemostatic interventions, and lower overall medical resource consumption. Copyright © AME Publishing Company. <62> Accession Number 651051662 Title Research Trends on Deep Breathing Exercises in Perioperative Care: A Bibliometric and Topic Modeling Analysis. Source Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses. (no pagination), 2026. Date of Publication: 29 Apr 2026. Author Yoltay H.E.; Yildirim Y.; Deveci Kocakoc I. Institution (Yoltay) Faculty of Nursing, Department of Surgery Nursing, Ege University, Bornova, Izmir, Turkey (Yildirim) Faculty of Nursing, Department of Internal Medicine Nursing, Ege University, Bornova, Izmir, Turkey (Deveci Kocakoc) Faculty of Economics and Administrative Sciences, Department of Econometrics, Dokuz Eylul University, Izmir, Turkey Abstract PURPOSE: The purpose of this analysis was to systematically map the intellectual structure, thematic evolution, and collaborative patterns of research in the field of deep-breathing exercises (DBEs). DESIGN: A comprehensive bibliometric analysis combined with Latent Dirichlet Allocation-based topic modeling was conducted using publications retrieved from Web of Science, Scopus, and PubMed. METHOD(S): A total of 2,017 publications published between 1940 and 2024 were included. Bibliometric indicators were used to examine publication trends, leading journals, authors, countries, and collaboration networks, while Latent Dirichlet Allocation was applied to identify dominant research themes. FINDINGS: The annual number of publications increased steadily over time, with a marked rise after 2011 and a peak observed in 2020. The most productive countries were the United States, Italy, and Germany, while the leading journals included Chest and The Annals of Thoracic Surgery. Collaboration analyses revealed limited international and interinstitutional research networks. Topic modeling identified three major thematic clusters: (1) education and training-focused DBE interventions, (2) application of DBE following cardiac and thoracic surgery, and (3) postoperative complication prevention and rehabilitation. CONCLUSION(S): This bibliometric and topic modeling analysis provides a structured overview of the intellectual organization and thematic evolution of DBE research in surgical and perioperative care. Rather than evaluating clinical effectiveness, the findings highlight prevailing research priorities, collaboration gaps, and underexplored areas. These insights may support perianesthesia nursing by informing future research agendas, encouraging interdisciplinary collaboration, and guiding the strategic development of DBE-related studies. Copyright © 2026. Published by Elsevier Inc. <63> Accession Number 2045301531 Title Preoperative statin use and postoperative mortality in cardiac surgery patients: a retrospective cohort study of the MIMIC-IV database. Source Journal of Thoracic Disease. 18(4) (no pagination), 2026. Article Number: 285. Date of Publication: 30 Apr 2026. Author Zou X.; Zheng J.; Zhou J.; Qiu H.; Wu X. Institution (Zou, Zheng, Qiu, Wu) Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China (Zhou) Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China (Zhou) Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China Publisher AME Publishing Company Abstract Background: The impact of preoperative statin use on postoperative survival in cardiac surgery (CS) patients remains controversial. While some randomized controlled trials (RCTs) have reported neutral or harmful effects, real-world evidence from large, granular databases like Medical Information Mart for Intensive Care IV (MIMIC-IV) can provide complementary insights into long-term outcomes and dose-response relationships. This study aimed to investigate the association between preoperative statin use and short- to medium-term postoperative mortality in cardiac surgery patients using a large, real-world database and to explore potential dose-response effects. Method(s): This retrospective cohort study utilized the MIMIC-IV database [2008-2019]. We included adult patients (>=18 years) with an intensive care unit (ICU) stay of >24 hours undergoing their first CS. Patients were divided into preoperative statin users and non-users. The primary outcome was in-hospital mortality, while secondary outcomes were 30-, 90-, and 360-day mortality. Multivariable Cox proportional hazards models were constructed, adjusting for demographics, vital signs, laboratory results, and comorbidities (e.g., hypertension, diabetes, heart failure). Follow-up data were derived from hospital records and related death registry information. Result(s): A total of 17,172 CS patients were finally included in the study. Among 17,172 CS patients, 3,647 (21.2%) received preoperative statins. Statin users were older and had a higher burden of comorbidities such as hypertension and diabetes compared to non-users. In the fully adjusted model, preoperative statin use was associated with significantly lower in-hospital mortality rates [hazard ratio (HR) =0.708, 95% confidence interval (CI): 0.622-0.807, P<0.001]. Similar associations were observed for 30-day (HR =0.826, P=0.001), 90-day (HR =0.829, P<0.001), and 360-day mortality rates (HR =0.884, P=0.002). Dose-response analysis revealed a more significant reduction in mortality rates with high-dose (>40 mg) atorvastatin. Conclusion(s): In this large, real-world cohort, preoperative statin use was associated with reduced short- and medium-term mortality rates after CS, with a potential dose-dependent effect. However, given the conflicting evidence from RCTs, these findings should be interpreted cautiously. Perioperative management should be individualized, and further research is necessary to identify patient subgroups most likely to benefit from statin therapy. Copyright © AME Publishing Company. <64> Accession Number 651059417 Title Early versus late surgical start times for on-pump cardiac surgery. Source The Cochrane database of systematic reviews. 4 (pp CD014901), 2026. Date of Publication: 28 Apr 2026. Author Liu Z.; Penny-Dimri J.C.; Nagel M.; Plummer M.; Segal R.; Morley P.T.; Smith J.; Perry L.A. Institution (Liu, Nagel) Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia (Liu, Segal) Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Australia (Penny-Dimri, Smith) Department of Surgery, Monash University, Melbourne, Australia (Plummer, Morley) Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia (Segal) Department of Medicine, University of Melbourne, Melbourne, Australia (Perry) Department of Anaesthesia, Victorian Heart Hospital, Monash Health, Clayton, Australia (Perry) Victorian Cardiac Anaesthesia Research Laboratory, Victorian Heart Institute, Monash University, Clayton, Australia Abstract RATIONALE: Circadian rhythms affect cardiovascular function, and the timing and severity of stroke and myocardial infarction (commonly known as a heart attack). Afternoon cardiac surgery may improve outcomes by reducing ischaemia-reperfusion injury (i.e. reducing tissue damage caused when blood supply returns to tissue (reperfusion) after a period of oxygen deprivation (ischaemia)). However, the evidence is conflicting. This systematic review assessed the impact of surgical timing on clinical outcomes after cardiac surgery. OBJECTIVE(S): To assess the effects of early versus late surgical start times for on-pump cardiac surgery on mortality, cardiac outcomes, and quality of life. SEARCH METHOD(S): We searched CENTRAL, MEDLINE, Embase, and Web of Science Conference Proceedings Citation Index - Science, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform trials registers. We also conducted reference checking, citation searching, and contacted study authors to identify studies for inclusion. The latest search date was 26 January 2025. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) in adults undergoing cardiac surgery comparing late with early surgical start times. We excluded non-randomised studies and studies in children. OUTCOME(S): Our critical outcomes were short-term mortality (<= 30 days postoperative), long-term mortality (> 30 days postoperative), and perioperative myocardial infarction. Other important outcomes were perioperative myocardial injury, postoperative atrial fibrillation, left ventricular ejection fraction, lengths of intensive care unit (ICU) and hospital stays, and quality of life. RISK OF BIAS: We used the Cochrane Risk of Bias 2 tool to assess bias in the included RCTs. SYNTHESIS METHODS: As only one study met the inclusion criteria, we did not perform meta-analysis. We synthesised results descriptively, and used GRADE to assess the certainty of the evidence for specified outcomes. INCLUDED STUDIES: We included one study with 88 participants. The included study was conducted in France, and reported on differences in outcomes between morning and afternoon on-pump elective aortic valve replacement in adults. SYNTHESIS OF RESULTS: Critical outcomes No study reported short-term or long-term mortality data for early versus late surgical start times for on-pump cardiac surgery. In the included study, there was no evidence of a difference regarding in-hospital mortality between groups, with no deaths in both groups (risk ratio (RR) and 95% confidence interval (CI) not estimable; 1 study, 88 participants). The evidence is very uncertain about the effect of early versus late surgery on perioperative myocardial infarction (RR 0.29, 95% CI 0.06 to 1.30; 1 study, 88 participants, very low-certainty evidence). Important outcomes There was evidence of lower perioperative myocardial injury as measured by cumulative troponin release over 72 hours in those undergoing late surgery compared to early surgery (MD -46 ng/L x 72 h, 95% CI -79 to -13; 1 study, 88 participants). In the included study, there was no evidence of a difference in new-onset postoperative atrial fibrillation during hospital stay between groups (RR 0.75, 95% CI 0.40 to 1.40; 1 study, 88 participants). No study reported differences in left ventricular ejection fraction at discharge as a continuous variable for early versus late surgical start times for on-pump cardiac surgery. In the included study, there was no evidence of a difference in left ventricular ejection fraction < 45% at discharge between groups (RR 0.40, 95% CI 0.08 to 1.95; 1 study, 88 participants). No study reported differences in length of ICU admission for early versus late surgical start times for on-pump cardiac surgery. There was no evidence of a difference in need for inotropic support between groups in the included study (RR 0.25, 95% CI 0.03 to 2.15; 1 study, 88 participants). The evidence is very uncertain about the effect of late surgery on length of hospital stay (MD 0.00, 95% CI -1.48 to 1.48; 1 study, 88 participants, very low-certainty evidence). No study reported on the outcome of quality of life. AUTHORS' CONCLUSION(S): The evidence is very uncertain about the effects of early versus late surgical start time for the outcomes of perioperative myocardial infarction and length of hospital stay. We found no data for the outcomes of short-term or long-term mortality, left ventricular ejection fraction, length of ICU stay, or quality of life. Late surgical start time could reduce the risk of perioperative myocardial injury as estimated by cumulative troponin release over 72 hours. More research is needed to determine whether scheduling heart surgery later in the day improves patient outcomes. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2022) DOI: 10.1002/14651858.CD014901. Copyright © 2026 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. <65> Accession Number 651045550 Title Nurse-led postoperative interventions in adult cardiac surgery: a systematic review. Source European journal of cardiovascular nursing. (no pagination), 2026. Date of Publication: 27 Apr 2026. Author Matthews S.; Fredericks S.; Delaney L.; Abbs M.; Guiriba G.M.; Nasrawi D.; Wynne R. Institution (Matthews, Delaney, Abbs, Guiriba, Wynne) Centre for Quality & Patient Safety in the Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Australia (Matthews, Guiriba, Wynne) Western Health, St Albans, Australia (Matthews, Fredericks, Delaney, Abbs, Guiriba, Nasrawi, Wynne) CONNECT: Cardiac Surgery International Nursing & Allied Professional Research Network (Fredericks) Toronto Metropolitan University, Toronto, Canada (Nasrawi) Faculty of Health, Southern Cross University Abstract AIMS: The primary aim of this systematic review was to identify nurse-led clinical interventions evaluated in randomised controlled trials (RCT) for adults who had undergone cardiac surgery. The secondary aim was to assess the effectiveness of these interventions on postoperative clinical and patient-reported outcomes during the acute inpatient phase. METHODS & RESULTS: A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute (JBI) methodology and PRISMA guideline for reporting. Eligible studies were RCT of adult (>=18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Of 2,690 records, 19 RCT were eligible, representing 13 countries, and 3,142 participants. Risk of bias varied, with only two low risk trials. Interventions were grouped into six domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care and infection prevention; respiratory and pulmonary function; and postoperative recovery, mobilisation, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. CONCLUSION(S): Nurse-led inpatient interventions contribute meaningfully to in-patient postoperative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCT. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. <66> Accession Number 2043544600 Title Impact of active cancer on mortality and complications after TAVR: A systematic review and meta-analysis. Source ASCO MEETING ABSTRACTS. Conference: ASCO MEETING ABSTRACTS. Chicago United States. 43 (no pagination), 2025. Article Number: e24024. Date of Publication: 01 Jun 2025. Author Aiman W.; Khawar M.; Qadeer A.; Ali U.; Hadeed Khawar M.M.; Saeed H.; Tayyab M.; Shah S.A.; Ali M.A.; Khan S.M.I.; Haider M.Z.; Kirchoff R.W. Institution (Aiman) New York Medical College - Saint Michael's Medical Center, Newark, NJ, United States (Khawar) King Edward Medical University, Lahore, Pakistan (Qadeer) Mayo Clinic Hospital, Phoenix, AZ, United States (Ali) King Edward Medical University, Lahore, Pakistan (Hadeed Khawar) Services Institute of Medical Sciences Lahore, Lahore, Pakistan (Saeed) KEMU, Lahore, Pakistan (Tayyab) King Edward Medical University, Lahore, Pakistan (Shah) King Edward Medical University, Lahore, Pakistan (Ali) Saint Mary's and Saint Clare's Hospital, New York Medical College, Denville, NJ, United States (Khan) National University of Medical Sciences, Rawalpindi, Pakistan (Haider) West Virginia University, Morgantown, WV, United States (Kirchoff) Mayo Clinic Hospital, Pheonix, AZ, United States Publisher American Society of Clinical Oncology Abstract Background: Patients with active cancer undergoing trans catheter aortic valvular replacement (TAVR) face a higher risk of adverse outcomes due to the interplay between cancer and cardiovascular disease. Although TAVR is increasingly used in high-risk populations, data on outcomes for these patients remain limited. This systematic review and meta-analysis aim to evaluate the clinical outcomes associated with TAVR in patients with active cancer compared to non-cancer controls, providing insights to inform clinical decision-making in this unique group. Method(s): A systematic search of major databases (PubMed, Embase, OVID, Web of Science, Scopus) was conducted to identify studies comparing clinical outcomes of TAVR between patients with active cancer and those without cancer. Key outcomes included measures of mortality, procedural complications, and post-procedure adverse events. The Mantel-Haenszel method was used for pooled analysis, applying random-effects or fixed-effects modeling based on heterogeneity assessed by Higgins I2. Statistical significance was set at a p-value < 0.05. Result(s): Twelve studies involving 5, 73, 192 patients (67, 684 active cancer, 505508 control) were included. Patients with active cancer undergoing TAVR have significantly higher risks of short-term mortality (OR 1.31, 95% CI [1.15, 1.49], p < 0.0001), long-term mortality (OR 2.24, 95% CI [1.85, 2.70], p < 0.0001), and major bleeding complications (OR 1.80, 95% CI [1.68, 1.92], p < 0.0001). There were no statistically significant differences in cardiovascular mortality (OR 1.33, 95% CI [0.94, 1.89], p = 0.11), myocardial infarction (OR 1.60, 95% CI [0.82, 3.11], p = 0.17), stroke (OR 0.61, 95% CI [0.28, 1.35], p = 0.22), AKI (OR 0.92, 95% CI [0.49, 1.73], p = 0.80), or the need for permanent pacemaker implantation (OR 1.12, 95% CI [0.85, 1.48], p = 0.42). Conclusion(s): Patients with active cancer undergoing TAVR face significantly higher risks of mortality and major bleeding compared to non-cancer controls. However, the risks of cardiovascular mortality, MI, stroke, AKI, and the need for permanent pacemaker implantation are comparable to those of non-cancer controls. Careful risk assessment and management are crucial for optimizing outcomes in this vulnerable population, and further studies are needed to refine treatment strategies. (Table presented.) Copyright © 2025 <67> Accession Number 2045092852 Title Antibiotics and Other Drugs Removal by the CytoSorb Haemoadsorber: A Systematic Review of Available Evidence. Source Antibiotics. 15(4) (no pagination), 2026. Article Number: 409. Date of Publication: 01 Apr 2026. Author Kenda S.; Gubensek J.; Vovk T. Institution (Kenda, Vovk) Faculty of Pharmacy, University of Ljubljana, Askerceva 7, Ljubljana, Slovenia (Kenda) General Hospital Dr. Franc Derganc Nova Gorica, Padlih Borcev 13a, Sempeter Pri Gorici, Slovenia (Gubensek) Department of Nephrology, University Medical Center Ljubljana, Zaloska 7, Ljubljana, Slovenia (Gubensek) Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Haemoadsorption has recently emerged as an extracorporeal treatment option for sepsis, septic shock, intoxications, and cardiac surgery to modulate dysregulated inflammatory responses or remove a wide range of circulating molecules. To ensure appropriate clinical use of the CytoSorb haemoadsorber, it is essential to understand the extent to which specific drugs are adsorbed by the device. Method(s): We conducted a systematic literature review using the PubMed and Ovid MEDLINE database to identify studies on drug binding to the CytoSorb haemoadsorber, including both in vivo and in vitro studies. Publications in English language, available up to 31 December 2025 that reported or enabled calculation of percentage of drug removal, CytoSorb clearance or half-life during CytoSorb therapy were included. Records were screened, eligibility and quality were assessed, and data were extracted independently by two reviewers. Result(s): We found that 26 studies reported on the binding of 56 drugs to CytoSorb, with most available information relating to antibiotics used in the treatment of sepsis and septic shock. CytoSorb appears to remove vancomycin and linezolid but not meropenem, although data for other antibiotics are insufficient to assess clinical relevance. Data on the removal of anticoagulant and antithrombotic drugs with CytoSorb before and during cardiac surgery indicate that using this procedure to reduce complications associated with apixaban and ticagrelor is feasible and safe. The available evidence on the use of CytoSorb for drug poisoning is of very low quality. Conclusion(s): Although the number of studies on drug binding to the CytoSorb is increasing, the review is limited by the marked heterogeneity among the included studies. It is advised to use therapeutic drug monitoring whenever possible during CytoSorb treatment. Research of binding of drugs to CytoSorb is crucial for its safe and effective clinical use, but adequate methodology is necessary. Copyright © 2026 by the authors. <68> Accession Number 2045284651 Title Efficacy of Cotton Candy Flavoured Edible Oil and Audio-Visual Therapy on Pain Perception and Anxiety among Children aged 6-9 years on Administration of Inferior Alveolar Nerve Block: A Randomized Clinical Trial. Source International Journal of Drug Delivery Technology. 16(35 Supplement) (pp 334-338), 2026. Date of Publication: 2026. Author Deorukhkar S.; Patil L.; Rathi N.; Chaudhari V. Institution (Deorukhkar, Patil, Rathi, Chaudhari) Department of Pediatric and Preventive Dentistry, Dr. D.Y Patil Dental College and Hospital, Pimpri, Pune, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Aim and Background: To compare efficacy of cotton candy flavoured edible oil and audio-visual therapy on pain perception and dental anxiety in children on administration of local anesthesia. Material(s) and Method(s): 40 children aged 6-9 years were included in the study and were divided into two groups. Group I was Lorr Ann Cotton candy flavour and group II was Audio-visual therapy. Pain perception and anxiety was assessed pre-operatively. The vitals (Heart Rate and Oxygen Saturation) of the child were recorded pre-operatively using pulse oximeter. Following this inferior alveolar nerve block was administered. Pain perception and anxiety was assessed after administration of the block. The vitals (Heart rate and Oxygen Saturation) were recorded post administration of inferior alveolar nerve block. Result(s): Statically significant decrease was seen in the anxiety levels and pain perception in both the groups. However, children were less anxious in Group I when compared to Group II. Conclusion(s): Both the methods were effective in reducing the anxiety of the child out of which cotton candy flavour being the most effective one. Clinical Significance: Both the techniques were effective in reducing dental anxiety of the children, allowing dental procedures to be performed more efficiently and with minimal behavioral disruption. Overall both the techniques contribute to a positive early dental experience, benefiting both the child and the clinician Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <69> Accession Number 2045345892 Title Efficacy of Surgeon-Administered Regional Anesthesia in Cardiac Surgery: A Double-Blinded, 2-Center, Randomized, Placebo-Controlled Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Rasmussen J.J.; Bisgaard J.; Honge J.L.; Sperling P.K.; Simonsen C.; Juhl-Olsen P.; Modrau I.S. Institution (Rasmussen, Honge, Juhl-Olsen, Modrau) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Bisgaard, Sperling) Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark (Bisgaard) Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (Simonsen) Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark (Juhl-Olsen, Modrau) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Publisher W.B. Saunders Abstract Objectives: Managing pain after median sternotomy is a clinical challenge of balancing adequate pain relief with avoidance of excessive opioid consumption. While regional anesthesia techniques are increasingly recommended and applied in cardiac surgery, evidence of sustained postoperative benefit remains limited and heterogeneous. The authors aimed to evaluate the efficacy and safety of long-acting regional infiltration anesthesia in patients undergoing coronary artery bypass grafting. Design(s): The trial was conducted as a double-blinded, placebo-controlled trial in which participants were randomized 1:1 to intervention or placebo. Setting(s): Cardiothoracic departments at 2 Danish university hospitals. Participant(s): Patients undergoing non-emergent coronary artery bypass grafting. Intervention(s): Participants were allocated to receive surgeon-administered intraoperative infiltration of the sternum and chest wall with either 62.5 mL of bupivacaine with epinephrine, clonidine, and dexamethasone or an equivalent volume of isotonic saline solution as placebo. Measurements and Main Results: The primary endpoint was total opioid consumption within the first 24 postoperative hours. Secondary endpoints included patient-reported postoperative pain, as well as measures of recovery, respiratory impact, and chronic opioid use. A total of 113 patients were randomized, with 100 patients completing the trial and being included in the final analysis. No difference in opioid consumption was observed between the two groups. The median oral morphine equivalents were 62.3 mg (interquartile range, 70.8 mg) in the active intervention group and 64.0 mg (interquartile range, 46.8 mg) in the placebo group (p = 0.649). None of the secondary or safety endpoints showed significant differences. Conclusion(s): In this double-blind, randomized trial, surgeon-administered regional anesthesia did not reduce opioid consumption or provide additional clinical benefits following median sternotomy. Copyright © 2026 The Authors <70> Accession Number 651047172 Title Prevalence of healthcare-associated infections in developing and developed countries: a systematic review. Source BMC infectious diseases. (no pagination), 2026. Date of Publication: 27 Apr 2026. Author Nappi F.; Avtaar Singh S.S. Institution (Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, France (Avtaar Singh) Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom <71> [Use Link to view the full text] Accession Number 2044974063 Title The impact of anesthetic modality and cardiopulmonary bypass flow type on intraoperative intraocular pressure during coronary artery bypass grafting: A prospective, randomized controlled trial. Source Medicine (United States). 105(2) (pp e47110), 2026. Date of Publication: 09 Jan 2026. Author Ucak D.; Ulku H.S.; Ciloglu E.; Badak T.O. Institution (Ucak, Ulku) Department of Anesthesiology and Reanimation, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey (Ciloglu) Department of Ophthalmology, Adana Sevgi Eye Center Hospital, Adana, Turkey (Badak) Department of Cardiovascular Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey Publisher Lippincott Williams and Wilkins Abstract Intraocular pressure (IOP) is an indirect marker of ocular perfusion and is critical during coronary artery bypass grafting (CABG) due to potential hemodynamic instability. The combined effects of anesthetic modality (sevoflurane vs propofol-based total intravenous anesthesia [TIVA]) and cardiopulmonary bypass (CPB) flow type (pulsatile vs nonpulsatile) on intraoperative IOP during CABG are not well established. This prospective, randomized controlled trial included 160 patients undergoing CABG, randomized into four groups (n = 40 each): Sevoflurane + pulsatile CPB (SP), sevoflurane + nonpulsatile CPB (SN), TIVA + pulsatile CPB (TP), and TIVA + nonpulsatile CPB (TN). Patients with preexisting ocular conditions were excluded. IOP was measured using a Tono-Pen Avia at four time points: before induction, after induction, after CPB initiation, and at the end of surgery. Statistical analysis included one-way analysis of variance, Tukey post hoc testing, and chi-square tests. Baseline characteristics and IOP values were comparable across groups. After induction, the TIVA groups (TP and TN) showed a significant reduction in IOP (mean difference -3.5 mm Hg; P < .001) compared with the sevoflurane groups. Upon CPB initiation, IOP increased in all groups, most prominently in the SN group (P < .01). Pulsatile flow was associated with significantly lower IOP values than nonpulsatile flow (P < .01), irrespective of anesthetic modality. The TP group exhibited the most stable IOP profile throughout surgery (P < .05). No acute glaucoma or serious ocular complications were observed. Propofol-based TIVA produced a greater reduction in IOP after induction, and pulsatile CPB contributed to a more stable intraoperative IOP profile during CABG compared with sevoflurane anesthesia and nonpulsatile CPB, respectively. Although IOP fluctuations remained within subclinical limits, these findings suggest that TIVA combined with pulsatile CPB may offer advantages in maintaining ocular hemodynamic stability, particularly in high-risk patients. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc. <72> [Use Link to view the full text] Accession Number 651046414 Title Surgical versus percutaneous revascularization in multivessel non-ST-elevation acute coronary syndrome: a meta-analysis of 77 989 patients. Source Coronary artery disease. (no pagination), 2026. Date of Publication: 27 Apr 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 (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, Ajman University, College of Pharmacy and Health Sciences, 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 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, Inc. All rights reserved. <73> [Use Link to view the full text] Accession Number 651047143 Title Evaluation of clinical impact of ultra fast-track versus conventional extubation in patients undergoing nonemergency cardiac surgery: 'CARDU-FAST': A randomised clinical trial. Source European journal of anaesthesiology. (no pagination), 2026. Date of Publication: 28 Apr 2026. Author Cruces L.M.; Alcazar M.C.; Sial R.L.B.; Vizcayno M.L.; Martin R.S.; Camargo D.P.; Carnicer J.C.; Mercadal L.A.; Morenza A.A.; Lacruz F.R.; Fernandez P.C.; Molano M.A.G.; Torron J.M.M.; Chavez M.B.S.; Castellanos L.C.M. Institution (Cruces) From the Department of Cardiac Surgery (LMC, MCA, DPC, FRL, PCF, LCMC) and Department of Anaesthesiology, Hospital Clinico San Carlos, MLV, RSM, LAM, Madrid, Spain Abstract BACKGROUND: Immediate extubation in the operating theatre (Ultra Fast-Track, UFT), compared with early extubation in the intensive care unit (ICU) (Fast-Track, FT), has been proposed as a strategy to improve postoperative recovery after cardiac surgery. However, its effect on major clinical outcomes remains unclear. OBJECTIVE(S): To compare the risk of a composite outcome including perioperative all-cause mortality, respiratory complications, and acute kidney injury between UFT and FT in patients undergoing major nonemergency cardiac surgery. DESIGN: Single-centre, randomised clinical trial conducted between February 2023 and November 2024. SETTING: A tertiary cardiovascular centre with standardised perioperative and anaesthetic management. PARTICIPANTS: A total of 612 adult patients undergoing major cardiac surgery were randomised to UFT (n = 306) or FT (n = 306). INTERVENTION: Patients in the UFT group were extubated in the operating theatre, whereas patients in the FT group underwent early extubation in the ICU. MAIN OUTCOMES AND MEASURES: The primary endpoint was a composite outcome of all-cause mortality, respiratory complications (prolonged intubation >24 h, reintubation, pneumonia), and stage III acute kidney injury (AKIN III). RESULT(S): The primary composite endpoint occurred in 6.5% of patients in the UFT group and 10.1% in the FT group, with no statistically significant difference (P = 0.105). Compared with FT, UFT was associated with shorter ICU and hospital length of stay, lower rates of prolonged intubation (2.0 versus 7.5%; P = 0.001), reduced need for noninvasive ventilation (5.6 versus 11.1%; P = 0.013), fewer reoperations for bleeding (2.6 versus 6.9%; P = 0.013) and a lower incidence of postoperative low cardiac output syndrome. CONCLUSION(S): Although UFT did not significantly reduce the primary composite outcome in the intention-to-treat (ITT) analysis, it was not associated with an increased risk of adverse events but was associated with improvements in several secondary outcomes. These findings suggest potential benefits of UFT in carefully selected cardiac surgery patients. TRIAL REGISTRATION: Evaluation of clinical impact of UFT versus conventional extubation in patients undergoing cardiac surgery. CARDU-FAST clinical trial. ClinicalTrials.gov Identifier: NCT05706857. Copyright © 2026 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited. <74> Accession Number 2045087910 Title Silent Stroke in Adult Cardiac Surgery: Mechanisms, Clinical Impact, and Preventive Strategies. Source Medicina (Lithuania). 62(4) (no pagination), 2026. Article Number: 675. Date of Publication: 01 Apr 2026. Author Condello I.; Dell'Aquila M.; Condello S.; Falco G.; Totaro A.; Dsouki Y.E.; Prapas S.; Katsavrias K.; D'Onofrio A.; Newman J.; Patel N.; Kalimi R.; Gaudino M.; Calafiore A.M. Institution (Condello) School of Medicine and Surgery, University of Insubria, Varese, Italy (Dell'Aquila, Newman, Patel, Kalimi) Northwell Health, Cardiovascular Institute, New York, NY, United States (Condello) Neuromotor Rehabilitation Unit, Istituti Clinici Scientifici, Maugeri SPA, Ribera, Italy (Falco) Cardiology Unit, University Hospital Consortium Polyclinic of Bari, Bari, Italy (Totaro) Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy (Dsouki) Faculty of Health, Medicine and Life Sciences, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands (Prapas, Katsavrias, Calafiore) 1st Division of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece (D'Onofrio) Division of Cardiac Surgery, University of Rome "Tor Vergata", Rome, Italy (Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Overt perioperative stroke remains a feared complication of adult cardiac surgery. Diffusion-weighted magnetic resonance imaging (DWI-MRI) has revealed a more prevalent form of cerebral injury, termed silent stroke or silent brain injury (SBI). Covert ischemic lesions occur without focal neurological deficits but are increasingly associated with postoperative delirium, cognitive decline, and elevated long-term cerebrovascular risk. Despite growing recognition, the true burden, mechanisms, and clinical relevance of SBI remain incompletely integrated into perioperative practice. Material(s) and Method(s): We performed a narrative review of the literature published between January 2000 and December 2025, identified through PubMed/MEDLINE and Scopus. Eligible studies included prospective and retrospective cohorts, randomized trials, systematic reviews, and meta-analyses involving adult patients undergoing coronary artery bypass grafting, valve surgery, or minimally invasive cardiac procedures, with or without cardiopulmonary bypass, and reporting MRI-detected ischemic lesions or validated surrogate markers of cerebral injury. Pediatric studies, transcatheter interventions, case reports, and non-English publications were excluded. Sixty studies met the inclusion criteria. Result(s): Silent stroke occurred more frequently than clinically apparent stroke, with new DWI-MRI lesions detected in approximately 20-60% of patients following cardiac surgery. Lesions were typically small, multifocal, and embolic in distribution, predominantly affecting cortical and watershed regions. Cardiopulmonary bypass-related factors, including aortic manipulation, cerebral microembolization, hemodilution, hypoperfusion, and impaired oxygen delivery, emerged as key contributors. Several studies demonstrated associations between SBI burden and postoperative delirium, early cognitive dysfunction, and functional decline. Perfusion-based neuroprotective strategies showed mechanistic benefit, although no single intervention conclusively prevented SBI. Conclusion(s): Silent stroke represents the most frequent form of neurological injury in adult cardiac surgery. Evidence suggests that these covert lesions reflect clinically meaningful cerebral injury, with potential short- and long-term consequences. Recognition of silent stroke as a relevant neurological endpoint supports a shift toward multimodal, perfusion-driven neuroprotective strategies and the routine incorporation of MRI-based outcomes in future cardiac surgical research. Copyright © 2026 by the authors. <75> Accession Number 2045227066 Title Prophylactic Use of Fibrinogen Concentrate on Postoperative Blood Fibrinogen Levels, Amount of Bleeding, and the Need for Blood Transfusion in Normofibrinogenemic Patients Undergoing Coronary Artery Bypass Graft Surgery. Source Archives of Anesthesiology and Critical Care. 12(3) (pp 288-292), 2026. Date of Publication: 01 May 2026. Author Ghavibonyeh K.; Dabbagh A.; Jahangirifard A.; Baghaei R.; Fani K.; Shahrabi M.; Fani M. Institution (Ghavibonyeh, Dabbagh, Jahangirifard, Fani, Shahrabi) Department of Anesthesiology and Critical Care, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Baghaei) Department of Cardiac Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Fani) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Tehran University of Medical Sciences Abstract Background: Different studies investigated strategies to prevent perioperative bleeding in cardiac surgeries. The use of fibrinogen concentrate is one of these efforts. In this study, we will investigate the efficacy and proper dosage of fibrinogen concentrate as a prophylactic adjuvant for reducing postoperative bleeding in patients with normal blood fibrinogen under coronary artery bypass grafting (CABG) surgery. Method(s): Patients with preoperative normal plasma fibrinogen levels were randomly divided into two groups (15 patients in each). At the final stage of cardiac surgery and after reversal of heparin, the first group received 2gr of fibrinogen IV concentrate in 15 minutes, while the other group received the same volume of placebo. In each patient, postoperative haematocrit percentage, intraoperative and postoperative administered blood products, and postoperative drainage amount were collected. Result(s): Although in the study group, the postoperative amount of plasma fibrinogen increased compared to preoperative and decreased in the control group, but this change was not statistically significant. Also there wasn't any significant difference in terms of blood drainage and blood product consumption. Conclusion(s): We did not find evidence of a significant difference in the change of fibrinogen blood level before and after the operation, the amount of drainage, and the consumption of blood products in the fibrinogen and placebo groups. Copyright © 2026 Tehran University of Medical Sciences. <76> Accession Number 2043544683 Title Transcatheter aortic valve replacement in cancer patients with chest radiation therapy: Risks and outcomes. Source ASCO MEETING ABSTRACTS. Conference: ASCO MEETING ABSTRACTS. Chicago United States. 43 (no pagination), 2025. Article Number: e24020. Date of Publication: 01 Jun 2025. Author Farooq S.; Khawar M.; Ali U.; Shah S.A.; Hadeed Khawar M.M.; Muhammad A.; Saeed H.; Khan S.M.I.; Qadeer A.; Haider M.Z.; Hamza M.; Kirchoff R.W. Institution (Farooq) Montefiore Saint Luke's Cornwall Hospital, Newburgh, NY, United States (Khawar) King Edward Medical University, Lahore, Pakistan (Ali) King Edward Medical University, Lahore, Pakistan (Shah) King Edward Medical University, Lahore, Pakistan (Hadeed Khawar) Services Institute of Medical Sciences Lahore, Lahore, Pakistan (Muhammad) King Edward Medical University, Lahore, Pakistan (Saeed) KEMU, Lahore, Pakistan (Khan) National University of Medical Sciences, Rawalpindi, Pakistan (Qadeer) Mayo Clinic Hospital, Phoenix, AZ, United States (Haider) West Virginia University, Morgantown, WV, United States (Hamza) Albany Medical Center Hospital, Albany, NY, United States (Kirchoff) Mayo Clinic Hospital, Pheonix, AZ, United States Publisher American Society of Clinical Oncology Abstract Background: Transcatheter aortic valve replacement (TAVR) is a widely adopted treatment for severe aortic stenosis, but outcomes in cancer survivors with prior chest radiation therapy (C-XRT) remain uncertain. This study compares the clinical outcomes of TAVR between patients with a history of C-XRT and those without prior radiation exposure (control group). Method(s): Patients with prior chest radiation therapy (C-XRT) were compared to a control group without radiation exposure to evaluate key clinical endpoints. For each endpoint, odds ratios (OR) and 95% confidence intervals (CI) were determined, and heterogeneity was analyzed using the I2 statistic. A p-value of <0.05 was considered statistically significant. Result(s): Nine studies were included in the meta-analysis, encompassing 3083 C-XRT and 8891 control patients. Patients with prior C-XRT showed significantly higher long-term mortality (OR 1.84, 95% CI [1.08, 3.13], p=0.02) compared to controls. Other outcomes, including access-related vascular complications, Acute Kidney Injury, Congestive heart failure, major bleeding, need for pacemaker, short-term mortality, and stroke, did not demonstrate significant differences between the groups. Conclusion(s): Cancer survivors with prior chest radiation therapy undergoing TAVR may experience higher long-term mortality compared to patients without radiation exposure. However, no significant differences were observed in other major outcomes. These findings suggest that while TAVR is a viable treatment for C-XRT patients, long-term risks require further investigation to optimize patient selection and management strategies. (Table presented.) Copyright © 2025 <77> Accession Number 2045094565 Title Artificial Intelligence in Cardiovascular Medicine: A Giant Step in Personalized Medicine?. Source Journal of Personalized Medicine. 16(4) (no pagination), 2026. Article Number: 192. Date of Publication: 01 Apr 2026. Author Jankauskas S.S.; Varzideh F.; Kansakar U.; Santulli G. Institution (Jankauskas, Varzideh, Kansakar, Santulli) School of Medicine, City University of New York, Manhattan, NY, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Artificial intelligence (AI) is rapidly reshaping cardiovascular (CV) medicine, driving a paradigm shift toward truly personalized and data-driven care. This comprehensive review examines the conceptual foundations, clinical applications, and future implications of AI across the CV continuum, spanning prevention, diagnosis, risk stratification, and therapy. Core AI methodologies (including machine learning, deep learning, natural language processing, and computer vision) are discussed in the context of cardiology's uniquely data-rich environment, encompassing imaging, electrocardiography, electronic health records, wearable devices, and multi-omics data. This systematic review highlights major clinical domains where AI has demonstrated a substantial impact, including CV imaging, ECG interpretation, hypertension and heart failure management, coronary artery disease, acute coronary syndromes, interventional cardiology, and cardiac surgery. AI-driven predictive analytics enable early detection of subclinical disease, improved prognostication, and individualized prevention strategies, while wearable technologies and remote monitoring platforms facilitate continuous, real-world patient surveillance. Emerging applications in pharmacotherapy, drug repurposing, and genomics further reinforce AI's role in advancing precision cardiology. Equally emphasized are the ethical, legal, and social challenges accompanying AI adoption, such as algorithmic bias, data privacy, cybersecurity, interpretability, and regulatory oversight. Our review underscores the necessity of rigorous clinical validation, transparent model design, and seamless integration into clinical workflows to ensure safety, equity, and physician trust. Ultimately, AI is best positioned as an augmentative tool that complements (but does not replace!) clinical expertise. By fostering hybrid intelligence that integrates human judgment with computational power, AI has the potential to redefine CV care delivery, improve outcomes, and support a more proactive, patient-centered healthcare model. Copyright © 2026 by the authors. <78> Accession Number 2045362425 Title Growth rate of the ascending aorta and risk of aortic dissection or reintervention in patients with bicuspid or tricuspid aortic valves undergoing valve interventions: A systematic review and meta-analysis. Source Revista Portuguesa de Cardiologia. (no pagination), 2026. Date of Publication: 2026. Author Fernandes Pedro J.; Figueiredo A.R.M.; Almeida R.; de Sousa C.; Pinto F.J.; Caldeira D. Institution (Fernandes Pedro, Figueiredo, de Sousa, Pinto, Caldeira) Servico de Cardiologia, Departamento de Coracao e Vasos, ULS Santa Maria, CAML, Lisboa, Portugal (Fernandes Pedro, Figueiredo, de Sousa, Pinto, Caldeira) Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal (Almeida) USF Moscavide, ULS Lisboa Central, Portugal (Caldeira) Centro de Estudos de Medicina Baseada na Evidencia (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal (Caldeira) Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal Publisher Sociedade Portuguesa de Cardiologia Abstract Background: Bicuspid aortic valve (BAV) is associated with premature valve dysfunction and progressive aortic dilation, potentially leading to dissection. The evolution of aortic dimensions after valve replacement remains uncertain, particularly compared with tricuspid aortic valve (TAV) disease. This systematic review and meta-analysis aimed to compare postoperative aortic growth and the risk of major aortic events between BAV and TAV patients. Method(s): A systematic search of MEDLINE, CENTRAL, and Web of Science (from inception to April 2025) identified prospective and retrospective cohort studies including adult patients with BAV or TAV undergoing surgical (SAVR) or transcatheter (TAVI) aortic valve replacement. Studies were required to report longitudinal data on aortic growth rate (mm/year) or the incidence of aortic dissection or reintervention; those with concomitant aortic surgery were excluded. Random-effects meta-analyses estimated mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI). Result(s): Fifteen studies were included (n=1772 for aortic growth; n=2307 for aortic dissection; n=2598 for aortic reintervention). There was no significant difference in annual aortic growth between BAV and TAV (MD 0.15 mm/year; 95% CI -0.03 to 0.33; p=0.09; I2=82.6%). Meta-regression confirmed that age differences between BAV and TAV cohorts did not modify the overall neutral effect on aortic growth rate. Subgroup analyses showed similar findings across study designs, but small differences in procedure types (SAVR MD 0.21 mm/year, p=0.07; TAVI MD -0.04 mm/year, p=0.53; p=0.02 for SAVR vs. TAVI differences). No significant differences were found in the risk of aortic dissection (RR 1.34; 95% CI 0.63-2.83; p=0.44) or aortic reintervention (RR 0.95; 95% CI 0.56-1.61; p=0.84). Conclusion(s): Postoperative aortic growth and event rates were comparable between BAV and TAV patients after valve replacement. These results challenge the long-standing assumption that bicuspid morphology intrinsically accelerates postoperative aortopathy in all patients. Copyright © 2026 Sociedade Portuguesa de Cardiologia <79> [Use Link to view the full text] Accession Number 2043575269 Title Balloon-Expandable Valves Versus Self-Expanding Valves in Patients With Small Aortic Annulus Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Source Cardiology in Review. (no pagination), 2025. Article Number: 10.1097/CRD.0000000000001108. Date of Publication: 09 Dec 2025. Author Tabassum S.; Burhan M.; Shehada W.; Naeem F.; Lashin A.A.; Wagdy M.; Naeem A.; Abdelazeem B.; Minhas A.M.K.; Virk H.U.H.; Velagapudi P. Institution (Tabassum, Naeem) From the Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, United States (Burhan) Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Shehada) Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine (Naeem) Department of Cardiology, Massachusetts General Hospital, Boston, MA, United States (Lashin) Faculty of Medicine, Benha University, Benha, Egypt (Wagdy) Faculty of Medicine, Modern University for Technology and Information, Cairo, Egypt (Abdelazeem) Department of Cardiology, West Virginia University, Morgantown, WV, United States (Minhas) Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States (Virk) Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (Velagapudi) Division of Cardiology, BJC Cardiology, St Louis, MO, United States Publisher Lippincott Williams and Wilkins Abstract Patients with a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR) face a high risk of prosthesis-patient mismatch and adverse outcomes. The 2 most studied valve types, balloon-expandable valves (BEVs) and self-expanding valves (SEVs), differ in structure and deployment, potentially impacting outcomes in this subgroup. To compare the hemodynamic and clinical outcomes of BEVs versus SEVs in SAA patients undergoing TAVR. A systematic search of major databases through March 2025 identified randomized controlled trials and propensity score matching studies comparing BEVs and SEVs. Pooled analyses were conducted using a random-effects model to derive mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) in R (version 4.4.1). Thirteen studies (n = 4582; BEV: 2290; SEV: 2292) were included. BEVs were associated with smaller indexed effective orifice area (iEOA) (MD: -0.15 cm2/m2), higher mean (MD: 4.92 mm Hg) and peak (MD: 4.78 mm Hg) transvalvular gradients, and higher overall (OR: 2.64) and severe (OR: 2.72) prosthesis-patient mismatch rates. However, BEVs had a significantly lower risk of permanent pacemaker implantation (OR: 0.62). No significant differences were found in mortality, stroke, bleeding, acute kidney injury, paravalvular leak, myocardial infarction, vascular complications, or heart failure hospitalization. BEVs and SEVs demonstrate comparable mortality in SAA patients undergoing TAVR. SEVs offer superior hemodynamic outcomes, while BEVs reduce pacemaker need. Prosthetic valve selection should be individualized based on anatomy, clinical profile, and procedural factors. Future randomized trials with long-term follow-up are warranted to inform optimal device selection in this population. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <80> Accession Number 651028985 Title Perioperative management of pulmonary arterial hypertension in children undergoing congenital heart surgery: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 25 Apr 2026. Author Ikwuanusi E.; Rajah T.; Scandrett K.; Asamane E.A.; Volpi S. Institution (Ikwuanusi) University Hospitals Birmingham, Birmingham, United Kingdom (Rajah) Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom (Scandrett) University of Birmingham, Birmingham, United Kingdom (Asamane) School of Medicine, Keele University, Keele, Newcastle, ST5 5BG, UK (Volpi) Department of Cardiac Surgery, St. Thomas' Hospital London, London, United Kingdom <81> Accession Number 651028788 Title Efficacy of Surgeon-Administered Regional Anesthesia in Cardiac Surgery: A Double-Blinded, 2-Center, Randomized, Placebo-Controlled Trial. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 27 Mar 2026. Author Rasmussen J.J.; Bisgaard J.; Honge J.L.; Sperling P.K.; Simonsen C.; Juhl-Olsen P.; Modrau I.S. Institution (Rasmussen) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Bisgaard) Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (Honge) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Sperling) Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark (Simonsen) Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark (Juhl-Olsen, Modrau) Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Abstract OBJECTIVES: Managing pain after median sternotomy is a clinical challenge of balancing adequate pain relief with avoidance of excessive opioid consumption. While regional anesthesia techniques are increasingly recommended and applied in cardiac surgery, evidence of sustained postoperative benefit remains limited and heterogeneous. The authors aimed to evaluate the efficacy and safety of long-acting regional infiltration anesthesia in patients undergoing coronary artery bypass grafting. DESIGN: The trial was conducted as a double-blinded, placebo-controlled trial in which participants were randomized 1:1 to intervention or placebo. SETTING: Cardiothoracic departments at 2 Danish university hospitals. PARTICIPANTS: Patients undergoing non-emergent coronary artery bypass grafting. INTERVENTIONS: Participants were allocated to receive surgeon-administered intraoperative infiltration of the sternum and chest wall with either 62.5 mL of bupivacaine with epinephrine, clonidine, and dexamethasone or an equivalent volume of isotonic saline solution as placebo. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was total opioid consumption within the first 24 postoperative hours. Secondary endpoints included patient-reported postoperative pain, as well as measures of recovery, respiratory impact, and chronic opioid use. A total of 113 patients were randomized, with 100 patients completing the trial and being included in the final analysis. No difference in opioid consumption was observed between the two groups. The median oral morphine equivalents were 62.3 mg (interquartile range, 70.8 mg) in the active intervention group and 64.0 mg (interquartile range, 46.8 mg) in the placebo group (p = 0.649). None of the secondary or safety endpoints showed significant differences. CONCLUSION(S): In this double-blind, randomized trial, surgeon-administered regional anesthesia did not reduce opioid consumption or provide additional clinical benefits following median sternotomy. Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved. <82> Accession Number 651029131 Title 2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS expert consensus statement update on cardiovascular implantable electronic device lead management and extraction. Source Heart rhythm. (no pagination), 2026. Date of Publication: 23 Apr 2026. Author Cha Y.-M.; El-Chami M.F.; Liu C.F.; Andreychuk L.J.; Beaver T.M.; Bergen K.M.; Berul C.I.; Birgersdotter-Green U.M.; Breitenstein A.; Epstein L.M.; Gross J.N.; Jackson L.R.; Karim S.; Krahn A.D.; Kusumoto F.; Lever N.; Linton-Frazier L.N.; Love C.J.; Mah D.Y.; Mason P.K.; Maynard M.T.; Maytin M.; Montgomery J.A.; Ngai J.; Parkash R.; Patton K.K.; Pothineni N.V.K.; Rojel-Martinez U.; Sohail M.R.; Atallah J.; Callahan T.D.; Carrillo R.G.; Cheung J.; Defaye P.; Kothari P.; Schaller R.D.; Vikram H.R.; Wynn G.; Zeitler E. Abstract AIM: The "2026 HRS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction" provides updated recommendations to guide clinicians in the management of cardiovascular implantable electronic device (CIED) leads. BACKGROUND: Since the publication of the "2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction," the field has evolved quickly. New evidence on CIED lead management and the blooming development of new CIED technologies, including leadless pacing and implantable cardioverter defibrillator leads implanted outside the vascular system and new lumenless pacing leads and lead extraction tools, have contributed to the field's rapid evolution. METHODS AND RESULTS: A comprehensive literature search was conducted in accordance with the Institute of Medicine standards. The writing committee reviewed evidence gathered through electronic literature searches encompassing clinical trials, original studies, and meta-analyses conducted on human subjects published in English from MEDLINE, PubMed, EMBASE, and the Cochrane Library up to December 2024. The comprehensive literature review supports each evidence-based recommendation and is compiled in the evidence tables. A predefined threshold of > 70% approval for each recommendation was required, with a quorum of two-thirds of the writing committee. The final mean consensus of 108 recommendations was 93.61%. DISCUSSION(S): The recommendations from the "2017 Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction" have been updated with new evidence to guide clinicians. The new recommendations address the latest CIED technologies with the advantages over transvenous leads, new evidence supporting diagnosis, treatment, and prevention for CIED infection, appropriate lead management in transcatheter tricuspid valve replacement for tricuspid regurgitation, and standardization of transvenous lead extraction approach, protocol, and facilities to improve the outcomes of CIED lead management and extraction. Copyright © 2026. Published by Elsevier Inc. <83> Accession Number 651030626 Title Screening rates and geographical disparities shape venous thromboembolism risk after cardiac surgery: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 25 Apr 2026. Author Chang R.; Xu Z.; Li W.; Liu X.; Shen Y.; Wang Y.; Mao Q.; Wang W.; Yang X. Institution (Chang, Xu, Li, Liu, Shen) Department of Cardiology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China (Xu) Medical College, Research Center for High Altitude Medicine in Qinghai University, Xining, Qinghai, China (Wang) Department of Medicine, Beijing Zhongwei Medical Research Center, Biological and Translational Medicine, Beijing, China (Mao, Wang) Department of Biology, Oasis Road Research Center, Watertown, MA, United States (Yang) Department of Cardiology, Deyang People's Hospital, China <84> Accession Number 651030128 Title Cardiovascular Benefit and Gastrointestinal Risk of Colchicine in Secondary Prevention: Risk Associated with Dose and Treatment Duration. Source American journal of cardiovascular drugs : drugs, devices, and other interventions. (no pagination), 2026. Date of Publication: 25 Apr 2026. Author Bian C.; Shen Q.; Liu X.-X.; Zhou M.; Ren Z.; Dong Z.; Jin X.; Song B.; Li B. Institution (Bian, Shen, Ren) School of Clinical Medicine, Shandong Second Medical University, Weifang, China (Bian, Li) Department of Cardiology, Zibo Central Hospital, South Shanghai Road, Zibo, China (Liu) Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China (Zhou) Department of Cardiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China (Dong) Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Jin) Department of Geriatrics, Zibo Central Hospital, No. 10 ,South Shanghai Road, Zibo, China (Song) Department of Cardiology, Zibo Central Hospital, South Shanghai Road, Zibo, China Abstract AIMS: This meta-analysis aims to evaluate the efficacy and safety of colchicine for the secondary prevention of cardiovascular and cerebrovascular diseases, and examines how dose and treatment duration modify its risk-benefit profile. METHOD(S): A meta-analysis comparing colchicine to placebo or standard care was performed. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. The secondary endpoint was expanded MACE (eMACE), defined as MACE plus ischemia-driven coronary revascularization. RESULT(S): Colchicine significantly reduced the risk of MACE (relative risk [RR] 0.83, 95% confidence interval [CI] 0.72-0.96) and eMACE (RR 0.78, 95% CI 0.64-0.96), with benefits driven by reductions in non-fatal MI and ischemia-driven coronary revascularization. No significant effect was observed on cardiovascular or all-cause mortality. Colchicine increased gastrointestinal adverse reactions (RR 1.90, 95% CI 1.41-2.55) and drug-related adverse event (DAE)-related colchicine discontinuation (RR 1.54, 95% CI 1.06-2.25). Sensitivity analyses revealed that the guideline-recommended dosage (0.5 mg once daily) for > 6 months maintained cardiovascular benefit (MACE RR 0.77, 95% CI 0.62-0.96), while gastrointestinal risk (RR 1.51, 95% CI 0.97-2.33) and DAE-related colchicine discontinuation risk (RR 1.42, 95% CI 0.80-2.51) became non-significant. CONCLUSION(S): Colchicine provides lasting benefit for patients with cardiovascular and cerebrovascular diseases. Gastrointestinal risk is dose and time dependent, and higher early in treatment. Tolerating and maintaining long-term standard-dose therapy improves the benefit-risk balance. These findings highlight the early treatment phase as a period of higher gastrointestinal risk, suggesting that strategies to support adherence during this period warrant further investigation. REGISTRATION: PROSPERO registration number CRD42024623329. Copyright © 2026. The Author(s), under exclusive licence to Springer Nature Switzerland AG. <85> Accession Number 651032860 Title Cerebral Embolic Protection Devices for Transcatheter Aortic Valve Replacement: A Meta-Analysis and Trial Sequential Analysis. Source American heart journal. (pp 107449), 2026. Date of Publication: 24 Apr 2026. Author Elbenawi H.; Hassan I.; Abdelgalil M.S.; Hanna M.; Almotawally S.; Fayed M.; Mohamed K.A.; Elnaggar H.; Abouainain L.; Hamed B.M.; Ibrahim A.; Khatib A.A.; Elhelw M.; Hassan E.; Eisa M.; Zaaya M.; Ibrahim R.; Goldsweig A.M.; Saad M.; Alfonso F.; Alkhouli M.; Elgendy I.Y. Institution (Elbenawi, Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Hassan) DeBakey Heart & Vascular Center, Houston Methodist Research Institute, Houston, TX, United States (Abdelgalil, Almotawally) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hanna) Department of Cardiology, Assiut University, Egypt (Fayed) Department of Neurology, University of Florida, Gainesville, FL, United States (Mohamed) Department of Internal Medicine, Hartford Hospital, Hartford, CT, United States (Elnaggar) Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt (Abouainain) Faculty of Medicine, University of Jordan, Amman, Jordan (Hamed) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Ibrahim) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Khatib) Department of Internal Medicine, MedStar Health, Baltimore, MD, United States (Elhelw) Department of Internal Medicine, University of Kentucky, Lexington, KY, United States (Hassan) Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, United States (Eisa) Internal Medicine Department, Rochester General Hospital, Rochester, NY, United States (Zaaya) Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States (Ibrahim) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, MA, United States (Saad) Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, United States (Alfonso) Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, Universidad Autonoma de Madrid, Madrid, Spain (Elgendy) Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, United States Abstract BACKGROUND: Transcatheter aortic valve replacement (TAVR) is associated with a periprocedural stroke risk due to embolic debris. The efficacy and safety of cerebral embolic protection devices (CEPDs) remain uncertain, with conflicting results between trials. We performed a meta-analysis of randomized controlled trials (RCTs) of current-generation CEPDs for TAVR. METHOD(S): Electronic databases were searched for RCTs comparing clinical outcomes with routine CEPD use vs. no CEPD use. Outcomes of interest included any stroke, disabling stroke, and all-cause mortality. Risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs) were pooled using random-effects models. The analysis was complemented by meta-regression and trial sequential analyses. RESULT(S): The meta-analysis included 8 RCTs (5 filter-based and 3 shield-based) with 11,597 patients. CEPD use was not associated with a lower incidence of any stroke (RR 0.92; 95%CI 0.75-1.14), disabling stroke (RR 0.80; 95%CI 0.55-1.15), new magnetic resonance imaging-detected lesions (RR 1.00; 95%CI 0.93-1.07), or all-cause mortality (RR 1.04; 95%CI 0.71-1.51). Trial sequential analysis provided conclusive meta-analytic evidence, affirmed the absence of CEPD benefit. Meta-regression showed no significant association between stroke risk and patient-level covariates, including age, sex, or the presence of diabetes, prior stroke, or atrial fibrillation (all p>0.05). CONCLUSION(S): Current generation CEPD devices during TAVR did not significantly reduce the risk of any stroke, disabling stroke, or all-cause mortality. TSA indicates that, at least with available data, cumulative evidence appears sufficient to question the predefined benefit thresholds for existing systems. These findings suggest the lack of routine use of current-generation CEPD in TAVR. Copyright © 2026. Published by Elsevier Inc. <86> Accession Number 651031166 Title Long-Term Outcomes of Transcatheter Aortic Valve Replacement in Low-Flow Low-Gradient Aortic Stenosis: A Reconstructed Time-to-Event and Multivariate Meta-Analysis. Source Journal of the American Heart Association. (pp e044431), 2026. Date of Publication: 27 Apr 2026. Author Soltani Moghadam A.; Kazemian S.; Soltani Moghadam S.; Nasiri P.; Mojahedi A.; Geraiely B.; Larti F.; Latib A.; Scotti A.; Kuno T.; Kolte D. Institution (Soltani Moghadam, Kazemian, Soltani Moghadam) Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran, Iran, Islamic Republic of (Nasiri) School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran, Iran, Islamic Republic of (Mojahedi) Department of Internal Medicine Stony Brook University Hospital Stony Brook NY USA (Geraiely, Larti) Cardiology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran, Iran, Islamic Republic of (Latib, Scotti) Division of Cardiology Montefiore Medical Center The Bronx NY USA (Kuno, Kolte) Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston MA USA (Kuno) Division of Cardiology, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA, Israel Abstract BACKGROUND: There are uncertainties regarding long-term outcomes of low-flow, low-gradient (LFLG) severe aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR). This study investigates long-term outcomes of TAVR for high-gradient (HG), classical LFLG, and paradoxical LFLG AS. METHOD(S): We systematically searched PubMed, Embase, Scopus, and Cochrane Library databases until January 2025 for studies comparing HG, classical LFLG, and paradoxical LFLG AS outcomes following TAVR. The primary outcome was all-cause mortality, analyzed using reconstructed individual patient data meta-analysis. Secondary outcomes included cardiovascular mortality, heart failure hospitalization, acute kidney injury, bleeding events, stroke, myocardial infarction, permanent pacemaker implantation, and echocardiographic outcomes, analyzed using multivariate meta-analysis. RESULT(S): We included 19 observational studies comprising 20 493 patients who underwent TAVR for severe AS. Time-to-event meta-analysis indicated a higher risk of 5-year all-cause mortality in patients with classical and paradoxical LFLG AS compared with HG AS (hazard ratio [HR], 1.92 [95% CI, 1.62-2.27] and HR, 1.20 [95% CI, 1.07-1.34], respectively). Multivariate meta-analysis indicated an increased risk of cardiovascular mortality in patients with LFLG versus HG AS (classical LFLG HR, 1.94 [95% CI, 1.74-2.16]; paradoxical LFLG HR, 1.40 [95% CI, 1.25-1.57]). Classical and paradoxical LFLG AS were also associated with a higher risk of heart failure hospitalization (HR, 4.12 [95% CI, 2.16-7.83]; HR, 1.80 [95% CI, 1.14-2.85], respectively) compared with HG AS. CONCLUSION(S): Classical and paradoxical LFLG AS were associated with higher all-cause and cardiovascular mortality following TAVR compared with HG AS. Future studies are needed to determine strategies to improve outcomes following TAVR in patients with LFLG AS. <87> Accession Number 651028899 Title The impact of home-based telerehabilitation versus center-based cardiac rehabilitation on anxiety, depression, and quality of life after coronary artery bypass grafting: a randomized controlled trial. Source BMC cardiovascular disorders. (no pagination), 2026. Date of Publication: 25 Apr 2026. Author Liu Y.; Wang X.; Li H.; Wang C.; Kong M.; Zhang M.; Ma J.; Liu H. Institution (Liu, Wang, Li, Kong, Ma, Liu) Department of Cardiovascular Surgery, First Hospital of Hebei Medical University, 89 Donggang RoadHebei Province, Shijiazhuang, China (Wang) Department of Cardiac Function and Rehabilitation, First Hospital of Hebei Medical University, Shijiazhuang, China (Zhang) Department of Otolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China <88> Accession Number 2045326437 Title Effect of care bundle in preventing delirium after bypass surgery: a single-blind, non-randomised clinical trial. Source Heart and Lung. 79 (no pagination), 2026. Article Number: 102826. Date of Publication: 01 Sep 2026. Author Elagoz I.; Koyuncu A.; Sensoy F.; Gonel A.; Iyem H. Institution (Elagoz) Kilis 7 Aralik University, Yusuf Serefoglu Faculty of Health Sciences, Department of Nursing, Kilis, Turkey (Koyuncu) Hasan Kalyoncu University, Faculty of Health Sciences, Department of Nursing, Gaziantep, Turkey (Sensoy) Gaziantep Medical Point Hospital, Department of Neurology, Gaziantep, Turkey (Gonel) SANKO University, Faculty of Medicine, Department of Medical Biochemistry, Gaziantep, Turkey (Iyem) Gaziantep Medical Point Hospital, Department of Cardiovascular Surgery, Gaziantep, Turkey Publisher Elsevier Inc. Abstract Background: Delirium is a common complication following coronary artery bypass graft (CABG) surgery, associated with longer hospital stays, increased morbidity, and higher healthcare costs. Objective(s): To evaluate the effectiveness of a multicomponent care bundle in preventing postoperative delirium among patients undergoing CABG surgery. Method(s): This single-blind, non-randomised trial included 94 patients consecutively allocated by time period (47 per group). The primary outcome was delirium incidence at postoperative day 1 assessed by a blinded neurologist using DSM-5 criteria. Delirium subtypes were classified by RASS scores. The control group received standardised care; the study group received standardised care plus continuous family presence, patient-selected music, and earplug use. Cortisol, ACTH, glucose, sleep quality, pain, and anxiety were evaluated. Statistical significance was set at p < 0.05. Result(s): At postoperative day 1, delirium incidence assessed by DSM-5 criteria was 14.9% in the study group vs. 38.3% in controls (p = 0.013; OR = 0.28, 95% CI: 0.10-0.76; ARR = 23.4%). Hyperactive delirium was markedly lower (2.1% vs. 14.9%). At postoperative days 1 and 2, cortisol, ACTH, glucose, pain, and anxiety levels were lower, and sleep quality was higher in the study group. Adherence to all bundle components exceeded 90%. Conclusion(s): The multicomponent care bundle was associated with significant reduction in postoperative delirium (NNT = 4.3), particularly hyperactive delirium, and improvements in stress biomarkers and psychological well-being. High adherence supports feasibility of this low-cost, nurse-led intervention. Randomised trials are needed to confirm causality. Copyright © 2026 Elsevier Inc. <89> Accession Number 2045321623 Title Alcoholic cardiomyopathy presenting with severe circulatory failure requiring mechanical circulatory support: A systematic review. Source American Journal of Emergency Medicine. 106 (pp 49-54), 2026. Date of Publication: 01 Aug 2026. Author Itagaki H.; Endo T. Institution (Itagaki, Endo) Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Sendai, Japan Publisher W.B. Saunders Abstract Background: Alcoholic cardiomyopathy (ACM) is a potentially reversible form of dilated cardiomyopathy associated with chronic excessive alcohol consumption. Although recovery of left ventricular function after alcohol abstinence has been reported, the clinical course of patients presenting with cardiogenic shock or cardiac arrest requiring mechanical circulatory support (MCS) remains poorly characterized. This study aimed to evaluate survival outcomes and myocardial recovery in patients with ACM presenting with severe circulatory failure. Method(s): A systematic literature search was conducted in PubMed, Web of Science, Google Scholar, and Ichushi-Web from database inception to February 28, 2026. Studies describing patients with ACM presenting with cardiogenic shock or severe circulatory failure requiring temporary MCS (including ECMO, Impella, intra-aortic balloon pump, or LVAD) were included. Extracted data included patient characteristics, type of circulatory support, survival outcomes, and recovery of left ventricular function. Result(s): Five studies (three case reports and two case series), including 10 patients, were identified. The median age was 43 years (IQR, 38-46), and 9 of 10 patients (90%) were male. The median baseline LVEF was 15% (IQR, 15-20%). Cardiac arrest occurred in 3 patients (30%). Veno-arterial extracorporeal support, including VA-ECMO/PCPS, was used in 9 patients (90%), Impella in 1 patient (10%), and LVAD support in 3 patients (30%). One patient ultimately underwent heart transplantation. All published cases survived. Among patients with available follow-up data, the median LVEF improved to 55% (IQR, 45-60%), representing a median absolute increase of approximately 40 percentage points. Conclusion(s): Published case-based evidence suggests that alcoholic cardiomyopathy may retain clinically meaningful reversibility even in selected patients with severe circulatory failure requiring mechanical circulatory support. Although favorable outcomes may be overrepresented in published reports, awareness of this potentially reversible phenotype may support timely recognition and appropriate management of severe circulatory failure. Copyright © 2026 Elsevier Inc. <90> Accession Number 2038061925 Title The Intelligent Cardiac Intensive Care Unit: Artificial Intelligence and the Critical Care Management of Post-operative Cardiac Surgery Complications. Source Journal of Cardiac Critical Care. 10(2) (pp 122-126), 2026. Date of Publication: 01 Apr 2026. Author Al Ebrahim K.E. Institution (Al Ebrahim) Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia Publisher Scientific Scholar LLC Abstract Background: Major post-operative complications remain a principal determinant of morbidity, mortality, and intensive care utilization after cardiac surgery despite advances in operative techniques and perioperative care. Early recognition, protocolized management, and multidisciplinary critical care are essential to improving outcomes. Emerging digital technologies, particularly artificial intelligence (AI), are beginning to reshape monitoring, risk prediction, and clinical decision-making within the cardiac intensive care unit (ICU). Objective(s): The objective of the study is to review contemporary advances in the prevention, early detection, and management of major post-operative cardiac surgery complications and to highlight the emerging role of AI-supported decision systems and their implications for resident training. Method(s): A targeted narrative review of recent clinical trials, meta-analyses, and international guidelines published between 2020 and 2025 was conducted. The review focused on major post-operative complications including atrial fibrillation, acute kidney injury (AKI), bleeding and transfusion-related syndromes, respiratory failure, neurologic complications, infection, and low cardiac output syndrome (LCOS). Evidence was synthesized to emphasize ICU-applicable management strategies and the growing integration of AI-assisted monitoring and predictive analytics. Result(s): Post-operative atrial fibrillation remains the most common rhythm disturbance, with prevention centered on perioperative beta-blockade, electrolyte optimization, and selective amiodarone prophylaxis. AKI affects up to one-third of patients; KDIGO-based care bundles, biomarker-guided detection, and hemodynamic optimization improve early recognition and outcomes. Contemporary patient blood management strategies, including viscoelastic-guided transfusion and antifibrinolytic therapy, reduce bleeding and re-exploration. Respiratory complications are mitigated through lung-protective ventilation, fast-track extubation protocols, and early mobilization. Neurologic complications and infections require systematic screening, prevention bundles, and prompt multidisciplinary intervention. LCOS remains a critical post-operative challenge requiring early hemodynamic optimization and timely escalation to mechanical circulatory support. Increasingly, AI-driven predictive models are being explored to support early complication detection, risk stratification, and real-time clinical decision support in the cardiac ICU. Conclusion(s): Post-operative complications continue to shape outcomes after cardiac surgery. Contemporary management relies on standardized care bundles, early detection strategies, and coordinated multidisciplinary ICU care. The integration of AI-enabled monitoring and predictive analytics may further enhance early recognition of deterioration, optimize resource utilization, and provide a valuable educational framework for training the next generation of cardiac surgery residents. Copyright © 2026, Scientific Scholar LLC. All rights reserved. <91> Accession Number 651021872 Title Digital Insulin Therapy Protocol in the Postoperative Period of Coronary Artery Bypass Graft Surgery: A Prospective Randomized Study. Source Diabetes. Conference: 81st Scientific Sessions of the American Diabetes Association (ADA). Virtual. 70(Supplement 1) (no pagination), 2021. Date of Publication: 01 Jun 2021. Author De Souza A.B.C.; Toyoshima M.T. Publisher American Diabetes Association Inc. Abstract Introduction: Adequate glycemic control with intravenous insulin therapy in the postoperative period of coronary artery bypass grafting (CABG) in an intensive care unit (ICU) reduces unfavorable clinical outcomes, such as mortality, acute kidney injury (AKI), arrhythmias and nosocomial infection. After discharge from ICU, even still hospitalized, adherence to consensus on inpatient insulin therapy is low, and about 50% of patients do not receive adequate subcutaneous insulin therapy in the ward, consequently in-hospital hyperglycemia (IH) is frequent. Medical apps are increasingly facilitating the medical routine. InsulinAPP is a digital protocol for inpatient glycemic management and already validated. A 16% reduction in blood glucose (BG) has been demonstrated in clinical patients with this protocol. Method(s): Prospective randomized trial was performed on diabetic patients in CABG postoperative period, after discharge from ICU. The groups were randomized according to the glycemic control protocol: InsulinAPP group (APP) or protocol defined by the assistant team (ST - standard group). The aim is to compare the groups regarding the composite outcome of AKI, nosocomial infection and atrial fibrillation. Result(s): A total of 41 patients were evaluated (15 in APP and 26 in ST). There was no difference between APP vs. ST group in age (65.1+/-9.8 vs. 65.1+/-9.8 years), female gender (40 vs. 46%), body mass index (28.5+/-4.9 vs. 27.3+/-5.1 Kg/m2) and estimated glomerular function (68.0+/-24.1 vs. 69.1+/-24.5 mL/min, respectively). APP had better BG than ST group (162+/-28.6 mg/dL vs. 183+/-34.4 mg/dL, respectively; p = 0.036). Besides, in APP there was a significant reduction of the composite outcome (27% vs. 77%, p=0.002), infection (20% vs. 61%, p<0.001) and AKI (13% vs. 50%, p=0.019). Conclusion(s): The InsulinAPP protocol was more effective in glycemic control and in reducing unfavorable outcomes in the postoperative period of cardiac surgery after discharge from the ICU. <92> Accession Number 651016083 Title Risk prediction models for postoperative delirium in adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Source BMC cardiovascular disorders. (no pagination), 2026. Date of Publication: 24 Apr 2026. Author Wang B.; Du W.; Shen H.; Sun J.; Cao H.; Huang Z.; Wang X. Institution (Wang, Huang, Wang) Interventional Radiology and Vascular Surgery Department, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (Wang, Wang) Nursing Department, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (Du, Shen, Sun) Anesthesiology, Surgery and Pain Management Department, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (Cao) Cardiovascular Surgery Department, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China <93> Accession Number 651003445 Title Frailty and postoperative complications in elderly patients undergoing cardiac surgery: a systematic review and meta-analysis. Source BMC geriatrics. (no pagination), 2026. Date of Publication: 24 Apr 2026. Author Zhang X.; Li Y.; Zhang L.; Xiao Y.; Huang H.; Feng F.; Chen J.; Wang S.; Chen X.; Wang L. Institution (Zhang, Chen, Chen) Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (Zhang, Zhang, Xiao, Wang) Faculty of Medicine, Macau University of Science and Technology, SAR, Macau, China (Li, Wang) Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Huang) Department of Nursing, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (Feng) College of Public health, Zhengzhou University, Zhengzhou, Henan, China <94> [Use Link to view the full text] Accession Number 2044464183 Title Perioperative management of adults with heart valve disease having noncardiac surgery: a narrative review. Source Current Opinion in Anaesthesiology. (no pagination), 2026. Date of Publication: 2026. Author Eichlseder M.; Schreiber N.; Flick M.; Sartori S. Institution (Eichlseder) Division of Anaesthesiology and Intensive Care Medicine 1 (Schreiber, Sartori) Division of Anaesthesiology and Intensive Care Medicine 2, Medical University of Graz, Graz, Austria (Flick) Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Publisher Lippincott Williams and Wilkins Abstract Purpose of review - This article reviews the perioperative management of adults with heart valve disease undergoing noncardiac surgery. It focuses on aortic and mitral valve disease, as well as prosthetic heart valves, in the context of the substantial hemodynamic challenges imposed by anesthesia during major surgery. We aim to integrate guideline-based recommendations for preoperative evaluation and risk stratification with pathophysiological principles to support individualized intraoperative hemodynamic and anesthetic management. Recent findings - Current literature and guidelines converge on symptom status and echocardiographic severity as key determinants of perioperative risk. For stenotic lesions, maintaining sinus rhythm, avoiding tachycardia, preserving preload, and preventing abrupt afterload reduction are central intraoperative goals. For regurgitant lesions, strategies that support forward flow by avoiding bradycardia and excessive afterload are emphasized. In prosthetic valves, perioperative management is driven by valve type/position and thromboembolic risk, guiding anticoagulation interruption and bridging, while endocarditis prophylaxis is reserved for selected high-risk dental procedures. Summary - A practical approach integrates surgical urgency, valve severity, symptoms, ventricular function, and pulmonary pressures to determine whether to proceed with surgery, optimize medically, or to perform valve intervention first, and to tailor intraoperative monitoring and anticoagulation plans. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <95> [Use Link to view the full text] Accession Number 2044993696 Title Feasibility pilot trial for the Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) Pragmatic Randomized Clinical Trial. Source Anesthesiology. (no pagination), 2026. Article Number: 10.1097/ALN.0000000000006089. Date of Publication: 2026. Author Janda A.M.; Pennington B.R.T.; Colquhoun D.A.; Kumar S.S.; Neuman M.D.; Politi M.C.; Spino C.; Kidwell K.M.; Swisher L.; Bollini M.; Vaughn M.T.; Cloyd C.; Pescatore N.A.; Thelen-Perry S.; Gregory S.H.; du Toit L.; Henrichs B.; Torres B.; Avidan M.S.; Kheterpal S. Institution (Janda, Colquhoun, Kumar, Vaughn, Cloyd, Pescatore, Kheterpal) Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States (Pennington, Swisher, Bollini, Gregory, du Toit, Henrichs, Torres, Avidan) Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States (Neuman) Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Politi) School of Public Health, Washington University, St. Louis, Missouri, United States (Spino, Kidwell, Thelen-Perry) Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States Publisher Lippincott Williams and Wilkins Abstract Background: - The Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) Trial is a multicenter prospective, randomized comparative effectiveness trial examining patients' experiences and outcomes after receiving either total intravenous anesthesia with propofol or inhaled volatile anesthesia for general anesthesia (NCT05991453). Prior to the 13, 000-patient trial, a pilot trial (NCT05346588) was performed to establish feasibility and determine percent success of: 1) patient enrollment, 2) intervention adherence, and 3) data completion. Method(s): - We conducted a feasibility trial including adult patients undergoing elective non-cardiac surgery requiring general anesthesia across two academic institutions in the United States. Patients were randomized to receive general anesthesia with total intravenous or inhalational anesthesia. Patients completed surveys on postoperative days 0, 1, 2, 7, 30, and 90. Percentages of consent, intervention adherence, and data completion were compared with pre-defined thresholds (10%, 80%, and 90%, respectively). Result(s): - 300 patients were enrolled across two sites, Washington University in St. Louis and the University of Michigan, from September, 2022 through March, 2023. The percentages achieved significantly exceeded pre-defined thresholds: 351 of 663 (53%, 95% CI, 49% to 57%) patients approached were successfully consented, adherence to the randomized intervention occurred in 142 of 149 (95%, 95% CI, 92% to 99%) total intravenous anesthesia cases and 150 of 151 (99%, 95% CI, 98% to 100%) inhaled cases, and complete data collection occurred for the Quality of Recovery-15 in 279 of 299 (93%, 95% CI, 91% to 96%) patients and 299 of 299 (100% complete 95% CI, 100% to 100%) patients for the modified Brice, the intraoperative awareness screening questionnaire. Conclusion(s): - It was feasible to enroll sufficient patients, adhere strongly to the randomized treatment allocation, and obtain adequate outcomes data at these two pilot sites for the THRIVE trial. Copyright © 2026 American Society of Anesthesiologists. All Rights Reserved. <96> Accession Number 2045265450 Title Effect of Power Breath Device on Arterial Blood Gases and Diaphragmatic Excursion After Valve Surgery. Source International Journal of Drug Delivery Technology. 16(32 Supplement) (pp 794-800), 2026. Date of Publication: 2026. Author Hassan H.M.; Zidan M.S.; Obaya H.E.; Naguib A.M.; El Shehy E.M.; Abdel Wahab K.A.M.; Wahba M.N.H.; Ghallab M.A.; Abd El-Wahab M.A.M. Institution (Hassan, Obaya, Ghallab, Abd El-Wahab) Department of Physical Therapy for Cardiovascular/ Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt (Zidan) Department of Physical Therapy, Faculty of Applied Medical Science, Al-Zaytoonah University of Jordan, Amman, Jordan (Naguib) Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt (El Shehy) Department of Cardio Thoracic Surgery, Faculty of Medicine, Cairo University, Egypt (Abdel Wahab) Department of Anesthesia and Surgical ICU, Faculty of Medicine, Cairo University, Egypt (Wahba) Department of Physiotherapy for Internal Medicine and Geriatrics, Alryada university for Science and Technology, Egypt Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Pulmonary complications are a common result of heart surgeries, even though surgical methods and postoperative care have improved greatly. Pulmonary complications contribute to high rates of morbidity and mortality as well as longer hospital stays and higher health care expenses. Inspiratory muscle training (IMT) is a therapeutic modality that aims to improve inspiratory muscle conditioning via respiratory muscle overload. Respiratory muscle training devices, such as power breath, strengthen the respiratory muscle, improve endurance, and increase exercise capacity (Nora et al., 2018, and Nadia et al., 2016). Aim(s): To evaluate the impact of the power breath device on arterial blood gases as well as diaphragmatic excursion following cardiac valve surgery. Method(s): Fifty female patients aged 25 to 35 years who had undergone valve surgery (either valve replacement or repair via a median sternotomy) were recruited from the Cardiothoracic Surgery Department at Kasr El-Aini Hospital and randomly assigned to two groups. These patients participated in daily inspiratory muscle training sessions, carried out once daily for seven days after surgery, beginning on the second day. group I (intervention group): This group consisted of 30 female patients who performed inspiratory muscle training using a Power Breathe device in addition to treatment by incentive spirometer, beginning the day following surgery, once daily for seven days a week group II (control group): This group consisted of 20 female patients who participated in a diaphragmatic breathing exercise program using an incentive spirometer (IS) only. The training was performed once daily, seven days per week, starting from the second day after surgery as part of inspiratory muscle training. Beginning in December 2022 and ending in February 2024, the study's practical work was conducted. Result(s): After management in both groups, there was no substantial difference among groups at pretreatment (p > 0.05). The post-treatment comparison among groups indicated a substantial elevation in PO2 levels. (ES (Effect size) = 1.99), diaphragmatic excursion (ES = 0.71), and 6MWT distance (ES = 1.73), and a significant decrease in PCO2 (ES = 0.84) in group I compared with group II (p < 0.01). There was no substantial difference regarding pH levels (ES = 0.13) as well as SpO2 levels (ES = 0.37) among groups (p > 0.05). Conclusion(s): It was concluded that IMT (inspiratory muscles training) by power breath revealed significant improvements in both PaO2 and PaCO2, as well as enhanced diaphragmatic excursion among the intervention group compared to the control. While there was no statistically significant difference in pH levels as well as SpO2 among groups. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <97> Accession Number 2045265849 Title Comparison of Fentanyl Versus Morphine-Ketamine-Lidocaine Infusion for Postoperative Pain Following Coronary Artery Bypass Grafting (CABG): A Randomized Clinical Trial. Source Journal of Critical and Intensive Care. 17(1) (pp 1-10), 2026. Date of Publication: 2026. Author Kashani S.; Sayyadi Nia M.; Tarbebar M.V.; Asoodeh I.Z.; Mahmoudi M.; Jandaghi A.; Jarineshin H. Institution (Kashani, Sayyadi Nia, Tarbebar, Asoodeh, Jarineshin) Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of (Mahmoudi) Department of Research and Technology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of (Jandaghi) Hormozgan University of Medical Sciences, Student Research Committee, Bandar Abbas, Iran, Islamic Republic of Publisher Society of Turkish Intensivists Abstract Aim: This study aimed to compare the effectiveness and safety of fentanyl infusion with a combination of morphine, ketamine, and lidocaine (multimodal analgesia) for postoperative pain management in patients undergoing coronary artery bypass grafting (CABG). Study Design: This randomized clinical trial was conducted from 2024 to 2025 and included 74 patients undergoing elective CABG at the study hospital. Patients received either fentanyl (500 microg/100 mL) or a combination of morphine (20 mg), ketamine (20 mg), and lidocaine (200 mg) diluted to 100 mL, administered as an infusion at 4 mL/h for the first 24 postoperative hours. Pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, 16, 20, and 24 hours after surgery. Additional recorded parameters included hemodynamic variables, respiratory depression, and the need for rescue analgesia. Result(s): Patients receiving fentanyl infusion demonstrated a statistically significant greater reduction in pain scores at 4 and 8 hours postoperatively compared to those receiving the multimodal regimen. However, at the remaining assessment times (1, 12, 16, 20, and 24 hours), no significant differences in pain intensity were observed. Over the full 24-hour period, both regimens provided comparable analgesia. Additionally, no significant differences were found between the groups regarding adverse effects or the need for rescue analgesia. Conclusion(s): Fentanyl infusion demonstrated greater efficacy in early postoperative pain control compared to the multimodal regimen; however, this benefit was of short duration. Over the first 24 hours following surgery, both strategies showed comparable efficacy and safety; therefore, both may be considered viable options for post-CABG analgesia. Copyright © 2026 Journal of Critical and Intensive Care by Kare Media. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. <98> Accession Number 2045264211 Title Comparative Study on Efficacy of Intraperitoneal Instillation of Levo Bupivacaine versus Ropivacaine for Post-Operative Analgesia after Laparoscopic Cholecystectomy - A Randomized Controlled Trial. Source International Journal of Drug Delivery Technology. 16(33 Supplement) (pp 640-645), 2026. Date of Publication: 2026. Author Malepati C.; David S.; Prabhu K.; Asokan A. Institution (Malepati, David, Prabhu, Asokan) Department of Anaesthesiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Postoperative pain control remains an important part of laparoscopic cholecystectomy. This study compares the efficacy of intraperitoneal instillation of Levobupivacaine to Ropivacaine for postoperative analgesia, evaluating hemodynamic stability, pain scores and analgesic demand. Aim(s): To compare the efficacy of intraperitoneal instillation of Levobupivacaine and Ropivacaine for postoperative analgesia after laparoscopic cholecystectomy. Method(s): A randomized controlled trial was done on sixty individuals who underwent elective laparoscopic cholecystectomy. Patients were randomly divided into two groups: Group R (Ropivacaine) and Group L (Levobupivacaine). Baseline features, hemodynamic parameters, Visual Analogue Scale (VAS) pain levels, duration of analgesia and rescue analgesic requirements were all documented and studied. Result(s): The average age was similar between groups (p = 0.316), while the gender distribution was significantly different (p = 0.012). There were no significant variations in weight (p = 0.629), height (p = 0.478), BMI (p > 0.05), or ASA classification. Group R and Group L are equivalent in duration of surgery (p > 0.05). Heart rate changes showed quicker analgesic decline in Group L (4-12 hours, p < 0.05), whereas systolic and diastolic blood pressure were equivalent between groups (p > 0.05). Group L showed a temporary increase in mean arterial pressure (MAP) (1-4 hours, p < 0.05), which then stabilized. Group R showed significantly lower VAS values at repeated postoperative intervals (p < 0.05), indicating better analgesic efficacy. Ropivacaine resulted in prolonged analgesia (9.13 +/- 0.86 vs. 7.57 +/- 0.50 hours, p < 0.001). Group R had considerably fewer patients who needed rescue analgesia (p < 0.01), with 93.3% requiring no extra analgesia compared to 66.7% in Group L. Conclusion(s): In laparoscopic cholecystectomy, Ropivacaine administered intraperitoneally gives better postoperative analgesia than Levobupivacaine. Ropivacaine improves pain control, extends analgesic duration and reduces the need for rescue analgesia, making it a better choice for postoperative pain management. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <99> Accession Number 651001821 Title Open Versus Intact Pleura During Internal Thoracic Artery Harvesting: A Meta-Analysis of Randomized Trials. Source The Annals of thoracic surgery. (no pagination), 2026. Date of Publication: 21 Apr 2026. Author Ingason A.B.; Gregg A.C.; Krieger K.; Redfors B.; Pisano F.; Demetres M.; Girardi L.N.; Sandner S.; Gaudino M. Institution (Ingason, Gregg, Krieger, Redfors, Pisano, Demetres, Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY, United States (Sandner) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York; Department of Cardiac Surgery, Vienna General Hospital - Medical University of Vienna, Vienna, Austria (Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY, United States Abstract BACKGROUND: The pleura is typically opened during internal thoracic artery (ITA) harvesting, but closed-pleura technique has also been described. Preserving pleural integrity may reduce risk of postoperative pulmonary complications. We performed a meta-analysis of all randomized controlled trials (RCTs) comparing outcomes of open versus closed-pleura techniques during ITA harvesting. METHOD(S): Systematic review through 4 November 2025 was conducted to identify RCTs comparing open versus closed-pleura technique during ITA harvesting. The primary outcome was pleural effusion. The secondary outcomes were changes in spirometry findings, pulmonary atelectasis, chest tube output, cardiac tamponade, changes in blood gas results, ventilation time, operative mortality, myocardial infarction, sternal wound infection, return to the operating room, intensive care unit stay, and hospital length of stay. Outcomes were pooled using inverse variance random effects model. RESULT(S): Nine RCTs including 1869 patients (1015 using open-pleura technique, 854 using closed-pleura technique)) were analyzed. Compared with the open-pleura technique, the closed-pleura technique was associated with less pleural effusion (OR 0.35, 95% CI 0.28-0.46), less pulmonary atelectasis (OR 0.35, 95%CI 0.28-0.43), less impairment of FEV1 (mean difference [MD] 13.0, 95%CI 7.3-18.7)) and shorter ventilation time (MD -1.0 hours, 95% CI -0.1 to -2.0 hours). The closed-pleura technique was also associated with lower chest tube output after 24 hours (MD -150 mL, 95%CI -118 to -230 mL), lower operative mortality (OR 0.37, 95%CI 0.20-0.66), but more cardiac tamponade (OR 11.05, 95%CI 1.14-106.82). CONCLUSION(S): Maintaining pleural integrity during ITA harvesting was associated with less pulmonary complications, more cardiac tamponade, and lower operative mortality. Copyright © 2026. Published by Elsevier Inc. <100> Accession Number 651016368 Title Effect of ultrasound-guided erector spinae plane block for preoperative CT-guided percutaneous localization of pulmonary nodules: a randomized controlled trial. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 24 Apr 2026. Author Ji Y.; Zhang H.; Jia R.; Cheng D.; Hu J.; Zhou X.; Shen Y. Institution (Ji, Zhang, Cheng, Hu, Zhou, Shen) Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (Jia) National Clinical Research Center, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China Abstract BACKGROUND: The increasing detection of pulmonary nodules through low-dose computed tomography screening has necessitated precise preoperative localization techniques. While local anesthesia is routinely used for CT-guided pulmonary nodule localization, it inadequately addresses deep tissue pain during pleural penetration. This study is to evaluate the analgesic efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) during CT-guided pulmonary nodule localization. METHOD(S): This single-center, prospective, randomized controlled trial was conducted from June 2024 to January 2025, enrolling 82 patients undergoing preoperative CT-guided pulmonary nodule localization. Participants were randomly assigned to either control group (local anesthesia with 4 ml 1% lidocaine) or ESPB group (ultrasound-guided ESPB with 20 ml 0.375% ropivacaine plus local anesthesia). The primary outcome was numerical rating scale (NRS) score during pleural penetration. Secondary outcomes included anxiety levels, radiation exposure, procedural time, hemodynamic parameters, pneumothorax incidence, and patient satisfaction. Statistical analysis was performed using independent-sample t-test and Mann-Whitney U test. RESULT(S): The ESPB group demonstrated significantly lower NRS scores during pleural penetration compared to the control group (2.68 +/- 1.52 vs. 5.17 +/- 1.32). Patients receiving ESPB exhibited reduced preoperative anxiety (44.71 +/- 3.45 vs. 50.63 +/- 3.74), decreased radiation exposure (401.06 +/- 266.01 vs. 875.36 +/- 377.45 mGy*cm), shorter fluoroscopy time (55.10 +/- 10.54 vs. 117.39 +/- 20.68 s, ), and lower pneumothorax incidence (4.88% vs. 19.51%), all P < 0.05. Post-procedural comfort scores and patient satisfaction were significantly higher in the ESPB group. CONCLUSION(S): Ultrasound-guided ESPB improves analgesia, reduces anxiety, radiation exposure and complications while enhancing patient satisfaction during CT-guided pulmonary nodule localization, representing a valuable adjunct for thoracic interventional procedures. TRIAL REGISTRATION: ClinicalTrials.gov NCT06441071, registered May 8, 2024. Copyright © 2026. The Author(s). <101> Accession Number 651021437 Title Substantial Cardiovascular Risk Reduction with Icosapent Ethyl Regardless of Diabetes Status or BMI: REDUCE-IT BMI. Source Diabetes. Conference: 81st Scientific Sessions of the American Diabetes Association (ADA). Virtual. 70(Supplement 1) (no pagination), 2021. Date of Publication: 01 Jun 2021. Author Bhatt D.L.; Brinton E.A.; Steg P.G.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz C.; Tardif J.-C.; Ballantyne C.M. Publisher American Diabetes Association Inc. Abstract Background: REDUCE-IT, a multinational, double-blind trial, randomized 8179 statin-treated patients with controlled low density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 grams daily or placebo. IPE reduced the primary (CV death, myocardial infarction [MI], stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, MI, stroke) endpoints 25% and 26%, respectively (each p<0.000001). At baseline, median body mass index (BMI) was 30.8 kg/m2, and 58.5% of REDUCE-IT patients had diabetes mellitus (DM). In patients with DM, the primary and key secondary endpoints were reduced 23% and 30%, respectively (each p<=0.00005). Method(s): We evaluated if BMI modulated CV risk reduction with IPE in patients with or without DM. Result(s): In the full cohort, similar CV risk reduction was observed across the prespecified endpoint testing hierarchy (interaction p=ns for all), and relative safety between treatment groups was generally consistent. In persons with or without DM, similar reductions in the primary endpoint were observed across BMI categories (Figure), with similar findings in the key secondary endpoint (interaction p=ns for all). Conclusion(s): The significant cardiovascular risk reduction provided by IPE 4g/day is consistent across BMI in patients with and without DM. <102> Accession Number 651002017 Title Influence of Baseline Smoking Status on Intensive Blood-Pressure Control: Results from the STEP Randomized Trial. Source The Canadian journal of cardiology. (no pagination), 2026. Date of Publication: 21 Apr 2026. Author Chen S.; Ji Y.; Yang R.; Peng X.; Bai J.; Fan X.; Song Q.; Cai J. Institution (Chen, Ji, Song) Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China (Yang, Peng, Bai) Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China (Fan) Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Cai) Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China Abstract BACKGROUND: The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial has proven that intensive systolic blood pressure (SBP) lowering reduces cardiovascular events. However, the cardiovascular risks posed by smoking have caused uncertainty regarding the effects of intensive SBP control in smokers. METHOD(S): In this secondary subgroup analysis of the STEP trial, the participants were categorized into non-smokers and current smokers based on their baseline smoking status. The primary outcome was a composite of cardiovascular outcomes, including stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, and death from cardiovascular causes. Cox proportional hazards regression and interaction analysis were used to assess the effects of baseline smoking status on intensive SBP control. RESULT(S): A total of 8489 patients were included in this analysis. The proportion of patients reaching the intensive SBP target was lower in current smokers during the first 9 months. Compared with non-smokers, current smokers had a higher adjusted risk of primary outcome (hazard ratio, 1.39; 95% CI, 1.03-1.88; P=0.03) and stroke (hazard ratio, 1.66; 95% CI, 1.03-2.67; P=0.04). The interactions between baseline smoking status and SBP treatment were not statistically significant for all outcomes. Findings were similar in sensitivity analyses using four smoking categories and in analyses including only never and often smokers. CONCLUSION(S): Smoking was associated with a higher risk of primary outcome and stroke. We observed no statistical evidence of heterogeneity in the treatment effect of intensive SBP control by smoking status. Copyright © 2026. Published by Elsevier Inc. <103> Accession Number 2045232710 Title Pregabalin versus dexmedetomidine for prevention of delirium after cardiac surgery: a randomized double-blind non-inferiority trial. Source Minerva Anestesiologica. 92(3) (pp 176-188), 2026. Date of Publication: 01 Mar 2026. Author Morsy I.; Bakr D.M.; Abdelwahab E.H.; Abo Elkhier A.E.; Abdallah M.K.; Rehab O.M. Institution (Morsy, Abdelwahab, Abo Elkhier, Abdallah, Rehab) Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Tanta University, Tanta, Egypt (Bakr) Anesthesiology, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Helwan University, Helwan, Egypt Publisher Edizioni Minerva Medica Abstract BACKGROUND: The incidence of postoperative delirium (POD) has been reported to be up to 53% following cardiac surgery. This trial aimed to determine the effect of perioperative administration of pregabalin versus dexmedetomidine (DEX) on the POD incidence in elderly patients planned for cardiac surgery, together with other secondary outcome measures. We hypothesized that pregabalin, with its sedative analgesic effects, would be non-inferior to DEX regarding POD prevention. METHOD(S): This randomized, double-blind, parallel-controlled, non-inferiority trial was conducted on 60 elderly cases planned for cardiac surgery. The cases were randomly assigned equally into a pregabalin group (group P) and DEX group (group D). The non-inferiority margin was set to 20%. The primary outcome was the POD incidence. Secondary endpoints included analgesic profile, sedation scale, and adverse events. RESULT(S): Pregabalin was non-inferior to DEX regarding the reduction in the incidence of POD (17.86% vs. 21.43%; risk difference, -3.6%; two-sided 95% CI, - 24.25% to 17.41%; meeting non-inferiority criteria). POD onset and duration showed an insignificant difference between the groups. The total morphine consumption in the first 48 hours after surgery was significantly lower in group P (25.64+/-7.04 mg) than in group D (34.66+/-9.25 mg; 95% CI, -13.42 to -4.61; P=0.0001). Both groups were insignificantly different regarding the visual analog scale score, sedation agitation scale measurements, recovery time, and adverse events. CONCLUSION(S): Pregabalin is non-inferior to DEX in terms of delirium prevention after cardiac surgeries with comparable sedative effects, but it has a superior analgesic profile in the form of a significantly lower 48-hour opioid dose. Copyright © 2025 EDIZIONI MINERVA MEDICA. <104> Accession Number 2045081966 Title Postoperative Complications in Patients with Frailty Syndrome Undergoing Esophagectomy-A Systematic Review with Meta-Analysis. Source Journal of Clinical Medicine. 15(8) (no pagination), 2026. Article Number: 3040. Date of Publication: 01 Apr 2026. Author Kaminska A.; Bonczar M.; Plutecki D.; Ostrowski P.; Koziej M.; Konturek A. Institution (Kaminska, Konturek) Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College Krakow, University Hospital in Krakow, Krakow, Poland (Bonczar, Plutecki, Ostrowski, Koziej) Department of Anatomy, Jagiellonian University Medical College Cracow, Krakow, Poland (Bonczar, Plutecki, Ostrowski, Koziej) Youthoria, Youth Research Organization, Krakow, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Introduction: Frailty syndrome is an increasingly recognized condition that affects a considerable proportion of elderly patients, particularly those undergoing major surgeries. In this meta-analysis, we aimed to systematically review and pool data from cohort studies to assess the effect of frailty on the clinical outcomes of patients undergoing esophagectomy for esophageal cancer. Method(s): Major online medical databases such as PubMed, Embase, Scopus, and Web of Science were searched to gather all studies on the clinical outcomes of patients with frailty syndrome who underwent esophagectomy due to esophageal cancer. The study included articles published up to March 2026. Finally, 15 articles matched the required criteria and were included in this meta-analysis. Result(s): The pooled odds ratio for surgery-related mortality in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 4.03 (Lower Limit: 2.20; Upper Limit: 7.38; p-value < 0.05). The pooled odds ratio for surgery-related postoperative pneumonia in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 1.86 (Lower Limit: 1.16; Upper Limit: 2.98; p-value < 0.05). The pooled odds ratio for surgery-related postoperative cardiac complications in patients with frailty syndrome and esophageal cancer undergoing esophagectomy has been established at 1.73 (Lower Limit: 1.54; Upper Limit: 1.94; p-value < 0.05). Conclusion(s): Frailty is a powerful predictor of mortality in patients undergoing esophagectomy, with frail individuals facing nearly four times higher odds of death. This underscores the urgent need to integrate frailty assessments into standard preoperative screening to enhance risk stratification and optimize perioperative decision-making. A multidisciplinary approach is essential to improving resilience, recovery, and long-term survival in frail esophageal cancer patients. Future large-scale prospective trials should focus on standardizing assessment tools and evaluating the lasting impact of tailored interventions to ultimately enhance patient outcomes. Copyright © 2026 by the authors. <105> Accession Number 2045268729 Title Feasibility and Effectiveness of a Multicomponent Exercise Program in Rural Post-Coronary Artery Bypass Grafting Patients. Source International Journal of Drug Delivery Technology. 16(30 Supplement) (pp 964-969), 2026. Date of Publication: 2026. Author Patil C.B.; Patil V.C. Institution (Patil) Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth, Deemed to be University, Karad, India (Patil) Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Deemed to be University, Karad, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Participation in cardiac rehabilitation (CR) after coronary artery bypass grafting (CABG) is associated with reduced morbidity and mortality [1, 2]. However, uptake in rural populations remains low due to access barriers [10]. Pragmatic, low-cost, multicomponent exercise programs may improve reach and outcomes in these settings. Objective(s): To determine the feasibility and effectiveness of an 8-week multicomponent exercise program on physiological outcomes in rural post-CABG patients. Method(s): In this parallel-group randomized controlled trial, 40 clinically stable adults enrolled between postoperative day 3 to day 15 following CABG from rural communities were randomized (1:1) to a multicomponent exercise program (intervention) or conventional CR (control). Feasibility outcomes included recruitment, retention, adherence, and adverse events. Effectiveness outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and resting respiratory rate (RR). Analyses included paired t-tests (within-group), independent t-tests (between-group), and ANCOVA adjusting for baseline values. Effect sizes (Cohen's d) and 95% confidence intervals (CI) were reported. Significance was set at p < 0.05. Result(s): Recruitment was 83.3% (40/48), retention 95% (38/40), and adherence 88.5% +/- 5.2, with no major adverse events. After adjustment, the intervention produced greater reductions than control in SBP (adjusted mean difference -9.5 mmHg; 95% CI -14.2 to -4.8; p < 0.001; d = 0.85), DBP (-7.2 mmHg; 95% CI -10.5 to -3.9; p < 0.001; d = 0.78), and RR (-2.8 breaths/min; 95% CI -4.1 to -1.5; p = 0.002; d = 0.65). Conclusion(s): A multicomponent exercise program is feasible, safe, and clinically effective for improving physiological parameters in rural post-CABG patients, supporting its use as an accessible CR model. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <106> Accession Number 2045260212 Title Paclitaxel- and Sirolimus-Coated Drug-Coated Balloons versus Drug-Eluting Stents in Acute Myocardial Infarction: A Comprehensive Systematic Review and Meta-Analysis. Source Iranian Journal of Pharmaceutical Research. 24(1) (no pagination), 2025. Article Number: e164739. Date of Publication: 2025. Author Zhang Z.; Yu G.; Guo R. Institution (Zhang, Yu, Guo) Cardiovasology, Dunhuang Hospital, Dunhuang, China Publisher Brieflands Abstract Context: Acute myocardial infarction (AMI) requires rapid yet durable coronary reperfusion. Drug-eluting stents (DES) are the standard for percutaneous coronary intervention (PCI) but pose long-term challenges such as late stent thrombosis and extended dual antiplatelet therapy (DAPT). Drug-coated balloons (DCBs), using paclitaxel or newer sirolimus formulations, deliver antiproliferative therapy without leaving a permanent scaffold, offering a potentially safer, stent-free option. Objective(s): To evaluate the efficacy and safety of DCBs versus DES in AMI, with emphasis on drug platform (paclitaxel vs. sirolimus) and specific outcomes. Method(s): This systematic review and meta-analysis followed PRISMA 2020 guidelines. Databases including PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from inception through 15 January 2025, according to a prospectively archived protocol on the Open Science Framework. Thirty-four eligible studies (14 randomized controlled trials (RTCs), 20 observational cohorts) comprising 19,642 participants and 2,313 major adverse cardiovascular events (MACE) were analyzed. Dichotomous outcomes were synthesized as pooled risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects (DerSimonian-Laird) model; heterogeneity was quantified by I2, tau2, and H2 statistics. Result(s): Drug-coated balloons were associated with a 15% relative reduction in MACE compared with DES (RR = 0.85, 95% CI: 0.73 - 0.99, I2 = 63.2%). Rates of myocardial infarction (MI) (RR = 0.93, 95% CI: 0.78 - 1.11), target lesion revascularization (TLR) (RR = 0.88, 95% CI: 0.71 - 1.07), and cardiovascular mortality (RR = 0.97, 95% CI: 0.81 - 1.16) were comparable between groups. Late stent thrombosis was significantly lower with DCBs (RR = 0.64, 95% CI: 0.42 - 0.97). Most pooled evidence involved paclitaxel-coated balloons, while sirolimus-coated DCB data, though directionally consistent, remain limited by smaller sample size and shorter follow-up. Conclusion(s): This meta-analysis suggests that DCBs represent a feasible, stent-free PCI strategy in AMI, providing comparable safety and efficacy to DES with a potential advantage in reducing late thrombosis. Device selection should be guided by lesion complexity, bleeding risk, and DAPT tolerance. Further large-scale, head-to-head randomized trials, particularly involving sirolimus-coated DCBs, are warranted to validate these findings. Copyright © 2025 Brieflands. All rights reserved. <107> Accession Number 2045033802 Title A Systematic Review of How Cardiopulmonary Bypass Parameters Influence Electroencephalogram Signals. Source Brain Sciences. 16(4) (no pagination), 2026. Article Number: 412. Date of Publication: 01 Apr 2026. Author Bao H.; Wang J.; Cui Z.; Zhu M.; Chen W.; Zhou L.; Northoff G.; Tao T.; Qin P. Institution (Bao, Wang, Cui, Chen, Zhou, Qin) Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China (Zhu) Department of Anaesthesia, Zhujiang Hospital of Southern Medical University, Guangzhou, China (Northoff) Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada (Tao) Center of Sleep and Brain Medicine, Shenzhen Hospital, Southern Medical University, 13 Xinhu Road, Baoan District, Shenzhen, China (Qin) Pazhou Lab, Guangzhou, China Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Cardiopulmonary bypass (CPB) is an essential technique for cardiac surgery but significantly increases the risk of perioperative neurological complications. Electroencephalography (EEG) enables real-time monitoring of brain function and provides sensitive biomarkers for early detection of cerebral injury. However, a systematic synthesis of how CPB-related physiological, pharmacological, and technical factors influence EEG signals, and how these insights can be integrated into clinical decision-making, is still lacking. Objective(s): To systematically review the effects of temperature management, mean arterial pressure (MAP), hemodilution, anesthetic agents, embolization, and systemic inflammatory response during CPB on EEG parameters (including frequency bands, Bispectral Index (BIS), quantitative EEG metrics such as burst suppression ratio (BSR), spectral edge frequency (SEF), etc.), and to evaluate the associations between EEG changes and postoperative delirium (POD) and stroke. Method(s): Following the PRISMA 2020 guidelines, we searched PubMed, Web of Science, and related databases for original English-language articles published between February 1974 and September 2025. Inclusion criteria: adult patients (>=18 years) undergoing cardiac surgery with CPB and intraoperative EEG monitoring (raw or processed). Exclusion criteria: reviews, case reports, animal studies, pediatric populations, and articles with inaccessible full texts. Two reviewers independently screened the literature and extracted data; a narrative synthesis was performed. Result(s): Fifty-one studies were included. Main findings: (1) Hypothermia: BIS decreases linearly with temperature (=1.12 units/degreeC); electrocerebral silence occurs during deep hypothermic circulatory arrest; EEG recovery dynamics during rewarming predict POD. (2) MAP and cerebral perfusion: The rate of MAP decline (>=0.66 mmHg/s) is a stronger predictor of EEG abnormalities than the absolute MAP value; under fixed pump flow, some patients exhibit coexisting cerebral overperfusion and metabolic suppression. (3) Hemodilution: Maintaining hemoglobin >=9.4 g/dL prevents EEG slowing; a drop below 9.2 g/dL significantly increases the risk of slowing. A >=10% decrease in regional cerebral oxygen saturation (rSO<inf>2</inf>) is associated with a 1.5-fold increased risk of burst suppression. (4) Anesthetic agents: Propofol maintains flow-metabolism coupling, and BSR reflects deep anesthesia better than BIS; sevoflurane and isoflurane impair autoregulation and suppress EEG. (5) Embolization and inflammation: EEG epileptiform discharges increase the risk of POD five-fold; a decrease in LIR predicts stroke (AUC 0.771) and POD (AUC 0.779); persistent EEG changes increase the risk of POD 2.65-fold. Conclusion(s): CPB-related factors affect EEG signals through distinct mechanisms, and specific EEG patterns (slowing, burst suppression, asymmetry, epileptiform discharges) are significantly associated with postoperative neurological complications. Multimodal monitoring (EEG + cerebral oximetry + hemodynamics) with clear intervention thresholds facilitates individualized brain protection. Future interventional studies using real-time EEG feedback are needed to confirm improvements in long-term neurological outcomes. Copyright © 2026 by the authors. <108> Accession Number 650987066 Title Use of Bicarbonate Based Purge Solution Versus Heparin Based Purge Solution in Patients with an Impella Post-Cardiotomy. Source 2025 ASHP Midyear Clinical Meeting. Conference: Advancing Science, Pharmcy Practice, and Health Outcomes Midyear Clinical Meeting, ASHP 2025. Las Vegas United States. 83(Supplement 2) (pp S1209), 2026. Date of Publication: 01 Mar 2026. Author Handal B.; Chau T.; Igneri L.; Kim S.; Solomon D. Institution (Handal) Saint Joseph's University, Philadelphia College of Pharmacy, PA, United States Publisher Oxford University Press Abstract Purpose: In the cardiac surgery setting, where Impella use is becoming more frequent, there remains a significant lack of evidence directly comparing heparin- versus bicarbonate-based purge strategies. This gap is especially important given the high baseline bleeding and thrombotic risks in this population, as well as the wide variability in practice patterns across centers.The aim of this study is to compare outcomes associated with heparin versus bicarbonate purge solutions in cardiac surgery patients supported with Impella. Method(s): This is a single center retrospective cohort study conducted at a large academic medical center. The study will compare outcomes in two cohorts: heparin-based purge solution versus bicarbonate-based purge solution. Patients 18 years of age or older will be included if they were admitted to the intensive care unit, underwent cardiac surgery, had an implanted Impella device for at least 24 hours, and used either a heparin-based or bicarbonate-based purge solution. Relevant exclusions will include concomitant mechanical circulatory support, use of a heparin protocol with a goal anti-Xa >0.5 units/mL, or use of an alternate anticoagulant within the purge solution. The primary outcomes will be the incidence of pump thrombosis and the incidence of major bleeding. The secondary outcomes will include arterial or venous thromboembolism, clinically relevant bleeding, hemolysis, in-hospital mortality, and 30-day mortality. Systemic anticoagulation intensity will also be characterized. <109> Accession Number 2045150744 Title RF106. AI-assisted education enhances diagnostic accuracy and surgical planning for pulmonary nodules in thoracic surgery residents: a randomized crossover trial. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S183), 2026. Date of Publication: 01 May 2026. Author He X.; Chen C. Institution (He, Chen) The Second Xiangya Hospital of Central South University, Hunan, Changsha, China Publisher Elsevier Inc. Abstract Objective: To evaluate, in a randomized crossover trial, whether AI assistance improves thoracic surgery residents' malignancy assessment, segmental localization, and surgical planning for small pulmonary nodules, while increasing efficiency and confidence. Method(s): We conducted a two-stage randomized crossover trial at the Second Xiangya Hospital, Central South University (Feb 2023-Mar 2024). One hundred patients undergoing anatomical segmentectomy or lobectomy were included, with CT scans (<=2 mm slice thickness) serving as teaching cases. Forty residents were randomized into two groups. In stage one, Group A evaluated cases with AI assistance while Group B evaluated without; groups crossed over after a 6-week washout. Primary outcomes were accuracy for malignancy assessment, segmental localization, operative planning, and recognition of key anatomy. Secondary outcomes were planning time and confidence (0-10). Result(s): AI assistance significantly improved malignancy assessment accuracy (82.5% +/- 3.8% vs. 69.6% +/- 5.8%, p < 0.001), with pronounced benefit for nodules <10 mm and pure ground-glass opacities (81.2% +/- 6.5% vs. 58.1% +/- 12.7%, p < 0.01). Sensitivity for malignancy rose from 68.5% +/- 4.5% to 81.9% +/- 5.2% (p < 0.005), while specificity improved from 65.4% +/- 6.2% to 77.6% +/- 4.8% (p < 0.01). Anatomical localization accuracy increased (87.5% +/- 2.8% vs. 63.4% +/- 4.1%, p < 0.001), and severe mislocalizations decreased (1.6% vs. 5.8%, p < 0.005). Surgical plan concordance with expert standards was higher with AI (78.9% +/- 3.5% vs. 55.3% +/- 6.3%, p < 0.001); overtreatment recommendations were fewer (1.3% vs. 4.2%, p < 0.01). Recognition of key anatomical structures improved (79.9% +/- 6.2% vs. 55.5% +/- 6.9%, p < 0.001). Planning time was significantly shorter with AI (9.4 +/- 2.5 vs. 16.7 +/- 3.3 minutes, p < 0.001). Confidence scores across all domains were consistently higher with AI (p < 0.001). No carryover or sequence effects were observed. Conclusion(s): AI assistance significantly improved residents' diagnostic accuracy, anatomical recognition, and surgical planning for small pulmonary nodules, while reducing planning time and enhancing confidence. These findings highlight AI's potential as a valuable adjunct in thoracic surgical education, supporting skill acquisition, self-directed learning, and safer clinical decision-making. [Formula presented] MULTI-SPECIALTY: Education Copyright © 2026 <110> Accession Number 2045022947 Title Perioperative Interventions Based on Fasting Protocols and Carbohydrate Loading in Non-Cardiac Surgery in Older Adults: A Scoping Review. Source Medicina (Lithuania). 62(4) (no pagination), 2026. Article Number: 756. Date of Publication: 01 Apr 2026. Author Lozano J.D.M.; Tuta-Quintero E.; Bonilla Llanos M.C.; Valencia M.C.; Solano F.; Cruz A.; Bonilla N.; Rios Barbosa F. Institution (Lozano, Bonilla Llanos, Valencia, Solano, Cruz, Bonilla, Rios Barbosa) Department of Anesthesiology, School of Medicine, Universidad de La Sabana, Campus del Puente del Comun, Km. 7, Autopista Norte de Bogota, Chia, Colombia (Tuta-Quintero) Department of Epidemiology, School of Medicine, Universidad de La Sabana, Campus del Puente del Comun, Km. 7, Autopista Norte de Bogota, Chia, Colombia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Material(s) and Method(s): A scoping review was conducted following the methodological recommendations of Arksey and O'Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults >= 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Result(s): A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusion(s): Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Copyright © 2026 by the authors. <111> Accession Number 2045150800 Title RF109. 25 Years of the Journal of Thoracic and Cardiovascular Surgery (2000-2024): Bibliometric Insights. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S185), 2026. Date of Publication: 01 May 2026. Author Yi J.; Wu J. Institution (Yi, Wu) Guangdong Provincial People's Hospital, Guangdong, Guangzhou, China Publisher Elsevier Inc. Abstract Objective: To map the historical trajectory, research trends, and key contributors of the Journal of Thoracic and Cardiovascular Surgery (JTCVS) over 25 years (2000-2024) using bibliometric methods to inform evidence-based strategies for advancing cardiothoracic surgery research and practice. Method(s): We queried the Web of Science Core Collection for Articles and Review Articles (2000-2024), yielding 9,190 records after excluding editorials, letters, and corrections. Using CiteSpace, VOSviewer, and Bibliometrix, we analyzed publication and citation trends; author, institution, and country contributions along with collaboration networks; top-cited studies; reference co-citation and clustering; as well as key term co-occurrence and burst analysis to identify research trends. Result(s): Publications rose from 329 (2000) to peak at 659 (2014), then stabilized at 329+/-32 (2015-2024). The impact factor peaked at 6.44 (2021). The United States dominated global contributions with 4,684 publications, followed by Japan and Canada. Harvard University topped institutional output (653 publications), while Blackstone EH was the most influential author (h-index: 65). The 20 most-cited articles were predominantly clinical studies focused on surgical techniques and outcomes. Co-citation and clustering analysis identified three seminal works as pivotal links in the foundational knowledge of cardiothoracic surgery, additionally identifying aortic surgery, cardiac valve surgery, and coronary artery surgery as major domains. Citation burst analysis revealed transcatheter aortic valve replacement (TAVR) as the most dynamic recent frontier, with Mack MJ, 2019, and Popma JJ, 2019, achieving the strongest citation bursts in the past five years. "Cardiac surgery" was the most frequent keyword (300 occurrences), followed by "non-small cell lung cancer" and "coronary artery bypass." Recent emerging terms include "acute kidney injury," "coronavirus disease" and "surgical aortic valve replacement." Conclusion(s): This 25-year bibliometric analysis reveals JTCVS as a leading platform for cardiothoracic surgery research with increasing scholarly impact. The field demonstrates strong North American dominance, with TAVR emerging as the primary research frontier. Future directions should emphasize enhanced international collaboration, transcatheter technologies, and translational research integration to shape the next era of cardiothoracic surgery. [Formula presented] MULTI-SPECIALTY: Education Copyright © 2026 <112> Accession Number 650992664 Title Short- and long-term outcomes of david versus bentall procedures in acute type a aortic dissection: a meta-analysis with reconstructed individual patient data for time-to-event analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 22 Apr 2026. Author Santos K.; Habiyambere G.I.; Bartolozzi H.; Obi O.S.; Carvalho P.E.P.; Madera D.; Plonek T. Institution (Santos) New Vision University School of Medicine, Tbilisi, Georgia (Santos, Plonek) Department of Cardiothoracic Surgery, Medisch Spectrum Twente, Enschede, Netherlands (Habiyambere) University of Global Health Equity, Butaro campus, Rwanda (Bartolozzi) Trakia University, Stara Zagora, Bulgaria (Obi) New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, Old Westbury, NY, United States (Carvalho) Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, United States (Madera) Department of Vascular Surgery Pasteur Hospital, Montevideo, Uruguay <113> Accession Number 650992340 Title Restrictive versus liberal red blood cell transfusion strategies for cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 22 Apr 2026. Author Shao J.; Zhang Y.; Lin W.; Yan M.; Cai X.; Luo Z.; Yu W.; Xu J. Institution (Shao, Zhang, Lin, Yan, Cai, Cai, Luo, Yu, Xu) School of Medical, Southeast University, 87 Dingjiaqiao Rd, Nanjing, China (Shao, Zhang, Lin, Yan, Cai, Cai, Luo, Yu, Xu) Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China <114> Accession Number 2045150954 Title RF62. A Phase 3 Randomized, Double-Blind, Multi-Center, Placebo-Controlled Study Evaluating the Efficacy of RBT-1 in Reducing Postoperative Complications in Patients Undergoing Non-Emergent Cardiac Surgery. Source Journal of Thoracic and Cardiovascular Surgery. Conference: Journal of Thoracic and Cardiovascular Surgery. Chicago United States. 171(4 Supplement 1) (pp S152-S153), 2026. Date of Publication: 01 May 2026. Author Jessen M.; Van Wagenberg F.; Leaf D.; Arora R.; Mack C.; Felten W.; Noiseux N.; Marzouk M.; Moront M.; Khanna A.; Gerdisch M.; Demers P.; Jeanmart H.; Brown C.; McIntyre W.; Reddy V.S.; Chertow G.; Wang C.; Snapinn S.; Ruiz S.; Singh B.; Lamy A. Institution (Jessen) UT Southwestern Medical Center, Dallas, TX, United States (Van Wagenberg) Huntsville Hospital, Huntsville, AL, United States (Leaf) Brigham And Women'S Hospital, Boston, MA, United States (Arora) Cleveland University Hospitals, Cleveland, OH, United States (Mack) Weill Cornell Medical College, Cornell University, Manhasset, NY, United States (Felten) Mymichigan, Midland, MI, United States (Noiseux) University Of Montreal, Montreal, QC, Canada (Marzouk) Iucpq, Quebec, QC, Canada (Moront) Promedica, Toledo, OH, United States (Khanna) Wake Forest University School Of Medicine, Winston Salem, NC, United States (Gerdisch) Franciscan Health, Indianapolis, IN, United States (Demers, Jeanmart) Montreal Heart Institute, Montreal, QC, Canada (Brown) Saint John Regional Hospital, Saint John, NB, Canada (McIntyre, Lamy) Mcmaster University, Hamilton, Ontario, Canada (Reddy) Hca Healthcare, Nashville, TN, United States (Chertow) Stanford, Stanford, CA, United States (Wang) Pharma Data Associates, Piscataway, NJ, United States (Snapinn) Seattle-Quilcene Biostatistics, Seattle, WA, United States (Ruiz, Singh) Renibus Therapeutics, Southlake, TX, United States Publisher Elsevier Inc. Abstract OBJECTIVE: RBT-1 is a novel cytoprotective preconditioning agent with antioxidant and anti-inflammatory properties. A Phase 3 (PROTECT) study was conducted to assess the efficacy of RBT-1 in reducing postoperative complications in patients undergoing cardiac surgery. METHOD(S): This double-blind, multi-center, placebo-controlled study enrolled patients scheduled to undergo non-emergent CABG and/or valve surgery on cardiopulmonary bypass. Key exclusion criteria included those expected to undergo surgery within 24 hours; acute organ dysfunction; CKD requiring dialysis; sepsis; asplenia; iron disorders, or porphyria. Eligible patients were randomized 1:1 to receive a single infusion of RBT-1 or placebo 24 to 48 hours before surgery. Patients were followed for outcomes through postoperative day 60. The primary objective was to evaluate the efficacy of RBT-1 compared with placebo on a hierarchical composite (win ratio [WR]) of the following components: death, AKI requiring dialysis, 30-day cardiopulmonary readmission, and ICU days. Key secondary objectives included primary analysis among patients undergoing higher complexity surgeries (e.g. combined CABG/valve, complicated valve surgery and concomitant aorta repair/replacement) and number of postoperative complications. RESULT(S): Randomization of 433 patients occurred across 30 sites in the US and Canada. Of these, 46% underwent an isolated CABG, 32% isolated valve surgery, and 22% combined CABG/valve. A majority (~70%) had an STS Mortality risk <2%. RBT-1 failed to show a significant benefit compared to placebo in the primary endpoint (WR 0.87 [0.66, 1.15], p=0.33) and two key secondary endpoints, i.e., higher complexity surgeries (n=154; WR 0.90 [0.59, 1.37], p= 0.63) and the mean number of post-operative complications (RBT-1 1.2+/-1.29 vs placebo 1.3+/-1.51, p=0.73). Post-hoc exploratory analyses suggest that RBT-1 may provide benefit in patients with CKD, at higher risk of AKI, and/or higher STS operative risk scores (Table 1). RBT-1 was generally safe and well-tolerated, with photosensitivity and transient infusion-related reactions being the most common treatment-related AEs. No treatment related AE resulted in cancelled or delayed surgery. CONCLUSION(S): The PROTECT RBT-1 study in patients undergoing cardiac surgery did not demonstrate an improvement in clinical outcomes versus placebo. Post-hoc analyses suggest potential benefit in higher-risk subsets; additional evaluation of these findings is warranted. [Formula presented] PERIOPERATIVE CARE: Innovations: New devices or novel approaches, preclinical or clinical Copyright © 2026 <115> Accession Number 2045193934 Title Effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting: a retrospective target trial emulation using the MIMIC-IV database. Source BMJ Open. 16(4) (no pagination), 2026. Date of Publication: 21 Apr 2026. Author Jiang Y.; Ding H.; Su J.; Li X. Institution (Jiang) Xuzhou Hospital of Traditional Chinese Medicine, Jiangsu, Xuzhou, China (Ding, Su, Li) Xuzhou Central Hospital, Xuzhou, China Publisher BMJ Publishing Group Abstract Objectives: The effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate the association between early antiplatelet therapy initiation and clinical outcomes in post-CABG patients. Design(s): A retrospective target trial emulation. Setting(s): Single academic medical centre in Boston, Massachusetts, USA. Participant(s): We included adult patients who underwent CABG and were admitted to the intensive care unit at Beth Israel Deaconess Medical Center between 2008 and 2022. Method(s): Patients were classified into the treatment group if they initiated antiplatelet therapy within 24 hours postoperatively; otherwise, they were assigned to the control group. To address immortal-time bias for the primary outcome of 30-day mortality, we used clone-censor-weighting. For the exploratory outcome of 30-day acute kidney injury (AKI) incidence, we employed inverse probability of treatment weighting to balance baseline covariates. Result(s): The analysis for 30-day mortality included 6887 patients. The mortality was 2.35% in the control group versus 1.44% in the treatment group, yielding an absolute risk difference of 0.90% (control group minus treatment group, 95% CI 0.09% to 1.72%). The difference in restricted mean time lost was 0.19 days (control group minus treatment group, 95% CI 0.03 to 0.36). For AKI incidence, 5543 patients were analysed. The incidence was 78.61% in the control group and 69.13% in the treatment group, with an absolute difference of 9.48% (control group minus treatment group, 95% CI 6.40% to 12.50%; p<0.001). Conclusion(s): In this target trial emulation, early antiplatelet therapy initiated within 24 hours after CABG was associated with lower 30-day mortality and a reduced incidence of postoperative AKI. These findings warrant confirmation in prospective randomised controlled trials. 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/. <116> Accession Number 2045193864 Title Intranasal dexmedetomidine in reducing postoperative delirium among cardiac surgery patients by improving sleep quality in China (DREAMS): study protocol for a single-centre, double-blind, randomised controlled trial. Source BMJ Open. 16(4) (no pagination), 2026. Date of Publication: 21 Apr 2026. Author Zhang Z.; Yang X.; Qin Y.; Gao B.; Wang Y.; Ji J.; Gao J.; Huang M.; Wang L.; Zheng Z.; Lei C. Institution (Zhang, Yang, Qin, Gao, Wang, Ji, Gao, Huang, Wang, Zheng, Lei) Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Shaanxi, Xi'an, China (Zhang, Yang, Gao, Huang, Wang, Zheng, Lei) Key Laboratory of Anesthesiology (the Fourth Military Medical University), Ministry of Education, Shaanxi, Xi'an, China (Zhang, Yang, Qin, Gao, Wang, Ji, Gao, Huang, Wang, Zheng, Lei) Anesthesia Clinical Research Center (ACRC), Xijing Hospital, Shaanxi, Xi'an, China (Qin) Department of Anesthesiology, Shanxi Provincial People's Hospital, Shanxi, Taiyuan, China (Wang) Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China (Ji) Department of Anesthesiology, Second Hospital of Shanxi Medical University, Shanxi, Taiyuan, China Publisher BMJ Publishing Group Abstract Introduction: Postoperative delirium (POD) is a common complication following cardiac surgery and is closely associated with adverse clinical outcomes. The effect of perioperative dexmedetomidine on reducing POD remains controversial in the existing literature. In our previous meta-analysis, we obtained preliminary evidence suggesting that dexmedetomidine may reduce the incidence of POD by improving sleep quality, which may partly explain the heterogeneity reported in previous studies. Based on these findings, the present randomised controlled trial aims to test the hypothesis that preoperative intranasal administration of dexmedetomidine reduces the incidence of POD in patients undergoing cardiopulmonary bypass assisted cardiac surgery by enhancing preoperative sleep quality. Methods and analysis: This trial is a single-centre, investigator-initiated, parallel, double-blind, randomised, placebo-controlled trial. Individuals aged 18 years or older who are scheduled for elective cardiopulmonary bypass-assisted cardiac surgery will be enrolled in the study. The planned sample size is 686. Participants will be randomly assigned to either the dexmedetomidine group receiving two doses of dexmedetomidine (1.5 microg/kg according to ideal body weight) administered between 21:00 and 21:30 on the night before surgery and 15 min before anaesthesia induction, or the placebo group, receiving an equivalent volume of normal saline at the same time points. The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include the severity, subtypes and duration of delirium, length of postoperative hospital stay, in-hospital all-cause mortality, postoperative sleep assessed by the Numerical Rating Scale score, pain intensity, postoperative anxiety and depression scores. Mediation analyses will be conducted using the preoperative Sleep Quality Index to assess whether dexmedetomidine reduces POD by improving preoperative sleep quality. The Baron and Kenny causal steps framework in conjunction with bootstrap resampling will be employed to estimate the direct, indirect and total effects. Ethics and dissemination: The study is approved by the Institutional Review Board of Xijing Hospital (KY20242259). Written informed consent will be obtained from all participants. The results will be submitted for publication in peer-reviewed journals. Trial registration number: NCT06619912. 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/. <117> Accession Number 2045023161 Title Ultrasound-Guided Sciatic and Saphenous Nerve Blocks Enhance Perioperative Analgesia in Sheep Undergoing Experimental Orthopaedic Hindlimb Surgery. Source Veterinary Sciences. 13(4) (no pagination), 2026. Article Number: 318. Date of Publication: 01 Apr 2026. Author Rodriguez O.; Figueirinhas P.; Vazquez D.; Del-Rosario S.; Brito-Casillas Y.; Martin S.; Paolini A.; Mateo-Cebrian A.; Rodriguez-Trujillo R. Institution (Rodriguez, Figueirinhas, Vazquez, Del-Rosario, Martin) Departamento de Patologia Animal, Universidad de Las Palmas de Gran Canaria, Trasmontana S/N, Arucas, Spain (Brito-Casillas) Instituto Universitario de Investigaciones Biomedicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain (Paolini) Small Animal Surgery and Anaesthesia Service, Department of Veterinary Medicine, University of Teramo, Teramo, Italy (Mateo-Cebrian) Las Palmas de Gran CanariaSpain (Rodriguez-Trujillo) Unit of Reproduction, University Institute of Biomedical Research and Health, University of Las Palmas de Gran Canaria, Transmontana S/N, Arucas, Spain Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract The demand for refined anaesthetic protocols in ovine experimental surgery has increased due to ethical considerations and the need to improve perioperative stability. This study evaluated the analgesic efficacy of ultrasound-guided combined sciatic and saphenous nerve blocks using two different local anaesthetics in Hair Canarian Sheep undergoing invasive orthopaedic hindlimb surgery. Fifteen clinically healthy sheep were randomly assigned to one of three groups: lidocaine (2%), bupivacaine (0.5%), or control (general anaesthesia alone). Intraoperative physiological parameters, including heart rate, respiratory rate, and arterial blood pressure, were recorded, and postoperative pain was assessed using a modified Melbourne Pain Scale. Sheep receiving locoregional anaesthesia showed significantly lower postoperative pain scores compared with control animals. Intraoperatively, a significant difference between groups was observed only for respiratory rate, with lower values in the bupivacaine group. The bupivacaine group exhibited lower and more stable respiratory rates, with a trend towards lower heart rates during surgery, as well as consistently lower pain scores during the early postoperative period. Lidocaine provided limited intraoperative and postoperative effects compared with the control group. Respiratory rate appeared to be more closely associated with pain scores than other physiological parameters. In conclusion, ultrasound-guided sciatic and saphenous nerve blocks were associated with improved perioperative analgesia in sheep undergoing orthopaedic surgery. The use of bupivacaine was associated with lower respiratory rates intraoperatively and reduced postoperative pain scores, suggesting a potential benefit in perioperative analgesia. Copyright © 2026 by the authors. <118> Accession Number 650993424 Title Acute Distal Limb Ischemia after Large-Bore Arterial Access: An Expert Review and Consensus Recommendations. Source The Annals of thoracic surgery. (no pagination), 2026. Date of Publication: 20 Apr 2026. Author Said R.; Grocott M.P.W.; Maxey-Jones C.; Hamdan A.D.; Crowley J.; Brudney S.; Kaiser E.; Weiss B.; Anandamurthy B.; Engelman D.T. Institution (Said) Hackensack University Medical Center, Hackensack, NJ, United States (Grocott) NIHR Southampton Biomedical Research Centre, University Hospital Southampton, University of Southampton, Southampton, United Kingdom (Maxey-Jones) CNY Medical Services, PLLC, Baldwinsville, New York; UHS-Wilson Hospital, Johnson City, New York; SUNY Upstate University Hospital, Syracuse, New York (Hamdan) Beth Israel Deaconess Medical Center, Boston, MA, United States (Crowley) Department of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA, United States (Brudney) Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Kaiser) Cleveland Clinic, Cleveland, OH, United States (Weiss) Thomas Jefferson University, Department of Anesthesiology and Perioperative Medicine, Philadelphia, PA, United States (Anandamurthy) Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio (Engelman) Heart and Vascular Program, Baystate Health and University of Massachusetts Chan Medical School-Baystate, Springfield, MA, United States Abstract BACKGROUND: Although large-bore arterial access (LBAA) enables lifesaving structural heart interventions and mechanical circulatory support, it increases patients' risk of acute distal limb ischemia (ADLI). Morbidity includes the potential need for fasciotomy or amputation, prolonged hospitalization, and death, yet practice patterns remain variable across centers. This consensus statement by multidisciplinary experts aims to define ADLI in the context of LBAA and to standardize best practices. METHOD(S): A 1-day consensus conference was convened with experts in critical care, anesthesiology, interventional cardiology, and vascular and cardiac surgery. A premeeting literature synthesis framed priority questions on physiology, prevention, detection, and management. Draft statements were refined through plenary and breakout sessions, finalized by recorded vote, and confirmed by the entire panel. Meeting transcripts and notes informed the narrative rationales. RESULT(S): Consensus was reached on a definition, 3 consensus statements, and 18 recommendations regarding ADLI after LBAA. Core elements were standardized prevention and monitoring standards, ultrasound-guided common femoral anterior wall puncture above the bifurcation by trained operators, a documented baseline neurovascular examination followed by at least hourly reassessment, consideration of near-infrared tissue oximetry for continuous trend monitoring, anticoagulation per institutional protocols, and early vascular surgery engagement with predefined escalation and transfer criteria. For patients supported by centrifugal pumps, a prophylactic distal perfusion cannula with hourly flow checks is recommended. The resulting algorithms emphasize early trend recognition and rapid reperfusion. CONCLUSION(S): This expert review provides minimum standards and consensus recommendations to shorten recognition-to-action time and improve limb salvage, thereby supporting quality improvement and multicenter learning. Copyright © 2026. Published by Elsevier Inc.

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